Updated March 8, 2017
What is Trump’s “Mexico City Policy,” also known as the “Global Gag Rule”?
On January 23, 2017, United States President Donald Trump issued a “Presidential Memorandum Regarding the Mexico City Policy.” This order reinstates and dramatically expands the “Mexico City Policy” adopted under previous Republican administrations since 1984.
US law has banned using US foreign aid for abortion-related activities since 1973. This rule goes further, and requires foreign organizations receiving US government foreign aid for all health programs, likely to include programs ranging from the PEPFAR AIDS-relief program to vaccination programs, to certify that they do not use their own, non-US funds to:
- provide abortion services,
- counsel patients about the option of abortion or refer them for abortion, or
- advocate for the liberalization of abortion laws.
This policy is also widely known as the “Global Gag Rule” due to the restrictions it places on how organizations use their own, non-US government funds, including through limiting conversations that health providers can have with their patients and preventing them from pressing for legal change in their own countries.
What does this mean in practice?
For example, if a foreign nongovernmental organization spends 50 percent of its budget on sexual and reproductive health services, including counseling, referrals, or services related to abortion with its own non-US funds, but receives the other 50 percent of its budget from the US to provide vaccinations for babies, nutritional supplements, or treatment for HIV/AIDS, malaria, and tuberculosis (TB), that group must now choose between losing its US funding and restricting or cutting its reproductive health programs.
Either way, health services in under-resourced communities will suffer. Under previous versions of the Global Gag Rule, organizations that chose to lose their US funding had to cut staff, services, and sometimes to close clinics. On the other hand, health providers in organizations that complied with the restrictions to keep their US funds have talked about seeing women die from unsafe abortions and being “gagged” from providing full and accurate information to patients and advocating for changes to restrictive abortion laws.
For example, in 2009 Human Rights Watch found that the rule affected funding to Peru for maternal health because it did not permit funding of organizations that used it to provide information about or to provide what is known in Peru as therapeutic abortions – to preserve the health of the mother or for fetal abnormalities incompatible with life.
What makes Trump’s version of the rule so much worse than earlier versions, and why do health advocates say it is devastating?
Under previous Republican administrations, the restrictions in the Mexico City Policy applied specifically to US family planning funds, approximately US$575 million.
Trump’s policy extends restrictions to all US global health assistance – which could be up to $9.5 billion in funding support for family planning, maternal and child health, nutrition, HIV/AIDS – including PEPFAR, infectious diseases, malaria, TB, and neglected tropical diseases. The effects on these programs are still unknown but are expected to be profoundly damaging.
- As the largest global donor on health, the US will be undermining progress on health outcomes instead of supporting improvements.
- Women and girls in about 60 low and middle-income countries will have less access to contraception, resulting in more unintended pregnancies, and more – often unsafe – abortions.
- The restrictions will lead to an increase in maternal deaths, both due to unsafe abortion and to an increase in unplanned pregnancies in places where rates of maternal mortality are already high.
- Health programs that lose US funding may have to cut services linked to newborn, infant and child health, including vaccinations; prevention and treatment of HIV/AIDS, malaria, and TB; and nutrition programs.
- The restriction makes needed health funds the instrument to curtail the speech and activities of activists and health providers in other countries, preventing them from sharing health information about abortion or discussing potential reforms to abortion laws without losing their US funds.
When and how does the Global Gag Rule go into effect?
Trump’s expanded Global Gag Rule will have a rolling impact. Foreign groups that receive US funds will have to choose to forego the US funding or to agree to the restrictions at the time of contract renewals, creating new funding agreements, or during the amendment of an existing funding agreement. However, it may already be having a chilling effect as groups curtail their activities in anticipation of the new restrictions.
Why is sexual and reproductive health care so important?
Women and girls have a human right – protected under international law – to make their own choices about whether, when, and how many children they have. Unintended pregnancies can affect a range of other rights, including by ending a girl’s education, contributing to child marriage, resulting in health complications, or putting a woman’s life at risk.
- An estimated 225 million women in developing countries would like to prevent or delay pregnancy but are not using contraception. Among the main reasons are limited access to contraception and poor quality of available services.
- Complications from pregnancy and childbirth are the second leading cause of death for adolescents ages 15 to 19 globally.
- More than 800 women and girls die globally from preventable causes related to pregnancy and childbirth every day, including unsafe abortions.
What can be done?
One priority is to narrow the funding gap for comprehensive sexual and reproductive health services and support groups that provide such services, including safe and legal abortion. In effect, Trump’s Global Gag Rule will produce a funding gap for some organizations that provide the highest quality services in some of the most under-resourced communities and countries. The funding gap left by the US, the world’s largest provider of health assistance, will be almost impossible to fill, but increasing and diversifying funding from other sources will be life-saving.
The Dutch government has created an international funding initiative to support groups affected by the Global Gag Rule called “She Decides.” An inaugural summit hosted by Belgium, Denmark, the Netherlands, and Sweden on March 2, 2017, resulted in pledges of roughly $190 million.
As a longer-term strategy, draft legislation in the US – called the HER Act – would permanently repeal the Mexico City Policy (Global Gag Rule). While it is highly unlikely to be adopted under the current administration, it has been gathering increased support and could be pursued as a long-lasting solution down the road.
 The 1973 “Helms Amendment” to the Foreign Assistance Act prohibits the use of US funds from paying “for the performance of abortion as a method of family planning.”
 The President’s Plan for Emergency Relief for AIDS (PEPFAR) is the US government’s initiative on HIV/AIDS, and is the largest component of the President’s Global Health Initiative.