Impacts on Affected Countries

Dominican Republic

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The United States: Both Friend and Foe of Reproductive Health in the Dominican Republic

It is within these contexts that USAID has been working in the Dominican Republic since 1962. Reproductive health and family planning have been a part of the mission’s work since the early 1980s. Currently, USAID is the biggest donor of HIV/AIDS money in the Dominican Republic, providing $5.3 million per year. In addition, the Dominican Republic receives roughly $2 million a year in USAID family planning funding. Today, USAID is spending fewer resources on personnel and administrative costs for local organizations and is instead contributing to their financial sustainability. The funding is scheduled to drop to $1.4 million in 2006, which will be in effect until the end of the strategy program in September 2007. At this point, funding will end as the U.S. will “graduate” the Dominican Republic from international family planning assistance, due in part to programmatic successes, as well as to satisfy the demand for USAID’s work in other countries.

However, the information and statistics that are informing USAID’s decision do not accurately reflect the political constraints faced by the country. The relatively high contraceptive prevalence rate (70 percent) is misleading in that almost half is due to sterilization. And while some reproductive health indicators appear compelling on paper, the political reality is that government buy-in has not happened. The chilling effect of the Mexico City Policy has created confusion and hesitance among some of the largest non-governmental reproductive health providers. As such, the health of Dominican women and children will surely suffer if the country is graduated from USAID international family planning assistance as scheduled.

Free speech is “gagged” in the Dominican Republic

Dominican government officials profess that the Global Gag Rule continues to affect international cooperation with the United States. Government ministers who were previously known to be in favor of decriminalizing abortion are now hampered in expressing their views. One government official stated, “We cannot openly speak out against abortion, but we are in ‘undercover’ alliance with the women’s movement…We acknowledge that clandestine abortion is one of the main causes of maternal deaths.” Officials insist that the gag rule has negatively influenced government processes and government actions, even though the policy is not directly applied to governments. The policy is viewed by many Dominican officials as an inappropriate display of American hegemony - one that has crippled the national debate on abortion.

“In the relation of cooperation between rich and poor governments, all politics and discourse influences national processes.” Dominican government official

Dominican nongovernmental organizations (NGOs) that openly seek to decriminalize abortion are in a complicated situation, because most sexual and reproductive health funds come from USAID—if not directly, then indirectly through Family Health International’s (FHI) programs. Organizations that have accepted U.S. funds, and thus agreed to abide by the gag rule, can no longer lobby or participate in public debates about abortion. According to Colectiva Mujer y Salud, a network of feminist groups, there was a coordinated effort among dozens of women’s groups to draft a petition in favor of the depenalization of abortion. But when the time came to actually sign the petition, only six organizations were free to do so. The others felt “gagged” by the gag rule. Many people remain involved with the movement on an individual basis, but, as institutions, their ability to participate in the public dialogue has been curtailed.

The Global Gag Rule and the current U.S. policy on “ABC” (Abstinence, Be faithful, and when appropriate, use Condoms) reportedly have made it difficult for other international donors to support the work of Colectiva. For example, Colectiva organized a meeting last year with Caribbean youth on sexual and reproductive health and rights, the first meeting of its kind in the region. The United Nations Children’s Fund (UNICEF) signed a contract to support the meeting with $5,000 to finance the participation of Haitian youth. Three days prior to the start of the event, UNICEF noticed that the program for the youth meeting included sessions such as “Impact of Abortion on Young Women in the Caribbean” and “Promotion of Emergency Contraception.” Colectiva was told to remove these topics from the program in order to maintain UNICEF support. Colectiva declined and UNICEF subsequently retracted their funding, an act Colectiva attributes to political pressure from the United States.

Margaret Sanger Center International (MSCI), the international branch of Planned Parenthood of New York City, was not forced to sign the gag rule as an American NGO but nevertheless opposed it on principle. Currently, MSCI’s program in the Dominican Republic is not receiving any USAID funds. The financial impact of MSCI’s decision to oppose the gag rule has been “catastrophic.” MSCI’s budget for their work in the Dominican Republic has been slashed, and the lost funds have not been replaced by support from other funders. Cuts to the staff of 17 began in August of 2004 and lasted until the close of an HIV prevention program. There are now only seven staff members left, and future cuts – perhaps the entire staff – are likely. While MSCI hopes to continue to work in the Dominican Republic, the organization remains financially vulnerable.

Pullquote: “No organization that is feminist and openly speaking out about abortion rights gets any U.S. funding. There is simply no funding for them—either for reproductive health or for HIV.” Staff, international NGO

The Global Gag Rule has weakened the country’s largest reproductive health service provider

Founded in 1966, Asociación Dominicana Pro-Bienestar de la Familia (Profamilia) is the largest provider of reproductive health services in the Dominican Republic. The public sector is the majority provider for long-term methods, such as sterilization and intrauterine devices (IUDs), but in terms of condoms, pills, and injectables, the private sector and Profamilia are the primary providers. Profamilia supplies between 60 and 70 percent of the pills and injectables available at pharmacies. A study a few years ago showed that Profamilia provides more pap smears than the government, performing about 40,000 to 50,000 a year. Profamilia is also one of the few private providers of free or low-cost mammograms in the country.

Profamilia is primarily self-sufficient, funding 80 percent of its work through the sale of its products. Still, Profamilia has worked directly with USAID since 1986 and in earlier years worked indirectly with USAID through funding from the International Planned Parenthood Federation (IPPF). Historically, Profamilia used USAID funds to open clinics and begin services until the programs became completely sustainable. Then, in 2001 Profamilia signed the Global Gag Rule for the first time. They agreed to a five-year contract with USAID for $1.8 million to support a coupon program that serves an estimated 6,000 poverty-stricken people every year, providing free testing for breast and cervical cancers and access to contraception for qualified recipients.

Profamilia continued to receive IPPF funding in 2001, despite having signed the gag rule. Because IPPF did not retract their funds, the policy did not impact Profamilia’s ability to provide services. At the time of the signing, the language and implications of the gag rule were not made clear to Profamilia’s staff. Following the signing, Profamilia’s Director invited a USAID health official to explain the gag rule. Upon receiving an explanation of the policy, Profamilia’s Director expressed concern for the reach of the policy, with respect to the health and lives of women with incomplete abortions or in risky conditions. Moreover, contrary to previous statements, USAID headquarters informed Profamilia that the gag rule prohibits post-abortion care (PAC), a critical life-saving service that Profamilia’s clinics provide. Although PAC is not legally prohibited by the gag rule, a top Profamilia spokesperson declared, “It is one thing what the law says—it is another thing altogether how it is interpreted and applied…I’m afraid to even mention the term ‘sexual health,’ forget even ‘sexual rights,’ because no one knows how this will be interpreted.”

Profamilia’s five-year contract with USAID was scheduled to end in June 2005. However, Profamilia has arranged to get an extension on the current contract through 2007, when USAID is slated to graduate the Dominican Republic from family planning assistance. This arrangement means that the old contract, signed five years ago, still stands, and Profamilia will continue to receive funds from USAID for the coupon program. After 2007, Profamilia hopes to replace the USAID funds with funds from other donors, but this is uncertain.

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