Expansion of the Mexico City Policy

Trump to Expand Funding Ban Tied to Abortion Overseas

By Gardiner Harris and Somini Sengupta
The New York Times, May 15, 2017

The Trump administration said on Monday it would vastly expand the so-called global gag rule that withholds American aid from health organizations worldwide that provide or even discuss abortion in family planning. The new policy could disrupt hundreds of clinics in Africa and around the world that fight AIDS and malaria.

It affects about $8.8 billion in global health funding, up from about $600 million during the administration of President George W. Bush.

The rules, issued by the State Department, mean that any foreign nongovernmental group that wants American money for any of its health activities — from AIDS treatment to malaria prevention to safe childbirth practices — must promise not to “promote abortion as a method of family planning.” Already, American taxpayer dollars cannot be used for abortion services abroad.

The global gag rule was introduced by President Ronald Reagan in 1984 at the International Conference on Population in Mexico City, and is also known as the Mexico City Policy. Since then, Republican administrations have kept or reimposed it, while Democratic ones have rescinded it.

Mr. Bush visited Botswana and Namibia only last month to highlight the need for aid under the President’s Emergency Plan for AIDS Relief, or Pepfar, to treat cervical cancer. He also argued that care for cervical cancer should be provided right along with care for H.I.V.

But under the policy announced Monday, that could be impossible.

The policy “risks undoing years of progress on women’s health in Pepfar countries,” said Asia Russell, executive director of the Health Global Access Project, a public health group.


Background Briefing: Senior Administration Officials on Protecting Life in Global Health Assistance

U.S. Department of State, May 15, 2017

MODERATOR: Thank you very much, and thanks to all those who have joined us for this afternoon’s call. This will be an on-background conference call on Protecting Life in Global Health Assistance. I’ll introduce our participants this afternoon, but as a reminder, for attribution they will be senior administration officials, and the rules for this call will be on background.

Today we are joined by [Senior Administration Official One]. We are also joined by [Senior Administration Official Two], and finally, by [Senior Administration Official Three].

SENIOR ADMINISTRATION OFFICIAL ONE: Thank you, [Moderator], and good afternoon.

On January 23rd, 2017, President Trump issued a presidential memorandum reinstating the 2001 presidential memorandum on the Mexico City policy, and directed the Secretary of State to implement a plan to extend to the extent allowable by law the Mexico City policy to global health assistance furnished by all departments or agencies.

Secretary Tillerson has approved a plan to implement the manner in which U.S. Government departments and agencies will apply the provisions of the Mexico City policy to foreign nongovernmental organizations that receive U.S. funding for global health assistance. The policy, now known as Protecting Life in Global Health Assistance, implements what the President has made very clear: U.S. taxpayer money should not be used to support foreign organizations that perform or actively promote abortion as a method of family planning in other nations.

Under this policy, global health assistance includes funding for international health programs, such as those for HIV/AIDS, maternal and child health, malaria, global health security, family planning, and reproductive health. Protecting Life in Global Health Assistance applies to global health assistance to or implemented by foreign NGOs, including those to which a U.S. NGO makes a sub-award with such assistance funds.

Once all appropriate steps have been taken, the policy will apply to all new funding agreements, grants, cooperative agreements, and contracts, and gradually to existing agreements when they are amended to add funding.

Protecting Life in Global Health Assistance applies to approximately $8.8 billion in funds appropriated to the Department of State, the U.S. Agency for International Development, and the Department of Defense. Previously, the policy applied only to family planning assistance provided by USAID and the Department of State.

Given the expansive nature of the new policy, the department will undertake a thorough and comprehensive review of the effectiveness and impact of the policy’s application over the next six months, which could include identifying implementation issues and any other new information affecting implementation going forward. Newly covered programs, including PEPFAR, the President’s Malaria Initiative, and other global health programs, will be given special attention under this review.

MODERATOR: And with that, we’ll open this up for questions. Thank you.

OPERATOR: Ladies and gentlemen, once again, it’s *1 for questions. And our first question will come from the line of Yeganeh Torbati of Reuters. Please, go ahead.

QUESTION: Thanks so much. A couple quick questions: Can you – you said that now it applies to $8.8 billion in funding. Other – some critics have said and I’ve seen the wording that previously it applied to $600 million in funding. Can you confirm that? And also, you mentioned that PEPFAR and the malaria – the President’s Malaria Initiative are new programs that will be added to this or newly covered under this. Can you name a few other specific programs that weren’t covered before and now will be? Thank you.

SENIOR ADMINISTRATION OFFICIAL ONE: Okay, thank you very much. Yes, the $8.8 billion includes primarily the PEPFAR program, which is approximately $6 billion. Additional funding included in this $8.8 billion is USAID family planning, reproductive health, maternal health, and other types of programs.

The $600 million figure that you mentioned was approximately the amount of money that was covered under the previous Mexico City policy that only affected USAID’s and State Department’s family planning program.

