As first-year medical students, we are taught to always prioritize patients over politics. However, our research in maternal health has shown us that the two are dangerously intertwined, with political decisions directly impacting the provision of health care not just domestically but around the globe.
On January 24, only four days into his second term, President Trump reinstated “Protecting Life in Global Health Assistance” (PLGHA), an expanded version of the Mexico City Policy (MCP) that was found to significantly harm reproductive health worldwide. First put into effect by the Reagan administration, the MCP restricted $600 million of USAID family planning assistance from going to foreign non-governmental organizations that provide or promote abortions. Trump took this a step further and expanded the MCP to cover approximately $8.8 billion of all U.S. global health assistance under the Department of State, the Department of Defense, and USAID. This policy has been coined the Global Gag Rule since NGOs that receive U.S. funding cannot provide abortions and must terminate advocacy work, essentially preventing providers from even discussing safe abortion services with their patients.
Devastating impact on reproductive health
As the world’s largest donor of foreign aid for global health, the Gag Rule is an example of how U.S. legislation has consequences beyond our borders. The enactment of the expanded Gag Rule in 2017 had devastating consequences for global health care systems, resulting in reduced services, clinic closures, increased costs for patients, and decreased access to contraception. One study published in the Bulletin of the World Health Organization showed that the Gag Rule was found to be associated with paradoxically increased abortion rates in sub-Saharan African countries. Another study found that the policy has been linked to reduced access to contraception, leading to more unintended pregnancies.
Now enacted, the Gag Rule forces foreign NGOs into an impossible position: Accept the policy to continue receiving American funding or lose crucial support for family planning and reproductive health. NGOs that decide to continue receiving U.S. aid are at the will of the fluctuating political landscape of the U.S., with the Gag Rule historically being repealed by Democratic administrations and reinstated by Republican administrations. The frequent reinstatement and rescission of the policy by subsequent presidential administrations, and limited communication between the U.S. government and recipients of funding, has led to confusion over the policy’s restrictions. This fear and confusion has resulted in a chilling effect, meaning organizations are restricting their services beyond what is mandated to protect themselves from accusations of non-compliance. For example, some organizations have ceased providing emergency contraception or education on menstrual regulation to patients, despite these being permissible under the policy.
On the other hand, NGOs that do not accept the policy are faced with a devastating loss of funding, leading to clinic closures, staff terminations, and cessation of rural outreach, as well as an overall weakening of health system functioning. Marie Stopes International (MSI) was one such NGO that lost critical funding. MSI estimated that the amount of funding lost would have provided 8 million people across the globe access to family planning services, prevented 1.8 million unintended pregnancies, and avoided 20,000 annual maternal deaths.
Taking action/conclusion
We fear that Trump’s reinstatement of the Gag Rule is just the tip of the iceberg. Project 2025 calls for Trump to extend the policy’s reach to all forms of U.S. foreign aid (including humanitarian assistance), despite ample evidence that women and girls in regions with humanitarian emergencies are more likely to experience sexual violence, unintended pregnancy, and maternal mortality. Health care professionals and trainees must take action now.
While power undeniably lies in the hands of the U.S. government and politicians, it also lies with U.S. physicians and health researchers who contribute to public opinion on abortion and have the ability to pressure members of Congress to enact the Global Health, Empowerment, and Rights Act (Global HER Act). This bill was reintroduced in the House and Senate on January 28 and would essentially prevent future administrations from unilaterally imposing the Gag Rule. However, for the bill to pass, we must call upon our elected officials and urge their support.
Members of the medical community can also engage in grassroots advocacy through organizations, including the Center for Reproductive Rights, Fòs Feminista, and Population Connection. Global health researchers should be charged with collecting data documenting the health and human rights impacts of Trump’s Gag Rule and distributing it to legislators, global health stakeholders, and the general public. Health care professionals should use their platform to raise awareness of the harmful impacts of the Gag Rule, as was previously put forth in 2017 by Global Doctors for Choice’s joint letter to Trump.
Overall, Trump’s Gag Rule operates under the guise of “protecting life” to weaponize U.S. global health funding and violate individuals’ right to life-saving reproductive health services. Therefore, “Protecting Life in Global Health Assistance” is a dangerous misnomer, as the policy inhibits longstanding efforts to reduce abortion-related morbidity and mortality and will continue to cause devastating setbacks to reproductive rights globally.
Analisa Conway and Ashley Gordon are medical students.
