Assessing the Impact of the Expanded Mexico City Policy

The Heilbrunn Department of Population and Family Health (HDPFH) was awarded $2 million by the William and Flora Hewlett and the David and Lucile Packard Foundations to study the impact of the expanded Mexico City Policy on reproductive health service provision, access, funding, and advocacy.

In January 2017, the President reinstated the Mexico City Policy, also informally referred to as the Global Gag Rule (GGR). Previous iterations of this policy prohibited the allocation of United States family planning funding to foreign nongovernmental organizations (NGOs) unless they certified that they would not “perform or actively promote abortion as a method of family planning,” using funds from any source (including non-U.S. funds). The expanded Mexico City Policy will apply to all global health assistance that is granted by all U.S. departments or agencies.  This means that international public health programs that are funded separately from family planning, such as HIV/AIDS and infectious disease, child health, water, sanitation and hygiene, and maternal health, to name a few, are now affected. 

The Mexico City policy is often erroneously described as an abortion policy. However, the policy is actually a foreign aid funding policy that limits what organizations can do with any funding if they wish to also accept U.S. global health funding. The policy stipulates that foreign organizations cannot receive U.S. global health assistance if they continue to:

• Provide abortion as a method of family planning;  

• Provide counseling and referrals for abortion as a method of family planning;

• Conduct public information campaigns on the availability of abortion; or

• Advocate for the liberalization of abortion laws or lobbying for the continued legality of abortion.  

Though exempt from the Mexico City Policy themselves, U.S. NGOs who are recipients of U.S. global health assistance must ensure that foreign organizations they provide U.S. funds to follow the requirements of the policy.  Foreign organizations receiving U.S. foreign aid directly must also comply. Moreover, this wide-reaching policy has been instituted at a time of deep cuts in U.S. foreign aid, particularly related to sexual and reproductive health (SRH). These policy changes will have devastating impacts on international family planning programs as well as the broader field of U.S. global health assistance by shifting funding away from some of the most effective—and sometimes only— providers and service delivery institutions relied upon by women in underserved communities around the world.

Given the policy’s implications for health, it is critical to track and document the impact of this expanded policy on access to contraception and abortion services, and on related SRH and maternal health outcomes such as HIV and STI testing and treatment, and antenatal care. As an institution that combines the implementation of rigorous research with on-the-ground programming, and has deep partnerships with academic institutions and community-based organizations and NGOs, HDFPH is well positioned to carry out this work.

The primary objective of this research is to answer the question, “How does the Mexico City Policy affect the provision of and access to SRH services?” To answer this question, we are partnering with Planned Parenthood Global to conduct a rigorous mixed-methods evaluation that will document the influence of the reinstated Mexico City Policy in three countries with diverse cultural and abortion-related legal contexts: Madagascar, Nepal, and Kenya. 

Findings from this in-depth assessment will illuminate the impact that the Mexico City Policy has on multiple domains related to funding, policy advocacy, referral networks, and health systems, enabling public health advocates to present comprehensive evidence during policy discussions. As part of this project, we will collaborate closely with research and service delivery experts in each country. We will develop and implement the methods based on their input, and will work to strengthen their capacity to conduct similar research in the future.

Another objective of this research is to investigate the global health funding landscape since the re-introduction of the Mexico City Policy. Through a series of interviews with bilateral and multilateral agencies, foundations, and civil society organizations, we are examining the extent to which the Mexico City Policy affects organizational policies and funding levels, and the implications that these shifting donor dynamics have on sexual and reproductive health and advocacy.

Lastly, HDPFH, together with the Center for Health and Gender Equity (CHANGE), supports a consortium of researchers, civil society advocates, and donors. Monthly meetings supported by HDPFH offer an in-person platform for researchers to coordinate and collaborate to avoid duplication and to share insights across our respective studies. We also support opportunities to connect the research consortium with existing Mexico City Policy legal, policy, and advocacy working groups. It is critical to foster information sharing among the partners included in those groups in order to determine what evidence needs to be generated to maximally support policy, advocacy, and legal challenges to the policy.

Each month, HDPFH releases a digest of the latest media and literature surrounding the Global Gag Rule and related issues in global sexual and reproductive health and rights. This digest highlights the effects of the policy worldwide, and the important work organizations are doing to mitigate its impact. To receive this monthly update, please complete the form below.

For more information on the Mexico City Policy, its provisions, and exceptions, visit: