Hangover Remedy: Passage of a Permanent Repeal of the Global Gag Rule Is the Cure

The back and forth of the global gag rule—which prohibits U.S. foreign aid for abortion care—has a chilling effect on family planning and reproductive health programs around the world.

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Advocates stage political theater outside Trump International Hotel on May 25, 2017 to protest the global gag rule. For decades, Republican administrations have instituted the global gag rule, which has blocked healthcare access, stifled local advocacy efforts, and undermined reproductive rights worldwide—and Democratic presidential administrations have repealed it. (Erik McGregor / LightRocket via Getty Images)

It’s been a year since the Biden administration announced the rescission of the global gag rule (GGR), but a nasty hangover of its harmful effects remains. The only way to ensure we, as a global community, don’t end up in this situation again is for Congress to take action to permanently bring an end to this policy.

PAI surveyed civil society organizations and implementing nongovernmental organizations (NGOs) in Ethiopia, Kenya, Malawi, Nigeria, Uganda and Zambia, and the evidence was clear: The stroke of a pen does not undo the harm of a policy designed to deny women access to comprehensive reproductive health services. Qualified and highly skilled foreign NGOs that lost funding and partnerships remain unable to reopen shuttered clinics, rehire staff or bring back key services lost due to noncompliance with the policy. High stockouts of family planning supplies at facilities are leaving women without access, as programs that offered buffer stock and distribution of commodities remain disrupted. Projects serving vulnerable communities including youth, people living with HIV/AIDS and rural populations that were abruptly closed may never be restored, leaving those groups without vital services.

The back and forth of the GGR has a chilling effect on family planning and reproductive health programs. When the GGR is in effect, NGOs that comply with the policy are required to not provide information, referrals or services for legal abortion or to advocate for the legalization of abortion in their country with their own non-U.S. funds. It inadvertently pits organizations working to provide comprehensive health care against one another. Service providers, advocates and donors who were divided along the lines of compliance versus noncompliance may be cautiously reapproaching each other to rebuild relationships and networks but many report they are hesitant to collaborate out of fear the policy will return.

Since the GGR was first imposed in 1984 under the Reagan administration as the Mexico City Policy, foreign NGOs have experienced a ping-pong effect between policy rescission by Democratic administrations and reinstatement by Republican administrations, or in the Trump administration’s case, vast expansion of the policy. Rebranded as “Protecting Life in Global Health Assistance,” this administration drastically expanded the policy to include all global health funding, which had unprecedented impacts that were further compounded by the COVID-19 pandemic.

When the GGR policy is put in place, foreign NGOs are quickly asked to comply or risk losing their funding. Suddenly, partnerships and subgrants that may have been a few years into development or implementation are broken apart. But when the policy is rescinded, it’s not an automatic switch. The damage that has been caused lingers for months and years. Ripple effects of the backtracking on policy gains and breakdowns in the supply chain due to damaged networks are felt deeply by the women and girls who are seeking services and the organizations that are providing services to them.

Since the global gag rule was first imposed in 1984, foreign NGOs have experienced a ping-pong effect between policy rescission by Democratic administrations and reinstatement by Republican administrations.

Although the GGR is not currently in place, NGOs report they’re reluctant to take U.S. funding or partner with U.S. organizations for fear that support could be subsequently cut off after the next election. That same fear prevents those who did comply with the policy from entering relationships with partners that did not.

Loss of funding and the disruption of networks allowed an insidious anti-choice, anti-rights opposition movement to gain strength that will take years to dismantle. Discussions around national sexual and reproductive health and rights policies and legislation are still stalled. Advocacy campaigns for implementation of comprehensive sexuality education in the school curriculum lost momentum when reproductive health partners were divided along the lines of compliance versus noncompliance, while teen pregnancy is at an all-time high and advocates are afraid to return to coalitions.

When President Biden announced the repeal of the GGR, congressional champions followed his lead and immediately reintroduced legislation to permanently end the GGR. The Global Health, Empowerment and Rights (Global HER) Act, led by U.S. Reps. Barbara Lee (D-Calif.), Jan Schakowsky (D-Ill.) and Ami Bera (D-Calif.) and U. S. Sens. Jeanne Shaheen (D-N.H.), Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine), states the eligibility of foreign NGOs to receive U.S. foreign assistance cannot be based “solely on the basis of health or medical services … provided by such organizations with non-United States Government funds.”

This legislation is supported by 196 members of the U.S. House of Representatives and 50 U.S. senators—yet, like so many other vital pieces of legislation, the Global HER Act has fallen victim to competing priorities and partisan gridlock, which has prevented it from being taken up for a vote by relevant authorizing committees.

Last year, another path forward emerged for the Global HER Act: The annual federal State Department and foreign operations (SFOPS) appropriations bill for fiscal year (FY) 2022. In fall 2021, it seemed that the political stars were finally aligned, and language was included in both the House and Senate appropriations bills. The inclusion of the Global HER Act language in both chambers’ FY 2022 bills should have made permanent GGR repeal a nonnegotiable as members of Congress worked to craft a final spending package after months of delays.

However, Republican lawmakers made clear that advances on sexual and reproductive rights through the appropriations bill—such as GGR repeal and even increases in funding for international family planning programs—were non-starters. As such, with a deadline looming, congressional leadership advanced a spending package that failed to include permanent GGR repeal or make any other advances on global SRHR. Instead, it maintains a status quo that’s been in place now for 12 years.

Failure to address the GGR in this bill is a tremendous setback for health organizations around the world. As they keep their eyes on U.S. politics, these organizations are aware the next presidential election could result in the restoration of the GGR if the policy is not permanently repealed, forcing them to make tough and consequential decisions once again.

But the fight is far from over. As advocates, we will now go back to the drawing board to begin preparing for the next appropriations cycle, where we may have another chance to bring this policy to an end. We will seek ways to advance the Global HER Act through the House Foreign Affairs and Senate Foreign Relations committees. And we will continue to educate members on why this is not a political issue, but rather, an issue of health, equity and dignity.

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Rebecca​ Dennis is the associate director of U.S. policy and advocacy at PAI, which advocates for accessible, quality reproductive healthcare and the rights of women, girls and other vulnerable groups.