What does the Global Gag Rule mean? A conversation with Suzanne Petroni

On January 23, President Donald Trump signed an executive memorandum reinstating the Mexico City Policy, a policy first set in place in 1984 by President Ronald Reagan. Historically, the policy, otherwise known as the Global Gag Rule, has restricted non-U.S. nongovernmental organizations (NGOs) that provide, counsel on, refer for or advocate about abortion care from receiving U.S. international family planning assistance. The new Global Gag Rule greatly expands previous policy so that it now applies to all U.S. global health funds from all departments and agencies of the U.S. government.

As organizations grapple with the implications of the expanded Global Gag Rule, we sat down with ICRW Senior Director Suzanne Petroni, who served in the U.S. State Department for several years, including as the Bush Administration (2001-2009) formulated and began to implement the policy, to discuss its impacts. A scholar of U.S. international family planning policy, Petroni wrote her doctoral dissertation on this topic.

What is the intent of the Global Gag Rule?

Presidents who previously imposed Gag Rules — Ronald Reagan, George H.W. Bush and George W. Bush —used Executive Orders to ensure no U.S. funds could be used for abortion internationally. In fact, funding for abortions through U.S. foreign aid has been banned under a U.S. law (the Helms Amendment) that has been in place since 1973.

What impacts has the Gag Rule had?

Its impacts have been significant and harmful.

Because abortion is legal in at least some circumstances in most countries of the world, many of the organizations supported through U.S. family planning assistance work on abortion in some way, with their own, non-U.S. funding. Even if they don’t provide abortion services, many health care providers — particularly in countries where unsafe abortion is prevalent — will counsel women on their options for safe abortion care or refer women to safe abortion services. Some organizations work hand-in-hand with their governments — funded by these governments — to improve the quality of safe, legal abortion services. But doing any of this — again, with their own, non-U.S. funding — would be in violation of the Gag Rule as implemented under previous Republican Administrations. And because health care providers want to be able to communicate openly with their patients and reduce unsafe abortion, many organizations refused to sign on. As a result, they gave up millions of dollars in aid, which curtailed or ended their work, and in several cases, led to the closure of entire health care clinics. In turn, under the Gag Rule, we have seen fewer family planning services being provided, which has contributed to increased rates of unintended pregnancy, which leads to pregnancy-related injuries and deaths, including from unsafe abortions.

Contrary to its stated intent, research has shown that this policy reduced access to voluntary family planning for women and increased abortion rates.

What do we know about the new Global Gag Rule?

This Gag Rule goes further — by far — than any administration in history, by covering not only family planning funds, but ALL global health assistance provided by the U.S. government. Under this more pervasive policy, foreign NGOs that reach the poorest women, men and children worldwide with such vital services as prenatal care, well-baby care, HIV prevention and treatment, malaria treatment and more will be required to certify that their organizations do not provide abortion services, counselling or referrals, or advocate on abortion — even with their own funds, and even where abortion is legal — as a condition of receiving assistance from the U.S. government.

Practically speaking, it’s a massive expansion of U.S. government bureaucracy and regulation of organizations working to save lives. It means that organizations providing what is often the most effective health care to people in developing countries will have to curtail their services, or close.

Given prior results, can we speculate on possible impacts of the expanded rule?

I’m an optimist by nature and not one for hyperbole, but I have no uncertainty in that this policy will result in more women — and men, and children — dying.

By the numbers, the policy as previously applied would have affected around $600 million in foreign assistance that was directed to family planning programs. The new policy will likely cover more than $9 billion used to tackle some of the most pressing global health challenges.

Think about this: In many parts of the least developed countries, the poorest, most vulnerable women, men and children have extremely limited access to health care. You may find one clinic in a 100-mile radius that provides — with funding from many sources — maternal health care, vaccines, anti-malarial bed nets, treatment for HIV, as well as family planning and safe, legal abortion. Because their bed nets are supplied under a U.S. government contract, they will be forced to choose between saving lives by preventing malaria or by providing safe abortion care.

What organizations or populations would be most affected by the new rule?

In the past, groups known for their reproductive health work, like national Planned Parenthood affiliates and Marie Stopes International — some of the most far-reaching, effective health-care organizations in the world — were most affected, and we know that they will again lose U.S. funding. But with this expansion, we will see global and local organizations that work across a wide range of global health issues now having to pledge to never speak of abortion in order to obtain U.S government assistance. So as I noted earlier, thousands of organizations and millions of individuals who have relied on U.S.-funded programs for life-saving HIV medication, vaccines, maternal health care and more will now be affected.

As a research organization, what are the questions we should be asking as we monitor the impact of this wide-ranging policy?

We have good documentation of the impacts of the Gag Rule under George W. Bush, but understanding just how far and wide the impacts of this Gag Rule are will be critical. Perhaps once the Trump Administration sees evidence of its impacts on the lives of the most vulnerable women, men and children, as well as on the very health systems the United States has helped to support in the poorest countries of the world, they will reconsider. As a globally-respected, 40-year old research institute, ICRW is well-positioned to document these impacts and share them with policymakers in the United States and worldwide.

That said, under any U.S. global health funding ICRW receives, the local partners we work with around the world would have to sign the Gag Rule, and several of our partners have already indicated they are not willing to do so. This may constrain our ability to conduct our research in the most efficient manner.

I am proud that ICRW is standing firm in supporting U.S. global health assistance that meets the needs of the most vulnerable individuals worldwide, and in opposing Trump’s Global Gag Rule.

UPDATE – May 2017 Q&A, following the approval of “Protecting Life in Global Health Assistance”

On May 15th, 2017, Secretary of State Tillerson approved a plan called “Protecting Life in Global Health Assistance,” which reinstates and expands on the “Mexico City Policy.” We sat down for another Q&A with Dr. Suzanne Petroni, a conversation that can be found here.