Trump Administration Steps Up War on Reproductive Rights

U.S. diplomats team up with a “rogues’ gallery” of conservative states to roll back global reproductive health gains of the past quarter-century.

A Filipina health worker speaks to pregnant women on family planning in Navotas City, suburban Manila, on March 3, 2011.
A Filipina health worker speaks to pregnant women on family planning in Navotas City, suburban Manila, on March 3, 2011. Ted Aljibe/AFP/Getty Images

The Trump administration is seeking to form a coalition of socially ultra-conservative governments from Brazil to Saudi Arabia to denounce international efforts to promote sexual and reproductive health and rights at a United Nations summit later this month, characterizing such concepts as “anti-family” and “pro-abortion.”

The effort sets the stage for a potential clash between the United States and its traditional liberal Western partners as world leaders arrive in New York later this month for a week of U.N. summitry and speeches. It adds another irritant to already strained relations between Washington and other capitals over a raft of issues, including trade, Iran policy, and climate change.

United Nations experts, advocates, and lawmakers say the U.S. position endangers millions of women and girls who rely on international programs for basic prenatal and postpartum health care services.

The campaign is modeled on a recent effort by the United States, Brazil, Egypt, Saudi Arabia, and several other states to denounce sexual and reproductive rights at a major conference of the World Health Organization last May. And it comes just after U.S. negotiators failed to secure the elimination of language promoting sexual and reproductive health rights from a declaration by world leaders at a U.N. summit Monday on universal health care.

U.S. Secretary of State Mike Pompeo and Secretary of Health and Human Services Alex Azar appealed in a draft letter to a select group of conservative governments to “push back on harmful efforts” to promote sexual and reproductive health and rights, which they say promote pro-abortion policies around the world. The statement—which was sent to 72 countries—is expected to be issued on the same day that U.S. President Donald Trump, who will not attend the health care summit, is scheduled to host an international meeting at the U.N. on religious persecution, titled the “Global Call to Protect Religious Freedom.” He will be introduced by U.S. Vice President Mike Pence.

“We respectfully request that your government join the United States in ensuring that every sovereign state has the ability to determine the best way to protect the unborn and defend the family as the foundational unit of society,” they wrote, according to a leaked copy of the draft posted late last month on the web site of the Center for Family and Human Rights, a conservative anti-abortion organization. “We remain gravely concerned that aggressive efforts to reinterpret international instruments to create a new international right to abortion and to promote international policies that weaken the family have advanced through some United Nations fora.”

Katherine McKeogh, a spokesperson for the Department of Health and Human Services, said Pompeo and Azar had expressed concern in the letter “about an aggressive effort in international settings that could decrease life-saving healthcare for millions of women. This troubling effort seeks to reinterpret international UN documents to wrongfully assert that they crease a new international ‘right to abortion’ and promote international policies weakening the family.”

The letter, McKeogh continued, asks countries to “collaborate” with the United States for “a joint statement supporting health for all people, born and unborn,” and on a universal health care declaration that “reflects shared values.”

McKeogh did not confirm whether the version of the letter published by the advocacy group was authentic. But three U.S. officials independently confirmed the letter is authentic.

The U.S. campaign comes against a backdrop of international negotiations on a declaration being prepared for world leaders at the U.N. Universal Health Care summit on Sept. 23. Some 45 world leaders and 70 foreign ministers are scheduled to attend the meeting, which will take place on the sidelines of the annual U.N. General Assembly debate, to promote the expansion of health care. The United States will be represented by Azar.

For an administration that often pays little attention to the United Nations, the intervention of two U.S. cabinet members underscores the importance it places on curbing sexual and reproductive rights, a key objective of Trump’s religiously conservative base, which views the term “sexual and reproductive rights” as code for abortion.

The Trump administration has granted extraordinary power to social and religious conservatives, placing them in influential positions in the State Department, the U.S. Agency for International Development, and the Department of Health and Human Services, where they have taken their fight against abortion, gender equality, and same-sex marriage global. The effort has resulted in a realignment of U.S. alliances on social issues, bringing the United States closer to countries such as Russia, Bahrain, Guatemala, Saudi Arabia, and the Vatican.

