The first time I visited Dr. Cynthia’s clinic, an old man sitting on the front step pinned a bougainvillea flower to my shirt. It was a sign of welcome, permission to cross the threshold into an entirely different world of health care. This cluster of single-story, dirt-floor buildings five kilometers from the Burmese border is one of the only clinics in a wide geographic radius where refugees and migrant workers displaced by civil war in Burma can receive quality health care. They are drawn by the legacy of Dr. Cynthia, an ethnic Karen doctor who opened her own clinic in the dusty border town of Mae Sot, Thailand. People from Burma trek great distances through malarial, land-mined jungles to seek treatment within these modest buildings. This clinic is an oasis for countless people straddling worlds along the border.

Women find particular sanctuary here, receiving family planning and maternal health care that is almost completely absent in rural Burma. As one of the UN’s recognized Least Developed Nations, Burma has a maternal mortality rate of 517 deaths per 100,000 births, compared to 200 in Thailand and 10 in Singapore. There is virtually no access to family planning in Burma, and abortion is also illegal. With one doctor per 12,500 people, women’s health needs suffer due to lack of access to and poor quality of care and medicine. A report submitted by a coalition of women from Burma to CEDAW (Convention for the Elimination of All Forms of Discrimination Against Women) at the United Nations in January, 2000, stated that illegal abortions cause 58 deaths per week, accounting for 50% of all maternal deaths in Burma. These appalling conditions earn Burma one of the highest-ranking countries for maternal morbidity and mortality in the world.

Abortion on demand is illegal in Thailand as well, but family planning is government subsidized, and international Non-Governmental Organizations (NGOs) increase access and distribution of services nationwide. It is NGOs that reach the country’s vulnerable populations, including 130,000 refugees from Burma. Since refugees are resettled in camps and thus have access to NGO health services, they generally fare better than migrant workers (estimated at one to two million), who must fend for themselves. Migrant communities treat illness with homemade remedies, injections of quinine water, and, when most desperate, a bribe to a Thai doctor. Migration, and the poverty that inevitably accompanies it, is the greatest barrier to women’s health care because it makes the delivery of services and medicine inconsistent and unpredictable. One of Dr. Cynthia’s many roles is to reach migrants and refugees on the Thai/Burma border who have very limited access to reproductive health care — this outreach is possible with substantial foreign funding.

In recent decades, the U.S. government has led a trend among industrialized countries to drastically cut funding to international NGOs. The U.S. disburses only one-thousandth of its GNP in foreign aid — the lowest among industrialized countries. The UN recommends giving a minimum of seven times that. A majority of Americans recently surveyed said they would support giving five percent of the GNP to aid programs. In addition, most Americans, pro-choice or not, support family planning programs. Disregarding this majority viewpoint, the Helmsian bastion of conservative ideologues in Washington has not only limited international aid but placed austere restrictions upon it.

One recent example of neo-colonial aid restrictions is the global gag rule, which prohibits international NGOs from receiving U.S. funding for family planning if they provide abortion-related services such as abortion counseling, abortion referrals, or abortion advocacy — even if these services are provided with their own funds or other non-U.S. funds, and even if abortion is legal in the host country. No nation besides the United States requires recipients of aid to contradict the laws of the country within which they operate. The gag rule disregards national sovereignty, manipulating family planning policy in countries across the globe with the power of the aid dollar.

President Bush reinstated this Reagan-era policy on his second day in office as a gift-wrapped thank you to the anti-choice religious right. By signing this executive order, President Bush demonstrated that he is willing to sacrifice the health of women when it is politically expedient to do so. Those who pay the price of this decision are not informed, organized, American women voters, but hundreds of thousands of poor women in developing countries who will die without access to reproductive choices, basic health care, and family planning services.

To glimpse the widespread ramifications of the global gag rule, it is instructive to look at the impact of USAID restrictions on Cambodia, where abortion has been legal since 1997. The government subsidizes family planning, but NGOs funded by USAID and other western countries meet a large portion of the demand for contraception and reproductive health education. NGO workers in Cambodia say that the gag rule will severely limit the funds they use to provide family-planning services and contraceptives. This is crucial in Cambodia, which has the highest HIV infection rate in the world outside of sub-Saharan Africa. Since 80 percent of the population of Cambodia is rural, NGOs use USAID funding to provide access to health services, including contraception and abortion services, to women who would not be able to travel to government-sponsored clinics. An estimated 90 percent of Cambodian NGOs will be denied family planning funding under the gag rule if they continue to provide legal abortions to Cambodian women who want them. “I can’t understand not wanting to give a pregnant, HIV-positive woman her full range of options,” said Yoshinka Zenda of the UN Population Fund in Cambodia.

