The recent expansion of the United States’ Mexico City Policy marks a turning point for global health and development assistance. What was once a contested restriction on abortion-related services has been transformed into a sweeping ideological test, applied across nonmilitary foreign aid.
The damage to health systems from last year’s Presidential Memorandum reinstating the Mexico City Policy is already evident, reflecting patterns well documented during previous enforcement periods. But the more fundamental question now is whether global health groups will accept this shift — or organize to resist it.
The policy has been embedded in a new framework, Promoting Human Flourishing in Foreign Assistance, or PHFFA, which conditions U.S. aid on compliance with opposition to what the administration labels “gender ideology” and “discriminatory equity ideology,” including diversity, equity, and inclusion programs. These requirements apply not only to recipient governments and foreign NGOs, but also to U.S. NGOs and multilateral organizations, extending even to humanitarian assistance, and covering a reported $30 billion in “assistance.”
About the authors
Kent Buse
Kent Buse is a professor at Monash University Malaysia, in Kuala Lumpur. He is a political economist who has published widely on global health governance and health policy analysis. He is co-founder and co-CEO of Global 50/50. He was head of strategy at UNAIDS for over a decade and taught at Yale University and the London School of Hygiene and Tropical Medicine.
Sonja Tanaka
Sonja Tanaka is the director of programs and innovation at Global 50/50. She works to advance gender justice, equity, and accountability in global health and beyond, with expertise in research, policy, and strategy development, global partnerships, and communications. She is a founding member of Global 50/50 and was previously with the United Nations, supporting a rights-based and evidence-informed global HIV/AIDS response.
Lynsey Robinson
Lynsey Robinson is health sector lead at Global 50/50, where she oversees the Global Health 50/50 Report and Gender and Health Index. She holds a Ph.D. from the UCL Institute of Education, where her research explored gender, religion, and regional dynamics in Nigeria’s primary education system.
Sharmila L. Mhatre
Sharmila L. Mhatre has over two decades of experience spanning health systems research, philanthropy, and policy, focused on advancing socioeconomic equity globally and in the United States. After senior roles at IDRC and Open Society Foundations, she now leads Sahavera Advisory, supporting leaders and teams through strategic transitions. She holds a Ph.D. from the University of Toronto.
