How American Anti-Abortion Stances Damage Global Health

A woman living with HIV rests in a Xai-Xai clinic in Mozambique. Clinics such as this are directly impacted by the funding limits of the global gag rule (UN Photo / Flickr Creative Commons)
A woman living with HIV rests in a Xai-Xai clinic in Mozambique. Clinics such as this are directly impacted by the funding limits of the global gag rule (UN Photo / Flickr Creative Commons)

The global gag rule (GGR), also known as the Mexico City Policy, has been limiting the resources of countless foreign non-governmental organizations (NGOs) over the last four decades. Despite studies in sub-Saharan Africa revealing that the global gag rule is associated with higher rates of abortion, this policy persists as a way for the United States to police abortion abroad. 

What is the GGR?

The GGR, initiated by President Reagan in 1984, was created to curb the use of United States funding in performing or actively promoting abortion “as a method of family planning in other nations.” Initially targeted towards family planning assistance, the Republican policy prohibited NGOs from providing legal assistance and referrals for abortion if they accepted U.S. aid. The sole exception was providing “passive referrals” to pregnant women who had already decided to have an abortion. Under the Trump administration, the policy was expanded to include restrictions on all foreign health-related assistance and currently prohibits NGOs from providing funding to other organizations who engage in the banned behavior. 

Even prior to President Trump’s controversial expansion, the policy caused widespread instability among NGOs. The funding of many health organizations was frequently removed and reinstated as it became vulnerable to political changes. For example, the International Planned Parenthood Federation (IPPF) lost $11 million dollars of U.S. aid during the Reagan administration and $18 million dollars during the Bush administration. 

Moreover, ambiguity in the wording of the policy and lack of open communication with the impacted NGOs led them to excessively restrict activities in order to protect themselves from possible funding cuts. Out of fear, organizations began withdrawing from meetings or conferences where contraception or abortion was expected to be mentioned. This so-called “chilling effect,” continues to impact HIV/AIDS prevention efforts and maternal and reproductive care services. 

A History of Meddling in Abortion Overseas

The involvement of the U.S. in utilizing funding to control the foreign anti-abortion agenda has not been limited to one single policy. The following timeline of events shows this development over the last 40 years.

1961: The Foreign Assistance Act (FAA) addresses utilizing U.S. funds to aid in voluntary population planning abroad. 

1973: The Helms amendment to the FAA prohibits the use of U.S. funds for abortion services.

1981: The Biden amendment to the FAA bans the use of U.S. funds for biomedical research related to abortion. 

1984: The Mexico City Policy is announced at the UN International Conference by President Reagan.

1993: The Mexico City Policy is rescinded by President Clinton.

2001: The Mexico City Policy is reinstated by President Bush.

2009: The Mexico City Policy is rescinded by President Obama, but the use of U.S. tax dollars for abortion is still prohibited.

2017: The Mexico City Policy is reinstated, renamed “Protecting Life in Global Health Assistance,” and expanded by President Trump. 

2019: Secretary of State Mike Pompeo clarifies that NGOs must not provide any funding to other organizations defying the rules set by the GGR.

Resistance to the GGR: WaterAID

An important case in understanding the unexpected impacts of the GGR is that of WaterAID. An organization dedicated to ensuring clean water, proper hygiene and sanitation, WaterAID is working to integrate water, sanitation, and hygiene (WASH) services into maternal and antenatal clinics in order to prevent maternal and infant deaths. In a statement released by Lisa Schlechman, the director of policy and advocacy for WaterAID, she revealed the intersections between sexual health and WASH: “In some countries where [WaterAID] operates, women face the risk of sexual assault as they walk to fetch water.” The referral of women to a clinic “gagged” under the GGR would have been a violation of the new Trump era policy. 

However, WaterAID chose to defy the 2017 GGR and signed a coalition statement along with 140 organizations opposing the policy. As a result, it lost funding opportunities for health and nutrition programs in six countries and was forced to terminate certain programs and limit the scope of outreach in countries such as Madagascar.

Cutting AMODEFA Funds in Mozambique

Another example demonstrating the deleterious effects of the GGR is that of the Associação Moçambicana para Desenvolvimento da Família (AMODEFA) in Mozambique. As a member association of the IPPF, AMODEFA provides a wide range of services including HIV prevention and education and family planning. In a country where 12 percent of the population is HIV positive and the majority of children are unaware of their status, AMODEFA clinics play a vital role in encouraging parents to educate their children on HIV, and providing the physical, social, and mental support for patients who deal with the difficulties of treatment and stigma. AMODEFA has lost approximately 60 percent of funding under the Trump administration gag rule, largely due to its involvement in legalizing abortion in Mozambique. As a result, AMODEFA was forced to slash the budget of their HIV prevention and education efforts, laying off a third of its staff and halving the number of youth education clinics. These cuts have caused job loss and and the reduction of services to thousands of families impacted by HIV. 

AMODEFA has also cut or completely removed services such as male condom consultations, gynecological appointments, and contraceptive recommendations. The executive director of the Global Access Project (GAP) highlighted the importance of multi-service clinics, stating “Women…need one-stop shopping…they’ll go to the [clinic]they think is the most important.” The structural changes forced by the GGR have reduced the number of these multi-service clinics available. 

What Does This Mean for Future Foreign Policy?

The foreign impact of the U.S. should be in the form of long-term non-conditional aid, not funds with strings attached and political moves without evidence of their benefits. Conditional aid sets the precedent that the U.S. can pressure other foreign entities into adopting stances that align with the morals of the political party in power. Moreover, recklessly pursuing agendas abroad without factual evidence and prior analysis of the implications causes harm to humanitarian aid efforts. The political leanings of the current U.S. administration should not determine the standard of healthcare offered to innocent people in other countries.


The views expressed by the author do not necessarily reflect those of the Glimpse from the Globe staff, editors or governors.


Krishni Satchi

Krishni Satchi is a junior studying Global Health and minoring in Psychology and Law. She is deeply passionate about the intersections between international relations and medicine. In writing for Glimpse, she seeks to find and highlight global health and human rights-related issues. As a student at USC, she also works within the Health Sciences Education Program and conducts research with the USC Institute for Inequities in Global Health.