Understanding the expanded Global Gag Rule

In one of his first official acts as president, Donald Trump reinstated the Mexico City Policy, otherwise known as the Global Gag Rule. Historically, the Global Gag Rule has restricted non-U.S. nongovernmental organizations (NGOs) that provide, counsel on, refer to or advocate for abortion care from receiving U.S. international family planning assistance. The January 23 memorandum from the White House suggested that the policy’s reach would be far more extensive than ever before. At the time, we sat down to discuss the Global Gag Rule with ICRW Senior Director Suzanne Petroni, who served in the U.S. State Department’s Office of Population under President Clinton and as the Bush Administration formulated and began to implement the policy in 2001. With more details of President Trump’s Global Gag Rule released this week, we once again spoke with Petroni to try to understand its potential impacts.

What did we learn this week about the new version of the Global Gag Rule?

What the State Department released on Monday confirms the worst fears of the global health community. For the first time ever, organizations that provide counseling, referrals, services or advocate for safe abortion with their own funding will be banned from all global health funding from the U.S. government. This will be a massive expansion of an onerous and harmful policy, applying not only to funds for reproductive health and family planning, but to programs that, for example, prevent and treat HIV/AIDS, malaria, diarrheal diseases and tuberculosis, and that promote maternal and child health.

This expansion will affect nearly $9 billion of assistance, 15 times the reach of previous iterations of the policy. It will mean a vast extension of U.S. government bureaucracy and regulations to organizations working to save lives and improve health for those living in poverty around the world.

Who will be affected by the new rule?

We already know that the International Planned Parenthood Federation (IPPF) and Marie Stopes International (MSI) — some of the most far-reaching, well-established health care organizations working in developing countries — will lose U.S. funding. But given the prevalence of legal abortion across the world and how integrated health services have become, we will also see numerous global and local organizations that work on various global health issues now having to pledge never to speak of abortion in order to obtain U.S government funding.

It’s important to keep in mind that most of the organizations that will be affected have been carefully and competitively selected by the U.S. government. And they were entrusted to manage U.S. global health funds effectively and efficiently, as they have the infrastructure, expertise and community trust in areas we must reach in order to achieve our global health goals. In some cases, these are the only health care providers serving hard-to-reach communities, including the most marginalized and poorest women and girls. For these most vulnerable individuals, a loss of services can have devastating, and even life-threatening consequences.

This is not hyperbole — it is based on evidence generated under the previous Gag Rule. That evidence, published by the World Health Organization, showed that, in the most-affected countries, women were far more likely to have unintended pregnancies and 2-½ times more likely to have an abortion — most of which were unsafe — than when the policy was not in effect. Now those impacts are set to be extended much more broadly. And from decades of research, we know that unintended pregnancies and unsafe abortions lead to higher rates of infant and maternal morbidity and mortality.

In fact, IPPF and MSI have estimated that the support they will lose from USAID in the next four years will, combined, mean they will be unable to prevent more than 11 million unintended pregnancies, 3.9 million abortions, and 40,000 maternal deaths.

These are truly catastrophic impacts. And when we consider the massive expansion of this policy, it is no stretch to say that we can expect thousands more deaths and untold numbers of illnesses.  The Washington Post does a great job explaining this.

What about the Administration’s assertion that other institutions that agree to sign the Gag Rule will step in and get the funds that others won’t?

Implementing effective global health programs isn’t like building widgets – you can’t just switch to another company whose policies you prefer and expect the same results. Many of the organizations that will be impacted have deep experience in developing and implementing culturally and contextually sensitive programming, as well as longstanding relationships with local governments and communities. So, it will not be as simple as taking away those services and handing over their work, their clinics and their relationships to other organizations, especially to those who may not provide the comprehensive services that women want. The impacts will be devastating.

How will it be implemented in practice?

Organizations that receive family planning funds from the U.S. government have had decades of experience with statutory requirements that have led them to separate their U.S. funds, monitor their services closely and report on exactly how these funds are and aren’t used. Many such organizations have whole guidebooks for their staff on implementing U.S. family planning restrictions. Under this new policy, tens, if not hundreds, of foreign NGO partners who receive global health assistance — many of them small and relatively new to U.S. funding — will now be required to do the same. The compliance with these new regulations will be expensive and burdensome for both them and the U.S. government

How will this affect ICRW?

ICRW does not have to sign the Gag Rule, because, as a U.S.-based institution, doing so would violate our First Amendment rights. We would, however, have to apply it to the many local NGOs we work with around the world, several of which have already indicated to us that they will not comply. So, we do have great concerns about being able to do our U.S. government-funded work in the most effective and efficient manner possible.