by Jallicia Jolly and Veronique Ignace
The first week of the Trump Administration witnessed one of the most brutal attacks on global health efforts. Trump extended the prohibition on using United States dollars for abortion services (The Global Gag) by freezing funding to nongovernmental organizations in poor countries that offer abortion counseling or advocate the right to seek abortion. This reinstatement of the Reagan-era policy expands the ban on U.S. global health assistance to international health organizations that provide a variety of family planning services.
The ban is a lethal divestment in the recent efforts to improve sexual and reproductive health among people living in poor countries, particularly Black women in the Caribbean and Sub-Saharan Africa. As low- and middle-income countries such as Haiti and Jamaica continue to suffer the impacts of colonial and ongoing imperial forces of Europe and the U.S., international health aid remains a crucial resource to improve health care and sexual and reproductive health services. Alongside growing health crises such as HIV/AIDS, maternal death, and increasingly poor health infrastructure, the ban on international aid reflects an unhealthy truth: the bodies of women of color in general, and black women in particular, remain the primary site for the exhibition of U.S. moral panics.
More profoundly, the recent ban reinforces the pervasive logic that poor Black women are undeserving of the resources to sustain their functionality on even the most basic level. The Trump administration, backed by a cohort of billionaire oligarchs, reinforces this logic while sending the message that access to good health, like citizenship in America, is a conditional privilege.
Context of Trump administration and selections
The Trump Administration is the public health crisis of the 21st century. This crisis stems from the autopsies of Trump’s victory, where we witnessed the nativist, anti-poor, pro-racist whitelash that marked one of the most notorious fear-based elections in U.S. history. In its aftermath, we have seen: 1) the continued dehumanization of the lives and livelihoods of people of color in the name of white supremacist consumption and profit; 2) legacies of racialized and sexualized violence plaguing our bodies, minds, ancestral and indigenous nations and communities; 3) and the ongoing possessive investments in whiteness to organize the white rural poor, middle-class, and wealthy suburbanites against their own interests.
This crisis strengthens with Trump’s Cabinet nominees – Tom Price and Jeff Sessions. Price, a Georgia representative and the potential secretary of the Department of Health and Human Services, remains fiercely opposed to hate crime legislations, funding for AIDS and malaria research, federal funding for Planned Parenthood clinics, and the Affordable Care Act (ACA). ACA remains one important piece of healthcare advocacy that provided health insurance to the most vulnerable patients and reduced the uninsured rate to the lowest level on record. Jeff Sessions, Alabama senator, Trump’s all-purpose advisor, and the President-elect’s pick for attorney general, is a staunch opponent of immigration and supporter of voting restrictions with an extensive track record of hate. Together with Trump, and other equally controversial Cabinet picks, Price and Sessions represent a government committed to the captivity and exclusion of the most vulnerable.
The public health crisis magnifies when we consider the fact that Trump will reside over a harmful history in black health locally and globally. Alongside the recent threats to health care and retractions in public health and social welfare programs in the U.S., are calls to address the country’s worsening STD epidemic and increase in chronic disease, which disproportionately affect low-income Black people. Furthermore, in Afro-Caribbean nations, consistently high rates of chronic disease and maternal deaths, coupled with reduced access to quality sexual and reproductive health services and information, continue to strengthen both unmet needs of healthcare in general and family planning in particular.
Implications for health in Caribbean
The recent attacks on health internationally coincide with the historical divestments in the health of people of color domestically. We see this in the violent dehumanization of the bodies and lives of people of color echoed in the history of American democracy: untreated syphilis among 399 men in the Tuskegee Syphilis Experiment, the coerced sterilization of black and Latina women in the U.S. and Puerto Rico, the use of eugenics policy to essentially exterminate Native American population, the neglected HIV infections rates among Blacks in the early stages of the epidemic, and the poisoning of water in urban cities and on ancestral lands.
The dimensions of this public health crisis take a frightening turn when we consider the recent ban on global health assistance in countries such as Haiti and Jamaica. International organizations receiving U.S. funds for health programs will now be required to certify that they do not provide abortion services, counseling, referrals, and information or advocate for the liberalization of abortion laws, even with non-U.S. funding. These organizations provide life-saving basic health services – including but not limited to HIV services, maternal health care, and counsel for women on the risks of Zika infection – to the poorest women anywhere in the world.
