INTERVIEWER: What is the 'global gag rule?'

DR STEVEN SINDING, newly appointed Director-General of the International Planned Parenthood Federation (IPPF): The global gag rule is a policy that was originally announced by President Reagan back in 1980, then eliminated by President Clinton for eight years, then re-imposed by President Bush when he came into office in 2000 - which says that any non-governmental organization that is based outside the United States will be denied funding from the United States if it provides abortion, or talks about abortion, or counsels for abortion, or advocates on behalf of abortion. It's essentially aimed at non-governmental organizations that don't have the protection of US law.

Why did George W. Bush's Administration re-instate it?

SINDING: Opposition to abortion has been a plank in the Republican Party platform since 1980. The party has consistently opposed abortion - both in the United States, and overseas. In the US, a Supreme Court decision in 1973 - the Roe v.Wade decision - guaranteed American women the right to abortion. So the efforts to roll back that right have been largely unsuccessful in the US. And as a consequence they have turned to the international scene as the place in which they can deliver on their commitment to oppose abortion to that constituency that cares so much about it in the US.

Which groups do you think were behind re-introducing the global gag rule? And why don't the same rules apply in the US?

SINDING: The groups that push hardest for the re-imposition of the global gag rule are largely conservative groups - both Catholic and non-Catholic. They tend to come from the Evangelical Christian right in the States, which is very powerful - particularly in the South - and also from the Catholic hierarchy. Both of those constituencies have been very important to Republican candidates over the years and form an important part of the Party. When the Republicans came back into power, they got considerable pressure from that constituency to return to the policy that had existed under Reagan and Bush's father.

Why don't the same rules apply in the United States? As I mentioned, basically the right to choose whether or not to have an abortion is now enshrined in US law. There have been numerous attempts to get the Supreme Court in the United States to overturn the original decision, and those have failed. And I think finally the anti-abortion forces have given up on trying to change US law. They have been successful in denying public funding for abortions in public programmes - both at the state level and at the federal level. But they have not been able to eliminate the fundamental right to abortion.

So how do they justify intervening in the policies of other countries?

SINDING: I don't think they've even attempted to justify it - they've just done it. They haven't attempted to rationalize the double standard, or to explain why a different standard applies internationally. It's a simple matter of power politics. They couldn't win domestically. There's no constituency to oppose them internationally - and so they've succeeded where they felt they could. It's interesting that this policy has never been applied to foreign governments, it has only been applied to non governmental organizations - precisely because I think they understand that there are foreign policy dimensions to this that could become troublesome, if they were attempting to apply the policy in bilateral relationships.

In terms of effect, what effect does the global gag rule have exactly in developing countries?

SINDING: It has an enormous effect. The US Government is far and away the largest single source of funding for international reproductive health and right programmes. In some years, US funding accounts for over 40 per cent of the total resources available internationally for work in this field. So the decision to withhold funding from some of the largest and most important organizations working in this field inevitably results in the direct loss of services for millions of women. They say that the funds are re-programmed - they're not lost, that they're spent in other ways. But the truth is that an organization like ours is responsible in many countries for the lion's share of the services, particularly the services available to the most disadvantaged and needy population. So denying us funds translates directly into services denied. And, by extension, into unwanted pregnancies that ironically result in unsafe abortions, and thousands of maternal deaths. The cruel irony of this policy is that it produces more abortions - not fewer abortions. And almost all of those abortions are unsafe, and therefore very risky for the women who submit to them.

How does this situation make you feel?

SINDING: Well, as an American, it makes feel particularly angry. And distressed. Because I don't think the majority of the American people support this policy. In fact we know from surveys that have been repeatedly done in the United States that the vast majority of Americans support a woman's right to choose, and by extension oppose a policy that denies that right to women who are not Americans. So I feel embarrassed that my government is applying internationally a standard that it doesn't apply at home. And I feel enraged that the consequences of this is the denial of vitally-needed services to millions of women around the world.

Which regions are, and will be, worst hit? And why?

SINDING: It really translates almost precisely into an economic question. The worst affected are the poorest, because these are the ones which can't substitute their own resources for those which are lost. In Latin America, abortion is illegal in most places, and the countries have the resources to some extent to substitute for the resources they lose from the US. But in Africa, and particularly in South Asia, the effects are very dramatic - because the governments don't have the resources to substitute. Because in many countries abortion is, under some or many circumstances, legal, and they have no alternative to the kind of funding that has come historically from the United States. So I would say Africa and Asia - and the poorest countries among them are the ones in which the effects on individual women will be the greatest.

Can you describe the effects at grass-roots level?

