Policy making is a political process over a rational process (Longest, 2010). More than just ethics or personal beliefs play into how laws and regulations play out. The personal preferences and beliefs of the individuals that will get the policy maker reelected play a large role as well as bargaining and vote trading that occurs between policy makers (Longest, 2010). Both comprehensive family planning and foreign aid are highly political topics that carry very specific viewpoints by the opposing parties.
In the United States (US), the political climate over safe abortions has escalated during the Trump administrations. Many women have stated that the government should not have the ability to decide what women can do with THEIR bodies. This was the basis of the Roe vs Wade Supreme Court case. However, as discussed in the previous blog post, foreign aid for family planning and abortive services has been a “hot topic” since the early 1970’s with the Helms Amendment. It leads to the question: if women IN the US, have the freedom to choose what they want to do with THEIR bodies, what gives the US the right to dictate how women in OTHER countries receive services for family planning?
When the Mexico City Policy has previously been reinstated, the use of modern contraception dropped 14%, the incidence of pregnancy went up 12%, and the number of abortions increased 40% in sub-Saharan Africa (Brooks, Bendavid, & Miller, 2019). The researchers compared data from 2001-2008 when the policy was in place versus data from 1995-2000 and 2009-2014 when it was inactive. It is known that closer interval pregnancies and frequent abortions are not healthy for a female or the infant (Mahande & Obure, 2016). Codes of ethics in the healthcare field call those in the profession to do no harm (American Medical Association, 2016; American Nurses Association, 2015). If a US policy is causing women in other countries to end up in harm’s way is this ethical? If the US prides themselves in freedom of religion is it ethical to use religion as an argument for not supplying aid to nongovernmental agencies that discuss the topic of abortions? Furthermore, if the US governments main goal by instituting the Mexico City Policy is to prevent/decrease abortions and the opposite is occurring why are lawmakers not questioning the policy?
Comprehensive healthcare, including family planning, is a RIGHT, not a political position.
Ethical impact in Real Life
Olabukunola Williams, Executive Director of Education as a Vaccine in Nigeria, explains the wide-ranging impact of the harmful policy
References
American Medical Association. (2016). AMA principles of medical ethics. Retrieved from https://www.ama-assn.org/delivering-care/ama-principles-medical-ethics
American Nurses Association (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursesbooks.org
Brooks, N., Bendavid, E., & Miller, G. (2019). USA aid policy and induced abortion in sub-Saharan Africa: an analysis of the Mexico City Policy. Lancet Global Health, 7, e1046-1053. http://dx.doi.org/10.1016/S2214-109X(19)30267-0
Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago,IL: Health Administration Press.
Mahande, M.J., Obure, J. Effect of interpregnancy interval on adverse pregnancy outcomes in northern Tanzania: a registry-based retrospective cohort study. BMC Pregnancy Childbirth 16, 140 (2016). https://doi.org/10.1186/s12884-016-0929-5
Reproductive Care Globally: A Look at Policy 
In addition to considering the ethical imperative of the code of nursing to do no harm, are there other ethical precepts relevant to the topic of U.S. foreign aid for reproductive health services? -HMR
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Kinley, I enjoyed reading your blog on the ethical impact of reproductive rights. You pose a good question about the Mexico City Policy. Why are lawmakers not questioning the Mexico City Policy if it is actually causing an increase in abortions? Unfortunately, I don’t think many understand the ramifications of stopping federal funding at non-governmental organizations. What happens is a ripple effect. When the Mexico City Policy is enforced, women that once received contraception care that is federally funded no longer receive those services. This decreases contraception adherence and increases unintended pregnancies, which may lead to an increased number of abortions.
One could argue that the Mexico City Policy does not provide women with the ethical principles of justice, beneficence, or respect for persons. Longest (2016), utilitarian perspective of justice may be expressed as “the greatest good for the greatest number.” The policy actually does the quite opposite. Beneficent is the act to do good, but policy is decreasing contraception access and increasing abortions rates. Respect for persons principle is the freedom of choice (Longest, 2016). The Mexico City Policy interferes with the freedom of choice because it does not allow healthcare agencies to properly educate patients about their reproductive rights in regard to abortions services. If a non-governmental organization is blocked from receiving federal funding this may interfere with women’s freedom of choice in receiving contraception care that they choose.
References
Longest, B.B. Jr. (2016). Health policymaking in the United States (6th ed.). Chicago, IL: Health Administration Press
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