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

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 Although the Mexico City policy has been alternately implemented and rescinded by Republican and Democratic presidents since Ronald Reagan (President Biden revoked it in January 2021), it took until 2020 for Democrats to introduce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.

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.