The Trump administration’s anti-abortion restrictions on US global health aid funding have significantly damaged healthcare for women in Africa and south Asia, according to a new report.

Restrictions on funding also include limiting access to funds for sex education, and shifting funds to anti-LGBTQ and pro-abstinence groups such as Focus on the Family, researchers say.

The “Crisis in Care” report from the International Women’s Health Coalition outlines the two-year impact of the Trump administration’s “global gag rule” which prohibits funding to international NGOs that do not sign a pledge saying they will not provide or promote abortions as a method of family planning. The rule applies to an organization’s non-US funded activities too, regardless of the local laws regarding abortion.

“I think the most impactful and glaring thing is that people are dying as a result of the policy,” said Vanessa Rios, pointing to a case in Kenya in which two women died from unsafe abortions – one used knitting needles – after a sex-worker organization stopped providing abortion information or referrals.

The new report, built on 118 interviews with community health organizations in Nigeria, Kenya, South Africa and Nepal, portrays an international health community grappling with confusion over the gag rule’s implementation, increased stigmatization of reproductive health services, and a ripple effect that is closing or fragmenting critical health services. It also illustrates the international implications of intensifying efforts in the US, primarily in Republican-dominated state legislatures, to roll back abortion access.

What is the 'global gag rule'? The rule, otherwise known as the Mexico City policy, requires NGOs to certify that they will not perform or promote abortions anywhere in the world as a condition for receiving US family planning funds. Every Republican president since 1985 has implemented it. But Donald Trump has adopted a stringent version of the rule, under which NGOs that refuse to sign will be refused all health assistance, including for HIV, primary care, nutrition, tuberculosis and malaria programs. As much as $8bn in US funding could be affected – money that developing world health budgets can ill afford to do without.









Though every Republican president since Ronald Reagan has implemented the gag rule, which is imposed by a presidential memo, the Trump iteration expands the amount of money susceptible to the order, and has implications for funds for a wide array of global health concerns such as malaria, HIV/Aids, tuberculosis and nutrition.

According to the new report, adherence to the gag rule now applies to $9bn in US foreign aid and extends to many organizations that previously did not have to comply with the policy.

The escalation of the gag rule, the report says, has led to confusion among international providers as to what services and advice they can offer, and increased fear that a wrong step will jeopardize vital funds.

Interviewees who received US funding from all four countries said they believed the gag rule allowed “absolutely no opportunity” for providing any information, service or referral relating to abortion, according to the report. “Even when prompted, many organizations did not or could not explain that the policy does not apply to abortion in cases of rape, incest, and when the woman’s life is in danger, and that it allows for post-abortion care.”

The report also warned that the US’s aggressive stance against abortion counseling and services was emboldening “regressive actors” – rightwing or anti-reproductive health groups – in Kenya, Nigeria and South Africa.

“The amount of money from the US to other countries isn’t decreasing, it’s just going more and more to regressive groups,” said Jedidah Maina, executive director, in Kenya, of Trust for Indigenous Culture and Health, at a panel previewing the report.

These groups include the anti-LGBTQ Christian group Focus on the Family, which now receives US funding to fight HIV/Aids in South Africa through a “purity pledge” program, which promotes sexual abstinence among young people.

Focus on the Family is one prominent example of how, two years into the more stringent gag rule, “we’re seeing the real shift: if organizations are declining to sign this policy, then where is that funding going? We’re seeing newer relationships with these [rightwing] groups,” said Rios.

One organization in Kenya which focused on maternal, newborn and child health, HIV/Aids, and support to orphans was forced to terminate programs after refusing to sign the gag rule; according to the report, the resulting $990,000 loss between 2018 and 2019 closed its office in Mombasa, cut 15 staffers and ended services and education for 13,000 children living with HIV.

As a solution, Rios and the International Women’s Health Coalition’s report advocated for the Global HER Act, which would legally end the gag rule and prohibit another president from implementing it. “We have the power to make it so presidents can’t, just with a stroke of their pen, implement a policy that is so harmful to the health of people worldwide,” Rios said.