The United States is expected to announce revised Mexico City Policy implementation guidelines, which could lead to the slashing of approximately $8 billion in U.S. bilateral global health assistance, and expand the reach of the policy to foreign health providers if they provide family planning services, including abortion counseling or referrals.
The announcement would impact all U.S. global health assistance, but exempt the public-private partnership The Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as the vaccine alliance GAVI. Humanitarian assistance would also likely not be included, according to multiple NGOs and policy groups tracking the movement of the policy, which is also known as the global gag rule for the silencing effect it has had on global health providers.
“We think that based on our experience we know the global gag rule is harmful to health programs and expansion will multiply the harm,” said Sneha Barot, a senior policy manager with the Guttmacher Institute.
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But the roll-out of the expanded guidelines has been delayed, and remains in flux, amid questions within the Trump administration on how to classify global health assistance, and whether technical work and research, for example, would be included, NGO sources believe. The State Department was widely expected to make an announcement on the expanded implementation guidelines this past Monday, and then roll them out May 1.
The $8 billion in bilateral global health assistance would not solely impact foreign NGOs and health providers. It is not clear how many foreign NGOs would not comply with the global gag rule and stand to lose funding.
The nonprofit Kaiser Family Foundation previously estimated that the global gag rule could result in a loss of more than $10 billion U.S. global health assistance, which was the total requested for the fiscal year 2016. The approximate $8 billion figure now excludes support to humanitarian assistance, as well as GAVI and the Global Fund — funding elements they had previously accounted for.
Under previous Republican administrations, the rule led to a slashing of approximately $500 million in U.S. aid funding, according to the office of U.S. Senator Jeanne Shaheen, who has introduced an act to permanently repeal the policy.
So far, the exact ramifications of the policy have been unclear. President Donald Trump reinstated an expanded version of the global gag rule at the end of January threatening all global health assistance. A more detailed document followed a little more than a month later, but the issued standard provisions duplicated those of Trump’s Republican predecessor, George W. Bush, and did not mention global health assistance.
“I have heard that administration officials are trying to figure out how to work this expansion, as stated in the memo. It is pretty significant to have so much of this be applied to their portfolio. How do you operationalize this policy? I think they are trying to figure out how to write the guidance,” said Jennifer Kates, vice president and director of Global Health & HIV Policy at the Kaiser Family Foundation.
The Kaiser Family Foundation is currently working to assess the number of foreign NGOs that will certify compliance with the rule— if it happens as expected — and the amount of funding associated with this. This includes NGOs that have contracts with the U.S., not just those who are grant awardees, significantly raising the number of NGOs at risk of losing U.S. funding, says Kates. This would be a departure from the policy under the Bush years, when grants and cooperative agreements were at stake.
The Kaiser Family Foundation will also soon release its findings on the specific abortion laws in countries — some where abortion is legal — that receive global health assistance from the U.S.
One major women’s health NGO, the International Planned Parenthood Federation, has said it will not sign the global gag rule. It says this loss of U.S. support means it will be unable to prevent approximately 20,000 maternal deaths, 4.8 million unintended pregnancies and 1.7 million unsafe abortions, according to its estimates.
More than 21.6 million women experience an unsafe abortion each year, according to the World Health Organization — and deaths from unsafe abortions account for 13 percent of all maternal deaths.
Editor’s note: This article has been updated April 26 to reflect that the $8 billion figure relates to a potential reduction in all U.S. global health assistance, not just funding at stake for foreign NGOs.
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