U.S. restrictions on foreign aid like the global gag rule are endangering women and girls by cutting off access to essential reproductive healthcare in humanitarian crises.
Shortly after taking office, the Trump administration issued a cascade of executive orders—among them, the reinstatement of the Mexico City Policy, commonly referred to as the global gag rule (GGR). The GGR restricts U.S. funding for international nongovernmental organizations (NGOs) that provide, refer for, lobby or counsel on abortion care. While much has been covered about the GGR’s adverse effects on global health and NGOs, its impact on vulnerable populations in humanitarian settings, particularly refugee women and girls, has received less attention.
In 2024, a record 122.6 million people worldwide were forcibly displaced due to climate change, political unrest, persecution and armed conflict. More than 90 million women and girls are expected to require humanitarian aid, including sexual and reproductive health services, such as perinatal and abortion care, gender-based violence (GBV) support, and STI screening and treatment.
For years, the U.S. has actively implemented policies restricting sexual and reproductive rights abroad, including defunding the United Nations Population Fund (UNFPA), endorsing abstinence-only programs through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to combat HIV, and passing the Helms Amendment that prohibits foreign assistance for abortion care. As a health policy analyst and educator on reproductive justice among migrants, I have observed how these acts embolden anti-choice sentiments and threaten the lives of vulnerable women and girls globally.
The U.S. has long served as the largest source of foreign aid and global health funding, but this aid comes with strings attached, often prioritizing U.S. national interests. During the Cold War, the U.S. leveraged its foreign policy by establishing the U.S. Agency for International Development (USAID) and later the GGR.
Initially enacted by Ronald Reagan in 1984, the GGR arose amid fervent backlash from anti-choice advocates following the Roe v. Wade decision. For example, religious groups were instrumental in electing Sen. Jesse Helms (N.C.)—a devout Baptist, self-proclaimed bigot and namesake of the Helms Amendment, who championed measures blocking U.S. funding to foreign NGOs offering abortion care except in cases of rape, incest or life endangerment. Consequently, USAID’s policies in the 1970s and ’80s withheld any funding to international NGOs that included abortion in their family planning services.
The GGR under the Reagan and George H.W. Bush administrations led the closing of several health facilities providing contraception care in sub-Saharan African countries. In Ghana, the subsequent reduction in contraception availability led to a 12 percent increase in unintended pregnancies, worsened infant health outcomes, and a rise in unsafe abortion practices.
They want to decimate not only abortion care, but also the provision of contraception more broadly.
Beth Schlachter
Even Democratic administrations have capitulated to the pressure exerted by anti-choice groups: President Bill Clinton accepted the “Fiscal Year 2000 Gag Rule,” which restricted USAID funding and barred NGOs from using any funds for abortion-related care or advocacy.
George W. Bush’s reinstatement of the GGR further expanded these restrictions, prohibiting foreign NGOs from counseling pregnant women on abortion, even in jurisdictions where it was legal. It also mandated foreign NGOs to publicly oppose prostitution before receiving U.S. funds, making services like STI screenings inaccessible for sex workers.
“The Trump administration’s obvious ideological aversion to sexual and reproductive healthcare has left us in no doubt that they want to decimate not only abortion care, but also the provision of contraception more broadly,” said Beth Schlachter, senior director for U.S. external relations at Marie Stopes International, or MSI Reproductive Choices, one of the world’s largest providers of family planning services.
While Trump’s reinstatement of the GGR expected by many public health officials, its implications on global health and human rights are still alarming—especially when coupled with threats to dismantle USAID and freeze operations across health agencies.
While global health aid differs from humanitarian assistance, NGOs providing emergency support are still impacted by the GGR. With 11 million pregnant women anticipated to need humanitarian aid this year, the consequences of conflict and political instability have left many without essential maternal care.
In Sudan, 80 percent of hospitals in conflict areas are not functional, leaving more than 200,000 pregnant women with no maternal care. South Sudan’s loss of investment in skilled birth workers has exacerbated its maternal mortality crisis. Abortion-related services including post-abortion care (PAC) in humanitarian settings are severely limited, and the GGR and the freezing of the USAID will make these services almost non-existent.
Ipas Bangladesh, an international NGO working to eliminate preventable deaths from unsafe abortions, reported that due to USAID’s funding restrictions, abortion care services were not available for Rohingya refugees, including sexual violence survivors.
In Kenya’s Kakuma Refugee Camp, 44 percent of women and girls have unmet needs for family planning services including abortion.
In Burkina Faso and Uganda, NGOs not complying with the GGR diverted thousands of dollars away from refugee settlements to support non-family planning services.
In other instances, the fear of losing U.S. funds has led to NGOs over-implementing the GGR by taking measures to remove PAC and contraceptive training for healthcare workers. NGOs receiving humanitarian aid funds have also been subjected to screening and surveillance on their stances on abortion despite the policy being inapplicable to them.
While humanitarian crises weaken global healthcare infrastructure and restrict healthcare, U.S. policies like the GGR and decisions to dismantle USAID may completely diminish even the scarce resources available to refugees and women in humanitarian settings. It is thus imperative to support the work of NGOs rejecting compliance with GGR as they collaborate to improve global health, secure women’s rights and protect democracy.
