With Jesse at the Helm, It’s Jesus Take the Wheel for Women Overseas Facing an Unintended Pregnancy—the Forgotten Legislative History of the Helms Amendment & New Efforts to Repeal It

With Jesse at the Helm, It’s Jesus Take the Wheel for Women Overseas Facing an Unintended Pregnancy—the Forgotten Legislative History of the Helms Amendment & New Efforts to Repeal It

In a 24-hour news cycle, it is easy to forget the politicians who once raised hell on Capitol Hill. Former Senator Jesse Helms (R-NC) may be one of them, but nearly two and a half decades after the conservative firebrand senator left Congress, his legacy still lives on, leaving women overseas facing an unintended pregnancy with a distinctly American response: Jesus, take the wheel.

Last Thursday, bicameral champions for sexual and reproductive health and rights (SRHR) in Congress again pushed back on that deadly legacy.  The Abortion is Health Care Everywhere (AHCE) Act (H.R. 10600 and S. 5565) would expand the use of U.S. foreign assistance funds for comprehensive reproductive health care, including safe abortion, by repealing the 50-year-old Helms amendment. Named for its author, the 1973 amendment restricts the use of U.S. foreign assistance funds “to pay for the performance of abortion as a method of family planning or to motivate or coerce persons to practice abortions.”

The AHCE Act was introduced in the House by Representatives Jan Schakowsky (D-IL), co-led by Ayanna Pressley (D-MA), Dianna DeGette (D-CO), Norma Torres (D-CA), and Marilyn Strickland (D-WA), and has 82 additional co-sponsors. In the Senate, it is led by Senator Cory Booker (D-NJ) and co-led by Tina Smith (D-MN), Richard Blumenthal (D-CT), Tammy Duckworth (D-IL), and Mazie Hirono (D-HI). It has 15 additional original co-sponsors. Fifty major national organizations endorsed the reintroduction of the AHCE Act.

The timing of the reintroduction of a bill to the repeal the Helms amendment also is a fine way to commemorate International Safe Abortion Day today. The day is an opportunity to recognize that access to safe abortion is a matter of health and human rights and that when safe care is inaccessible, women are more likely to face preventable injury and death. Unsafe abortion remains a leading cause of maternal mortality, with 97% of unsafe abortions occurring in low- and middle-income countries. Access to safe and legal abortion can prevent this needless suffering. Yet U.S. foreign assistance policy continues to restrict the use of those funds for abortion care in countries where abortion may be legal, leaving health systems and patients without access to resources that could make abortions safer.

While neither chamber is expected to take up the bill before the end of the 119th Congress, its reintroduction provides an important opportunity to educate and mobilize lawmakers and advocates ahead of the new Congress. It also lays the groundwork for pursuing repeal of the Helms amendment if the arrival of the next Congress brings a more favorable political alignment to Capitol Hill.

The grievous harm to women’s health around the world caused by the Helms amendment over the last five decades is incalculable. A 2021 study by the Guttmacher Institute estimated that repealing the Helms amendment and allowing U.S. foreign assistance to support safe abortion services could have had a profound impact. In the 33 USAID-assisted low- and middle-income countries where abortion was legal on at least some grounds at the time, could have resulted in 19 million fewer unsafe abortions, 17,000 fewer maternal deaths, and 12 million fewer women suffering abortion-related complications requiring medical treatment each year.  In addition, the overall number of maternal deaths from unsafe abortions in these countries would decline by 98% and result in net health system savings of $641 million annually. The estimates were based on 2021 funding levels, when the U.S. Agency for International Development (USAID) provided $575 million for bilateral family planning and reproductive health (FP/RH) services and before the demolishment of the agency at the beginning of the second Trump term by Elon Musk and his DOGE minions in early 2025.

Let’s explore how the Helms amendment came to be by delving into the Congressional Record and PAI’s archives as the legislative history of the Helms amendment provides some potentially useful insight for some of today’s more urgent battles with the Trump regime’s implementation of the dramatic expansion of the Global Gag Rule (GGR) restrictions beyond abortion to LGBTQI+ rights and gender equality, known collectively as “Promoting Human Flourishing in Foreign Assistance (PHFFA)” rule.

The Forgotten Legislative History of the Helms Amendment

Following the landmark Supreme Court ruling in Roe v. Wade establishing a constitutional right to abortion on January 22, 1973, freshman Senator Jesse Helms, an ultraconservative Republican from North Carolina who might be viewed as the prototype of what is now referred to as a white Christian nationalist, sought to block any USAID involvement in abortion-related activities by proposing an amendment to the Foreign Assistance Act of 1961 (FAA), the permanent foreign aid authorizing statute, later that year.

