In one of a number of sharp reversals from the Obama era, Donald Trump on Monday signed an executive order banning international NGOs from providing abortion services or offering information about abortions if they receive US funding.

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 critical funding stream. Many international health advocates insist that their efforts are not comprehensive without abortion services. 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 to global health efforts, providing nearly $3bn toward health efforts through the United States Agency for International Development (USAid) alone. The state department and groups like the Peace Corps offer additional funding. A spokeswoman for International Planned Parenthood Federation (IPPF) said the group will not abide by the gag rule and stands to lose up to $100m it currently receives from the US. None of that money is used for abortion services.

Public health advocates across the globe warned that a change in funding would have grave consequences.

“It would be devastating,” said Amu Singh Sijapati, president of the Family Planning Association of Nepal, a member of IPPF. Her association has used the funds to train healthcare workers and open clinics in remote parts of the country that offer long-acting, reversible contraceptives to disadvantaged women.

The loss of funds would limit the reach of her organization, she said. “Funding cuts would mean we can’t support … the government of Nepal’s effort on sexual and reproductive health and rights. Additionally we would not be able to run community clinics or mobile health days or train healthcare workers. The impact also means we would lose essential medical staff like nurses, doctors and health experts.”

Trump’s signature reinstates a Reagan-era rule that was not in effect for most of the Obama years. The order does not eliminate international aid for abortions, which is already prohibited by federal law under the Helms amendment. Rather, the gag rule takes Helms one step further by preventing NGOs from using private funds to offer abortions or even refer women to groups that provide abortions.

The gag rule also prevents health workers in foreign countries from advocating for abortion rights, which includes testifying about the impacts of illegal abortion.

The rule does not enjoy uniform support. In 2015, Senate legislation introduced by New Hampshire’s Jeanne Shaheen that would have made the gag rule impossible to reinstate by executive order attracted support from several moderate Republicans.



Still, the reinstatement of the global gag rule, also known as the Mexico City policy, has been long sought by opponents of abortion rights. To their eyes, funding groups that perform or even discuss abortions is tantamount to funding the procedure.

“President Trump is continuing Ronald Reagan’s legacy by taking immediate action on day one to stop the promotion of abortion through our tax dollars overseas,” said Marjorie Dannenfelser, president of the anti-abortion political advocacy group Susan B Anthony List.

“President Trump’s immediate action to promote respect for all human life, including vulnerable unborn children abroad, as well as conscience rights, sends a strong signal about his administration’s pro-life priorities.”



Trump is not the first president to reinstate the rule. George W Bush signed a similar order when he entered office in 2001.



At IPPF, that change resulted in a significant loss of funds that affected its programs for years. For instance one IPPF member association, a group that provided family planning and HIV services in Ethiopia, lost 10% of USAid funding and 25% of its funding from IPPF. As a result, Ethiopia experienced a major contraceptive supply crisis, a spokeswoman for IPPF said.

According to EngenderHealth, a global women’s health organization, Bush-era cuts resulted in more than 20 developing countries in Asia, Africa, and the Middle East losing access to contraceptives provided by the US. Many NGOs were forced to shut down or lay off staff, which drastically reduced the availability of family planning services, HIV programs and maternal and child health programs.

“President Trump’s reinstatement of the global gag rule ignores decades of research, instead favoring ideological politics over women and families,” said Shaheen, who serves on the foreign relations committee.

“We know that when family planning services and contraceptives are easily accessible, there are fewer unplanned pregnancies, maternal deaths and abortions. And when women have control over their reproductive health, it improves the long-term health of mothers and children and creates a lasting economic benefit.”