SINDING: Women depend upon rural health clinics to get their contraceptive supplies. The global gag rule is forcing many of the non-governmental organizations to close them down. In many countries, women depend upon community-based services: their neighbours, or local health-care workers who deliver services at the household level, at the doorstep - whose salaries are cut off because the organizations that support them have become ineligible. In Bangladesh alone, we estimate that 500,000 clients - half a million clients of the IPPF service delivery system of the family planning association in Bangladesh - are losing services because the gag rule has closed down what the Bangladesh association are able to do. And the numbers are comparable in Nepal, and in India. In that cluster of three very large, and very high population growth countries, the consequences of the global gag rule are just amazing.

And then, in addition to being able to get services, there's the problem that I mentioned earlier of the unwanted pregnancies that result, often to women desperate to avoid another pregnancy - or a pregnancy outside of marriage, which happens all too often - who are so desperate that they will turn to almost any means to avoid that pregnancy. IPPF and others NGOs have been the primary source of safe abortion services in many of these countries. The denial of funding of course directly affects the availability of those services. But that doesn't mean that abortions aren't available. It simply means that 'safe' abortions aren't available, and women turn to back-alley abortionists, with just horrendous consequences for their health, and in many instances for their lives.

Besides abortion, can you explain how the cutting-off of US funds actually affects safe motherhood?

SINDING: Well, what does safe motherhood mean? It means the ability to have children when you want them, to get proper pre-natal and post-natal care, to be attended by a skilled attendant at delivery, to be tested for sexually-transmitted infections and diseases and to be treated for those infections and diseases when they occur - all of those are the regular services of reproductive health system, and those of many other non governmental organizations. All of those are affected. When the global gag rule is imposed, it doesn't just target abortion - it targets organizations, most of whose activities have nothing to do with abortion. But if they refuse to renounce counselling or referral, or provision of abortion, they lose all of their money. And that's the harsh reality at the field level - that safe motherhood is denied because of abortion politics in the United States.

Who's worst affected?

SINDING: The poorest. The worst affected are inevitably the poorest. Middle class people may find it more difficult to get services but if they have money, they can find those services. Often it means the money to travel to a place where they are available. In India, for example, a woman in the village - if she has a little bit of money - can get to an urban centre where safe services are available. But a poor woman doesn't have those resources. And she's the one who really is forced to turn to the most unsanitary and dangerous service-providers - typically in the rural areas or the urban slums. So it's the poorest who suffer.

What violations of individual rights does this perpetuate? Can you give an example?

SINDING: One of the most fundamental human rights - and one which has been endorsed over the last 30 years by each of the international population conferences, and by human rights conferences, is the right to determine freely and responsibly the number and spacing of one's children, and to have the information and the means to do so. That human right is directly affected by the global gag rule - in all of the ways we've been talking about. It's affected to the extent that the rule prevents organizations from providing the information and means that people need to determine the number and spacing of their children. So it's a direct violation of the fundamental right to reproductive freedom.

What's IPPF's stance on the global gag rule?

SINDING: Well, it should be obvious by now - IPPF vigorously opposes the global gag rule. We have refused to abide by it, and have given up our right - our access to US resources. Most of our member associations have done the same. There are exceptions. The official policy is that neither the IPPF Central Office, nor any of our Regional Offices, may accept US money if it requires the signing of the global gag rule. But we leave it to the discretion of individual associations whether or not they choose to abide by the overall policy. A handful of countries where abortion is illegal have chosen to sign the global gag rule so that they can continue to receive US money and provide services.

One example of this is Colombia. Without USAID, the Colombian Family Planning Association finds it difficult to generate the resources to serve the poor population. In Colombia, there are two million internally displaced people who are living in the most abject poverty. By signing the global gag rule, the Colombian Family Planning Association, Profamilia, was able to access US money, and is able to serve those two million women with basic reproductive health services. One of the agonies of the global gag rule is that it creates that kind of a dilemma for our associations. If they sign the rule, they can continue to do their primary function - which is to provide services to disadvantaged, needy and marginalized populations. If they refuse out of principle to sign it, they deny themselves the resources in many cases to do that. So many have had to weigh this very painful question of whether they should allow principle to stand in the way of their primary mission, or just swallow hard, and do what they have to to get the money. It's a terrible dilemma for many of our associations.

How are you publicising it?

