HELP WITH STRINGS ATTACHED
● When Europe was on the verge of collapsing after the carnage of World War II, countries in the region were at risk of drifting into the communist orbit of the Soviet Union. To contain the threat, the United States government in 1948 created a recovery programme worth US$12.7 billion — $128 billion in today’s money.
The rescue fund came to be known as the Marshall Plan, named for then secretary of state George Marshall, and was one of the first major examples of US foreign aid. It succeeded on both the economic and political fronts and was seen as a cornerstone of American influence and the exercise of soft power.
Foreign aid, while an act of financial generosity, is essentially a strategic diplomatic instrument that assists recipient countries in ways that also serve the interests of the donors.
In the United States, in order to overcome isolationist sentiment that tends to be stronger than in many countries, foreign assistance has always been portrayed as an instrument that serves American interests. It is also a valuable tool in “carrot and stick” diplomacy, as American governments try to nudge other countries into line with their view of the world.
But foreign aid — or official development assistance (ODA) as the aid professionals prefer to call it — has a political life of its own in many countries. In the United States, administration after administration has used it as leverage in negotiations — with both domestic and overseas players — to secure agreement on policies that the incumbent president favours.
President Donald Trump, who honed his negotiating skills in the bare-knuckles world of New York real estate, is often seen as holding aid hostage as he pursues his administration’s agenda. For example, in October 2018, American humanitarian aid workers were barred from entering North Korea when the administration was leaning on Pyongyang to agree to curbs on its nuclear programme.
US foreign aid spending is also falling in line with Mr Trump’s distaste for committing his country to expensive programmes abroad on which he sees no direct financial return. The proposed federal budget for the 2021 fiscal year, which will begin on Oct 1, calls for foreign aid to be slashed by nearly 21%, from $55.7 billion in fiscal 2020 to $44.1 billion. The move is widely perceived as means to trim the deficit.
The budget is still before Congress, which of course has had other priorities in recent weeks, such as saving the economy from total collapse amid the spread of Covid-19.
On paper, the number might look like a colossal amount. However, US foreign aid spending in fiscal 2019 accounted for just under 1% of the federal budget, down from 1.2% in fiscal 2017, the last budget passed in the Barack Obama era.
But analysts say cutting foreign aid by the world’s biggest donor country is risky at a time when its biggest political and economic rival, China, is flexing its muscle as a donor, spreading its influence across, South, Central and Southeast Asia, to Africa and beyond.
It is crucial for the US to reconsider its position on aid, which can be an effective instrument in countering the growing influence of China and promoting American interests in the region, says Prof Kalaya Chareonying, a lecturer on International Relations at Chulalongkorn University.
“If assistance is about bolstering allies, I don’t see the point of not employing it,” she told Asia Focus.
In her view, foreign aid has essentially been used as a means to expand markets and American capitalist values and promote the role of Washington as a saviour on the global stage.
But in the Trump era, US foreign policy has come to be heavily influenced by the president’s “America First” views, she said. “He’s trying to bring down what he doesn’t think will benefit the business sector.”
Since World War II, foreign aid has evolved to embrace a wide array of humanitarian causes and the promotion of global peace and stability. America believes it can do a lot of good work and still serve its national security, commercial and humanitarian interests.
President Harry Truman, in his “Point Four” speech in 1949, laid the groundwork for the US to embrace the role of a benefactor that uses its industrial power to bolster growth and development abroad to “go out and save the world”, Prof Kalaya said.
Many European countries followed suit, as they sought to dim the memories of their often shameful colonial pasts and reinvent themselves as benefactors. Both the US and wealthy European nations have done a lot of valuable work in areas such as poverty reduction, public health promotion, education and infrastructure in the past six decades.
But aid often comes with strings attached, and global health assistance, especially reproductive health, has been particularly vulnerable to shifts in the political wind in the United States.
“Overall health spending is actually a fairly small portion of overall aid spending. The majority of funding often goes to energy, government, civil society and transport,” noted development finance expert Samantha Custer, director of policy analysis at AidData, a research lab based at William & Mary College in Williamsburg, Virginia.
The focus of health assistance is mainly on basic health, while sexual and reproductive health receives a fraction of that sum, she said, adding that the US accounts for over half of all of sexual and reproductive health spending by donors.
“The US and the Global Fund (to Fight Aids, Tuberculosis and Malaria) are by far the largest donors that are
If assistance is about bolstering allies, I don’t see the point of not employing it
focused on the sexual and reproductive health region,” said Ms Custer. “These two donors have outsized influence in this subsector of health.”
