Earlier this week, the Trump administration moved forward with plans to withhold global-health funding for organizations that “perform or actively promote abortion” abroad. This move revives an older policy that restricted funds for family-planning organizations—groups that focus on things like contraception and maternal health—and goes further to apply to all global-health funding. As a result, some fear it could wreak havoc on global HIV/AIDS-relief efforts.
Global-health advocates and experts are concerned that the expanded rule could hinder one of the largest disease-relief projects any country has undertaken: the President’s Emergency Plan for AIDS Relief, or PEPFAR, an initiative that has invested billions of dollars in providing HIV/AIDS counseling and testing, distributing life-saving antiretroviral medication, and training hundreds of thousands of health-care workers around the world, to great success. PEPFAR relies on a web of clinics, supply chains, and foreign governments working together, and the expanded policy could, some fear, force clinics and community-health organizations to choose between restricting their services or doing without U.S. government funding.
PEPFAR has historically been exempted from previous versions of the revived policy, known as the Mexico City Policy—or, to critics, the global gag rule. The U.S. government first illegalized direct funding of abortions abroad in the 1970s. Ronald Reagan then enacted Mexico City Policy in 1984 to block family-planning funding to any foreign nongovernmental organization that provides abortion-related services, even if those services were paid for by sources other than the U.S. government. Every Republican president since Reagan has enacted some form of the rule, and every Democratic president has undone it.