ArticleBMJ global health2022
Beyond abortion: impacts of the expanded global gag rule in Kenya, Madagascar and Nepal.
Article in BMJ global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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8 citing papers in PubMed.
- Promoting sexual and reproductive health in development and governance priorities for youth in Nepal: a qualitative exploration using reproductive justice framework.Health promotion international · 2026Article
- US Presidential Party switches are mirrored in global maternal mortality.BMJ global health · 2026Article
- Global health consequences of the 2025 US foreign aid freeze: rapid assessments in Colombia, Kenya and Nepal.BMJ public health · 2026Article
- Competing framings of abortion access reform campaigns in Madagascar: barriers to effective coalition building.Frontiers in reproductive health · 2026Article
- Can audit and feedback improve health service readiness and delivery outcomes in a low-resource setting? Effectiveness results of the IDEAs strategy from central Mozambique.PLOS global public health · 2025Article
- Two decades of research capacity strengthening and reciprocal learning on sexual and reproductive health in East Africa - a point of (no) return.Global health action · 2024Article
- Striving toward safe abortion services in Nepal: A review of barriers and facilitators.Health science reports · 2024Article
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14 authors.
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Abstract
Since 1984, Republican administrations in the US have enacted the global gag rule (GGR), which prohibits non-US-based non-governmental organisations (NGOs) from providing, referring for, or counselling on abortion as a method of family planning, or advocating for the liberalisation of abortion laws, as a condition for receiving certain categories of US Global Health Assistance. Versions of the GGR implemented before 2017 applied to US Family Planning Assistance only, but the Trump administration expanded the policy's reach by applying it to nearly all types of Global Health Assistance. Documentation of the policy's harms in the peer-reviewed and grey literature has grown considerably in recent years, however few cross-country analyses exist. This paper presents a qualitative analysis of the GGR's impacts across three countries with distinct abortion laws: Kenya, Madagascar and Nepal. We conducted 479 in-depth qualitative interviews between August 2018 and March 2020. Participants included representatives of Ministries of Health and NGOs that did and did not certify the GGR, providers of sexual and reproductive health (SRH) services at public and private facilities, community health workers, and contraceptive clients. We observed greater breakdown of NGO coordination and chilling effects in countries where abortion is legal and there is a sizeable community of non-US-based NGOs working on SRH. However, we found that the GGR fractured SRH service delivery in all countries, irrespective of the legal status of abortion. Contraceptive service availability, accessibility and training for providers were particularly damaged. Further, this analysis makes clear that the GGR has substantial and deleterious effects on public sector infrastructure for SRH in addition to NGOs.
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