A Reagan-era policy that prohibits foreign non-governmental organizations that receive U.S. global health funds from performing or promoting abortion as a method of family planning may be permanently repealed this year. The policy, officially called The Mexico City Policy but often referred to as the Global Gag Rule (GGR), was introduced during a 1984 United Nations conference in Mexico City and has been in effect for 21 of the last 36 years, mostly through executive action. Since the GGR was instituted in 1984, it has been rescinded and reinstated by presidents along party lines, mostly impacting international people who do not have a say in whether the policy is in place or not. Former President Donald Trump expanded the policy in 2017 to block most bilateral global health assistance, impacting access to health care and abortion care for thousands of people, families, and LGBTQ+ people globally.
President Joe Biden recently repealed the policy on his first day in office last year, but a future president can still reinstate it through executive action. Advocates are calling on senators to pass a permanent repeal of what they say is a harmful policy, through the Fiscal Year 2022 Department of State, Foreign Operations, and Related Programs Appropriations Bill. They have until Feb. 18 to pass the bipartisan effort as part of the federal budget.
“This is where we have exported our domestic politics in the most callous way,” said Serra Sippel, chief global advocacy officer for Fòs Feminista, an international alliance for sexual reproductive health rights and justice.
Opponents of the policy say that the people most impacted by GGR are not voters in U.S. elections and therefore do not have a voice in whether this policy is in place or not. Sippel says that conservative lawmakers use the policy as a “bone to throw” at their constituents, but international lives are on the line. According to a report from Fòs Feminista, the GGR has impeded people’s access to contraception in low- and middle-income countries, resulting in significant increases in unintended pregnancies and births. Trump’s expansion of the policy in 2017 lasted until the end of his term and coincided with the onset of the COVID-19 pandemic, exacerbating the unmet need for contraception and unintended pregnancy in low- and middle-income countries where people may also lack access to sexual and reproductive health services because of the GGR.
According to Brian Ligomeka, executive director of the Centre for Solutions Journalism in Malawi, many people have died as a result of unsafe abortions in Malawi. In Nepal, between the years 2018 and 2021, research from Center for Research on Environment, Health, and Population Activities (CREHPA) illustrates that the GGR has restricted reproductive rights and the ability to access sexual and reproductive health services.
“We found that the policy’s harmful impacts disproportionately affect the rural, poor, illiterate, and the most marginalized communities of Nepal,” said Mahesh Puri, a researcher at CREHPA. “Further, the GGR’s mandate stands in contradiction to the sovereignty of Nepal and to its constitution, which protects safe abortion services with the consent of the pregnant woman and also protects the provision of services by trained health providers from accredited health facilities.”
It’s not just contraceptive access, but basic health services that have been affected by the GGR. When Trump expanded the program, it applied to the President’s Emergency Plan for AIDS Relief, maternal and child health, malaria, nutrition, and other U.S. programs and potentially impacted $7.3 billion in fiscal year 2020. In Malawi, clinics in rural areas offer a multitude of health services, including providing medications for HIV, AIDS, and malaria patients. With the GGR in place, clinics were forced to close down or stop providing abortion services altogether.
“When that clinic closes down, it’s not only those people who are wishing to access contraceptives that actually suffer, it is the whole community that suffers because that clinic was just providing general services,” Ligomeka said. “The impacts are huge.”
Rouzeh Eghtessadi, the executive director of SAfAIDS, hopes the policy is permanently repealed so access to safe abortions can increase. According to Eghtessadi, many people in the South African development community region look to U.S. policy as guidance. She hopes a permanent repeal will influence fairer reproductive rights globally. Ligomeka likewise believes that a repealing of the GGR will create a conducive environment for policy and legal reforms on abortion in Malawi.
“GGR gave this [harmful] stamp of approval that yes, it is okay for you to continue to oppose advocacy to access safe abortion as a sexual and reproductive health right,” Eghtessadi said. “There’s really an ethical onus on making decisions; it’s not just for your country, but it actually has such a large impact on the rest of the world.”
Eghtessadi said that every year that goes by, the need to repeal the GGR becomes more urgent. With midterm elections coming up in the fall, and another presidential election in 2024, advocates hope a permanent repeal will prevent any more back and forth. The repeal has received bipartisan support led by Democrat Sen. Jeanne Shaheen and Republican Sens. Susan Collins and Lisa Murkowski.
