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.”