United States Aid Policy and Induced Abortion in Sub-Saharan Africa/Politique D'aide Des Etats-Unis d'Amerique et IVG En Afrique subsaharienne/La Politica De Asistencia De Estados Unidos Y El Aborto Inducido En El Africa Subsahariana

Article excerpt

Introduction

Public policies governing abortion are contentious and highly partisan in the United States of America. (1) New presidential administrations typically make a critical decision concerning abortion during their first week in office: whether or not to adopt the Mexico City Policy. First announced in Mexico City in 1984 by President Reagan's administration, the policy requires all nongovernmental organizations operating abroad to refrain from performing, advising on or endorsing abortion as a method of family planning if they wish to receive federal funding. To date; support for the Mexico City Policy has been strictly partisan: it was rescinded by Democratic President Bill Clinton on 22 January 1993, restored by Republican President George W Bush on 22 January 2001 and rescinded again by Democratic President Barack Obama on 23 January 2009. (2-4)

The Mexico City Policy is motivated by the conviction that taxpayer dollars should not be used to pay for abortion or abortion-related services (such as counselling, education or training). (2) The net impact of such a policy on abortion rates is likely to be complex and potentially fraught with unintended consequences. For example, if the Mexico City Policy leads to reductions in support for family planning organizations, and family planning services and abortion are substitute approaches for preventing unwanted births (moral considerations notwithstanding), s then the policy could in principle-increase the abortion rate. When the policy is in force, family planning organizations that ordinarily provide (or promote) abortion face a stark choice between receiving United States government funding and conducting abortion-related activities. In practice, several prominent family planning organizations, including the International Planned Parenthood Federation and Marie Stopes International, have chosen to forego United States federal funding under the policy. (6-8)

The primary aim of this study was to determine whether a relationship exists between the reinstatement of the Mexico City Policy and the probability that a sub-Saharan African woman will have an induced abortion. Specifically, we examined the association between a country's exposure to the Mexico City Policy and changes in its induced abortion rate when the policy was reinstated. Exposure was defined as the amount of foreign assistance provided to the country for family planning and reproductive health by the United States during years when the policy was not being applied. This approach enabled us to control for a variety of potential confounding factors, including fixed effects related to the country and the year of reporting, the women's place of residence and educational level, the use of modern contraceptives, and the receipt of funding for family planning activities from sources outside the United States. To the best of our knowledge, this is the first quantitative study of the association between the Mexico City Policy and abortion and the first to investigate the possibility of unintended consequences. Regardless of one's views on abortion, this lack of evidence is a critical impediment to the design of effective foreign policy and has implications for maternal mortality in places where abortion is unsafe.

Methods

We investigated the association between a country's exposure to the Mexico City Policy and the odds of abortion among women of reproductive age between 1994 and 2008 using the reinstatement of the Mexico City Policy in 2001 as a natural experiment.

Induced abortion data

We used longitudinal, individual data on terminated pregnancies collected by Demographic and Health Surveys (DHS) to estimate induced abortion rates. These standardized surveys, designed and implemented by ICF Macro, United States, in collaboration with in-country and international partners, are nationally representative surveys of women aged 15 to 49 years and are conducted approximately every six years in low- and middle-income countries. …

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