President George Bush has shocked the world with his decision to re-introduce the so-called 'gag rule', which stops US-funded organisations from publicly discussing or offering advice about abortion.
United States President George W Bush – a long-time opponent of women's right to abortion – has wasted no time in reimposing a controversial restriction on foreign groups which receive US funds for family planning.
In his first full day in office, Bush revived the so-called 'gag' rule, which prohibits these organisations from advocating changes in abortion laws or, except in limited circumstances, providing abortion information, counselling or services -even with their own funds.
The restriction has been a battleground between women's rights advocates and foes of abortion for nearly 20 years. First announced by former president Ronald Reagan in Mexico City in 1984 (hence also called the Mexico City policy), it was rescinded by President Bill Clinton almost a decade later. Pushed through again in 1999, Clinton reversed it once more in 2000.
The impact of the restriction will be global -and already some family planning providers are saying they will not obey the rule. A group of US senators is attempting to challenge the move, which Democrat Senator Harry Reid describes as "anti-woman and anti-American".
In Latin America, abortion has for long been a serious public health concern -and an ideological battleground. Although its legal status varies from country to country, access is generally difficult and often impossible. Deaths from unsafe or illegal abortions are high throughout the region, particularly in Chile.
While the US Agency for International Development (USAID) does not fund Chilean groups, lawyers and other experts fear the 'gag' rule will reinforce the conservative climate and strengthen the hand of those opposed to women's access to abortion.
In Chile, a woman can be jailed for having an abortion: the law recommends a sentence of three to five years. Abortion is illegal in all circumstances, including rape and incest. Therapeutic abortions – in cases where the woman's life is in danger – were permitted under the military dictatorship of August Pinochet (1973-1990). But in one of its last acts, the ruling junta did away with that option in February 1990.
The current president, Socialist Ricardo Lagos, promised Catholic bishops he would leave the situation untouched during his six-year term which ends in 2006. The Catholic Church is opposed to abortion and any form of contraception.
In August 2000, Paulina, living in one of the sprawling working-class neighbourhoods in west Santiago, found she was pregnant for the third time, despite consistent condom use with her husband. Fearing the financial burden of a third child, she consulted her doctor, who made an appointment for her at his private practice. But Paulina could not produce the 400,000-500,000 pesos ($525-700) needed for a safe, clandestine abortion. She went elsewhere.
The day after her back alley abortion, she became gravely ill and ended up in the emergency room. A few days later, the police came for her. "They cursed me, called me a bad mother and threatened that my husband would be charged as an accomplice, that my children would be left abandoned. They took me down to a basement and showed me instruments supposedly used by abortionists to scare me out of my wits."
Since Paulina would not co-operate in giving details of where the abortion had occurred, she was jailed for four days. Her case remains under investigation and she continues to be called in for further questioning.
Researchers estimate that some 150,000 to 175,000 abortions occur each year in Chile, despite the dangers and police surveillance. Given the 270,000 live births registered annually in the country, this means that at least one-third of all pregnancies end in abortion.
Despite Chile being a signatory to the Beijing Women's Conference agenda for action, which calls for countries to "consider reviewing laws containing punitive measures against women who have undergone illegal abortions", its laws still prevent many women from asking for help when they need it.
Where abortion is totally illegal economics determines which women can find a secure service and which are forced into backroom abortions. "The doctor told me of a nice clinic uptown where you could get it done, no problem," says Paulina. "For 1 million pesos [$1,750], no questions asked."
"Middle-class women always find it," agrees Susana Galdos, technical coordinator of ReproSalud, a women's health project in Peru. "It's the poorest women who arrive sick or dead."
The organisation, a beneficiary of USAID family planning funds which protested in writing against the 'gag' rule last year, said it understood that the US government "has every prerogative to determine the manner in which a recipient organisation uses USAID funds". But it objected that "any government or foreign agency… place conditions on our own funds and autonomy". Peru recognises the right to abortion where the woman's life is endangered, but not for rape, incest or other reasons.
Family planning and reproductive health groups in Latin America are indignant. Aside from its direct effect on women, they describe the 'gag' rule as a bullying intrusion on their freedom of speech. They point out that the measure would be unconstitutional if applied within the United States.
Says lawyer Lidia Casas, author of a book about women imprisoned for abortion in Chile, "The suppression of free speech is very damaging in Southern countries because it is precisely the avoidance of a public discussion that is part and parcel of the strategy of the conservative forces in maintaining the status quo."
In an open letter signed in January by an array of large NGOs, including the Global Health Council, Pathfinder International and the Population Institute, representatives said the rule forces medical personnel to "give up their ability to provide legal health services, ethically required information about their patients' health options, and their right to take part in important policy debates in their own countries."
Groups receiving funds from USAID must sign a "certification" letter promising that they will abide by the conditions laid out in the regulation. While most USAID beneficiaries have done so, some have refused and forfeited their US funding.
The International Planned Parenthood Federation (IPPF) which works in 182 countries has refused to comply with the restrictions. Some of its services, including those providing information, contraceptives, HIV education and counselling for youth will face closure. IPPF director general Ingar Brueggemann says, "The Mexico City policy has cost many lives and actually increased to a large degree the number of unintended pregnancies and illegal, unsafe abortions causing death and disability."