Foreign ideology vs. national priority: impacts of the US Global Gag Rule on Nepal’s sexual and reproductive healthcare system

Sexual and Reproductive Health Matters

Jyotsna Tamang¹  Aagya Khanal¹  Anand Tamang¹  Maggie Magee²  Naomi Gaspard²  Emily Maistrellis²  Terry McGovern²  Marta Schaaf³ 

[1] Center for Research on Environment Health and Population Activities;Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University;Independent Consultant, New York, NY, USA;

关键词: abortion;    sexual and reproductive health;    family planning;    global gag rule;    nepal;    chilling effect;    referral system;    sovereignty;    global health assistance;    us government;   

DOI  :  10.1080/26410397.2020.1831717

来源: DOAJ

【 摘 要 】

In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and increase the affordability and accessibility of safe abortion and family planning have contributed to significant improvements in maternal mortality and other sexual and reproductive health (SRH) outcomes. The Trump administration’s Global Gag Rule (GGR) – which prohibits foreign non-governmental organisations (NGOs) from receiving US global health assistance unless they certify that they will not use funding from any source to engage in service delivery, counselling, referral, or advocacy related to abortion – threatens this progress. This paper examines the impact of the GGR on civil society, NGOs, and SRH service delivery in Nepal. We conducted 205 semi-structured in-depth interviews in 2 phases (August–September 2018, and June–September 2019), and across 22 districts. Interview participants included NGO programme managers, government employees, facility managers and service providers in the NGO and private sectors, and service providers in public sector facilities. This large, two-phased study complements existing anecdotal research by capturing impacts of the GGR as they evolved over the course of a year, and by surfacing pathways through which this policy affects SRH outcomes. We found that low policy awareness and a considerable chilling effect cut across levels of the Nepali health system and exacerbated impacts caused by routine implementation of the GGR, undermining the ecology of SRH service delivery in Nepal as well as national sovereignty.

【 授权许可】

Unknown