Expanded global gag rule restricting services to women will affect about $8.8 billion in U.S. funding for global health, disease responses

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With a new policy titled “Protecting Life in Global Health Assistance,” the United States will restrict its international support for a broad array of medical services and disease responses that include HIV prevention and treatment, maternal and child health interventions, malaria care and control, Zika monitoring, surveillance, diagnosis, and more, the Department of State announced Monday.

The newly named policy, unveiled with a release outlining its impacts, is a greatly expanded version of the “Mexico City Policy” initiated by President Ronald Reagan in 1984 and barring U.S. funding from overseas organizations providing family planning services that included abortion services, counseling, referrals or other information regarding pregnancy termination. That obliquely named policy, which affected the healthcare access, quality, and decisions of women worldwide, also has been known as the “global gag rule.” It has been widely criticized by global health advocates who noted that a separate policy already prevented U.S. dollars from funding abortions, and it has been alternately reversed by incoming Democratic administrations and reinstated by Republican administrations. Last reinstated in its original form by President George W. Bush, the policy did not affect funding for other global health responses that had become all the more critical as U.S. leadership of global HIV and AIDS responses accelerated, with the vital component of maternal health services that helped dramatically reduce mother-to-child transmission of the virus.

That changed with President Trump’s reinstatement of the policy, four days after he assumed office, with instructions to then still unnamed heads of USAID, the department of Health and Human Services, and the State Department to broaden the reach of the policy to encompass all health services supported overseas by U.S. funding. While the previous “Mexico City Policy” restricted $600 million in funding allotted to USAID and the State Department’s overseas family planning assistance programs, the “Protecting Life” policy will restrict $8.8 billion, in U.S. funding, including for the Presidents Emergency Plan for AIDS Relief, the President’s Malaria Initiative, maternal child health programs, and “other infectious disease programs and the full array of global health assistance provided by USAID.” That information was provided in a State Department call with media representatives call Monday with three department authorities only to be identified in coverage as “senior administration officials.”

The clause, restricting information as well as services that medical providers receiving U.S. funding for any health services can supply — even outside the programs receiving U.S. dollars — will be added to agreements between the U.S. Centers for Disease Control and Prevention, the Peace Corps, and the Department of Defense, among others. That means, global health advocates have noted, the policy will affect research and capacity building efforts as well as direct services.

“We do remain committed to helping women and children thrive, and that’s certainly where our programs will go and we don’t expect this to change that in any way, shape, or form,” the State Department representative identified as “Senior Administration Official Three” said. All the same, added “Senior Administration Official One,” the impacts of the policy will be evaluated after it goes into effect over the  six months that follow.

In addition to concerns about the impact of the “Protecting Life” policy on adequate resources as well as the scope and quality of services to confront deadly and damaging health conditions, critics have noted that data have shown that compromised family planning services led abortions to increase in countries affected by the Mexico City Policy.

Lead Democrats on the House Appropriations and Foreign Affairs Committees call the policy a “cruel and unprecedented attack on the world’s most vulnerable women,” in a statement that also charges the policy will weaken U.S. leadership and undermine its authority by burdening the most effective partners with a harmful requirement. Rep. Lowey also responded to President Trump’s reinstatement and expansion of the global gag rule in January with the introduction of the Global Health, Empowerment and Rights (HER) Act, which would permanently repeal the policy.

Also in January, a Dutch government minister launched the multi-national “She Decides” Initiative, which has about $200 million toward replacing funding lost to health organizations because of the expanded policy.


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