US Health and Human Services Secretary Alex Azar is encouraging world leaders to expand access to health care without the inclusion of terms such as “reproductive health and rights.” He delivered these remarks at a high-level meeting on universal health coverage during the United Nations General Assembly in New York City on Monday.
The Trump administration, along with some other countries, is pushing for the United Nations to oppose “ambiguous terms” relating to sexual and reproductive health in policy documents, because such language could “promote practices, like abortion,” Azar said.
“We do not support references to ambiguous terms and expressions, such as sexual and reproductive health and rights in UN documents, because they can undermine the critical role of the family and promote practices, like abortion, in circumstances that do not enjoy international consensus and which can be misinterpreted by UN agencies,” Azar said while standing next to health officials from Guatemala, Brazil, Iraq, Poland and Hungary.
“There is no international right to an abortion and these terms should not be used to promote pro-abortion policies and measures,” he said. “Further, we only support sex education that appreciates the protective role of the family in this education and does not condone harmful sexual risks for young people.”
What the US and 18 other countries want
Azar said that he and the other health officials who were present during his remarks were speaking on behalf of the United States, Bahrain, Belarus, Brazil, Democratic Republic of the Congo, Egypt, Guatemala, Haiti, Hungary, Iraq, Libya, Mali, Nigeria, Poland, Russia, Saudi Arabia, Sudan, United Arab Emirates and Yemen.
Out of those countries, Congo, Egypt, Haiti and Iraq prohibit abortion altogether, according to data from the Guttmacher Institute. Some of the other countries allow abortion only to save the life of the mother or preserve her health. There is no restriction based on such reasons in the United States, Bahrain, Belarus, Hungary and Russia, according to the institute.
“We therefore request that the UN, including UN agencies, focus on concrete efforts that enjoy broad consensus among member states. To that end, only documents that have been adopted by all Member States should be cited in UN resolutions,” Azar said in his remarks.
“We support equal access to health care, which includes, but is not limited to reproductive concerns, maternal health, voluntary and informed family planning, HIV, elimination of violence against women and girls, and empowerment to reach the highest standard of health,” he said.
“Let us focus on concrete issues and challenges to accelerate access to health for all. To this end, international solidarity has a key role to play, in order to the build broad consensus by member states,” he added.
The high-level meeting on universal health coverage aims to accelerate progress toward universal health coverage for everyone, including access to health care services, medicines and vaccines.
The meeting is the first on this topic at the United Nations and “will be the most significant political meeting” held on universal health coverage to date, according to the United Nations.
The effort is part of the UN’s 2030 Agenda for Sustainable Development, under which all countries have committed to try to achieve universal health coverage by 2030.
This isn’t the first time the United States has spoken out against mentions of “reproductive health” to the United Nations.
In April, the US delegation to the United Nations successfully used the threat of its veto power on the UN Security Council to demand significant changes to a resolution on sexual violence, because the resolution contained language about “sexual and reproductive health,” sources confirmed to CNN.
“Sexual health” references were removed and the altered resolution passed following major changes granted by Germany in the face of demands from the US, sources told CNN at the time.
More than ‘a symbolic gesture’?
Even though Azar’s latest remarks may represent “a very symbolic gesture,” they could have a potential real-world impact on how universal health coverage is approached, said Dr. Megan Huchko, an obstetrician-gynecologist and director of the Center for Global Reproductive Health at Duke University in North Carolina.
“When setting the stage for a universal health coverage debate, it really introduces the idea that family planning and reproductive health may not be included services and that’s a dangerous precedent,” Huchko said.
“We see this increasing understanding that people need access to reproductive health services and this feels like a definite step backwards when talking about medicines and vaccines, but explicitly excluding reproductive health,” she said. “I think that while some could say that this is just a symbolic gesture talking about values, the result is that it actually represents a lot of what the Trump administration has done both globally and domestically on reproductive health and increasing restrictions and defunding.”
Dr. Jody Steinauer, distinguished professor and director of the Bixby Center for Global Reproductive Health at the University of California, San Francisco, said Azar’s remarks are reminiscent of the Trump administration’s final rule that revised the regulations governing the Title X family planning program in the United States. The rule prohibits funding programs where abortion is a method of family planning and referrals for abortion as a method of family planning.
“This kind of feels like the US domestic and global gag rule, preventing physicians from being able to talk about abortion. … This feels like it’s an extension of that,” Steinauer said.
Next steps in a ‘landmark’ declaration
On Monday, world leaders adopted a political declaration on universal health coverage, in which UN Member States reaffirmed the effort to achieve universal health coverage by 2030 and committed to cover 1 billion additional people with health services by 2023.
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“This declaration represents a landmark for global health and development,” Dr. Tedros Adhanom Ghebreyesus, director-general at the World Health Organization, said in a news release on Monday.
“The world has 11 years left to make good on its sustainable development goals. Universal health coverage is key to ensuring that happens,” he said. “Universal health coverage is a political choice: today world leaders have signaled their readiness to make that choice. I congratulate them.”