On September 23, 2019, the U.N. General Assembly held a High-Level Meeting on Universal Health Coverage that aimed to accelerate progress toward universal health coverage for everyone around the world, which would include access to health care services, medicines and vaccines in accordance with the U.N.’s 2030 Agenda for Sustainable Development, under which all countries have committed to try to achieve universal health coverage by 2030.
At this High-Level Meeting, Alex Azar, the U.S. Health and Human Services Secretary, read a joint statement on behalf of the following 19 countries representing more than 1.3 billion people: the United States of America plus Africa (Democratic Republic of the Congo, Egypt, Libya, Mali, Nigeria, Sudan), Eastern Europe/North Asia (Belarus, Russia), Europe (Hungary, Poland), Latin America (Brazil, Guatemala, Haiti) and Middle East (Bahrain, Iraq, Saudi Arabia, United Arab Emirates, Yemen).
The U.S. Joint Statement
“We believe that health of women, men, children and adolescents supports and improves the overall health of our families and communities, and that the family is the foundational institution of society and thus should be supported and strengthened.”
“We commend the United Nations and the Member States on the significant work done on the Universal Health Coverage Political Declaration, and for the high priority placed on expanding access to health care.”
“We therefore urge Member States to join us in focusing on the important work of expanding health and opportunities for all people, and especially those in situations of risk and/or vulnerability.”
“To make the most meaningful progress without delay or dissension, we respectfully call upon Member States to join us in concentrating on topics that unite rather than divide on the critical issues surrounding access to health care.”
“We do not support references to ambiguous terms and expressions, such as sexual and reproductive health and rights in U.N. 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 U.N. agencies.” (Emphasis added.)
“Such terms do not adequately take into account the key role of the family in health and education, nor the sovereign right of nations to implement health policies according to their national context. There is no international right to an abortion and these terms should not be used to promote pro-abortion policies and measures.” (Emphasis added.)
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.” (Emphasis added.)
“We therefore request that the U.N., including U.N. 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 U.N. resolutions.” (Emphasis added.)
“To this end, we also understand the important role the Sustainable Development Goals play in assisting countries realize their own path to universal health coverage, in accordance with national policies and legislation.”
“We strongly support the highest attainable health outcomes for women, men, children, and adolescents holistically and throughout their lives.”
“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.” (Emphasis added.)
“We support programs to improve the health, life, dignity, and well-being of women, men, children, and families, and we will continue to be their stalwart defender.”
“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.”
Preceding U.S. Letter Urging Support of the Joint Statement
Prior to this High-Level Meeting, Secretary Azar and U.S. Secretary of State Michael Pompeo reportedly sent a letter to at least some of the other U.N. members that were to attend this High-Level Meeting encouraging them to sign this joint statement opposing “harmful UN policies, especially at the World Health Organization, that promote sexual and reproductive health and rights” and “ensuring that every sovereign state has the ability to determine the best way to protect the unborn and defend the family as the foundational unity of society vital to children thriving and leading healthy lives.”
This letter reportedly also said, “We remain gravely concerned that aggressive efforts to reinterpret international instruments to create a new international right to abortion and to promote international policies that weaken the family have advanced through some United Nations forums.” Evidence of this [effort] is found in references throughout many multilateral global health policy documents to interpret ‘comprehensive sexuality education’ and ‘sexual and reproductive health’ and ‘sexual and reproductive health and rights’ to diminish the role of parents in the most sensitive and personal family-oriented issues. The latter has been asserted to mean promotion of abortion, including pressuring countries to abandon religious principles and cultural norms enshrined in law that protect unborn life.”
Other U.S. Challenges to U.N. Documents
This U.S. letter and the Joint Statement are consistent with prior efforts by the Trump Administration to delete and remove language from various U.N. agreements. Here are examples of this effort: (a) this April intense lobbying by U.S. officials resulted in the removal of references to sexual and reproductive health from a UN security council resolution on combatting rape in conflict; and (b) the U.S.previously attempted to water down language and remove the word “gender” from UN documents.
On September 24 Secretary Azar remained at the U.N. to attend President Trump’s address to the General Assembly and to meet with other governments representatives. He also was interviewed on Tony Perkins’ “Washington Watch” radio program 
Opposition to U.S. Joint Statement
The Netherlands’ Minister of Foreign Trade, Sigrid Kaag, spoke out in a competing joint statement issued on behalf of 58 countries. Although it did not mention the U.S. Joint Statement or use the word “abortion,” her joint statement clearly opposed the U.S. position. Her main points were the following: (1) “We strongly believe that SRHR [Sexual Reproductive Health and Rights] is an integral part of Universal Health Coverage and the SDGs [Sustainable Development Goals]. (2) “Investing in SRHR has proven to be affordable, cost-effective, and cost saving.” (3) “Gender-related barriers to accessing UHC [Universal Health Care] must be addressed, including by direct involvement of women, adolescents and marginalized groups in policy and program design.” (4) “Investing in comprehensive sexual and reproductive health services in UHC is necessary to address the needs of women, girls, adolescents and people in the most marginalized situations who need these the most.”
