The Trump administration on Monday significantly expanded a Reagan-era policy banning foreign aid to international healthcare providers who discuss abortion or advocate for abortion rights, in a move critics fear will jeopardize efforts to fight diseases such as malaria, HIV/Aids, and the Zika virus.
The new terms of the ban will apply to $8.8bn in existing foreign aid provided by the state department, USAid, and the Department of Defense – dwarfing the $600m in programming that fell under the ban during previous administrations.
“Votes in America have international consequences,” said Marjorie Dannenfelser, the president of the Susan B Anthony List, an anti-abortion political action committee. “The [policy] implemented today is one of the reasons pro-life voters worked to elect Donald Trump to the White House. We have officially ceased exporting abortion to foreign nations.”
US law already bans the use of taxpayer dollars to support abortion services abroad. Every Republican president since Ronald Reagan, however, has gone further, and blocked foreign aid to non-governmental organizations that discuss abortion as part of family planning or advocate for abortion rights, even using non-US funds.
Barack Obama lifted that policy in 2009. But just days into his presidency, Donald Trump signed an executive order reimposing the ban, known as the Mexico City policy.
And Trump expanded the policy even further. He directed his incoming secretary of state, Rex Tillerson, to identify a larger range of international aid programs that could fall under the ban.
The change in policy will not cut the amount of foreign aid distributed through existing channels, and it does not apply to emergency disaster relief funds. But it will prevent those funds from going to any organization that promotes abortion rights.
Critics feared the broader policy could significantly cut aid to groups combating the types of infectious diseases that have plagued poorer countries.
“There is no indication that the Trump administration has conducted any assessment of the impact of the expanded global gag rule,” said Serra Sippel, the president of the Center for Health and Gender Equity. “For example, how will this expansion impact prevention of the spread of HIV or Zika, especially given the role of contraceptives in prevention efforts?”
At the very least, critics said, the rule will put thousands of international healthcare workers in the difficult position of deciding whether to continue to offer family planning care that includes abortion at the expense of a crucial funding stream.
Worldwide, unsafe abortions are a major cause of maternal mortality and kill tens of thousands of women every year.
The US is the single largest donor country to global health efforts, meaning the new rule is expected to have a far-reaching impact on reproductive health initiatives abroad.
One group alone, the International Planned Parenthood Federation (IPPF), stands to lose $100m in annual funding because it will not abide by the new rule, a spokeswoman said in January. None of that money is currently used for abortion services.
After George W Bush reinstated the Mexico City policy in 2001, 20 developing countries in Asia, Africa, and the Middle East lost some access to contraceptives provided by the US. Many NGOs were forced to shut down or lay off staff, which reduced the availability of family planning services and also threatened programs geared toward HIV prevention and maternal and child health.
The ban is known as the Mexico City policy after the location of the United Nations conference where Ronald Reagan first announced the ban in 1984. Every Democrat elected since Reagan has suspended the policy, which opponents refer to as the global gag rule.
Trump’s administration has named its plan to implement the Mexico City policy “Protecting Life in Global Health Assistance”.
“The president, it’s no secret, has made it very clear that he’s a pro-life president,” Sean Spicer, the White House press secretary, said days before Trump ordered the ban in January. “He wants to stand up for all Americans, including the unborn, and I think the reinstatement of this policy is not just something that echoes that value, but respects taxpayer funding as well.”
Because dangerous births and abortions drive such a high rate of maternal deaths in poor countries, many international health advocates say that a ban on even discussing abortion inhibits their work.
Research has also repeatedly called into question the assertion that the ban results in fewer abortions.
A study of nearly two dozen countries in sub-Saharan Africa found that the abortion actually rate rose during the George W Bush administration in countries affected by the ban.
For IPPF, the Bush-era policy resulted in a significant loss of funds that affected its programs for years. One IPPF member association, a group that provided family planning and HIV services in Ethiopia, lost 10% of its USAid funding and 25% of its funding from IPPF. As a result, Ethiopia experienced a major contraceptive supply crisis, a spokeswoman for IPPF said.
“We know that when family planning services and contraceptives are easily accessible, there are fewer unplanned pregnancies, maternal deaths, and abortions,” said Senator Jeanne Shaheen on Monday. “Yet the Trump administration has chosen to ignore decades of research in favor of an ideological crusade that cuts off vital family planning services.”
Shaheen is the author of a bill that would block future administrations from enforcing the Mexico City policy. But similar legislation introduced by Democrats over the years has never passed.