SENIOR ADMINISTRATION OFFICIAL THREE: Just to add on, the other programs affected also would include exactly as [Senior Administration Official One] said – the maternal child health programs, malaria, PEPFAR, as well as other infectious disease programs and the full array of global health assistance provided through USAID.

OPERATOR: Okay. Next, we’ll go to the line of Jina Moore of BuzzFeed.

QUESTION: And just a quick follow-up. I know this came up a little earlier, but can you talk a little bit more specifically about how you will measure compliance?

SENIOR ADMINISTRATION OFFICIAL THREE: So compliance is measured by the ongoing monitoring of programs, right. We do – typically we do visits to our partners on a regular basis, and [Senior Administration Official Two] can talk about this more specifically with regard to PEPFAR. But it is certainly routine visits, if you will, routine monitoring of what the programs are doing, paying attention to what kinds of information they – the partners put out in the general press and those kinds of things. So it really is part of the routine monitoring.

SENIOR ADMINISTRATION OFFICIAL TWO: Just to pick up on that, and this is talking from the PEPFAR standpoint, we’ve extended our monitoring very much down to the site of where we deliver services. We think that’s absolutely critical. So our – both our U.S. Government personnel who are in country as well as our large implementing partners and host governments actually go to the sites. And we require quarterly reporting from the sites so we know exactly what’s being provided at the site, the gender of the person receiving those services, and the age band that they’re in so that we can monitor the quality of our services. So this would be one more element of monitoring. So I just want to really make it clear that this is not new to us about ensuring quality global health assistance services provisions, whether it’s for TB, HIV, malaria, or immunizations. So that’s a standard component of our program, to ensure high quality of services that the U.S. Government funds.

OPERATOR: Thank you. And now we have Rachel Oswald of the Congressional Quarter.

QUESTION: Okay, great. What, if any, outreach was had with PEPFAR receiver countries, the governments there, like Uganda, about the expansion of the Mexico City policy? And what feedback did those foreign governments give to you about any concerns they may have about the new policy?

SENIOR ADMINISTRATION OFFICIAL TWO: Yeah, thank you. So we’re in dialogue with our countries all along about implementation of PEPFAR, because obviously this is done in cooperation with host governments but also civil society. So I think we were waiting for the guidance from the Secretary; so now that we have guidance on the implementation, we will circle back to all of our countries.

And we have, of course, people in all of our countries well-represented by the ambassadors that are in that country from the U.S. State Department, who are poised to talk immediately to our host countries but also to our communities and civil society, because we implement all of our programs in conjunction both with the host government but also the communities that we’re serving.

MODERATOR: All right. If there are no further questions, as one final reminder, attribution for today’s call is on background to senior administration officials. And now that this call has concluded, the embargo is lifted. Thanks very much, everyone. Have a nice day.

U.S. Department of State Background Briefing:

U.S. Department of State Fact Sheet:

PEPFAR - The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government initiative to help save the lives of those suffering from HIV/AIDS around the world:



By Don McCanne, M.D.

Today’s topic is not on abortion per se, but rather it is on Donald Trump’s expansion of Ronald Reagan’s Mexico City Policy, which pertains to abortion, and the impact this will have on George W. Bush’s Emergency Plan for AIDS Relief (PEPFAR). So what are these programs?

The global gag rule introduced by President Reagan in 1984 at the International Conference on Population in Mexico City prohibited foreign nongovernmental organizations that receive U.S. aid funds from promoting abortion as a method of family planning.

PEPFAR is an important public health program initiated by President Bush which has helped to stem the world-wide epidemic of HIV/AIDS.

President Trump has expanded the Mexico City Policy to apply to PEPFAR. Since it is virtually impossible to eliminate all references to termination of pregnancy from the PEPFAR program, this means that about $6 billion of U.S. aid will be denied to this program. That can have only tragic results in turning back some of the progress we have made in countering the scourge of HIV/AIDS.

This is highly nefarious, and the Trump administration seems to understand that. Look at the excerpts from the State Department teleconference announcing the expansion of the Mexico City Policy. Although they introduced three senior officials to explain the expansion, they established rules for attribution in which these administrators would be referred to only as SENIOR ADMINISTRATION OFFICIAL ONE, SENIOR ADMINISTRATION OFFICIAL TWO, and SENIOR ADMINISTRATION OFFICIAL THREE. That’s bizarre. Is this to protect these administrators from potential personal attacks? If so, they seem to understand that there must be considerable passionate opposition to this policy change. Or is this simply more evidence of this dysfunctional administration simply moving forward with the implementation of obviously detrimental policies while  trying to hide in order to avoid blame? Clearly they are not attempting to invite accolades.

This is really sad. As we try to advocate for health care for all in America, how can we expect to make any progress when we have a Congress and an Administration that are tearing down our fortresses of health care justice - here, and throughout the world.