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A Bad Policy Is Born
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Playing Politics With Women’s Health
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Worldwide Access Denied
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A Resurgent Threat
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A Bad Policy Is Born
In 1984, the Reagan Administration, announced a new policy, the Global Gag Rule, which forbids foreign NGOs from receiving US Family Planning funds if they perform, counsel or refer women for abortion services, or advocate for the liberalization of abortion laws where they work.
Stop President Trump's Global Gag Rule! Stand with millions of women and oppose this attack on their autonomy, health, and lives. SIGN THE PETITIONPart 1
The Anti-Choice Roots of the Global Gag Rule
The Global Gag Rule is a brainchild of the U.S. anti-choice movement, and one of the first over-reaches of domestic abortion battles into the global health space.
Also known as the Mexico City Policy, it was first announced in 1984 by the administration of President Ronald Reagan at the International Conference on Population in Mexico City. As the first president elected on an anti-choice party platform, Reagan felt compelled to deliver the movement a victory, at any cost. At the conference, the U.S. allied itself with the Vatican, Iran, Libya, Syria and Sudan in opposing women's access to abortion information and services.
"What the policy said was, 'If you're doing something with your own money that we don't like, you're not eligible for a grant.' That would not be legal in the United States."
– Joe Spiedel, Former PAI Vice President
Part 2
Dangerous Restrictions
Broken down, the Gag Rule contains three basic restrictions. First, it withholds U.S. family planning funding and technical assistance from foreign NGOs — including reproductive health organizations, private hospitals, and clinics — that perform or promote abortions. Second, the policy forbids NGOs that receive U.S. funding from advocating for liberalization or decriminalization of abortion in their countries. Third, in countries where abortion is permitted, the policy prohibits health workers at NGOs that receive U.S. funding from offering abortion as an option or referring women to an abortion provider.
The Gag Rule’s impact is extensive. It goes beyond telling organizations how they can use U.S. aid money, and restricts how they spend their own funds if they want to be eligible for U.S. family planning assistance. In many cases, the policy forbids health workers from counseling women on all legal pregnancy options. And most importantly, it puts women’s health at risk—hurting trusted providers, cutting basic services, and forcing women to risk their lives with unregulated, unsafe abortions.
"It's almost as if we're, in fact, encouraging unsafe illegal abortion by failing to support those organizations."
- Sharon Camp, Board Member and Former Vice President at PAI
Part 3
Early Impact
When the Gag Rule was announced, PAI staff sprang into action. At the Mexico City conference, Joe Speidel and Sharon Camp, who were both Vice Presidents at PAI, gave up to a dozen interviews a day explaining the policy and condemning it as an attack on women's health.
It was clear that women in the developing world would suffer. Two of the biggest family planning providers, the International Planned Parenthood Federation and Marie Stopes International, refused to comply and were suddenly ineligible for U.S. funding.
"PAI was there on the ground responding directly to this — let's face it, it was an attack on the international family planning program."
- Sharon Camp, Board Member and Former Vice President at PAI
To investigate the early effects of the policy during the Reagan administration, Sharon Camp traveled to a dozen countries on all continents. What she found was disturbing. In places where abortion was already legal, like Turkey, organizations were forced to curtail critical training for doctors on safe abortion techniques because the programs had been partially funded by the U.S. In India, many leading family planning organizations and health care providers simply closed down after losing U.S. support.
- Sharon Camp talks about PAI's role when the Global Gag Rule was first introduced.
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Playing Politics With Women's Health
Since its inception the Global Gag Rule has been put into place at the start of every Republican administration and is promptly rescinded under each Democratic administration.
Stop President Trump's Global Gag Rule! Stand with millions of women and oppose this attack on their autonomy, health, and lives. SIGN THE PETITIONPart 1
A Political Football
The Gag Rule remained in place for four years under President Reagan, and another four years under George H.W. Bush. In 1993, President Clinton finally rescinded it. But when Republicans won control of Congress in 1994, they made yearly efforts to reinstate it, often blocking the release of family planning funding as a bargaining chip.
