Three days into Donald Trump’s new presidential administration, he followed a long-standing White House tradition and reinstated the Mexico City Policy, referred to by its critics as ‘the global gag rule.’ This law was the brainchild of President Ronald Reagan, who introduced it in 1984 during a United Nations Conference in Mexico City. It provided an easy path for President Reagan to commit himself to the pro-life platform after his controversial appointment of Sandra Day O’Connor to the Supreme Court, whose position on the issue was ambiguous. Reagan found it necessary to express his disapproval of the procedure to the Evangelicals and Catholics who had helped elect him. While the Helms Amendment of 1973 already made it illegal for foreign aid to contribute to funding abortions, the Mexico City Policy ensured that American dollars would not indirectly fund the procedure by making it illegal for non-governmental organizations (NGOs) receiving funding to provide information on terminations.

Image courtesy of Elizabeth Glaser Pediatric AIDS Foundation © 2009, some rights reserved.

Image courtesy of Elizabeth Glaser Pediatric AIDS Foundation © 2009, some rights reserved.

This time, the unconventional President Trump was not breaking with tradition: since 1984, presidents have developed a habit of rescinding or reinstating this legislation during their first days in office. It has become something of a symbolic gesture, an early way for Democratic presidents to indicate their support for reproductive rights and for Republican presidents to show their allegiance to the pro-life movement. President Trump, who prior to his presidential campaign expressed support for Planned Parenthood and ‘partial-birth abortion,’ certainly needed to convince his party and his supporters that he will take the Republican line on reproductive rights.

Naturally, this law has huge repercussions for the many countries that receive American aid dollars. The United States is the most generous bilateral donor to reproductive health causes, currently spending around $575 million. The Guttmacher Institute estimated that last year’s budget for foreign family planning gave 27 million women access to contraception, preventing two million unsafe abortions and six million unintended pregnancies. The Mexico City Policy will influence every health organization that receives US dollars, therefore, groups will have to make the choice to provide false or reductive information to patients or to stop accepting the funding altogether. Marie Stopes International, one of the largest providers of reproductive services to underserved women and a partner of the US Agency for International Development, will stop accepting American aid to continue their work. This will strip the organization of seventeen per cent of its budget, and spokesman Will Harris commented that, ‘Without alternative funding, we estimate the global gag rule will deprive around 1.5 million women a year of the ability to choose whether and when to have children.’

Although most of the repercussions of this policy are well known to reproductive rights NGOs, there are some reasons to fear that Trump’s administration will implement the strictest version of this policy to date. This is largely due to some of the fearfully ambiguous phrasing of the presidential decree, which promised to ‘extend the requirements…to global health assistance furnished by all departments or agencies.’ This means that the law can theoretically affect the $9.5 billion in foreign aid that goes to global health assistance, rather than the $575 million that funds reproductive healthcare. Much concern has emerged over what this means for US funding for HIV and AIDS prevention programs. President George W. Bush established the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, putting America at the forefront of the global initiative to eradicate the deadly disease. Bush was careful to exempt AIDS-related funding when he reinstated the Mexico City Policy, as he was eager to ensure the success of one of his most important legacies in health policy. This exception was made in recognition of the fact that global goals to reduce AIDS across Africa would be impossible within the confines of the Mexico City Policy, as many local health clinics would be ineligible for American funding or unable to provide adequate information to patients under these circumstances.

Trump’s administration has not been clear about how it will counter the negative repercussions of this decree. While Vice President Mike Pence, a staunchly pro-life conservative, has previously supported PEPFAR, some of his comments have cast doubt on the administration’s commitment to HIV and AIDS prevention. During the Congressional debate on the program in 2003, then-Representative Pence stressed that ‘abstinence and marital faithfulness before condom distribution are the cure for what ails the families of Africa’ and that American should be sending ‘values that work’ rather than money to fight HIV and AIDS. Trump’s transition team has questioned the importance of these funds altogether, asking if it is ‘worth the massive investment where there are so many security concerns in Africa’ and if the program will become a ‘massive, international entitlement program.’ These positions have raised huge concerns about how the Mexico City Policy will affect health funding during this administration, with the potential to place more initiatives at risk than ever before. While it is possible that the transition team simply did not think through the repercussions of their statements, NGOs around the world continue to be left in the dark as the future of their work hangs in the balance.

Some remain hopeful that other countries will fill the likely void of US funding for reproductive health services. In recent years, European countries have increased their international aid funding to affected countries and NGOs in order to compensate for such losses, and the Dutch government has committed to this mission since the order was reinstated. However, Trump’s executive order is threatening more than just international aid, diminishing the ability of the US government to respond to international health crises in a bipartisan way. Given that one of the most partisan policies will now affect every realm of American health aid, the ability of the world’s most generous aid donor to combat epidemics will be severely curtailed. While this bodes well with President Trump’s oft-repeated campaign promise to put ‘America First,’ it could spell disaster for some of the poorest and most vulnerable regions dependent on American aid.