Do As We Pay, Not As We Do

On May 19, the Bush administration backed off of a policy that would have prohibited billions of dollars in American foreign aid funds from going to any organization or country that failed to publicly condemn prostitution. Though it would be nice to believe that this decision was prompted by the realization that perhaps health care providers would be better at evaluating how to fight the spread of HIV/AIDS in the developing world, this sadly was not the case.

While the Brazilian government's highly publicized rejection of $40 million in U.S. aid turned out to be enough to scare the Bush administration from implementing this decision, they still seem convinced that keeping more strings on foreign aid money than a marionette is the best way to ensure effective health care.

On the contrary, placing such conditions on aid money has seemed more focused on staking ground in an American values debate than in providing the best treatment to the people who need it most. In the case of the prostitution conditions, the Brazilian government concluded, and rightfully so, that condemning prostitution would have alienated legal sex workers who constitute a high-risk group for transmission of sexually transmitted infections-thus making it less likely for the government to reach them with HIV/AIDS awareness and prevention programs.

Unsurprisingly, this is not the first time a Republican administration has attached counterproductive provisions to foreign aid money in the name of a moral cause. First instituted in 1984 by Ronald Reagan, the Mexico City Policy prevented any organization that performs or even provides education regarding abortion from receiving U.S. foreign aid funding. Known as the "global gag rule" to the alliterative activists of the left, this law has forced international family planning organizations such as Planned Parenthood International and Marie Stopes International to decide between providing complete reproductive health services and government money since it was reinstated by President Bush in 2001.

Although most of these groups have sided with their conscience and have continued to provide comprehensive care while making do without the federal money, it has been difficult for these already cash-strapped organizations.

While the effect on abortion rates is difficult to track due to the number of illegal and "back-alley" procedures, the impact on overall health care has been detrimental in general. Because the only exposure many women in the developing world have to modern health care facilities and procedures is through the clinics of these non-governmental organizations-and because many of these organizations have had to scale back programs and close clinics-fewer women have access to reproductive health care than when this law was not in effect. While these women might not be hearing about abortion anymore, they are not hearing about contraceptives, family planning or maternal healthcare either.

In fact, some of the groups hardest hit by the gag rule do not even provide abortions. The Family Guidance Association of Ethiopia lost $500 million even though they never performed the procedure due to local laws. Because they sought to educate members of the Ethiopian government about the role that unsafe, illegal abortions have on that country's maternal mortality rate, however, they were forced to forsake their federal aid funds. As a result, over 500,000 men and women in urban areas lost access to health services.

Depending on one's cynicism and partisan allegiance, such policies as the prostitution clause and the global gag rule either help the needy in accordance with good moral values or hurt women in the developing world to rally political support. Considering that one of President Bush's first actions on assuming office was to reinstate the gag rule, which had been overturned in 1992 by then President Clinton, this is obviously an important issue to American conservatives with significant political benefits. Because the 1973 Roe v. Wade decision and Democratic opposition make curbing domestic abortion rights difficult, the Mexico City policy executive order, has become as much a symbolic gesture of solidarity with the pro-life lobby as a policy choice.

If the administration intends for its foreign aid agenda to be premised on political patronage and patronizing morality, then its current policy agenda is right on target. If it aims to help the developing world by addressing the healthcare issues that affect the lives of millions of people across the globe, then it should continue dropping restrictions on aid money as they did with the prostitution clauses. These provisions, like the global gag rule, only reduce the reach and efficacy of these much-needed programs in the name of domestic self-indulgence.

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