President Joe Biden issued a memorandum Thursday that broadly restored United States funding support for women’s reproductive health services and rights, both rescinding the Mexico City Policy and announcing that the country would reinstate funding to the United Nations Population Fund.
The memorandum immediately rescinds the controversial policy, widely known as the “global gag rule,” which withholds all U.S. global health assistance from international organizations that provide or even offer information on abortions. Federal agencies are set to shortly follow by issuing guidance to their grantees, according to experts, though a follow-up explaining the practical next steps for foreign NGOs has not yet been made publicly available.
"Again, I'm not initiating any new law, any new aspect of the law. This is going back to what the situation was prior to the president's executive order,” Biden said during a White House press briefing Thursday afternoon, referring to the decadeslong political tussle surrounding the policy.
President Ronald Reagan first initiated the rule, which has been rescinded and reinstated by subsequent Democratic and Republican presidents. Under President Donald Trump, the policy was greatly expanded so that all U.S. global health assistance, not just reproductive assistance, could be withheld — a change that led to a dangerous and even fatal “disintegration” of health services in some areas.
The move will free up at least $7.3 billion in U.S. global health funding, making foreign NGOs and partners again eligible for U.S. global health assistance, even if they engage in abortion-related services or acitivites. For UNFPA, it could mean an additional $69 million each year, as well as the reemergence of one of their largest traditional donors — though the agency has largely rebounded from the funding hit over the last several years.
“The return of the United States as a major donor to UNFPA at this challenging time sends a message of hope to vulnerable women and girls everywhere,” UNFPA Executive Director Natalia Kanem said in a statement. UNFPA estimates that if U.S. funding returns to previous levels, it can help prevent 1.4 million unintended pregnancies within a year, in addition to 32,000 unsafe abortions.
But change regarding the global gag rule, in particular, is likely to unfold in a complicated, drawn-out manner that could stretch on for several years. Serra Sippel, president at the Center for Health and Gender Equity, is among the experts who called for clear follow-up guidance from the executive office.
Amid expectations of Joe Biden’s U.S. administration rescinding the "global gag rule," experts say it will take time and work to reverse its impacts.
“Once the executive action happens, that really sets forth a whole series of actions that we need, and we need it quickly. In addition to any kind of guidance, we need the standard provisions to be changed to remove the global gag rule,” Sippel said during a media briefing shortly before the announcement.
Practically, this work will involve a “a huge undertaking,” said Jonathan Rucks, senior director of policy and advocacy at PAI. “We have got to have a lot of conversations to make sure they [NGOs] know what the new modus operandi is going to be with this administration.”
The White House will first instruct U.S. agencies, including the U.S. Agency for International Development and the State Department, to not enforce the Mexico City Policy, according to Jen Kates, senior vice president and director of global health and HIV policy at the Henry J. Kaiser Family Foundation. Agencies will then be tasked with spelling out what this means specifically for foreign NGOs that receive U.S. assistance, as well as for some organizations that have chosen to forgo U.S. assistance because of the policy.
“If you rescind the policy, it means going forward it is no longer going to apply and be in any cooperative or agreement,” Kates said. This would extend to future agreements but could also apply to existing contracts.
U.S. agencies will then communicate to foreign NGOs that though their existing global health agreements technically still prohibit them from engaging in abortion-related work, the U.S. would no longer enforce this grandfathered clause.
“The Trump administration made a concerted effort to make it as confusing as possible. In terms of this new moment that we are in, the Biden administration and agency leaders, the career staffers, will have to go do the hard work of clarifying what is really allowed, especially in the context of a complete removal of the global gag rule,” said Seema Jalan, executive director of the Universal Access Project and policy at the United Nations Foundation.
If existing agreements are covered by the policy reversal, NGOs that have the capacity to begin engaging in abortion-related informational campains, for example, or to renew partnerships with abortion-related organizations, could then immediately resume this work, regardless of their present funding from the U.S. government.
It could take months, or a year, to see the impact of new funding contracts that remove global health funding restrictions based on abortion-related work.
“It does not turn on a dime. It is a process,” Kates said.
The impacts of the restrictive policy have reached far beyond sexual and reproductive health in the southeast African country, according to advocates.
Some organizations might also be hesitant to immediately apply for U.S. funding. MSI Reproductive Choices, for example, declined U.S. funding after Trump reinstated the policy in 2017. In November 2020, MSI told Devex it was still considering whether to reapply for funding if the restrictions were lifted.
PAI’s Rucks cautioned that the “chilling effect” the policy has had will also take time to undo and to resonate with organizations carrying out health work in the field.
“It causes a lot of providers to have a conversation around, ‘Is it worth partnering with the U.S. government if they cannot really be relied on?’” Rucks said. “And there is the damage that just cannot be undone.”
Many human rights and women’s health organizations rushed to commend the administration’s decision, though some experts also noted that the work should go further and include an irreversible repeal of the policy. Anu Kumar, president and CEO at Ipas, noted that Biden did not use the word “abortion” in his announcement.
Others, meanwhile, praised the announcement as a clear symbol of hope for reproductive rights.
“The policy's impacts not only have been devastating to marginalized communities, but also to health care providers, organizations and their partnerships, leading to clinic closures, staff layoffs, family planning program cuts, and generally disrupting the public health system,” said Melvine Ouyo, former clinic director at Family Health Options Kenya, in a statement. “President Biden's repeal of the Global Gag Rule will demonstrate his humane leadership and help restore the world's hope for reproductive freedom.”