Assessing the Impacts of the Expanded Global Gag Rule
In January 2017, U.S. President Donald J. Trump reinstated and dramatically expanded the Mexico City Policy, also known as the Global Gag Rule (GGR). When in place, this policy requires foreign (meaning not US-based) nongovernmental organizations (NGOs) to certify that they will not use funding from any source to “perform or actively promote abortion as a method of family planning” as a condition of receiving U.S. global health assistance funding. The GGR forces foreign NGOs to choose either to certify the policy and alter activities and funding relationships in accordance with its restrictions or become ineligible for U.S. global health assistance. U.S.-based NGOs must ensure GGR compliance from foreign subgrantees.
Whereas prior iterations of this policy applied only to U.S. Family Planning Assistance, the Trump administration’s expanded GGR extended these restrictions to nearly all global health assistance - including funding for HIV/AIDS and infectious disease, maternal and child health, nutrition, and water, sanitation and hygiene (WASH). An additional expansion of the policy announced in March 2017 required GGR-certifying NGOs to flow the policy down to organizations they provide sub-grants to, irrespective of the funding source. This expansion meant that the policy could affect non-USG funding, and NGOs that did not receive any US global health assistance.
Between 2017 and 2020, with generous grant support from the William and Flora Hewlett and the David and Lucile Packard Foundations, GHJG implemented a three-country study to assess the impacts of this expanded Global Gag Rule. The primary objective of this research was to answer the question, “How does the expanded GGR affect provision of and access to SRH services?” Additional research questions explored the impact of the expanded GGR on multiple domains, including funding, policymaking, advocacy, service delivery, referral networks, and health systems.
To answer these questions, we partnered with local research institutions in three countries with diverse cultural and abortion-related legal contexts: Madagascar, Nepal, and Kenya. In each country, our partners interviewed stakeholders at multiple levels of the health system, including government officials, NGO program managers, SRH service providers, and clients who both accessed and were denied SRH services. GHJG also led a series of interviews with bilateral and multilateral funding agencies, foundations, and civil society organizations, in order to shed light on the extent to which the GGR affected organizational policies and funding levels at the global level.