Sweden’s Minister for International Development Cooperation tweeted that the action was “unbelievable news” and that “women’s rights must be protected at all times.” Another objector was Françoise Girard, president of the International Women’s Health Coalition, who said that “sexual and reproductive rights are human rights, and are enshrined in UN agreements for almost 25 years now” and that “the Trump administration’s position is extreme and its repeated attempts to strip women, girls, and gender- diverse people of their rights at the United Nations have failed.”
Shannon Kowalski, director of advocacy and policy at the International Women’s Health Coalition, said the Pompeo-Azar letter “shows how they are trying to erode international consensus and roll back the clock for women and girls. It’s not just abortion that they care about, they care about women’s ability to exercise autonomy over their bodies and about denying them critical access to the services they need.” That Pompeo and Azur both signed the letter suggests an escalation of the US strategy to undermine policy statements, she added.
Keifer Buckingham, senior policy adviser for international public health at the Open Society Foundations, said that rather than an escalation, “it could be them just putting out in public what they have been doing in private.” She said the US was effectively sending a message of “if you’re not with us, you’re against us”, which could have funding implications.
Other civil society and women’s rights groups expressed alarm at the efforts and accused the U.S. of aligning with countries like Saudi Arabia and Sudan with poor human rights records and, also, of putting unfair pressure on poor countries that depend on U.S. aid.
Support for U.S. Joint Statement
On the other side of this controversy were anti-abortion groups that praised the statement as a sign of the administration’s “strong pro-life leadership on the world stage.” For example, the group Susan B. Anthony (SBA ) List issued a statement, saying, “From day one, President Trump has worked to restore respect for life as a foundational American value, not only in our domestic policies, but in our international relations as well.”
This speech by Secretary Azar, the preceding letter and the U.S. lobbying for other nations’ support against abortion and reproductive health can be seen as confirmation of fears that the U.S. Commission on Unalienable Rights that was announced this June was designed to put a gloss of respectability on efforts to attack women’s rights and to appeal to the Administration’s base of very conservative religious supporters.
As noted in other posts, this U.S. Commission emphasizes the July 4, 1776, U.S. Declaration of Independence’s statement “that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these, are life, liberty, and the pursuit of happiness.” But the Commission ignores that phrase’s indications that “life, liberty, and the pursuit of happiness” are “among” certain unalienable rights; i.e., there are other such rights. Moreover, the Commission ignores the very next sentence of that Declaration: “That, to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed.” In other words, this Declaration recognizes that these recited rights need to be “secured” by subsequent legislation that will have details not specified in this Declaration. (Emphasis added.)
Moreover, the U.S.-promoted Joint Statement’s requiring all 193 U.N. members to adopt a U.N. document or treaty as a precondition for them to be used in other U.N. documents would give every one of those members a veto right on the subsequent use of those documents or treaties. Is there any such document or treaty that has such unanimous approval? (That is exceedingly unlikely.) It also is antithetical to the provisions of such treaties requiring a certain number of ratifications in order for the treaties to go into effect for the parties to the treaties. In short, this provision of the Joint Statement would totally prevent progress on these and many other issues.
In short, the U.S. positions expressed in the U.N. speech by Secretary Azar were most unfortunate.
 U.S. HHS Dep’t, [Secretary Azar], Remarks on Universal Health Coverage (Sept. 23, 2019); Howard, U.S. wants the U.N. to oppose terms such as “reproductive health and rights” in policies, CNN (Sept. 23, 2019).
 The Political Declaration stated that the High-Level Meeting will have “a dedicated focus for the first time on universal health coverage . . . and [a strong recommitment] to achieve universal health coverage by 2030” with 83 numbered paragraphs of specific actions towards that goal. (U.N. Gen. Ass’bly, Political Declaration on the High-level Meeting on Universal Health Coverage (Sept. 10, 2019).)
 Cha, U.S. joins 19 nations, including Saudi Arabia and Russia: ‘There is no international right to an abortion, Wash. Post (Sept. 24, 2019); Ford, Leaked letter suggests US is rallying UN members to oppose abortion, Guardian (Sept. 23, 2019).
 HHS Dep’t, Secretary Azar Attends Presidential Address at UNGA, Furthers U.S. Partnerships on Health through Bilateral Meetings (Sept. 24, 2019).
 SBA List, Pro-Life Groups Praise Trump Admin’s Defense of Life at the UN (Sept. 24, 2019).