USAID, for example, has had a commitment in Haiti for several years to strengthen the country’s ability to provide family health services and reproductive health services. During fiscal year 2015, USAID spent $20.4 million dollars on just that, along with $31.3 million on HIV/AIDS and $31.9 millions on maternal and child health. U.S. support for family planning currently amounts to about $575 million in 40 countries, while global health assistance totals about $9 billion to about 60 countries. Impeding this kind of funding for critical health programs, which serve as potentially the only source of medical care for some populations, is devastating.
Correspondingly, the United Nations Populations Fund reports that the maternal mortality ratio in Haiti is the highest in Latin America and the Caribbean at 523 per 100,000 in 2006. In 2015, Amoin Suleman, a midwife at a UNFPA-supported clinic in Port-Au-Prince, noted that part of the cause of women dying during pregnancy is that only 37% of them give birth in the presence of a skilled attendant. Alongside poor maternal health, the country has low HIV-testing rates and a 2% prevalence as well as the highest rates of HIV/AIDS and maternal mortality in the Caribbean. The prevalence rate among poor Haitian women is double the national average.
These figures are daunting given the fact that today HIV/AIDS has allegedly moved out of the infectious disease category and into the chronic disease division because of the resources now available to make living with HIV/AIDS more manageable. Where we, in the U.S, have shifted our attention to discussions about PrEP – a drug that can greatly reduce the likelihood of becoming HIV-positive – those in many Afro-Caribbean countries are still taking steps to access basic health resources and services.
For countries already facing decreased international support, the ban undermines existing efforts to support women’s health. Jamaica’s recent World Bank classification as an “upper middle-income” country has prevented it from accessing greater levels of funding for development and other economic support as it has masked growing inequalities, weakening public health infrastructures, and increasing health issues. A striking paradox remains: even as the small island conjures an iconic portrayal of “sun, sex, and smiles” in the global imaginary, it remains undeserving of the resources needed to both maintain its caricature and address its imminent health concerns – growing rates of maternal mortality and HIV/AIDS.
USAID, the United Nations Population Fund, and regional family planning advocates have ensured the sustainability of family planning investments since the 1990s. In 2008, the U.S. disbursed $14.2 million in targeted development assistance to prevent and treat HIV and AIDS between 2009 and 2012. This aid was critical as HIV was becoming a leading cause of maternal death and was disproportionately affecting young women throughout the country. Given the Jamaican health care system’s lack of family planning services and community-based prenatal health education and screening, alternative funding allows various organizations to provide family planning and HIV and STD testing to women in under-resourced urban and rural communities where government service is limited.
As echoed by many reproductive justice advocates, the lives and the health of many black women remain subject to the whims of American politics. Alongside the white nationalist revival and nativism that accompanies Trump’s platform of bigotry, the recent divestments in health evoke a special terror in the Caribbean – the U.S.’s “backyard”, a region that continues to be a “strategic ‘battlefield’ for US geopolitics no matter the human costs.”
Looking to abolitionism for answers
Health remains an important political tool used to define the quality of life of Black women as it characterizes historically disenfranchised groups as the repository of social death. Knowing that we face one of the most lethal public health crisis with far-reaching effects within and beyond U.S. borders, we can take time to more closely examine what abolitionism offers at this moment.
An abolitionist democracy recognizes that health is one of the weapons of war in our amerikan democracy. Amidst our biomedical warfare, it demands that we resist captivity through efforts to unsettle the imperial logics that have enabled dynamic violences and subjected their lethal impacts to erasure in the name of diplomacy, progress, multiculturalism, and liberalism. It invites us to leverage our individual and collective insurgent grounds amidst historically dystopian realities cultivated by the empowerment of an increasingly oligarchical ruling class. Anchored firmly within the revolutionary battlefields of our (wom)ancestors, these realities invite us to reimagine and implement meaningful transformation and restoration that strategizes a present worth living and a future worth dreaming.
About the authors: Veronique Ignace is an MPH student who merges her passion for public heath and global health in her dance, her writing, and research interests. Jallicia Jolly is a writer, poet, and PhD student studying HIV/AIDS and reproductive justice in the U.S. and Caribbean. Ignace and Jolly co-lead Resist.Restore. – a global-health-art organization that uses performance art, research, and community engagement to address health issues and disparities in African diasporic communities in Brooklyn, Haiti, and Jamaica. Twitter: @jallicia and @resist_restore