Every year, PAI fought reinstatement of the policy, and with champions in Congress, fought to sustain funding for family planning programs.
The Gag Rule was fully reinstated in 2001 by President Bush, rescinded again in 2009 by President Obama, and imposed once more in 20017 by President Trump. However, in a cruel and unusual approach, President Trump vastly expanded an already harmful policy. The Trump Gag Rule widens the scope to “all health assistance furnished by all department or agencies”—not just family planning assistance.
Part 2
A Chilling Effect
When the Gag Rule was in effect, it hurt family planning clinics and organizations and impeded women’s access to health services. Health providers faced a painful choice between losing their funding and losing the freedom to offer their patients a full range of reproductive health services, as well as participate in national debates on abortion.
The political back-and-forth over the Gag Rule also has a chilling effect on family planning programs around the world. Some organizations are still reluctant to take U.S. funding, or partner with U.S. organizations, for fear that support could be subsequently cut off on the whims of politicians in Washington.
"You see, the Global Gag Rule has thrown fears into the hearts of people."
- Hilary Fyfe, Family Life Movement of Zambia
- PAI’s short documentary, 30 Years is Enough, details the Global Gag Rule’s destructive 30 year history.
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Worldwide Access Denied
The policy, when in place, has had the effect of not only decreasing access to safe abortion services, but cutting off some of the most experienced and respected providers of family planning and other health services.
Stop President Trump's Global Gag Rule! Stand with millions of women and oppose this attack on their autonomy, health, and lives. SIGN THE PETITIONPart 1
Clinics in Crisis
With millions of women worldwide who want to prevent pregnancy but lack modern contraception, the Gag Rule hurts an already-dire situation.
PAI documented the effects of the Gag Rule with Access Denied, a film and series of case studies in six countries. What we found was consistent, and devastating.
In many countries, the Gag Rule forced providers that declined U.S. funding to close clinics, cut services, and increase fees. Established health care referral networks collapsed as key family planning providers downsized and struggled to cope with budget cuts. For example, the Planned Parenthood Association of Ghana (PPAG), the country’s oldest and largest provider of reproductive health services, lost $200,000 in USAID funding in 2003 when they rejected the Gag Rule. As a result, PPAG laid off 67 key staff members and reduced nursing staff by 44 percent, leading to a 40 percent reduction in family planning use by those served by the organization. More than 1,327 communities in Ghana were affected by the cuts.
Similarly, Marie Stopes Kenya and the Family Planning Association of Kenya (FPAK), the county’s two leading reproductive health providers, refused to comply in 2001 and lost all U.S. funding. The policy forced MSI Kenya to close two clinics in 2002 and the organization was only able to keep further clinics from closing by laying off staff. Unable to raise enough funds to replace the USAID money lost, FPAK closed 15 clinics between 2001 and 2005.
- Watch Access Denied, PAI’s 8-minute documentary showcasing the effects of the Gag Rule in Zambia.
Similarly, Marie Stopes Kenya and the Family Planning Association of Kenya (FPAK), the county’s two leading reproductive health providers, refused to comply in 2001 and lost all U.S. funding. The policy forced MSI Kenya to close two clinics in 2002 and the organization was only able to keep further clinics from closing by laying off staff. Unable to raise enough funds to replace the USAID money lost, FPAK closed 15 clinics between 2001 and 2005.
Part 2
Supplies Cut Short
The Gag Rule also led to a shortage of contraceptives and condoms in developing countries. Shortly after the reinstatement of the policy in 2001, shipments of U.S.-donated condoms and contraceptives completely ceased to 16 developing countries, primarily in Africa. Family planning providers in another 16 countries lost access to condoms and contraceptives as a result of their refusal to accept the policy’s restrictions.
For example, by refusing to comply with the Gag Rule, the Family Planning Association of Nepal lost $400,000 in USAID-funded contraceptives, two-thirds of its total stock, thus reducing the number of women they could serve. The Family Guidance Association of Ethiopia (FGAE), which also rejected the policy, stopped providing free condoms at their clinics due to recurring shortages. In 2003, FGAE’s branch office in Nazareth reported that they were about to run out of Depo-Provera, the birth control method used by 70 percent of their clients.
