Trump reinstated the global gag rule. Here’s what’s at Stake.
The global gag policy, also known as Mexico City Policy, was introduced in 1984. The global gag rule prohibits non-governmental foreign organizations (NGOs), which receive U.S. funds for family planning, from providing abortion referrals or advocacy. The Helms Amendment had prohibited the use of U.S. aid funds to pay for abortions since 1973. The Helms Amendment has been in place continuously, whereas the global gag rule was imposed by Republican presidents from Ronald Reagan onwards. Donald Trump, however, went further in his first term than any other president. Trump expanded the global gag rule to include all U.S. international health assistance in 2017, rather than just family-planning programs. It was not clear which version of gag rule Trump reinstated on Friday night. MSI Reproductive Choices, one of the largest providers of reproductive healthcare services in the world, estimated that restrictions on U.S. funding could affect as many as three out of every four women in reproductive age in the world.
And, if Trump’s administration follows Project 2025’s recommendations, Project 2025 also calls for “deep” cuts to aid programs and fewer grants going to “expensive and inefficient U.N. agencies and global NGOs and contractors.” It also encourages more partnerships with faith based organizations and limits speech on sexual and reproductive rights and health. The U.S. is the Trump is likely to follow his blueprint
According to KFF, the U.S. contributed 32 percent of global health funding in 2022. The United States was the largest donor to many United Nations and multinational health programs including the Global Fund to Fight AIDS (GFFA), the United Nations Population Fund(UNFPA), the World Health Organization(WHO), and others. Soon, this funding could be substantially cut, and due to the gag rule, some of it could also go unused.
According to the U.S. Government Accountability Office, during Trump’s first term, his expanded gag rule applied to about $12 billion in planned international aid funds from May 2017 through the end of 2018. The NGOs who refused to follow the rule lost about $153 millions in U.S. assistance. Trump also withheld funding from UNFPA. This is another decision that he will likely repeat. The Helms Amendment ban on direct funding of abortions, even under Democratic administrations, is holding back global reproductive health. The Helms Amendment’s ban on direct funding for abortions has been a barrier to global reproductive health. Even the status quo under Democratic administrations–the Helms Amendment’s ban–has held back global reproductive health. The gag rule prevents NGOs who provide abortions from receiving U.S. funding, as long as the funding does not go to abortion care. With the gag rule in place, any association with abortion care is essentially disqualifying.
MSI says that it lost out on $120 million in total funding during Trump’s first term. The International Planned Parenthood Federation, another major global reproductive healthcare provider, claims it will lose $60 million. Project 2025 directly calls out both MSI and IPPF as “pro-abortion NGOs,” alongside a false claim that the Biden administration has given them “abortion subsidies.”
“We’re going to start to see projects that are reliant on U.S. funding start to close out,” Shaw said. “We will start to see a reduction in service provision within those countries if they’re not able to find alternative funding.”
Abortion-providing organizations are also likely to become isolated, as other NGOs and even governments fear jeopardizing their relationships with the U.S.
“More broadly, we’re going to see a wider chilling around our partnerships and around how we engage within governance and decision making in the health system,” she continued. “Our teams will start to find that they’re not invited to meetings… particularly those partners that are receiving USAID
funding, they’ll start to distance themselves.”
This will affect the provision of services not related to abortion, Shaw said, because in many communities, MSI and its partners are the only local reproductive health providers.
“Particularly for adolescents and more marginalized and underserved women, it’s going to be harder to access contraceptive services,” she said.
A growing international anti-rights movement
During the first Trump administration, many European governments stepped in to fill some of the funding gaps left by his policies. This may not be the case this time.
Beth Schlachter is MSI’s senior Director of U.S. External Relations. She previously worked 15 years at the State Department. This populist wave does not only affect the United States. Huber is one example. She was a prominent figure in the anti-abortion international movement, spreading abstinence only, anti-comprehensive programs of sexual health and education around the globe. Huber said that she would like to see this number double. The Geneva Consensus signatories agreed that “there is no international right to abortion” and promised to “support the role of the family as foundational to society,” among other claims.
Through her nonprofit Institute for Women’s Health–part of the Project 2025 Advisory Board–Huber established an initiative called Protego to implement the principles of the Geneva Consensus Declaration around the world.
In Zambia–one of the countries where Protego operates–“we’ve seen attempts to roll back reproductive health education,” Shaw said. “Not even comprehensive sexuality education, because that’s long gone, but we’ve seen attempts to restrict access to education for adolescents.”
Shaw added that there has also been an effort to remove the word “rights” from “SRHR,” which stands for “sexual and reproductive health and rights,” a commonly used acronym among governments and NGOs.
“This is hugely problematic because we know that it will affect implementation,” she said. “This is hugely problematic because we know that it will affect implementation,” she said. What about married women? What about adolescents?”
Schlachter noted that many of these anti-rights policies grew out of the Commission on Unalienable Rights, a project of Trump-appointed former Secretary of State Mike Pompeo. The Commission’s report essentially elevated the right to religious liberty and private property over human rights, including sexual and reproductive rights and LGBTQ+ rights.
Unprecedented limits on speech
Another harbinger of new restrictions is the first Trump administration’s “domestic gag rule,” which applied a global gag rule-style policy to funds from Title X, the federal family planning program. Title X funds can’t be used for abortion care due to the Hyde Amendment, but Title X providers had been able to provide abortion information and referrals–until 2019.
According to the Guttmacher Institute, an estimated 981 clinics were forced to leave the Title X network until the Biden administration reversed Trump’s policy in late 2021, reducing the entire network’s capacity by at least 46 percent, or 1.6 million patients.
Internationally, U.S.-based organizations have not previously been subject to a gag rule. The government can’t fund abortions, but they are allowed to speak freely. “It should also remove references to ‘abortion,’ ‘reproductive health,’ and ‘sexual and reproductive rights’ and controversial sexual education materials,” the plan continues.
As an abortion-providing organization, MSI has chosen to speak out even though it means losing U.S. funding and partnerships.[U.S. Agency for International Development]”Other organizations are already declining to step forward and are behaving in a cautious way, so that we’re looking at a completely different landscape for the global reproductive health sector,” Schlachter said. In the past, there has been a consistency of U.S.-based organizations that have been able to speak up and form partnerships with other organizations. Schachter said that there will be a massive shift in how we all work together.