SINDING: Well, we've done it in a variety of ways. When the global gag rule was first introduced, we held a number of press conferences and published op ed pieces and so on. We attempt, whenever the opportunity presents itself, to speak out publicly against it. There will be a conference in Bangkok in December - the Asia Pacific Conference on Population - where I will use the opportunity of speaking at the ministerial meeting to announce and reaffirm IPPF's opposition to the global gag rule. I'll be speaking at a conference of global parliamentarians in Ottawa in November, where I'll do the same. Every opportunity that's available for speaking out, we try to capitalize on.

What role can, or should, IPPF play to ensure reproductive health and reproductive rights remain central to development policies - and so to the whole agenda for sustainable development? How are you doing this?

SINDING: IPPF is in the unique, or nearly unique, position of being both a service delivery organization and an advocacy organization. Our primary function has always been to ensure that men and women - particularly women - have the right to choose. To choose when and whether to have children, how many children to have, and to have the protection they need against all forms of sexually transmitted infections and diseases. And we do that in the first instance through a global network of clinics and community-based services, so that we're servicing - a conservative estimate would be 10 to 15, maybe 20 million women, and men, every year with services. We use our service-delivery base as a platform for pressing governments to do what we feel they have to do - to include these services in the regular services that countries provide to their people - because we realise that no matter how large and effective might become, we will never be able to meet more than a fraction of the demand. So we press governments hard, and always have, to fulfil their responsibilities to meet the reproductive sexual and health needs of their populations. That's what we do. And to the extent that we are provided the resources that we need to do this work, we will continue to press governments and provide services ourselves. We believe firmly that a sustainable world depends upon the ability of millions of couples acting individually to have the number of children they want, when they want them. We know that when they have access to information and services, they will have fewer children. And fewer children means a slower population growth. Slower population growth does translate into a more sustainable world.

You've only recently taken up your new position as Director-General. IPPF is celebrating its 50th anniversary. What do you see now as the priorities for IPPF at the start of the 21st century? Do you feel 'brave and angry'?

SINDING: Yes, I do. IPPF's motto when it was founded in 1952 was to be 'brave and angry'. And being 'brave and angry' in 1952 meant forcing governments and the international community to recognize the importance of family planning. We were about family planning, primarily, in the early years. And I think one of the great global success stories of the last 50 years has been the revolutionary change in reproductive behaviour that has resulted from IPPF's, and other organizations', success in expanding the availability of family planning information and services. When we started in 1952, the average family in the developing world had six children, contraceptive use was around five-seven per cent. Today, the average number of children per woman in the developing world is a little bit over three, and contraceptive use is now approaching 60 per cent, on a global basis. So we've had an enormous impact by being 'brave and angry'.

But the issues are different as we enter the 21st century. Today, the tragedy of HIV/AIDS is at the centre of the reproductive health agenda. It has to be a top priority for us. The tragedy of unsafe abortion, and of completely avoidable maternal deaths, is high on the agenda. And at the centre of that is the reproductive health needs of young people. It is people between the ages of 15 and 15 - many of them, the majority, still unmarried but sexually active - who require our primary attention today. I think what we did in the 20th century was very effectively to respond to the need of married couples. What we have to do in the 21st century is move beyond that population base to the rest of the sexually-active population, which also happens to be that part of the population that is at gravest risk of unsafe abortions and AIDS. So the priorities of IPPF going forward will be adolescence, AIDS and safe abortion.

How will you set about achieving this?

SINDING: It's not easy with the global gag rule. Generating the resources to make this possible is our greatest challenge. Without the United States there as an important supporter, getting the money that we need to expand these services is very difficult. But we're not deterred. The need is great. We have many friends in the donor community, and in the developing countries. Several have stepped forward. Recently the European Union committed 10 million Euros of additional support to IPPF to help to compensate for the loss of money that we experienced with the global gag rule. We'll do it by a combination of returning to our 'brave and angry' traditions, only directed this time not to family planning, but to unsafe abortion and HIV/AIDS, and by our traditional approach of pilot projects, demonstrations, experiments, trying new things, seeing what works - and then scaling up ourselves. But more importantly, pressing others - governments in the first instance - to pick up what works and expand it, take it to scale, make it part of the regular health systems of countries.

What's your view of what's happening to the Cairo agenda today? Are we in fact going backwards? Or is there still progress?

SINDING: That's a very complicated question, and I'm not sure I know the answer to it. The Cairo agenda has been widely adopted at the level of national policy. The vast majority of countries which attended the Cairo conference went home, and adopted policies that were consistent with the Cairo Programme of Action. Some of these countries have moved vigorously forward in implementing those policies. Mexico is a very good example of a country which really shifted from a population control and family planning policy to a comprehensive reproductive health approach. And they did it very effectively, and very quietly, but they did it. Many Asian countries have done the same. They've moved from the family planning-base of the 20th century to a reproductive health approach in the 21st century. In that sense, I think the Cairo Agenda has been widely adopted.

