Transition 2017: A more sweeping global gag rule returns, as cabinet head hearings continue

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With executive order Trump reinstates, broadens scope of rule restricting speech, services of health providers receiving U.S. support

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With his signature Monday on a Presidential Memorandum Regarding the Mexico City Policy, President Donald Trump instructed the yet-to-be installed heads of the departments of State, Health and Human Services and of USAID to ensure that no health provider funded with any form of support from the United States offer counseling, referrals or services to terminate a pregnancy. With that he returned a policy long criticized by advocates and providers of global maternal and reproductive health care, HIV treatment access, and infectious diseases responses — while extending its impacts.

In its original form, the 1984 policy initiated by President Reagan in Mexico City expanded existing — and continuing — restrictions that already barred U.S. family planning assistance from funding abortion procedures, to a restriction preventing family planning funding from going to organizations that provide abortion-related services from their own resources.

Over the years since, as the policy was revoked by President Clinton, reinstated by President Bush, and revoked again by President Obama, responses first to the global HIV pandemic, and more recently to the continuing spread and effects of Zika virus, have highlighted damaging impacts and complications of limitations on resources for health services and information provided to women and girls.

Now, while the previous version of the policy applied to U.S. funding for international and local  family planning services, the additional language in the order signed by Trump on Monday directs the Secretary of State, with the Secretary of Health and Human Services and USAID Administrator “to implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments or agencies” (our italics) an extension that, global health advocates note will impact a greatly increased range of organizations, care and services, including those to prevent, test and treat HIV, Zika, and to provide maternal and child health care.

The American Public Health Association released a statement shortly after the White House announced the reinstatement of the policy, calling it “a stand against women’s health,” adding that a full range of reproductive and sexual health care services “are essential to women’s lives, for population health and for advancing income equality, women’s rights and women’s individual freedom.” A coalition of 138 health and human rights organizations also released a statement noting that the policy “interferes with the doctor-patient relationship by restricting medical information healthcare providers may offer, limits free speech by prohibiting local citizens from participating in public policy debates, and impedes women’s access to family planning by cutting off funding for many of the most experienced health care providers who chose to prioritize quality reproductive-health services and counseling over funding that restricts care and censors information.”

In the meantime, also on Monday, the Senate Foreign Relations Committee by an 11 to 10 vote strictly along party lines approved the nomination for former ExxonMobil CEO Rex Tillerson to be the next Secretary of State, paving the way for his confirmation, likely later this week. Tillerson was a member of the Center for Strategic and International Studies panel that in 2010 produced a report on “Smart Global Health Policy,” emphasizing the importance of supported global HIV responses, and integrated health services.

Hearings for Health and Human Services Secretary nominee Rep. Tom Price continue today.

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