The United States is the world’s largest government funder of global health, meaning its policy decisions affect healthcare for millions of people around the world.
America has a big influence on global reproductive rights. A clear example is the former Global Gag Rule (officially known as the ‘Mexico City Policy’ and renamed under Trump as the ‘Protecting Life in Global Health Assistance Policy’). Even though the US government never funds abortion overseas—as it’s prohibited by the 1973 Helms Amendment—the Global Gag Rule prevents international organisations like MSI from receiving US funding if they provide, promote, advocate for, or even refer to abortion.
It was first enacted by Ronald Reagan in 1984 and has been reinstated by every Republican president since. And by blocking comprehensive sexual and reproductive health services, women bear the brunt of its effects. It deprives women of their right to make choices about their own fertility and denies them access to primary healthcare—evidence shows that the Global Gag Rule leads to higher rates of unintended pregnancies, unsafe abortions, and maternal deaths.
It’s called a ‘gag rule’ because it has a chilling and silencing effect all over the world.
In communities where family planning is already stigmatised, the Global Gag Rule further reinforced negative attitudes, and made it difficult for organisations like ours to create a culture of acceptance around women’s reproductive choice.
Organisations were scared to refer women to safe abortion services, even in cases of rape, incest, or to save a woman’s life (the policy permits abortion under these circumstances), and some NGOs ceased their advocacy work in case it stripped them of their funding. The policy creates confusion and silences important conversations around women’s health.
When Donald Trump became President in January 2017, one of his first acts was to reinstate the Global Gag Rule, a decision that undid years of global progress on reproductive rights, hurting millions of women and limiting their opportunities for the future.
For many MSI programmes—in Uganda, Madagascar and Nepal to name a few—this led to service closures, a recorded rise in unintended pregnancies and unsafe abortions and impacted partnerships and advocacy for women’s healthcare.
Even when the Global Gag Rule is repealed by Democratic presidents, the harmful effects don’t disappear overnight. It takes time to repair the damage done: to re-open closed programs, re-forge partnerships, and get services up and running.
When President Biden took office in 2021, he repealed the Global Gag Rule to protect access to reproductive healthcare. But the effects will continue to reverberate long past this. Funding is still not fully restored.
To receive US government funding while the gag rule is in effect, organisations have to sign that they won’t provide or refer to abortion. MSI has never – and will never – sign the Global Gag Rule. We are proud to provide safe abortion care wherever the law permits. That means we were denied USD $30 million a year during Trump’s presidency; funding that had previously supported us to reach an estimated 2 million women with information and voluntary family planning services every year.
Here we share our suggestions on what the US government and global community can do to protect reproductive access and ensure Trump's policies don't outlive his presidency.
In this briefing, we collate the evidence on how the Global Gag Rule has affected policy, partnerships, provision and access across MSI’s programmes.
Despite the devastating threat the Global Gag Rule posed, it also inspired a generation of women working in family planning to stand stronger than ever for those who depend on them.