The Global Gag Rule (GGR or Mexico City Policy) is a regressive, harmful policy that violates the human rights of women, girls, and people of diverse sexual orientation, gender identity and expression, and sex characteristics (SOGIESC). Given the cyclical re-enactment by Republican administrations and recent of expansion of the GGR to encompass all global health assistance, permanent changes via the Global Health, Empowerment, and Rights Act (Global HER) Act offer the strongest possibility for ensuring consistent US support for sexual and reproductive health (SRH) and realisation of human rights.
As a condition for receiving US family planning funding, the GGR policy restricts non-US NGO’s from promoting or performing abortions as a method of family planning. Since 1984, the GGR has been repealed and enacted every four to eight years by Republican presidents. Most recently, the Trump administration enacted an expansive version, renamed Protecting Life in Global Health Assistance (PLGHA), which applied to all US foreign assistance funding, not just family planning funds, and applied to subgrantees of any certifying non-US NGO. The policy reached beyond abortion, crippling programs across the health sector such as maternal and child health, HIV/AIDS care, contraceptive access, and even water and sanitation. The GGR’s impact is profound and lasting, especially for those who already experience barriers to access care.
One enduring consequence of the GGR is its “chilling effect” which stems from confusion and apprehension around meeting the policy’s parameters. Certifying organisations over-implemented the policy and cut ties to non-certifying organisations. Entities that refused to certify the policy found themselves entirely excluded from longstanding partnerships, programs, funding, and advocacy spaces. With the policy continuously cycling between enactment and repeal, non-certifying organisations struggled to maintain operations between funding cliffs during enactment periods. The Trump administration’s review of the policy found that agencies were not always able to find a suitable replacement for non-certifying organisations. This ultimately pushes access to abortion and other care out of reach, increasing the likelihood of adverse health outcomes from unsafe abortions and pregnancy-related complications.
The GGR violates the human rights of women, girls, and people of diverse SOGIESC globally. It undermines the right to physical and mental health by restricting access to sexual and reproductive health information and services. It violates the right to privacy and the right to make decisions about the spacing and timing of pregnancy. When access to care is eroded, women, girls, and people of diverse SOGIESC are forced to seek out new providers, which may increase their chances of experiencing stigma and discrimination, a violation of their human rights which is a direct result of the breakdown of services caused by the GGR. Delay or denial of time-sensitive abortion care has been identified as a form of gender-based violence that in some circumstances can also amount to torture or cruel, inhuman or degrading treatment. No matter how the policy is framed, it is cruel upon impact.
Though President Biden rescinded the policy shortly after taking office, it continues to reverberate as health care systems, providers, and advocates assess the damage and work to reestablish care. Sometimes, it simply is not possible for service providers to reopen after years-long gaps in funding, leaving some communities with minimal or no SRH care. Alarmingly, the expanded GGR is likely to serve as the blueprint for future administrations looking to reenact the policy. They will certainly be emboldened by the expansive interpretation under the Trump Administration and attempt to codify it through the regulatory process.
The Global HER Act, legislation pending consideration before the US Congress, would eliminate eligibility restrictions like the GGR on foreign assistance funding, made on the basis of provision or referral for health care. The Biden administration has made permanent repeal of the GGR a priority in its National Strategy on Gender Equity and Equality, a whole-of-government strategy that aims to dismantle barriers and advance the rights of women, girls, and people of diverse SOGIESC worldwide. The Global HER Act is a clear path to eradicating this harmful policy completely. The United States must make deeper commitments to global sexual and reproductive health and rights politically and via increased funding in order to mitigate the GGR’s long-term effects, improve health outcomes, and support the realisation of human rights.