Crisis in Care: The Impact of Trump’s Global Gag Rule, Two Years Out

The Trump administration’s Global Gag Rule is depriving women of essential information and health care, stripping them of their right to make decisions about their bodies—and, ultimately, killing them.

This is the major finding of a new report from the International Women’s Health Coalition (IWHC)—the second in a multi-year study conducted by IWHC and its grantee partners Trust for Indigenous Culture and Health in Kenya, Center for Research on Environmental Health and Population Activities in Nepal, Education as a Vaccine in Nigeria and the Critical Studies in Sexuality and Reproduction Unit at Rhodes University in South Africa. 

“This deadly policy violates the rights of patients and ties the hands of providers,” said IWHC President Françoise Girard in a statement. “After two years of implementation, the impact is clear: The Global Gag Rule reduces access to contraceptives and abortion care, leading to unwanted pregnancies, unsafe abortions, and preventable deaths.”

By prohibiting U.S. global health funding to foreign nongovernmental organizations (NGOs) that provide abortion services, counseling, referrals or advocacy—or fund other organizations that do so—the Global Gag Rule forces NGOs to make the difficult choice between offering honest and comprehensive sexual and reproductive health care or receiving critical U.S. funding.

Since implementation began two years ago, IWHC and grantee partners in Kenya, Nepal, Nigeria and South Africa have conducted more than 170 interviews with individuals affected by the policy. The interviews reveal that the Global Gag Rule is reducing the quality and availability of care, particularly for marginalized communities.

In all four countries, the policy has cut off access to both comprehensive sexual and reproductive health information and services, leading one interviewee in South Africa to declare that the Global Gag Rule “promotes unsafe abortion.” Even interviewees from faith-based groups that hold anti-abortion views recognize the harmful impact of this ideologically driven policy.

The policy also directly conflicts with national laws, and interviews show that it threatens governments’ ability to protect the human rights and health of its people—and it is dismantling a decade of U.S. investments to integrate health care services and strengthen health systems.

The Trump administration’s expansion of the policy to cover all global health funding—including for HIV—has driven a wedge between the delivery of sexual and reproductive health and HIV services, reducing the ability of patients to access the care they most need.

Organizations working with women and girls described being forced to “ignore a huge part of what makes them susceptible to HIV infection, like limited information around their bodies, their health, their rights and their right to access safe abortion,” ultimately threatening the sustainability of HIV responses.

The Global Gag Rule stigmatizes and silences the voices of organizations that work on abortion, and has emboldened anti-abortion ideologues in all four countries. Documentation in Kenya and South Africa shows that there has been an uptick in funding to organizations that provide abstinence-only education and hold extreme anti-rights views. This has shifted policy conversations from a focus on human rights and bodily autonomy to one on religious values and subjective morality.

“The Global Gag Rule is a reflection of the Trump administration’s extreme anti-women agenda, and a rejection of evidence, rights, and national health priorities,” said Girard. “U.S. policymakers have the power to end this policy, and they must, because women’s lives are on the line.”

IWHC laid out recommendations in the report to stop or mitigate the impact of the Global Gag Rule. They’re advocating for Congress to permanently end the Global Gag Rule through passage of the Global HER Act; for donor governments and organizations to close the funding gap by increasing funding to groups affected, while prioritizing local and community-based organizations; and for civil society implementers, donors and other affected entities to, whenever feasible, document and publicize the impact of the Global Gag Rule on their work—including misapplication, over-application and chilling effects of the policy on civil society.