'We are completely captured': The Influence of the Expanded Global Gag Rule on Malawi's Sexual and Reproductive Health and Rights Landscape Restricted; Files Only

Iyer, Aishwarya (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/cf95jc61n?locale=en


Background: The Global Gag Rule (GGR) prohibits foreign organizations receiving U.S. family planning funding from providing, referring, or advocating for abortion access or abortion law liberalization. Since 1984, it has been repeatedly enacted by Republican presidents and rescinded by Democratic presidents. In 2017, President Trump renamed the policy Protecting Life in Global Health Assistance (PLGHA) and expanded it to apply to all of U.S. global health assistance. On January 28, 2021, President Biden revoked PLGHA, effective immediately. 

PLGHA is the only U.S. global health restriction that can be enforced or removed at will by the President. Although existing literature details the impacts of the policy over decades, limited research documents the impacts of PLGHA after it has been revoked in countries that receive U.S. global health assistance. 

Objective: To analyze how PLGHA has impacted Malawi’s sexual and reproductive health and rights (SRHR) landscape, both when it was in effect and since its revocation. 

Methods: We partnered with Fòs Feminista to conduct 17 virtual in-depth interviews with current and past recipients of U.S. global health assistance and civil society organizations familiar with the SRHR landscape in Malawi. We recruited participants via purposive and snowball sampling, using Fòs Feminista’s prior in-country contacts, publicly available U.S. government data, and interviewees’ suggestions. We transcribed interviews verbatim and thematically analyzed them in MAXQDA.  

Results: PLGHA stalled the passage of a liberalized abortion law, strengthened conservative attitudes towards abortion, and hindered national sovereignty when it was in effect. The revocation of PLGHA signals increased freedom for SRHR programming and advocacy efforts but the potential for the policy to be reinstated by a future U.S. president causes continued fear and hesitation about investing time and resources in public health programs and advocacy. 

Discussion: The U.S. holds significant influence over Malawi through its funding relationship and enforcement of the GGR. Congress should permanently repeal the GGR, to allow NGOs and the Malawi government freedom to invest fully in public health interventions that benefit communities in SRHR and other areas. Future research could examine this phenomenon in other countries reliant on U.S. foreign assistance. 

Table of Contents

Introduction 1 

Definition of Terms 9 

List of Acronyms 12 

Literature Review 13 

Methods 52

Results 58 

Discussion 86 

Implications and Recommendations 94 

Appendix 98 

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