The text of the Helms amendment initially proposed on the Senate floor on October 2, 1973, during debate on the Foreign Assistance Act of 1973 (S. 1443, P.L. 93-189) stated:

Prohibiting the Use of Funds for Abortion.—None of the funds made available to carry out this part shall be used in a manner, directly or indirectly, to pay for abortions, abortifacients drugs, or devices, the promotion of the practice of abortion or the support a research designed to develop methods of abortion. The provisions of this section shall not apply to any funds obligated prior to the date of its enactment. . . (emphasis added)

The final version of the Helms amendment was significantly less restrictive, including, most importantly, deleting any language prohibiting indirect support for abortion-related activities.  It reads:

Limiting use of funds for abortion.—None of the funds made available to carry out this part shall be used to pay for the performance of abortions as a method of family planning or to motivate or coerce any person to practice abortions. (emphasis added)

The main differences between the original and final version of the Helms amendment were the fact that while the intent of the text of the original amendment was “prohibiting” funding for abortion, the revised version merely “limits” the use of funds for a much narrow set of abortion-related activities. And with relevance to the statutory rationale for the GGR, the original version prohibited both direct and indirect support for abortion-related activities. The concept of banning “indirect support” underpins the legal foundation of the GGR eligibility condition—an implementing entity can be rendered ineligible for U.S. government assistance if it engages in a restricted activity, such as abortion, even if that activity is supported with non-U.S. government funds. Congressional intent was crystal clear in approving final text of the Helms amendment—only direct U.S. government support of abortion-related activities was restricted, not what a recipient can do with its own, separately raised funds.

In the debate on the Senate floor of the House-Senate conference report on December 5, 1973, Senator Helms expressed his satisfaction with the compromise on the final text of his amendment noting that the House did not have a comparable provision in its version of the foreign aid authorization bill and the House was willing to sign off on a modification of the Helms Senate language that in his words “is now direct and simple, and in some respects stronger than the original version.”

But anti-abortion activists like Patrick Trueman, general counsel and executive director of Americans United for Life, were clearly dissatisfied with the outcome of the House-Senate conference negotiations, and Trueman wrote in 1981 that “the truncation of the original Helms language was a clear victory for the abortion promoters at AID, and their support for abortion continues virtually unhindered.”

In response to the passage of the Helms amendment, the Ford administration’s USAID Administrator Dan Parker issued a policy determination on June 10, 1974 which essentially barred use of U.S. foreign assistance “for the direct support of abortion activities in the developing countries,” including: procurement and distribution of equipment “provided for the purpose of inducing abortion as method of family planning;” and funding an “information, education, training or communication program” that promotes abortion, while allowing training of overseas doctors in the “latest techniques used in [obstetrics and gynecological] practice.” The policy determination also allowed the continuation of support to “research programs designed to identify safer, simpler, and more effective methods of fertility control.” It also explicitly prohibited coercion in U.S.-funded family planning programs and any payments to a woman to have an abortion or to “persons to perform abortions or solicit persons to undergo abortions.”

In short, USAID could not provide funds for the “direct support” of abortion-related activities or to pay women to motivate them to have an abortion for purpose of limiting births, but it could continue certain kinds of training and research involving abortion and could also contribute to organizations which were involved in providing abortion services provided that USAID’s money was not used directly for that purpose. But in practice, the Helms amendment forced USAID to withdraw from most abortion-related activities.

Particularly galling to abortion opponents was the failure of the negotiated compromise on the Helms amendment to prohibit or restrict biomedical research on abortion, euphemistically described in the 1974 USAID policy determination as “hindsight methods of fertility control.” In the event of an unintended pregnancy, as in life, hindsight is always 20/20.

That perceived deficiency from the perspective of anti-abortion activists was rectified in the Fiscal Year 1982 foreign aid authorization bill when the House-Senate conference committee agreed in December 1981 to adopt language on abortion research from the Senate rather than the House bill, adding a new subsection to the FAA after the Helms amendment. That language reads as follows: “None of the funds made available to carry out this part may be used to pay for any biomedical research which relates, in whole or in part, to methods of, or the performance of, abortions or involuntary sterilizations as a means of family planning.”

Commonly known as the Biden amendment, the Senate language included in the final conference agreement was more temperate than the House version authored by Rep. Chris Smith (R-NJ), the leading anti-abortion activist in either chamber for the last 45 years, who sought to ban funding “for research, within or outside the United States, in or related to any methods or techniques that will, with reasonable likelihood, cause the death of a fetus after conception.”

It is important to note that USAID was spending a miniscule amount on abortion-related research programs—less than $700,000 a year, or 0.004% of its total FP/RH budget in the late 1970s and very early 1980s—for epidemiological studies of the health impact of abortion as well as some research into methods to perform abortion, including abortifacient drugs like prostaglandins, which have proved vital in the treatment of postpartum hemorrhage. Even one penny is one penny too many to help improve women’s reproductive and maternal health for abortion opponents.

