Trump expands 'global gag rule,' targeting $8.8B in global health aid

A health worker attends to a patient in Pakistan. Photo by: USAID Pakistan

President Donald Trump’s administration will significantly expand the “global gag rule” to include much of the United States’ global health assistance, placing more than $8.8 billion of funding on the line.

The U.S. is rebranding the Reagan-era regulation — which is also called the Mexico City Policy — as the “Protecting Life in Global Health Assistance” policy. It previously impacted about $600 million in family planning aid.

This new measure will affect HIV/AIDS work, maternal and child health, malaria, global health security, and family planning and reproductive health programs supported by the State Department, U.S. Agency for International Development and the Department of Defense, the State Department announced Monday.

“The policy will apply to all new funding agreements (grants, cooperative agreements and contracts) for global health assistance, and to existing agreements when amended to add funding,” the State Department said in a statement posted on its website.

Foreign NGOs that receive U.S. aid will soon have to choose between providing any abortion services, including referrals and counseling, or any global health assistance funding they receive from the U.S.

There will be certain exemptions — such as the The Global Fund to Fight AIDS, Tuberculosis and Malaria, GAVI, The vaccine alliance, and humanitarian aid — as Devex previously reported. It will also extend “the reach of restrictions beyond NGO grants and cooperative agreements” to include contracts, according to the reproductive health advocacy group PAI.

“This [expansion to contracts] will also broaden the reach of the policy’s already deadly effects, including increasing unintended pregnancies, unsafe abortions, and maternal and child mortality. Previously known within the U.S. government as the Mexico City Policy, Trump’s expanded global gag rule has been deceptively re-branded ‘Protecting Life in Global Health Assistance,’” the group said in a statement.

News of the announcement circulated Monday, following reports of a White House official confirming the expanded policy to the Christian Broadcasting Network.

The new rules will not spare the President’s Emergency Plan for AIDS Relief (PEPFAR), an initiative previously not subject to the Mexico City Policy, explained Akila Radhakrishnan, the vice president and legal director of the Global Justice Center.

While the exact number of foreign NGOs and other groups on the receiving end of this policy are not known, more than half of the 64 countries that received U.S. health aid in 2016 were in Africa, the Kaiser Family Foundation found. Thirty-seven of them also allow abortions in at least one scenario that is not permissible under the “Protecting Life” policy.

The International Planned Parenthood Federation alone could lose $100 million in funding.

Civil society groups and advocates — such as Democratic Sen. Jeanne Shaheen from New Hampshire, who has been working to repeal the policy — began to speak out Monday against the damage this expanded policy will likely cause.

“Today, the Trump administration confirmed our worst fears regarding this new, drastically expanded global gag executive order," Shaheen said in a statement. “This administration's pathetic rebranding of this policy ‎is a thinly-veiled attempt to hide the tremendous harm it has around the world. President Trump's dangerous obsession with rolling back reproductive rights has severe consequences for millions of vulnerable women and children, and grossly undermines our nation's humanitarian leadership around the globe."

The “She Decides” fund, a fund backed by European governments to counter the effects of the global gag rule, raised about $190 million in March. Efforts like these to fill the funding gap will need to be sustained, Radhakrishnan said.

“Because of the amount of money involved, it will be a lot harder for organizations to choose to not receive U.S. assistance (before they would only have lost U.S. family planning assistance, which amounted to far less money),” she told Devex. “For those donors who are looking to fill the gap, there will now be a gap to fill not only with family planning, but also in maternal health, HIV/AIDS, malaria etc. In filling all of these gaps, there is a danger that funding for abortion will fall between the cracks, as it’s the most ‘controversial.’”

Stay tuned to Devex for more news and analysis of what the Trump administration means for global development. Read more coverage here and subscribe to The Development Newswire.

About the author

  • Amy Lieberman

    Amy Lieberman is the U.N. Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.