Bangkok Post

HELP WITH STRINGS ATTACHED

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● 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.

CHINA CHALLENGE

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

KALAYA CHAREONYIN­G

Chulalongk­orn University

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.

ANTI-ABORTION AGENDA

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.

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Source: USAID Explorer ??
BKPgraphic­s Source: USAID Explorer
 ??  ?? Medical equipment for the fight against Ebola, supplied by the US Agency for Internatio­nal Developmen­t (USAID), is offloaded in Monrovia, Liberia in 2014.
Medical equipment for the fight against Ebola, supplied by the US Agency for Internatio­nal Developmen­t (USAID), is offloaded in Monrovia, Liberia in 2014.
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 ??  ?? A pro-choice demonstrat­or stands in a crosswalk during a rally outside the US Supreme Court, where justices were hearing a case on the legality of a Louisiana law that imposes restrictio­ns on abortion doctors, in Washington on March 4.
A pro-choice demonstrat­or stands in a crosswalk during a rally outside the US Supreme Court, where justices were hearing a case on the legality of a Louisiana law that imposes restrictio­ns on abortion doctors, in Washington on March 4.
 ??  ?? Women in developing countries are at risk of losing a wide range of health services because of the US “gag rule” against abortion counsellin­g, says Jonathan Rucks of Population Action Internatio­nal (PAI).
Women in developing countries are at risk of losing a wide range of health services because of the US “gag rule” against abortion counsellin­g, says Jonathan Rucks of Population Action Internatio­nal (PAI).

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