Research Associate, Center for Research on Environment Health and Population Activities, Kathmandu, Nepal.
Field Officer, Center for Research on Environment Health and Population Activities, Kathmandu, Nepal.
Sex Reprod Health Matters. 2020 Dec;28(3):1831717. doi: 10.1080/26410397.2020.1831717.
In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and increase the affordability and accessibility of safe abortion and family planning have contributed to significant improvements in maternal mortality and other sexual and reproductive health (SRH) outcomes. The Trump administration's Global Gag Rule (GGR) - which prohibits foreign non-governmental organisations (NGOs) from receiving US global health assistance unless they certify that they will not use funding from any source to engage in service delivery, counselling, referral, or advocacy related to abortion - threatens this progress. This paper examines the impact of the GGR on civil society, NGOs, and SRH service delivery in Nepal. We conducted 205 semi-structured in-depth interviews in 2 phases (August-September 2018, and June-September 2019), and across 22 districts. Interview participants included NGO programme managers, government employees, facility managers and service providers in the NGO and private sectors, and service providers in public sector facilities. This large, two-phased study complements existing anecdotal research by capturing impacts of the GGR as they evolved over the course of a year, and by surfacing pathways through which this policy affects SRH outcomes. We found that low policy awareness and a considerable chilling effect cut across levels of the Nepali health system and exacerbated impacts caused by routine implementation of the GGR, undermining the ecology of SRH service delivery in Nepal as well as national sovereignty.
近几十年来，尼泊尔政府采取了大胆的措施来放宽其堕胎法，并提高安全堕胎和计划生育的可负担性和可及性，这使得孕产妇死亡率和其他性健康和生殖健康（SRH）结果得到了显著改善。特朗普政府的全球套套禁令（GGR）——禁止外国非政府组织（NGO）接受美国全球卫生援助，除非它们证明不会使用任何来源的资金来提供与堕胎有关的服务、咨询、转介或宣传——威胁到了这一进展。本文探讨了 GGR 对尼泊尔民间社会、非政府组织和 SRH 服务提供的影响。我们在两个阶段（2018 年 8 月至 9 月和 2019 年 6 月至 9 月）、在 22 个地区进行了 205 次半结构化深入访谈。访谈参与者包括非政府组织项目管理人员、政府雇员、非政府组织和私营部门的设施管理人员和服务提供者，以及公共部门设施的服务提供者。这项大型的两阶段研究通过捕捉 GGR 在一年中的演变过程中的影响，并揭示该政策影响 SRH 结果的途径，补充了现有的轶事研究。我们发现，政策意识低下和相当大的寒蝉效应贯穿尼泊尔卫生系统的各个层面，并加剧了 GGR 的常规实施所造成的影响，破坏了尼泊尔 SRH 服务提供的生态系统以及国家主权。
