IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0231960.html
   My bibliography  Save this article

Investigating the early impact of the Trump Administration’s Global Gag Rule on sexual and reproductive health service delivery in Uganda

Author

Listed:
  • Margaret Giorgio
  • Fredrick Makumbi
  • Simon Peter Sebina Kibira
  • Suzanne Bell
  • Selena Anjur-Dietrich
  • Elizabeth Sully

Abstract

Background: The Global Gag Rule (GGR), reinstated by President Trump in January 2017, makes non-U.S. non-governmental organizations ineligible for U.S. foreign assistance if they provide access to or information about abortion. While evidence suggests previous iterations of the GGR negatively impacted sexual and reproductive health outcomes, no studies have quantitatively assessed the impacts of the Trump administration’s GGR. Methods: We constructed a panel dataset of facilities (76% public) using 2017/2018 Performance Monitoring and Accountability 2020 service delivery point (SDP) surveys in Uganda. Based on information from stakeholder meetings, we classified districts as more or less exposed to the GGR; 45% (N = 34) of study districts were classified as “more exposed”, which corresponded to 145 “more exposed” and 142 “less exposed” health facilities in our sample. We assessed changes in provision of long-acting reversible contraceptives, contraceptive stock-outs, mobile outreach services, engagement with community health workers (CHWs), service integration, and quality of care from 2017 (pre-GGR) to 2018 (post-GGR). Multivariable regression models were estimated, and difference-in-differences impact estimators were determined by calculating predicted probabilities from interaction terms for exposure and survey round. Findings: We observed no immediate impact of the GGR on the provision of long-acting reversible contraceptives, contraceptive stock-outs, mobile outreach services, service integration, or quality of care. We did observe a significant impact of the policy on the average number of CHWs, with “more exposed” facilities engaging 3.8 fewer CHWs post-GGR (95% CI:-7.31,-0.32). Conclusions: The reduction in CHWs could reduce contraceptive use and increase unintended pregnancies in Uganda. The lack of other significant findings may not be surprising given the short post-GGR observation window. Rapid organizational responses and stopgap funding from foreign governments may have mitigated any immediate impacts on service delivery in the short term. The true impact may not be felt for many years, as stopgap funding potentially ebbs and service providers adapt to new funding environments.