In Asia, sexual and reproductive health funding often focuses on Cambodia, Indonesia, the Philippines and Vietnam. The majority of the funding is concentrated on control of sexually transmitted diseases (STD), including HIV/Aids, except in the Philippines where most of the financing goes toward family planning and reproductive health, she said.
In any case, the US exerts a powerful influence over which reproductive health programmes get funded — and which ones do not. A few days after President Trump took office in 2017, he put abortion, a highly divisive issue, at centre stage by reinstating the “Mexico City Policy” — widely known as the “global gag rule”.
The policy requires all non-governmental organisations (NGOs) operating outside the US that wish to receive funding from Washington to refrain from performing, advising on or endorsing abortion as a method of family planning. The decision was popular with a conservative segment of Mr Trump’s loyal voter base.
It also bars advocacy for abortion law reform — even if an NGO does that with its own funds. The policy allows access to abortion only in cases of rape, incest, or when a woman’s life is at risk.
The Mexico City Policy has been applied strictly along partisan lines for the last 30 years. It was rescinded by Democratic President Bill Clinton, restored by Republican George W Bush, repealed by Democrat Barack Obama, and now reinstated by the Republican Trump administration. It has also been expanded it to apply to US health assistance programmes.
But whereas earlier versions of the policy applied specifically to family planning funds (approximately $575 million), the extended version encompasses all US global health assistance, worth an estimated $8.8 billion. Many developing countries are afraid of losing valuable assistance as a result.
The programmes under scrutiny include family planning and reproductive health, maternal and child health, nutrition, the President’s Plan for Emergency Relief for Aids (Pepfar), prevention and treatment of tuberculosis, malaria, infectious diseases and neglected tropical diseases. The policy even extends to programmes that deal with water, sanitation and hygiene.
NGOs that refuse to sign on will be refused all health assistance, including for HIV, primary care, nutrition, tuberculosis and malaria programmes.
Jonathan Rucks, senior director of policy and advocacy at Population Action International (PAI), an NGO focused on family planning and reproductive healthcare, said the rule is targeting comprehensive service provision in a way that is designed to cut providers out of the system, while also sending a signal that access to comprehensive services is stigmatised.
“If you’re a provider delivering nutrition care to a woman and her children, you now are gagged,” he said. “You have to comply even if you’re not doing anything with respect to providing information or referral for abortion.”
Mr Rucks said the global gag rule also signals the current administration’s lack of recognition for women’s economic empowerment and is causing chaos in countries that are dependent on US health assistance.
He argues that the rule tries to overreach and decreases the network of providers who can provide abortion, which is legal in a number of contexts around the world.
According to Mr Rucks, the $8.8 billion in US health assistance goes to more than 60 countries, 24 of which have a focus on family planning and reproductive health.
Empowering women, he says, also means ensuring they have autonomy over their own bodies and are able to access contraceptive methods.
“Sexual and reproductive health can be used to ensure that women have access to contraceptives. They can decide when, if and how many children they want to have, in recognition that this allows women to be active contributors to society,” he said, adding that unplanned pregnancies bar women from doing so.
The Trump administration’s policy, he said, has stigmatised comprehensive abortion care, access to contraceptives for adolescents and unmarried youth.
“As a result of the policies from this administration, we have had clinics close. There’s no guarantee that clinics in a number of remote areas are going to be able to reopen,” he said.
“Women in less developed areas are relying on these private service providers because they know that when they show up at those clinics, they’re going to receive quality care.”
In the absence of such services, more women may also seek out unsafe methods of abortion which could have fatal consequences, he added.
Human Rights Watch has also warned that if the global gag rule persists in its current sweeping form, women and girls in about 60 low- and middle-income countries will have less access to contraception, resulting in more unintended pregnancies and more unsafe abortions.
Without US funding, NGOs may also have to cut services linked to newborn, infant and child health, including vaccinations; prevention and treatment of HIV/Aids, malaria and tuberculosis (TB), and nutrition programmes.
Women are losing access to critical services because normally contraceptives, along with tuberculosis, HIV and Aids treatments, are often offered in the clinics that offer comprehensive reproductive health services, says PAI.
The Open Society Foundation, a human rights funding organisation founded by billionaire George Soros, points out that organisations receiving funds from the US are also barred from funding groups that provide abortion services and information, even though those organisations don’t get any US aid.
While abortion will continue to be a partisan issue, World Health Organization guidelines dictate that healthcare providers are obligated to provide life-saving medical care to any woman who suffers abortion-related complications, including treatment of complications from unsafe abortion, regardless of the legal grounds for abortion.
The WHO estimates that around 25 million unsafe abortions take place worldwide each year, over half of them in Asia.
Almost every abortion death and disability could be prevented through sexuality education, use of effective contraception, provision of safe, legal induced abortion and timely care for complications, it said.