Opinion | Abortion Is Authorized in Ethiopia. However Half of These Clinics Received’t Present Them.

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Abortion has been legal in Ethiopia under a broad range of circumstances for the past 17 years. Nevertheless, at the Shekebedo Health Center, abortions cannot be performed at all. The clinic, situated in a rural part of southwestern Ethiopia where quality health care is hard to access, is partially funded by the U.S. Agency for International Development. This funding has stopped the clinic from offering abortions to Ethiopian women.

The U.S. law that has impeded Shekebedo from providing abortions, known as the Helms Amendment, was passed in 1973 during the backlash to Roe v. Wade, the Supreme Court decision that legalized abortion in all 50 states — and which the current court overturned in June. Helms prohibits the federal government from using foreign aid to pay for “abortion as a method of family planning.”

A valid interpretation of that language could still allow abortions under Helms in cases of rape or when the pregnant woman’s life is at risk. But the law has not generally been implemented that way, and instead has incorrectly been applied as an outright ban on all abortions. Although the Helms restriction applies only to U.S. funds, in many cases — especially in poorer, rural areas — the complication of securing other funding that could be used for abortions is too difficult, which means the entire health care facility simply does not offer abortions at all.

Most of the political action surrounds a related rule, known as the Mexico City policy, which prevents foreign nongovernmental organizations that receive U.S. aid from using any funding, including their own, to provide or discuss abortion services. Although the Mexico City policy has been alternately implemented and rescinded by Republican and Democratic presidents since Ronald Reagan (President Biden revoked it in January 2021), it took until 2020 for Democrats to introduce legislation to repeal the Helms Amendment. Though the bill never received a vote, Democrats recently reintroduced the Abortion Is Health Care Everywhere Act in the House and also introduced it in the Senate.

As international cultural and legal standards changed drastically over the past 50 years, the Helms Amendment has stood still, holding back women’s health care access worldwide. A conservative American view of abortion continues to influence medical treatment in places as far-flung as Kenya, East Timor and Guatemala.

Sources: Data before 2005 from Abortion Liberalization in World Society by Boyle et al., provided by Elizabeth Boyle and Minzee Kim. Modern data from the Center for Reproductive Rights.

Some clinics in countries like Nepal — where the law permits women to receive abortions on request — do not provide abortions if they accept U.S. family planning funds, even if a woman has been raped or the pregnancy threatens her life. Health care workers often aren’t able to get basic supplies, like uterine evacuation kits (a tool to treat early miscarriages), because doctors can also use them to perform abortions. In some cases, confusion about U.S.A.I.D. rules has resulted in workers believing that clinics are not allowed to buy misoprostol (which treats stomach ulcers in addition to abortion complications and miscarriages), despite regulations stating otherwise.

The United States is the largest donor to global health care efforts, and the ubiquity of U.S. foreign aid amplifies the effects of the Helms Amendment. In 2020, America sent more than $592 million in family planning funds overseas — about as much as the next three countries combined — and has contributed 40 percent to 50 percent of total direct funding over the past decade. Even in countries accepting lower levels of U.S. aid, the influence of Helms is widely felt. According to data from our office in Ethiopia, the United States funded about 30 percent of total family planning foreign aid in Ethiopia from 2018 to 2020, but that funding is spread among more than 45 percent of health facilities in the country.

The United States is the single largest funder of family planning foreign aid

Total family planning funds received annually, compared with the percent funded by the U.S.

Abortion availability

On Request

On Broad Grounds

To Preserve Health

To Save the Woman’s Life


Where the United States is one of the top three funders

Where the United States is not a top funder

Source: Kaiser Family Foundation analysis of data from the O.E.C.D.

Data represents the average of total commitments from 2018-20, and counts only money through the Family Planning and Reproductive Health program. The United States also provides family planning aid through the Maternal and Child Health and PEPFAR programs, but not in a way that is directly comparable with other countries.

The high number of unsafe abortions still occurring in 2022 — approximately 35 million annually — is among the many world’s most important and most simply preventable public well being tragedies. Restrictions on abortions, particularly in areas the place high quality well being care is troublesome to entry, typically push ladies to pursue abortions by way of unsafe means.

In international locations that at present settle for U.S. household planning help and the place abortion is now authorized underneath some circumstances, greater than 19 million unsafe abortions happen yearly — greater than half of the worldwide whole.

These unsafe abortions lead to problems requiring medical therapy — starting from minor bleeding to shock and sepsis — for greater than 11.8 million ladies and women in these international locations yearly. And yearly, greater than 16,000 of the ladies and women who’ve acquired these unsafe abortions die from extra severe problems. Repealing Helms would little question avoid wasting ladies from this destiny.

Most abortions in international locations affected by the Helms Modification are unsafe

If extra abortions may very well be carried out safely, the variety of abortion-related problems requiring follow-up medical care would fall enormously.

Abortion availability

On Request

On Broad Grounds

To Protect Well being

To Save the Lady’s Life


Supply: Guttmacher Institute’s Including It Up report, based mostly on 2019 information.

Projected follow-up medical care charges are based mostly on present follow-up care charges for protected abortions noticed within the nation, or estimated from comparable international locations.

As extra international locations liberalize their abortion insurance policies, the hurt seeded by the Helms Modification continues to develop. The Abortion Is Well being Care In every single place Act would substitute the Helms Modification with language stating that international locations might use U.S. help to supply abortions, coaching and tools to the extent permitted by native regulation.

Sadly, the fact of the filibuster within the Senate and widespread Republican help for the Helms Modification signifies that this invoice is unlikely to move, even when it has majority help. It’s, nonetheless, a optimistic signal that lawmakers are even discussing this laws in Congress.

President Biden additionally has the facility to mitigate among the harms of the Helms Modification. The president might problem federal steering to make clear that Helms permits utilizing U.S. funds for abortion care in circumstances of rape, incest and life endangerment. His administration might additionally make sure that clinics in international locations the place abortion is authorized perceive that U.S. guidelines enable them to supply abortion data and counseling.

Via its energy of the purse, the USA is stripping folks of the rights and well being care entry they’re legally entitled to of their house international locations within the title of a half-century-old regulation that exports conservative American values abroad. Everybody deserves entry to abortion — irrespective of the place they reside. The Helms Modification is an act of worldwide interference and overreach, and it has to finish.

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