Loyce Pace, President and Executive Director and Danielle Heiberg, Senior Advocacy Manager, Global Health Council

This week, the U.S. State Department released guidelines for the implementation of the Mexico City Policy (also known as the Global Gag Rule) as it will be applied to U.S. global health funding. (Guidance that covers family planning/reproductive health funding was released in early March.)

When President Trump signed the Executive Order reinstating and expanding the Mexico City Policy (now known as the “Protecting Life in Global Health Assistance” policy) to cover all global health funds, he did not simply “gag” an organization’s ability to provide or discuss abortion as an option, but he put at risk health programs that provide an important range of services to communities worldwide.

The State Department estimates that approximately $8.8 billion of U.S. foreign assistance (the bilateral share of U.S. global health funding provided through the State Department, USAID, the National Institutes of Health, the Centers for Disease Control and Prevention, and the Department of Defense) is subjected to the expanded policy. But the cost goes beyond dollars, and could set back years of progress made in fighting some of the deadliest and costliest diseases, such as HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases, as well as programs that improve nutrition, water, sanitation, and hygiene, and maternal and child health.

We know that U.S. investments in global health work.

That’s because organizations that work in all of these global health priorities would be subject to losing funding, if they fail to comply with the order, or for U.S.-based NGOs, fail to certify that their local partners do not provide abortion services. And since the U.S. is the largest donor of foreign assistance, this funding gap will be difficult for other donors to close.

NGOs are in a difficult position: either comply with the policy and lose the option to provide, counsel, refer, or advocate for abortion services (using non-U.S. funds), or not comply and lose access to U.S. funding that may be the lifeline for a rural clinic to provide comprehensive care to its clients or that provides the funding for purchasing bed nets to prevent malaria or the drugs to combat TB infections. This is especially relevant, given the hard work we’ve done as a global health community to ensure seamless, person-centered services on the ground. Ideally, our programs address the needs of women, children, and families across the spectrum and integrate with local resources so that the U.S. employs its resources efficiently and with the greatest sustainable impact. Decoupling initiatives limits our ability to coordinate multiple global health programs and funding streams.

We know that U.S. investments in global health work. Over the past decade, these investments helped to lower malaria deaths by 60%; introduce new drugs to fight HIV/AIDS, TB, and NTDs; and put almost 10 million people living with HIV on antiretroviral treatment. Now, the global health community is bracing itself for the full consequences of such a broad application of the policy. Our greatest fear is that these gains are reversed due to new funding or programmatic constraints put in place as a result of the recent guidance. We heard of initiatives across sectors and priorities being put on hold, in anticipation of changes, resulting in slowed progress toward benchmarks and end goals. Global Health Council is convening representatives from implementing organizations to better understand the ultimate reach of this latest decision. While we won’t know the impact of the expanded policy for a while, the restrictive policy puts our vast accomplishments in jeopardy at a time we can’t afford to lose ground.

Image: Mothers and their babies are pictured at a primary health center, ante-natal care site with voluntary counseling and testing, family planing and reproductive health in downtown Antananarivo, Madagascar. UN Photo/Eskinder Debebe.