Editor's Note: (Caroline Kuo is the inaugural Dean of Diversity and Inclusion at Brown University School of Public Health and a professor in the Department of Behavioral and Social Sciences. She is a fellow with the Public Voices Greenhouse through The OpEd Project. The views expressed in this commentary are her own.)
(CNN) Thandiwe, whose name has been changed to protect her identity, wakes up every morning at 6 a.m. to iron her school uniform in a township on the outskirts of Cape Town, South Africa. She times her walk to make it as quickly and safely as possible over the main artery of the township, through narrow alleyways and into her middle school.
Walking alone, Thandiwe is necessarily wary. South Africa has some of the highest rates of rape and sexual assault in the world. Over a quarter of South African men reported they perpetrated rape, with 1 in 20 men reporting rape of a child under 15, according to a survey by Dr. Rachel Jewkes at the South African Medical Research Council.
South Africa also has the largest HIV epidemic in the world. If a girl or young woman is raped, it is possible to prevent her from getting HIV. However, she must get life-saving medication as soon as possible, and ideally within 72 hours of an assault from a clinic that is accessible and close by.
These are the clinics and services that face closure under the Mexico City Policy, which prohibits funding to nongovernmental organizations offering information, referrals and services for abortion as part of comprehensive sexual and reproductive health education.
President Donald Trump signed an executive memorandum to reinstate the policy earlier this year, restricting how foreign nongovernmental organizations spend their money for a full spectrum of life-saving reproductive health services if they receive any amount of money from the US government.
And, on Monday, the US State Department notified the Senate Foreign Relations Committee that US funding for the United Nations Population Fund (UNFPA) would be withdrawn on the grounds that UNFPA supports coercive abortion or involuntary sterilization. UNFPA responded in a statement clearly refuting this assertion with details of its lifesaving work in over 150 countries and territories.
Defunding UNFPA is just the latest Trump administration policy decision, of several, that undermines the health and safety of girls across the globe.
Advocates of these Trump administration policies describe them as anti-abortion policies. Opponents argue these policies takes away knowledge and access to safe abortions as a choice for girls, women and families.
Since its initiation in 1984, various presidential administrations have rescinded and reinstated the Mexico City Policy. A study by Dr. Eran Bendavid at Stanford University School of Medicine shows the policy never worked as intended. After analyzing abortion rates in African countries over 14 years, whenever the Mexico City Policy was restored, Bendavid's team found women were two and a half times more likely to get abortions in African countries implementing the policy compared to countries where the policy was not applied.
This evidence indicates the Mexico City Policy was detrimental to nongovernmental organizations providing modern contraceptives, inadvertently leading to more, rather than fewer abortions. This failed policy was -- and continues to be -- a danger to the reproductive health of girls and women.
What is even more dangerous now is the expansion of the policy under the current executive memorandum. In this iteration, the reinstated policy is being expanded from family planning to restrict spending for any organization that accepts US government global health funding. Organizations newly captured under this expansion include those involved in life-saving HIV and AIDS prevention, treatment and response (along with delivery of other critical health programs such as childhood vaccinations, nutrition, malaria and more) -- the kind young girls like Thandiwe rely on.
This reinstated policy also expands restrictions so that organizations cannot spend other streams of funding on these essential programs if they accept any amount of US government funding, and choose to provide comprehensive sexual and reproductive health information, referrals, and services.
The US government spends $6.6 billion annually to address the global HIV epidemic. This includes the President's Emergency Plan for AIDS Relief, better known as PEPFAR. Last year, PEPFAR provided lifesaving HIV treatment to 11.5 million children, women, and men; cared and supported 6.2 million orphans and vulnerable children; prevented 2 million babies from being born with HIV; and reached 1 million girls and young women with innovative prevention programs.
Reinstating this policy now puts these lives at stake in addition to the reproductive health of girls and young women.
More than 7,000 miles from the US in the streets of South Africa, there is a palatable sense of fear for people's lives with the pending full-scale implementation of this American policy decision. The impact of this American policy decision will be felt most in girls' and women's bodies, families affected by HIV, and in community organizations and hospital wards where activists, leaders, doctors, nurses and social workers work to stem the tide of the HIV and AIDS epidemic.
The signed executive memorandum has not made it into the Federal Register. That is the "how-to" manual that breathes policies to life through action steps implemented in all federal bureaucracies affected by the order.
The time to act is now. American citizens can still intervene to negate policies detrimental to girls and women worldwide. Do so by publicly voicing dissent to overturn this misguided executive memorandum. Do so by communicating your desire for action by federal representatives who control important aspects of implementation that can limit policy damage. And for all global citizens, do so by contributing your energy, time and funds to supporting the life-saving work of organizations that may disappear because of this policy.
The Mexico City Policy has been reversed three times in 32 years. It is time to do so again.