But like any kind of revolutionary change - and the Cairo Programme of Action truly was a revolutionary shift in thinking about these issues - it stimulated a reaction. And there has been some ground lost, as people who disagree with the Cairo agenda - who find it threatening - have organized and gained momentum in some places. I think unquestionably the strength of the reactionary forces in the United States has had an impact on the US position and on US policy and US support for the Cairo agenda. The retreat of the United States from a leadership position has had a chilling effect. Other countries which were prepared to support the United States when it was taking a leadership role on Cairo are now following the US into a more cautious position. I think very few have shifted ground as dramatically as the US has. But many which were prepared to follow the US in the revolutionary changes of Cairo are now also prepared to follow the US into some degree of retreat.

Have other donors stepped in to fill the vacuum?

SINDING: The European Union - the European Commission - did. The Dutch have been very good at stepping forward to compensate. The UK has. Several of the Scandinavian countries. So, yes, other donors have to a degree stepped forward. But it's interesting to me that when the Reagan administration imposed the original version of the gag rule in 1984, the response from this side was much stronger than it has been this time around. The money lost by IPPF at that time was more than compensated for, with renewed pledges from other donors. That hasn't happened now. We very much appreciated the support we received from the UK and from Holland, and from Sweden and Denmark. But it has not compensated for the loss of the US money. One of the reasons that we have been a net loser in this equation is nothing to do with the global gag rule. It has to do with economic conditions in Japan which have forced Japan to severely curtail their international development aid. They have been for the last 15-20 years by far our largest donor. And we've suffered the consequences of the Japanese economic difficulties.

Can you tell us a bit about how you see international policies on population issues developing in the future? Does the US stance reinforce the idea of the 'clash of civilizations'?

SINDING: I'm afraid that the US stance does reinforce that notion to a degree. It surely gives support and comfort to groups that find the Cairo Agenda threatening. And those groups tend to be groups that are in many other respects conservative as well - groups that find the Cairo Agenda threatening to fundamental family values; groups that feel that the Cairo Agenda was a projection of Western feminism; groups that feel that the Cairo Agenda encourages promiscuity and irresponsible sexual behaviour. The US position is in large part influenced by that body of thought. And certainly reinforces it in other countries. So, yes, I think that the US position does to some degree reinforce the idea of a 'clash of civilizations'.

But having said that, I also want to emphasize that countries that have often been accused of being fundamentalist, like Iran, are in the forefront of today of expanding family planning and other reproductive health services to their population. Iran has one of the most enlightened, comprehensive and strong family planning delivery system services in the world. And the same is true of many Islamic countries. We often associate the culture wars - or the 'clash of civilizations' - with Islam. But in fact in this area, Islam has been very progressive in many countries. In Egypt, in Tunisia, in Morocco, in Bangladesh, in Indonesia, there are very strong reproductive health and family planning programmes that I think belie the common belief that Islam is against family planning. It isn't. There are conservative Muslims who have the same fears about the Cairo agenda that conservative Catholics and conservative Protestants, conservative Christians, have. But I think it comes down more to questions of personal value systems and senses of morality than movements of a political or religious nature.

How do you define 'clash of civilizations'?

SINDING: The 'clash of civilizations' is a term that was coined by an American political scientist named Samuel Huntington to convey the sense that whereas the clashes of the 20th century were primarily clashes of ideology, the clashes of the 21st century may prove to be clashes of much more fundamental cultural difference - clashes that surround religious and cultural and even linguistic divides, rather than more explicitly political divides.

How do you personally feel about what's happening as a result of the global gag rule?

SINDING: I've worked in this field for over 30 years now, and for 20 years I was working in the population programme of USAID, the US government's programme. I was very proud through that period to be part of an assistance system that got services to women in the most remote rural areas of the entire world - I worked in Kenya, I worked in Pakistan, I worked in the Philippines. I spent hours and hours in the most remote rural areas seeing how American assistance - often delivered through NGOs like Planned Parenthood - was making services available to poor women. Often, these were the only services that were available. Education wasn't there; nutrition services weren't there; food was scarce and difficult to come by. But they had access to decent reproductive health services.

And for me, it's just terribly painful to see that the decision of an American president, with the stroke of a pen, can result in so many millions of people being immediately and directly affected at the grass-roots level - in village, and in small towns, all around the world. That's how important international development assistance is. When it's well administered, it really makes a tremendous difference in people's lives. And when it's denied, it makes just as much of a difference - in a very cruel way.

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