U.S. global health aid policy and family planning in sub-Saharan Africa.

The Trump administration reinstated and expanded the Mexico City Policy (MCP) in 2017 as the Protecting Life in Global Health Assistance (PLGHA) policy, forbidding international organizations receiving all U.S. health assistance from promoting abortion. Existing evidence suggests that abortion rates rise under the MCP, but the direct effect of U.S. funding restrictions on supply and use of family planning has received less attention. By studying PLGHA's impact on health service delivery providers and women in eight sub-Saharan African countries, we are able to fill this gap. We find that health facilities provide fewer family planning services, including emergency contraception, and that women are less likely to use contraception and more likely to have given birth recently under the policy. These findings suggest that PLGHA has important unintended consequences that are detrimental to reproductive health and the autonomous decision-making of health service providers and women.

Abortion Liberalization in World Society, 1960-2009.

Controversy sets abortion apart from other issues studied by world society theorists, who consider the tendency for policies institutionalized at the global level to diffuse across very different countries. The authors conduct an event history analysis of the spread (however limited) of abortion liberalization policies from 1960 to 2009. After identifying three dominant frames (a women's rights frame, a medical frame, and a religious, natural family frame), the authors find that indicators of a scientific, medical frame show consistent association with liberalization of policies specifying acceptable grounds for abortion. Women's leadership roles have a stronger and more consistent liberalizing effect than do countries' links to a global women's rights discourse. Somewhat different patterns emerge around the likelihood of adopting an additional policy, controlling for first policy adoption. Even as support for women's autonomy has grown globally, with respect to abortion liberalization, persistent, powerful frames compete at the global level, preventing robust policy diffusion.