JAMA Forum: Women’s Rights Are Human Rights—Aren’t They?

Eli Adashi, MD, MS

Eli Adashi, MD, MS

So far, this summer has brought some interesting developments in the area of international women’s rights. Although precious few gains made it to the winning column, those that did were worth the wait. The common thread for these developments was Congress’s annual push-and-pull ritual in crafting the FY 2015 State and Foreign Operations Appropriations spending bill, which includes a large proportion of funding for US global health programs.

Here are some of the highlights.

Peace Corps Volunteers and Abortion Coverage

Since 1979, health coverage for Peace Corps volunteers has excluded coverage for abortions, even in the context of rape, incest, or when a pregnancy endangers a woman’s life. No other federal employees, and that includes Peace Corps employees, are similarly constrained. In a surprise move on June 24, the House Appropriations Committee approved an amendment to the House version of the State and Foreign Operations Appropriations spending bill (HR 5013) for next year, proposed by Rep Nita Lowey (D, NY), to remove this exclusion on Peace Corps volunteers in cases of rape, incest, and life endangerment.

This outcome could hardly have been anticipated. The House Appropriations Committee’s actions followed in the footsteps of its Senate counterpart, which approved a comparable measure on June 19 within the framework of its version of the spending bill (S 2499). The amendment, previously introduced as a stand-alone bill known as the Peace Corps Equity Act of 2013(S 813), was reintroduced in the Senate in May by Sen Jeanne Shaheen (D, NH). Given the bicameral consensus on this matter, all indications are that the provisions in question will be deemed exempt from further negotiation between the chambers and that coverage for abortion in the face of rape, incest, or life endangerment will in all likelihood be available to Peace Corps volunteers when the appropriation legislation is enacted into law later this year.

Global Gag Rule

The Senate version of the State and Foreign Operations Appropriations spending bill (again inspired by an amendment proposed by Sen Shaheen) also included a provision to permanently repeal the 1984 “global gag rule,” also known as the Mexico City Policy. This requires US-funded foreign nongovernmental organizations (NGOs) to certify, as a condition for receiving family planning assistance, that they would not perform or promote abortion as a method of family planning, even with funds from another source. The policy further requires US-funded foreign NGOs to refrain from providing information, referrals, or access to legal abortion and from advocating for local laws that would legalize abortion or provide access to it.

The global gag rule is currently in a state of abeyance by dint of an Executive Order by President Obama. The amendment, which would permanently repeal the policy if signed into law, was approved in the Senate committee with a significant bipartisan margin of 19 to 11.

In contrast, the House Appropriations Committee unveiled a FY15 State and Foreign Operations Appropriations spending bill that would reinstate the global gag rule. As articulated under the provision titled “Limitations on Family Planning/Reproductive Health,” the House version of the appropriation bill “prohibits funds for population planning activities or other population assistance to foreign nongovernmental organizations that promote or perform abortion, with certain exceptions.” An amendment by Rep Barbara Lee (D, CA) to strike the global gag rule from the draft version of the House bill failed on a vote of 19 to 25. If past precedent is any indication of the final outcome, any and all language applicable to the global gag rule is likely to be deleted in the upcoming conference between House and Senate negotiators, as it has under previous Democratic administrations.

United Nations Population Fund

Congress also revisited, as it does annually, the multilateral funding of the United Nations Population Fund (UNFPA) to support the UNFPA’s quest to ensure universal access to reproductive health. In this context, the House’s version of the FY15 State and Foreign Operations Appropriations spending bill included a proviso stipulating “no funds for the United Nations Population Fund.” An amendment by Rep Rose DeLauro (D, Conn) to reverse the funding ban in the draft bill was defeated on a vote of 20 to 26.

In contrast, the Senate version of the spending bill resolved that $37.5 million “shall be made available for the United Nations Population Fund” subject to the condition that the “UNFPA does not fund abortions.” While the final resolution of this intercameral disagreement is far from certain, past precedents suggest that the UNFPA will live to be funded another year.

The time frame for the enactment of the House and Senate committee–approved bills remains to be determined. However, with only a limited number of days left on the legislative calendar before the new federal fiscal year (October 1, 2014) and with adjournment planned for the 2014 midterm November elections, floor action seems unlikely. More likely than not, an interim (if unresolved) version of bill will likely be incorporated into a “continuing resolution,” until such time that a lame duck session of Congress convenes after the election.

The arcane congressional debate on the funding of international women’s health services may come across as a surreal throwback to times long gone by. It is precisely this harsh if improbable reality which prompts one to wonder all over again: women’s rights are human rights—aren’t they?

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About the author: Eli Y. Adashi, MD, MS (eli_adashi@brown.edu) is a professor of medical science and the former dean of medicine and biological sciences at the Warren Alpert Medical School of Brown University in Providence, Rhode Island. A member of the Institute of Medicine, the Association of American Physicians, and the American Association for the Advancement of Science, Dr Adashi has focused his writing on domestic and global health policy at the nexus of medicine, law, ethics, and social justice. A former Franklin fellow, Dr Adashi served as a senior advisor on Global Women’s Health to the Secretary of State office of Global Women’s Issues during the first term of the Obama Administration.

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.

 



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