In many places, the Gag Rule likely increased abortions, as women lost access to contraceptives and the means to prevent unintended pregnancies. A 2011 study found the Gag Rule to be associated with increased abortion rates in sub-Saharan African countries. The odds of a woman having an abortion in countries that were most dependent on U.S. foreign aid were more than twice those observed in less-dependent countries. Abortion rates began to rise noticeably only after the Gag Rule was reinstated in 2001.
"There is something that is lethal about the U.S. government's policies."
– Desta Kebede, Family Guidance Association of Ethiopia
- Watch Wendy Turnbull, PAI Senior Advisor for International Advocacy, talk about the effects of the Global Gag Rule she saw in Ghana
Part 3
Unconstitutional and Un-American
In addition to these direct losses, the Gag Rule also has more indirect, insidious effects on reproductive health care. Prohibiting organizations from providing information, counseling, and referrals on abortion hurts their ability to provide comprehensive health care requested by women and undermines trust between providers and patients. According to the American Congress of Obstetricians and Gynecologists, the policy's restrictions "violate basic medical ethics by jeopardizing a health care provider’s ability to recommend appropriate medical care."
The Gag Rule also negatively impacts other U.S. global health priorities, including HIV/AIDS prevention and maternal and child health. In Kenya and Ethiopia, community-based outreach services were curtailed or even shut down, and these programs were often the only access rural men and women had to contraceptive supplies and education on HIV/AIDS.
The Gag Rule undermines a central tenet of U.S. foreign policy—the promotion of democracy abroad—and violates core democratic principles by restricting foreign organizations’ freedom to engage in public policy debates. For example, when the Gag Rule is in place, a family planning clinic or organization in a country where abortion is illegal cannot advocate for legalization without losing U.S. funding. The Gag Rule would be unconstitutional if applied to U.S. citizens, as it violates the right to free speech.
"It is un-American in, in the most basic way."
– Wendy Turnbull, PAI Senior Advisor to International Advocacy
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A Resurgent Threat
With the imposition and vast expansion of the policy by President Trump, the impact of the Global Gag Rule is more dangerous than ever, threatening the lives of millions of women.
Stop President Trump's Global Gag Rule! Stand with millions of women and oppose this attack on their autonomy, health, and lives. SIGN THE PETITIONPart 1
A Resurgent Threat
On January 23, 2017, just days after taking office, President Trump issued a presidential memorandum imposing a massively expanded global gag rule, after an eight year reprieve from this harmful policy under the Obama Administration.
Trump’s Global Gag Rule goes further than previous iterations of the policy, cruelly extending its restrictions to all global health assistance provided through USAID, the Department of State and the Department of Health and Human Services in more than 60 low and middle income countries. Now, in addition to all foreign NGOs providing family planning and reproductive health care, those providing services related to HIV/AIDS, maternal and newborn health, malaria, tuberculosis, other infectious diseases, nutrition or any other global health program will be required to certify that they do not provide abortion services, counsel or refer for abortion, or advocate for the liberalization of abortion laws, in order to continue to receive U.S assistance.
"Women around the world deserve to make important, personal health care decisions without politicians in Washington interfering."
– Congressman Eric Swalwell
Part 2
Championing Women's Rights
This policy is not about abortion. It is about the Trump-Pence Administration placing politics above the health and lives of women around the world. As in the past, the Global Gag Rule will not prevent abortions. What it will do is shutter clinics, limiting access to contraception, HIV testing, counseling and treatment, safe delivery and newborn care, and other critical health services.
In response to President Trump’s announcement, family planning champions in Congress stood up to oppose this policy by introducing the Global Health, Empower and Rights (HER) Act. This bill, if passed, would permanently repeal the Global Gag Rule once and for all.
Get additional Global Gag Rule information and resources"We are hanging on to a set of policies that are completely out of touch with what is happening in the world."
- Sharon Camp, Board Member and Former Vice President at PAI
Stop President Trump's Global Gag Rule! Stand with millions of women and oppose this attack on their autonomy, health, and lives. SIGN THE PETITION