Implications of the Helms Amendment for Trump’s Dramatically Expanded Global Gag Rules

• Definition of “abortion as a method of family planning”

In the standard provisions implementing the GGR—the “Mexico City Policy” of Presidents Reagan and the two Bushes and the Trump first term’s “Protecting Life in Global Health Assistance” (PLGHA)—the definition of “abortion as a method of family planning” allowed for the performance of abortion in cases where “the life of the mother would be in danger if the fetus were carried to term” or “following rape or incest.” Under the terms of the earlier iterations of the GGR, abortions performed for any other reason or circumstances would be forbidden including explicitly “physical or mental health of the mother and abortions performed for fetal abnormalities.”

Under the new anti-abortion GGR rule, Trump’s “Protecting Life in Foreign Assistance (PLFA),” in defining “abortion as a method of family planning,” administration lawyers have adopted a legal formulation more akin to the domestic Hyde amendment rather than the internationally focused Helms amendment with much stricter language forbidding abortions to protect the physical health of the woman. The definition in the PLFA anti-abortion rule reads:

“Abortion as a method of family planning is any abortion, except, provided that the abortion is lawful under local law— (I) if the pregnancy is the result of an act of rape or incest, or (II) in the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed. The exceptions in this definition only apply for purposes of this rule.”

The inclusion of this last proviso is intriguing to this non-lawyer as it stipulates that the definition of “abortion as a method of family planning” does not apply in interpreting the term as it may appear in any other statutory or policy context, such as most notably the Helms amendment. Although it restricts the use of foreign assistance for “abortion as a method of family planning,” the Helms amendment has been interpreted and enforced by every presidential administration—Republican and Democratic alike—since its 1973 enactment as a complete ban on abortion funding even in cases of life endangerment, rape, or incest—the so-called “exceptions” in the final proviso.

SRHR advocates have been lobbying Democratic administrations since the Clinton presidency in the 1990s to allow the use of U.S. foreign assistance funds to provide safe abortion services in the cases of life endangerment, rape, or incest to no avail. Even Jesse Helms’ own granddaughter called on President Biden in a July 2022 op-ed to “end the unnecessarily broad enforcement of the Helms amendment” and to “champion legislation to fully repeal the amendment” and to “help put an end to one of my grandfather’s harmful legacies.”

• Why does the PLFA cite Hyde rather than Helms?

In the executive summary accompanying the PLFA rule, the Helms amendment is never mentioned by name, nor does it appear in the preamble or the text of the standard provision implementing the rule itself. Instead, there is a reference to the Hyde amendment in a listing of Trump presidential actions, specifically Executive Order 14150 of January 24, 2025, entitled “Enforcing the Hyde Amendment,” as part of the basis for concluding that the PLFA rule is consistent with administration policy.

The absence of a reference to the Helms amendment seems to be an odd omission. In legal challenges to the GGR by DKT International and the Planned Parenthood Federation of America in the late 1980s, government lawyers asserted that the Helms amendment was a part of the statutory authority available to the president for the implementation of the GGR along with the president’s broad responsibilities in the conduct of foreign policy and wide discretion in setting the terms and conditions for the provision of health assistance.

Did Trump administration lawyers notice the legislative history of the Helms amendment and the explicit decision by Congress to deliberately exclude indirect support of abortion-related activities from the restrictions and choose not to call attention to it? Does clear legislative intent even matter much anymore?

Introduction of the Abortion is Health Everywhere Act

First introduced in July 2020, the AHCE Act that was reintroduced on Thursday updates some of the previous findings and modifies the operative language to reflect the promulgation of the PLFA rule, specifically by adding “regulation, or policy” to “provisions of law” to which the notwithstanding authority applies. The language in the bill strikes the Helms amendment, leaves in place the Biden amendment restricting funding for biomedical research on abortion, and adds a new subsection 104(g) to the FAA, which reads:

“(g) Use of Funds for Comprehensive Reproductive Health Care Services.—Notwithstanding any other provision of law, regulation, or policy, funds made available to carry out this part may be used to provide comprehensive reproductive health care services, including abortion services, training, and equipment.” (emphasis added)

Comprehensive abortion care is health care. That is not a political assertion—it is a public health reality. When safe abortion care is not available, abortions do not stop. They become more dangerous, contributing to preventable maternal death and morbidity.  For more than 50 years, the Helms amendment has restricted U.S. foreign assistance for this care, putting women’s health and lives at risk. U.S. global health policy should be grounded in evidence and focused on preventing needless maternal deaths and illness.

Women and girls overseas facing an unintended pregnancy deserve more than thoughts and prayers for their safety or policies that leave their health to chance. They deserve the information, resources, and quality health care they need to make decisions about their own lives and futures, and the ability to take the wheel themselves. It is time for Congress to pass the Abortion is Health Care Everywhere Act and to take Jesse Helms out of the driver’s seat.