The global gag rule has other insidious elements to it. Reproductive health service providers and advocates from internationally funded NGOs are gagged from helping local groups lobby the government to gain abortion rights for women. Local groups often solicit the help of NGOs to help change restrictive laws, working to make health care more equitable and effective. The International Rescue Committee, the USAID-funded international NGO that provides health care to refugees in camps in the north of Thailand, is not only gagged from providing counseling to refugee women about abortion, it also cannot help Thai groups affect legislation that would address health needs of refugees. In these extremely remote camps where women are geographically and culturally isolated, international NGOs equip and support local providers who help refugee women identify their health needs. The global gag rule forbids a lobbying role for U.S.-funded NGOs, depriving vulnerable women of their main health care advocates.

I first tried to induce an abortion with an injection. But after five days I had no menstruation. So, I paid to go to a midwife. She used an iron rod to abort. I was afraid so I returned home and instead asked my husband to massage and step on my stomach. I also bought medicines that are very hot. But I still did not abort.
—Burmese woman, age 42, migrant worker in Thailand

Unsafe abortions happen every day in refugee and migrant communities in Thailand. The need for effective family planning including abortion counseling and services was demonstrated by a recent survey conducted by Mahidol University in Thailand of three migrant communities of people from Burma. Because of cultural taboos against discussing reproductive health within these communities, it is not uncommon for women to wait until they are seriously ill or dying before seeking medical treatment. According to the report titled “Sexuality, Reproductive Health, and Violence: Experiences of Migrants from Burma in Thailand, 2000”: “The majority of female participants did not have this access [to education on sexuality and reproductive health] and possessed little to no knowledge of such issues.” Due to migration and safety issues, the communities had little or no contact with NGOs that could have provided health services and reproductive health education. The research revealed that “All of the participants were interested in obtaining more information on specific types of contraceptive methods and their side effects.”

This study illustrates the point that women in vulnerable situations think more, not less, deliberately about building a family, and they desire tools to help them make informed decisions about their reproductive health. By barring NGOs from counseling women about abortion, and from helping to affect positive change in host countries, the gag rule strips women of the agency to decide what is best for their health, their families, and their futures.

Expanding the divisive abortion debate into the realm of international family planning allows Bush to score political points with the hard-line anti-choicers while dodging the political fallout among women voters. Unseen and unheard on Capitol Hill are the faces of women who will be affected by this rule. Feminists deserve credit for their outcry against the global gag rule, especially national groups like Planned Parenthood USA and NARAL. Due largely to their efforts, sympathetic representatives in both Congressional houses led by Senator Barbara Boxer (D-CA) are co-sponsoring the “Global Democracy Promotion Act”, which could overturn the executive order. Bush is countering with a Presidential Memorandum that could in-turn nullify the legislation, but it is still important to urge legislators to take a stand against aid restrictions.

So what do we as feminists in the U.S. do to support reproductive rights worldwide? Organize, organize, organize. Join the email listserv called Roe v. Bush hosted by Planned Parenthood (visit for instructions on how to join). The list sends periodic updates on the status of the global gag rule, and the latest on the Bush administration’s assault on women. You can also write the President directly from the site.

There are also many groups you can join around the country who are waging grassroots campaigns against the global gag rule. In Seattle, for example, a group of young women formed the Washington Reproductive Rights Network (WaRRN) soon after Bush signed the executive order and is building a coalition within Washington State to specifically address this issue. Feminists in this country are the foot soldiers for reproductive health care providers like Dr. Cynthia, and especially for women who do not have the education or resources to demand these rights for themselves.

Katrina Anderson worked with different populations in Thailand for nearly two years, including Thai sex workers and later with Karen refugees on the Thai/Burma border, documenting human rights abuses by the Burmese military. She now lives in Seattle and is a founding member of WaRRN (Washington Reproductive Rights Network), a local activist group committed to protecting reproductive rights worldwide.