The Global Gag Rule (GGR) makes non-U.S. nongovernmental organizations (NGOs) ineligible for U.S. Government global health funding if they provide, refer, or promote access to abortion. This study quantitatively examines the impacts of the GGR on family planning service provision in Ethiopia. Using a panel of health facilities (2017–2020), we conduct a pre–post analysis to investigate the overall changes in family planning service provision before and after the policy came into effect in Ethiopia. Our pre–post analyses revealed post-GGR reductions in the proportions of facilities reporting family planning provision through community health volunteers (−5.6, 95% CI [−10.2, −1.0]), mobile outreach visits (−13.1, 95% CI [−17.8, −8.4]), and family planning and postabortion care service integration (−4.8, 95% CI: [−9.1, −0.5]), as well as a 6.1 percentage points increase in contraceptive stock-outs over the past three months (95% CI [−0.6, 12.8]). We further investigate the impacts of the GGR on facilities exposed to noncompliant organizations that did not sign the policy and lost U.S. funding. We do not find any significant additional impacts on facilities in regions more exposed to noncompliant organizations. Overall, while the GGR was slow to fully impact NGOs in Ethiopia, it ultimately resulted in negative impacts on family planning service provision.

中文翻译：

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特朗普政府扩大全球禁言规则政策对埃塞俄比亚计划生育服务提供的影响

全球禁言规则 (GGR) 使非美国非政府组织 (NGO) 没有资格获得美国政府的全球卫生资金，如果他们提供、推荐或促进堕胎的获取。本研究定量研究了 GGR 对埃塞俄比亚计划生育服务提供的影响。我们使用一组卫生机构（2017-2020 年）进行了事前分析，以调查该政策在埃塞俄比亚实施前后计划生育服务提供的总体变化。我们的事后分析显示，通过社区卫生志愿者（-5.6, 95% CI [-10.2, -1.0]）、移动外展访问（-13.1, 95% CI [ -17.8, -8.4])，以及计划生育和流产后护理服务整合 (-4.8, 95% CI: [-9.1, -0.5])，以及 6. 过去三个月避孕药具缺货增加 1 个百分点（95% CI [-0.6, 12.8]）。我们进一步调查了 GGR 对暴露于未签署政策并失去美国资金的不合规组织的设施的影响。我们没有发现对不合规组织更容易受到影响的地区的设施有任何重大的额外影响。总体而言，虽然 GGR 对埃塞俄比亚非政府组织的全面影响缓慢，但最终对计划生育服务的提供产生了负面影响。我们没有发现对不合规组织更容易受到影响的地区的设施有任何重大的额外影响。总体而言，虽然 GGR 对埃塞俄比亚非政府组织的全面影响缓慢，但最终对计划生育服务的提供产生了负面影响。我们没有发现对不合规组织更容易受到影响的地区的设施有任何重大的额外影响。总体而言，虽然 GGR 对埃塞俄比亚非政府组织的全面影响缓慢，但最终对计划生育服务的提供产生了负面影响。