Suggested Citation

  • Margaret Giorgio & Fredrick Makumbi & Simon Peter Sebina Kibira & Suzanne Bell & Selena Anjur-Dietrich & Elizabeth Sully, 2020. "Investigating the early impact of the Trump Administration’s Global Gag Rule on sexual and reproductive health service delivery in Uganda," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-15, April.
    • Handle: RePEc:plo:pone00:0231960
    DOI: 10.1371/journal.pone.0231960
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231960
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0231960&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0231960?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Kelly M. Jones, 2015. "Contraceptive Supply and Fertility Outcomes: Evidence from Ghana," Economic Development and Cultural Change, University of Chicago Press, vol. 64(1), pages 31-69.
    2. Hinh T. Dinh & Adugna, Abebe & Myers.Bernard, 2002. "The impact of cash budgets on poverty reduction in Zambia : a case study of the conflict between well-intentioned macroeconomic policy and service delivery to the poor," Policy Research Working Paper Series 2914, The World Bank.
    3. Junmin Wan, 2006. "Cigarette tax revenues and tobacco control in Japan," Applied Economics, Taylor & Francis Journals, vol. 38(14), pages 1663-1675.
    4. Tzu‐Chun Kuo, 2012. "Evaluating Californian under‐age drunk driving laws: endogenous policy lags," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 27(7), pages 1100-1115, November.
    5. Diana Silver & James Macinko & Margaret Giorgio & Jin Yung Bae, 2019. "Evaluating the relationship between binge drinking rates and a replicable measure of U.S. state alcohol policy environments," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-12, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Echica van Kelle & Sarah I. Spronk & Denis Kibira & Carolien J. Aantjes, 2023. "Rethinking the donor's role in strengthening health systems through sexual and reproductive health and rights partnerships: A qualitative analysis of Ugandan case studies," Journal of International Development, John Wiley & Sons, Ltd., vol. 35(7), pages 1711-1730, October.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. J.M. Ian Salas, 2012. "Consequences of withdrawal : Free condoms and birth rates in the Philippines," UP School of Economics Discussion Papers 201220, University of the Philippines School of Economics.
    2. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2020. "Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices," Journal of Health Economics, Elsevier, vol. 73(C).
    3. Myong-Il Kang & Shinsuke Ikeda, 2010. "Time Discounting and Smoking Behavior under Tax Hikes," ISER Discussion Paper 0782, Institute of Social and Economic Research, Osaka University.
    4. Grant Miller & Christine Valente, 2016. "Population Policy: Abortion and Modern Contraception Are Substitutes," Demography, Springer;Population Association of America (PAA), vol. 53(4), pages 979-1009, August.
    5. Finlay, Jocelyn E., 2021. "Women’s reproductive health and economic activity: A narrative review," World Development, Elsevier, vol. 139(C).
    6. Clarke, Damian, 2023. "The Economics of Abortion Policy," IZA Discussion Papers 16395, Institute of Labor Economics (IZA).
    7. Erasmus Kersting & Christopher Kilby, 2021. "Do domestic politics shape U.S. influence in the World Bank?," The Review of International Organizations, Springer, vol. 16(1), pages 29-58, January.
    8. Brittany Moore & Yana van der Meulen Rodgers & Ernestina Coast & Samantha R Lattof & Cheri Poss, 2021. "History and scientific background on the economics of abortion," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-9, September.
    9. Eiji Yamamura, 2016. "Effects of Female Labor Participation on Smoking Behavior in Japan: Selection Model Approach," Journal of Economics and Econometrics, Economics and Econometrics Society, vol. 59(3), pages 1-18.
    10. repec:hal:spmain:info:hdl:2441/8367 is not listed on IDEAS
    11. Jishnu Das & Stefan Dercon & James Habyarimana & Pramila Krishnan & Karthik Muralidharan & Venkatesh Sundararaman, 2013. "School Inputs, Household Substitution, and Test Scores," American Economic Journal: Applied Economics, American Economic Association, vol. 5(2), pages 29-57, April.
    12. Myoung-jae Lee & Yasuyuki Sawada, 2020. "Review on Difference in Differences," Korean Economic Review, Korean Economic Association, vol. 36, pages 135-173.
    13. Samantha R Lattof & Ernestina Coast & Yana van der Meulen Rodgers & Brittany Moore & Cheri Poss, 2020. "The mesoeconomics of abortion: A scoping review and analysis of the economic effects of abortion on health systems," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-25, November.
    14. Rajeev Goel & Xingyuan Zhang, 2013. "Gender dynamics and smoking prevalence in Japan," Journal of Economics and Finance, Springer;Academy of Economics and Finance, vol. 37(4), pages 622-636, October.
    15. R. Duarte & J. Escario & J. Molina, 2014. "Are estimated peer effects on smoking robust? Evidence from adolescent students in Spain," Empirical Economics, Springer, vol. 46(3), pages 1167-1179, May.
    16. World Bank, 2003. "Nigeria - Policy Options for Growth and Stability : Volume 1. Main Report," World Bank Publications - Reports 14388, The World Bank Group.
    17. Myong‐Il Kang & Shinsuke Ikeda, 2014. "Time Discounting And Smoking Behavior: Evidence From A Panel Survey," Health Economics, John Wiley & Sons, Ltd., vol. 23(12), pages 1443-1464, December.
    18. Bloom, David E. & Luca, Dara Lee, 2016. "The Global Demography of Aging: Facts, Explanations, Future," IZA Discussion Papers 10163, Institute of Labor Economics (IZA).
    19. Anderson, D. Mark & Sabia, Joseph J., 2016. "Child Access Prevention Laws, Youth Gun Carrying, and School Shootings," IZA Discussion Papers 9830, Institute of Labor Economics (IZA).
    20. Gitanjali Sen & Mitul Surana & Rakesh Basant, 2023. "To What Extent Does the Fertility Rate Explain the Education Gap?," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(3), pages 1-31, June.
    21. Bloom, D.E. & Luca, D.L., 2016. "The Global Demography of Aging," Handbook of the Economics of Population Aging, in: Piggott, John & Woodland, Alan (ed.), Handbook of the Economics of Population Aging, edition 1, volume 1, chapter 0, pages 3-56, Elsevier.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0231960. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.