The White House has been struggling to turn back the clock on the U.N.’s long-standing commitment to promote women’s sexual and reproductive health care services, which have been recognized internationally since the adoption of the Beijing Declaration, a landmark 1995 agreement that stands as the progressive blueprint for women’s rights. Previous Republican administrations, including that of George W. Bush, have sought to counter any suggestion that the nonbinding declaration conferred legal rights, including the right to abortion. But Trump has gone further, seeking to strike any mention of the term in U.N. agreements.

In previous U.N. conferences, the United States had made similar demands, only to back down to avoid blame for breaking the international consensus, including two such retreats in 2018. In exchange for backing down and joining the consensus, the United States insisted on an insert affirming that “in no case should abortion be promoted as a method of family planning.”

The latest diplomatic scrap dates back to 2015, when the Obama administration joined other governments in endorsing an ambitious set of so-called sustainable development goals aimed at dramatically reducing poverty, extending access to health care, and improving the environment by 2030. The goals—outlined in the U.N.’s 2030 Agenda for Sustainable Development—include an effort to ensure “universal access to sexual and reproductive health care services.”

The Trump administration sought to walk back that agreement, contending that long-accepted phrases such as “sexual reproductive health”—which includes a broad spectrum of health services aimed at women, girls, and infants—is coded language for policies that promote abortion around the world.

But Washington has faced stiff resistance from its Western partners, lawmakers, and women’s advocates, who fear the U.S. strategy will result in greater risks, including decreased access to maternal health care and fewer programs to combat violence against women and girls. In the end, the Trump administration allowed the inclusion of the same language on sexual and reproductive health that had been used in the 2015 agreement.

The current round of talks—which pitted the United States against the European Union, Australia, Canada, and New Zealand—initially ran aground earlier this month over a U.S. proposal to eliminate the previously agreed provision in the 2015 pact on sustainable development.

The Trump administration was forced to temper its ambitions after hitting a wall of opposition from Western governments, which argue the U.S. amendments would have reversed years of hard-fought gains in global health care and reversed a quarter-century of progress for women’s rights. In an effort to secure a concession, the United States sought to insert a clause into the document that would limit the scope of the agreement.

But a coalition of Western powers, including Canada and the EU, balked.

“Our delegations continue to have concerns with the text, in relation to paragraphs on sexual and reproductive health and reproductive rights, and gender,” the coalition governments wrote in a letter to the ambassadors of Georgia and Thailand, who are leading the negotiations. “We cannot accept any modification of Sustainable Development Goal targets—which we consider would set a very dangerous precedent.”

“They [the United States] are completely isolated on this,” said one diplomat close to the negotiations, who voiced frustration that the talks on the declaration have needlessly dragged on for months. “It should have been done and dusted six weeks ago.”

The United States eventually reached an agreement in principle on Sept. 13 with other delegations to preserve language on sexual and reproductive health and rights used in the 2015 declaration.

“Attempts to block or remove sexual and reproductive health and rights language (SRHR) speaks to the alarming global trend that strips women and girls of their bodily autonomy,” Eleanor Blomstrom, a senior program officer at the International Women’s Health Coalition, told Foreign Policy by email.

The language, she added, “is about much more than abortion. These basic human rights include everything from reproductive health education to contraception, to sexual and gender-based violence prevention, to HIV, and cancer treatment.”

“When U.N. agreements remove this language,” she added. “It trickles down to the loss of critical programs and dramatically decreased funding on the ground.”

“Removing [the phrase ‘sexual reproductive health’] from a discussion about universal health coverage is a rejection of science,” said Beirne Roose-Snyder, the director of public policy at the Center for Health and Gender Equity, a Washington-based advocacy organization that promotes reproductive health care access. “It ignores a central aspect of health, one that cannot be isolated from the rest of health in good faith.”

At the May meeting of the World Health Assembly, the decision-making body of the World Health Organization, the United States joined forces with Brazil, Egypt, Ghana, Haiti, Indonesia, Iraq, Nigeria, and Saudi Arabia to issue a joint statement denouncing “ambiguous terms and expressions, such as the right to sexual and reproductive health (and its derivatives),” arguing that the language is associated with abortion. 

“I think it is incredible that they list out the World Health Assembly allies in the letter with pride, because it is just a rogues’ gallery of autocrats or other countries struggling with democracy,” said Roose-Snyder. “It is wild that the United States wants to put itself on the side of those countries, that is wild.”

Staff writer Robbie Gramer contributed to this report.

Colum Lynch is a senior staff writer at Foreign Policy. Twitter: @columlynch

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