Lancet Global Health: USA aid policy and induced abortion in sub-Saharan Africa: An analysis of the Mexico City Policy

15 July, 2019

(with thanks to Maternal Health Task Force)

Lancet Global Health: Authors empirically examined patterns of modern contraception use, pregnancies, and abortion among women in 26 countries in sub-Saharan Africa in response to the reinstatement and subsequent repeal of the Mexico City Policy, which prohibits US foreign assistance to any organization that performs or provides counseling on abortion. Their findings suggest that curbing US assistance to family planning organizations, especially those that consider abortion as a method of family planning, increases abortion prevalence in sub-Saharan African countries most affected by the policy.

Citation, abstract and a comment from me below.

CITATION: Lancet Glob Health. 2019 Jun 27. pii: S2214-109X(19)30267-0. doi: 10.1016/S2214-109X(19)30267-0. [Epub ahead of print]

USA aid policy and induced abortion in sub-Saharan Africa: an analysis of the Mexico City Policy.

Brooks N1, Bendavid E2, Miller G3.

ABSTRACT

BACKGROUND: The Mexico City Policy, first announced by US President Ronald Reagan and since lifted and reinstated by presidents along partisan lines, prohibits US foreign assistance to any organisation that performs or provides counselling on abortion. Many organisations affected by this policy are also providers of modern contraception. If the policy reduces these organisations' ability to supply modern contraceptives, it could have the unintended consequence of increasing abortion rates.

METHODS: We empirically examined patterns of modern contraception use, pregnancies, and abortion among women in 26 countries in sub-Saharan Africa in response to the reinstatement and subsequent repeal of the Mexico City Policy across three presidential administrations (William Clinton, George W Bush, and Barack Obama). We combine individual-level data on pregnancies and abortions from 743 691 women, country-year data on modern contraception use, and annual data on development assistance for family planning and reproductive health in a difference-in-difference framework to examine relative changes in use of modern contraception, pregnancy, and abortion in response to the policy.

FINDINGS: We found that when the Mexico City Policy was in effect (2001-08), abortion rates rose among women in countries highly exposed to the policy by 4·8 abortions per 10 000 woman-years (95% CI 1·5 to 8·1, p=0·0041) relative to women in low-exposure countries and relative to periods when the policy was rescinded in 1995-2000 and 2009-14, a rise of approximately 40%. We found a symmetric reduction in use of modern contraception by 3·15 percentage points (relative decrease of 13·5%; 95% CI -4·9 to -1·4; p=0·0006) and increase in pregnancies by 3·2 percentage points (relative increase of 12%; 95% CI 1·6 to 4·8; p<0·0001) while the policy was enacted.

INTERPRETATION: Our findings suggest that curbing US assistance to family planning organisations, especially those that consider abortion as a method of family planning, increases abortion prevalence in sub-Saharan African countries most affected by the policy.

FUNDING: The William and Flora Hewlett Foundation, the Doris Duke Charitable Foundation, the David and Lucile Packard Foundation, and the Stanford Earth Dean's Fellowship.

COMMENT (NPW): The authors restrict their paper to analysis and do not comment on implications for future policy. I would like to invite discussion on implications for US policy. There is a logical case that if a policy that is designed to prevent abortions is in fact leading to a paradoxical increase in abortions, then the policy is not working - it must be reviewed and revised. It will be interesting to see how the Trump administration interprets this study, and whether they will review and revise the Mexico City Policy as a result.

Best wishes, Neil

Coordinator, HIFA Project on Evidence-Informed Policy and Practice

http://www.hifa.org/projects/evidence-informed-policy-and-practice

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org