The Trump administration reinstated the global gag rule immediately upon taking office in January 2017, and has expanded it more than any other prior administration. And they are continuing to expand the rule even today. We have a long way to go to ensure that the U.S. regains its position as a leader in global health.
Although the Trump presidency is in its lame duck stage, the administration is continuing its assault on health care, especially reproductive health care services. In the midst of an uncontrolled pandemic, instead of focusing on policies to prevent death and disease, the Trump administration is pushing forward with its dangerous expansion of the global gag rule (GGR), which is a threat to health in so many countries.
What Is the Global Gag Rule?
The GGR prevents foreign non-governmental organizations (NGOs) from receiving any U.S. government funding, even if they use non-U.S. funding, to provide abortion care or even refer or counsel patients about abortion services.
Every Republican administration since 1984 had enacted the global gag rule, also known as the Mexico City Policy, and it has been in effect 19 of the last 34 years. Every Democratic administration has abolished the rule upon taking office, and the Biden administration has indicated it will follow that same pattern.
The Trump administration reinstated the GGR immediately upon taking office in January 2017—but expanded it more than any other prior administration. And they are continuing to expand the rule even today.
The Trump Administration’s Expansion of the Global Gag Rule
The GGR was first enacted by the Reagan administration and required that NGOs certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S. funds) as a condition of receiving U.S. government global family planning assistance.
The Trump administration expanded this to make it a condition of receiving most other U.S. global health assistance, including the President’s Emergency Plan for AIDS Relief (PEPFAR).
To get an idea of how large that expansion was, the Kaiser Family Foundation estimates that yearly U.S. family planning assistance constitutes $600 million, which while significant, is just a drop in the bucket compared to the $7.3 billion in U.S. global health assistance. The Guttmacher Institute estimates that under the Trump administration, the GGR was applied to almost $12 billion in funding.
Therefore, the expansion of the GGR significantly impacted how U.S. global health funding assistance is provided throughout the world.
How the Global Gag Rule Impacts Health Care Access
The expanded GGR directly harms the health of people who rely on U.S. government funded NGOs for their care. Such NGOs typically receive almost 40 percent of U.S. global health spending.
Many areas of the world rely on these NGOs to provide health care services, especially rural areas that do not have other health care access. These NGOs provide HIV/AIDS, tuberculosis (TB), and malaria testing and treatment; family planning and reproductive health services; maternal, newborn and child health services; nutrition, water supply and sanitation aid; and aid against public health threats, such as pandemic influenza and COVID-19.
The impact of the Trump administration’s expanded GGR policy has resulted in reduced health care access in areas that were reliant on U.S. government funding. For example, health clinics for teenagers in Ethiopia that were supported by U.S. foreign aid have shut down, and efforts to combine HIV testing with family planning advice in Kenya have unraveled.
A recent study notes that policies like the expanded GGR significantly impact the spread of HIV/AIDs. These funding reductions, the study found, “disproportionately harmed pregnant women, youth and key populations such as sex workers and men who have sex with men.”
Much like the Hyde Amendment that restricts the use of Medicaid for abortion care and harms poor women of color in the U.S. the most, the GGR harms vulnerable populations around the world.
It’s Not Over Yet
During a pandemic, when over 200,000 Americans have died, the Trump administration focused instead on further broadening its GGR by expanding its restrictions to apply to any contracts an NGO may have. The proposed rule was published in September 2020.
Zara Ahmed of the Guttmacher Institute has expressed concern that these expansions will harm global health by “decreasing access to contraceptive care and abortion information, interfere in existing patient-provider relationships, harm public health systems and result in an abdication of U.S. leadership in global health policy.” It is quite astonishing that this administration is pushing through a rule that will harm health care access during a global pandemic.
The Biden administration will have to repair relationships with NGOs and global heath entities, even after it repeals the expanded GGR in January 2021. It is an arduous process to communicate the changes in policy to global health partners. Reopening clinics which have been shut down is not an easy process.
The Global Health, Empowerment and Rights (HER) Act, which would repeal the GGR permanently, was introduced in Congress in 2019 to attempt to put an end to the GGR and the uncertainty that global health organizations face in terms of U.S. global health aid. However, as the balance of power looks now, it seems unlikely that the Biden administration will be able to garner enough support for the HER Act to become law.
We have a long way to go to ensure that the U.S. regains its position as a leader in global health.
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