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A woman walks past a mural on a Family Health Options clinic in the Kibera slums in Nairobi, Kenya, May 16, 2017. © 2017 Reuters
(Washington, DC) – United States President Joe Biden has issued a presidential memorandum that is an important first step to repair harm to sexual and reproductive health and rights, but more executive and legislative action is needed, Human Rights Watch said today.
The memorandum, issued on January 28, 2021, rescinded regressive actions by the administration of former president Donald Trump that made it difficult for women to speak freely with their doctors, access health services, and get information they need to make health decisions, undermining their right to health, right to information, and other rights. Such policies also affected the rights to life, to be free from cruel, inhuman or degrading treatment or punishment, to nondiscrimination, to privacy, and to freedom of expression – all vital to the realization of other human rights.
“President Biden took a necessary step to end US policies that actively harm the human rights and health of women and girls in the US and around the world,” said Amanda Klasing, interim women’s rights co-director at Human Rights Watch. “The Biden administration should now take affirmative steps to promote and protect sexual and reproductive health and rights across foreign and domestic policy, and work to reduce the health disparities created by decades of harmful domestic and international policies aimed at limiting healthcare access for women.”
The presidential memorandum addresses four regressive policies or actions of the past administration. First, it revoked the Protecting Life in Global Health Policy, also known as the “Global Gag Rule” or the “Mexico City Policy.” This policy was instituted by successive Republican administrations and by President Trump during his first full day in office. US law has banned using US foreign aid for abortion-related activities since 1973. This rule went further and prohibited using US funding to support foreign organizations that used their own non-US funds to engage in any abortion-related activities, including counseling, referrals to, or advocacy for legal and safe services.
The policy had life-altering impacts for women and girls around the world, Human Rights Watch said. It disrupted the provision of necessary health services globally, including dedicated funds for the President’s Emergency Plan for AIDS Relief (known as PEPFAR) and HIV/AIDS programming, and nutrition, alienating already fragile civil society groups, and undermining foreign governments’ ability to fulfill their human rights obligations. Moreover, it had a disparate impact globally on people in marginalized and disadvantaged communities.
Second, the memorandum ordered agencies to take steps necessary to restore funding for the United Nations Population Fund, which among other support provides safe maternity care and gender-based violence protection in crisis situations globally. The US Department of State began blocking funding to the agency in 2017, endangering key health and protection services for some of the world’s most marginalized women and girls. The UN Population Fund and the US government should work together with all countries to end coercive reproductive health practices around the world, Human Rights Watch said.
Third, the memorandum called for relevant agencies to begin initiating the regulatory process necessary to revoke the Compliance with Statutory Program Integrity Requirements (also known as the “Domestic Gag Rule”). The rule places restrictions on healthcare providers in the Title X program, a national program inside the US that funds family planning services for more than four million people and ensures access to basic reproductive health care. The rule eliminated the requirement for doctors to give neutral and factual information to pregnant women and prevented providers from telling women in the US about all of their pregnancy options, including abortion.
These are significant actions to have taken on the ninth day of the new administration. However, additional action is needed to ensure the rights of women, girls – and of everyone – to get comprehensive health care.
Alternating approaches by Republican and Democratic administrations have led to decades of mixed messages to executive agencies, implementing organizations, and both US state and foreign governments that receive federal funding. The Biden administration should issue careful guidance clarifying what federal assistance is permitted under current law, to the maximum extent allowed, for reproductive health care, domestically and globally, including for abortion.
The Biden administration should support congressional action, such as the Global HER Act, which was introduced on January 28 in both the Senate and House of Representatives, aimed at permanently repealing the global gag rule, ending the dangerous pendulum of denying and protecting the rights of women and girls based on the executive’s political will. And the president should signal to Congress he would support repealing existing restrictions on federal funding domestically and globally for safe abortion care. Further, the US government should not only make protecting sexual and reproductive health and rights a priority for domestic policy, but it should promote this goal around the world and in multilateral forums. The State Department should assess the realization of these rights globally in its annual human rights country reports.
Biden’s memorandum also ordered the Secretaries of State and Health and Human Services to withdraw co-sponsorship and signature from the Geneva Consensus Declaration. The administration should go further to repudiate this declaration, which was led by the US and joined by the governments of Saudi Arabia, Bahrain, Brazil, Hungary, Poland, Pakistan, and South Sudan, that purports to promote women’s health, but specifically is focused on undermining reproductive health and rights, particularly to abortion. Biden should also definitively reject the report of the Trump-created Commission on Unalienable Rights, and the notion of the commission as a whole, which sought to create a hierarchy of rights inconsistent with international human rights law and US international legal obligations. Secretary of State Tony Blinken indicated in his confirmation process that he would repudiate the report; the US should make clear to other nations that the report does not represent or inform US policy.
The Biden administration should halt or rescind regulations that promote discrimination and reduce access to reproductive health care in the US on the basis of religious or moral objections, including the “Refusal of Care Rule” and rules on exemptions to preventive services under the Affordable Care Act.
The administration should also address health disparities resulting from structural racism, discrimination, and a failure of the US government to protect the human rights of all women and girls. Another executive action published on January 28 strengthening Medicaid and the Affordable Care Act is an important step, Human Rights Watch said. However, Biden should assist Congress to develop and enact a policy that provides affordable, accessible health coverage to everyone in the US during the pandemic and beyond. Supporting Medicaid expansion into all states would help increase access to affordable and accessible healthcare coverage for marginalized, low-income, and uninsured women.
The president should also act swiftly to ensure that the medical needs of jailed and imprisoned women and detained immigrant women are met, including their access to reproductive health services, such as gynecological cancer care and abortion services.
In addition, young people need information on their sexual and reproductive health, including information on the human papillomavirus (HPV) vaccine, which protects against most of the strains of HPV that can lead to cancer. By addressing barriers to accessing the HPV vaccine, the government can take concrete steps toward improving health and eliminating inequality that leads to racial health disparities, including disproportionate cervical cancer mortality rates for Black women in the US.
The Biden administration should take steps to ensure that all federal programs related to sexual health education are comprehensive, medically and scientifically accurate, and inclusive of all young people. Further, it should use its leverage with states to urge removing harmful parental involvement requirements that delay abortion care for young people under age 18, and other barriers states impose to limit young people’s access to reproductive health care.
The Biden administration has also signaled its intent to address health impacts of the climate crisis and a presidential order issued on January 27 promised to “deliver environmental justice” and action by the entire government to build resilience and protect public health against the impact of climate change. Increasing funding for health adaptation efforts should include significant funding for reproductive health care and infant health within a reproductive justice framework that centers on addressing racism and racial inequities. The Biden administration should also establish a high-level gender adviser position within any federal body or task force working to address the climate crisis nationally or internationally.
“Reproductive rights are human rights, and the Biden administration should make clear – through policy, public statements, and practice – that the US will work to promote the protection and realization of these rights at home and around the world,” Klasing said.