Washington (CNN) The US will dramatically expand its efforts to enforce a rule that denies funding to overseas aid groups and health organizations that provide or promote abortion services, Secretary of State Mike Pompeo said Tuesday.
"We will refuse to provide assistance to groups who provide funding to other groups" that provide or discuss abortion with clients, Pompeo said in an announcement at the State Department. "American taxpayer dollars will not be used to underwrite abortions," Pompeo said. He added that, "This is decent; this is right."
Aid groups and lawmakers said the move will harm global public health, further undermining programs focused on issues such as HIV, malaria, and maternal and child health that have already come under pressure from the Trump administration's policies. Tuesday's announcement will lead to more, not fewer abortions, these groups said, an argument backed by long term independent studies.
"The Trump administration's actions threaten access to critical services that prevent maternal deaths, treat HIV and Zika, and provide communities with lifesaving health care," said Sen. Jeanne Shaheen, a New Hampshire Democrat and the only woman who sits on the Senate Foreign Relations Committee.
"This administration's obsession with attacking women's reproductive health is egregious and dangerous," Shaheen said. "Further expanding the Global Gag Rule puts international organizations in an impossible position: provide women the full scope of reproductive health care services or deny critical funding that saves lives. That is unconscionable."
Pompeo said that the US would also reduce funding for the Organization of American States, saying that an arm of the international organization had conducted abortion-related advocacy.
The Mexico City policy, also known as the global gag rule, is a US mandate that requires foreign organizations to pledge that they won't perform or promote abortion as a condition of receiving US funding for family planning programs.
The Trump administration, which reapplied and expanded the rule in January 2017, told foreign aid and medical groups that if they promoted or performed abortions, they would be denied US funding for nearly all health assistance programs, including nutrition, malaria, tuberculosis, tropical diseases and maternal and child health, including water, sanitation and hygiene programs.
State Department deputy spokesman Robert Palladino said that the US would reduce funding to the OAS by $210,000, an amount Pompeo said "equals the estimated US share of possible OAS expenditures on these abortion-related activities."
"The institutions of the OAS should be focused on addressing crises in Cuba, Nicaragua, and in Venezuela, not on advancing the pro-abortion cause," Pompeo said.
The announcement was hailed by US anti-abortion groups. But global health advocates say the rule has a pernicious ripple effect, as clinics in developing countries lose funding and have to scale back a broad array of health services, including contraception and sex education that can prevent unwanted pregnancies.
These advocates say that providing safe abortions keep women from seeking illegal and unsafe procedures that can end in death. Clinics that refuse to stop discussing or offering abortion have had to cut back across the board.
Aid groups in Africa, Asia and Latin America are documenting a steep decline in services where clinics have closed, staff have been laid off and family planning programs have been eliminated because of the policy.
Marie Stopes International, an NGO that provides contraception and abortion services, has had to cut mobile health teams in Uganda that serve hard-to-reach populations. An Ethiopian NGO ended a US-funded program providing vasectomies and tubal litigations to rural populations.
In Nepal, where abortion is legal, two clinics have had to pull services from four districts and lay off staff because of funding cuts, according to PAI, an organization that champions reproductive rights.
A 2011 Stanford University study found that the policy caused abortion rates in African countries most affected to double between 2001 and 2008. Women in countries most affected by the ban were 2.6 times more likely to have an abortion, compared with those in countries not affected by the policy.
A November 2018 Rutgers University study released in January found that women in Latin American were up to three times more likely to have an abortion under the policy. Professor Yana Rodgers, the study's author, said the impact of the Trump administration expansion "is devastating on women's reproductive health, but on men and children as well, because all health services are seeing less funding from the US."
Rodgers flagged recent studies examining the impact on HIV AIDS that report reduced services. It's what health workers in the field report as well.
The global gag rule "affects other communicable diseases like tuberculosis, malaria, HIV," Melvine Ouyo, a former clinic director for Family Health Options Kenya, the largest, oldest reproductive health-care provider in the nation, told CNN. "If a clinic is closed down, people going for HIV or TB care are left standing there. They're coping with distance or a lack of funds. You cannot separate some of these conditions from reproductive health services."
Ouyu, a nurse, said that the network her clinic belongs to treats 76,000 women, but since the Trump administration ban, three clinics have closed, staff has been let go, family programs and outreach eliminated with impacts on general and reproductive health.
When people "don't receive their medication for TB or HIV, then they keep infecting each other, because they live in small rooms, crowded, with babies," Ouyu said. "Clinics have closed down they're likely to infect more people in the slum areas." Funding cuts mean that "we cannot reach out to them to provide condoms, HIV counseling or screenings."
During global gag rule periods, when women have less access to safe abortions, they turn to back alley practitioners, Ouyu said, and when those procedures go wrong, they often reach out to the clinic afterward. "They're coming bloody, they're coming in shock, we try to resuscitate that kind of woman, but if they don't get to the facility in time, they die," she said.
"It's frustrating," she said. "Women are asking, 'why does Trump want us to die?' It's difficult to answer that question."
Pompeo was asked Tuesday about the finding that abortions increased under the policy and non-governmental organizations' statements that the rule is particularly harmful to women in rural areas.
"They're just wrong ... they're just, they're just wrong," Pompeo said, and then addressed a question that hadn't been asked, adding "the moneys that this administration is providing for global health remain."
Pompeo insisted Tuesday that groups aren't being forced to choose between continuing programs that fight diseases such as HIV, tuberculosis and malaria and dropping abortion services. "No, they simply are prohibited from doing these things that run counter to the United States policy," he said.
A bipartisan group of lawmakers -- all women -- have introduced a bill that would permanently repeal the policy.
Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska joined Shaheen and the Democratic chairwoman of the House Appropriations committee, New York Rep. Nita Lowey, to reintroduce the Global Health, Empowerment and Rights Act in both the Senate and House in February.
"Reversing this global gag rule, we're removing eligibility restrictions that could unintentionally restrict access to vital, often life-saving services," Murkowski said in a statement.