Earlier this month, the State Department revealed the specifics of President Trump’s expanded Mexico City Policy or the so called “Global Gag Rule.” The new rule, called (or rather mislabeled) “Protecting Life in Global Health Assistance,” surpassed expectations of both the amount of global aid it would endanger and the magnitude of potential negative consequences it would have for global health. While some version of the policy has been reinstated during all Republican administrations over the past 23 years, the current policy increases the amount of foreign aid subject to the rule’s restrictions more than 14-fold, to almost $9 billion a year. The bulk of the increase comes from the inclusion of PEPFAR, the US AIDS Relief Program worth roughly $6 billion, into the list of programs that need to comply with the “Global Gag Rule.”

In past versions of the rule, non-governmental organizations abroad that were in any way involved with abortion services (whether by providing them directly, by counseling patients about them or even referring patients to abortion providers) were prevented from receiving foreign aid from U.S. family planning programs. The rule even prohibited funding for organizations that worked on abortion advocacy in their countries.

However, the prior versions of the “Global Gag Rule” only applied to family-planning funds, which currently amount to roughly $600 million a year. The current version is significantly more expansive in both size and scope. Trump’s version of the “Global Gag Rule,” which he reinstated through an executive order during his first business day in office (providing us the first of many lovely photos of groups of radiant white men signing away women’s rights), extends to all $8.8 billion of U.S. global health aid. This means the restriction now applies to organizations providing a wide scope of health services across the globe, including HIV, malaria, Ebola, Zika, maternal health, family planning, child health care and tuberculosis.

It is important to note that U.S. foreign aid is prohibited from funding abortion services by the 1973 Helms amendment to the Foreign Assistance Act. Therefore, although the “Global Gag Rule” targets organizations affiliated with abortion, it effectively impacts only the non-abortion medical services provided by these organizations (in the past – primarily contraception; currently – both contraception and, potentially, a wide variety of other health programs), since U.S. aid is already diverted away from abortion by the Helms amendment. For instance, in 2001, the policy impacted condom distribution in Lesotho, where the H.I.V. prevalence among women was 25 percent at the time (more than 400,000 condoms, previously shipped to Lesotho Planned Parenthood, were no longer provided to the organization after 2001).

The rule will also essentially penalize many countries for optimizing their health care in recent years by consolidating health services (that could include abortion) into single facilities. Many of these facilities will now have to refuse care to patients in need of abortion (without the opportunity to even discuss the procedure with these women or refer them to alternative facilities), or risk losing their U.S. funding and the ability to provide multiple other services to patients. The policy also deprives organizations from technical support and donations of contraceptives from the U.S. For instance, some contraception distribution initiatives in rural areas in Ghana and Kenya were either downsized or scrapped altogether because of the reinstatement of the “Global Gag Rule” during the Bush years.

The combination of restricted access to contraception and safe abortions has the potential to lead to both a higher number of total abortions and a higher percentage of abortions performed under unsafe conditions. And, in reality, these exact effects were demonstrated in at least two different studies of abortion and contraception trends across the world during the George W. Bush administration, despite the policy’s ostensible goal to reduce the number of abortions globally.

 Ronald Reagan first enforced the “Global Gag Rule” in 1984, and each Republican administration since then has kept it in place or reinstated it (while the Clinton and Obama administrations revoked the policy). The resulting several long periods during which the rule was reinstated and revoked several times have provided researchers with an opportunity to study the real-world effects of the policy over the years. A group of Stanford researchers, studying the relationship between induced abortions and the “Global Gag Rule” between 1994 and 2008 in sub-Saharan Africa, found that women in the region had over two and a half times higher probability of having an induced abortion when the rule was enforced in countries highly exposed to the policy, even after controlling for a number of factors such as “place of residence, educational attainment, use of contraceptives and funding for family planning and reproductive health from sources other than the United States.” The study also found slower growth in contraceptive use in countries with higher exposure to the Mexico City Policy.

Another study, conducted by the International Food Policy Research Institute, found a 12 percent increase in rural pregnancies in Ghana during times when the “Global Gag Rule” was enforced there during the period between the inception of the Mexico City Policy in 1984 and 2005. The study also found an increase in abortions and unintended pregnancies, as well as a diminished nutritional status of the children born from these unintended pregnancies.

The “Global Gag Rule” also posed significant challenges to health professionals and advocates in Nepal in the early 2000s. Nepal had one of the world’s highest maternal mortality rates at the time (according to data from the World Bank, Nepal ranked among the top 40 countries with highest maternal mortality rate in 2001), unsafe abortions leading to half of these maternal deaths. To address that, advocates were lobbying against restrictive abortion laws in the country, but many organizations were unable to join in the effort after the “Global Gag Rule” was reinstated by the Bush administration around the same time. Moreover, workers in USAID-sponsored organizations were not allowed to provide information about access to safe abortions to women who were receiving unsafe or incomplete abortions. The Family Planning Association of Nepal (FPAN) lost two-thirds of the contraceptives it had available for patients and had to lay off staff in clinics across the country, adversely affecting “FPAN’s most rural and impoverished clients’ access to permanent and long-term methods of family planning.”

The take-away appears to be that the current administration took a policy that has been demonstrated to have disastrous effects on global health overall, and women’s health in particular, and significantly expanded it, endangering numerous lives in the process and making it clear that the “Protecting Life” part of the policy’s name is about as genuine as the “Democratic” part in North Korea’s “Democratic People’s Republic of Korea” name.

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To learn more about the “Global Gag Rule” and to follow activist initiatives opposing it visit the following organizations, who are working hard to raise awareness about the policy’s consequences and spearhead efforts to oppose it:

Additionally, if you want to personally spread the word about the “Global Gag Rule,” you can find a social medial toolkit with sample tweets to use here.  And, if you are interested in printing out some flyers, you can find some here.