Frequently Asked Questions

The Global Gag Rule, also known as the Mexico City Policy, was first announced by the Reagan administration at the International Conference on Population in 1984. The policy remained in place for eight years under the Reagan and George H.W. Bush administrations. Ten years later, in response to President Clinton rescinding the Global Gag Rule, congressional Republicans made yearly efforts to restore the policy — often blocking the release of family planning funding as a means to punish the program and force President Clinton to negotiate its return.  

When President George W. Bush entered the White House, he reinstated the Global Gag Rule. In 2003, he expanded the policy’s scope to not only include U.S. Agency for International Development (USAID) family planning and reproductive health assistance programs, but also U.S. State Department “voluntary population planning” activities under the Bureau of Population, Refugees and Migration — including those provided as part of humanitarian relief — while specifically exempting HIV/AIDS assistance.  

The election of President Obama brought an end to the Global Gag Rule, but much like during the Clinton administration, congressional Republicans were unwilling to accept the policy’s removal. After regaining control of the U.S. House in early 2011, they renewed but failed at their efforts to legislatively reimpose the Global Gag Rule. Immediately after taking office in 2017, President Trump reinstated the Global Gag Rule and began the process of his administration’s series of unprecedented expansions. On January 28, 2021, President Biden took the first step to reverse the Trump-Pence administration’s damage to sexual and reproductive health and rights by rescinding the massively expanded policy. The Trump-Vance administration reinstated the policy within the first week of taking office.

The back and forth of the policy’s enforcement creates confusion and has a chilling effect on family planning and reproductive health programs around the world. Even when the Global Gag Rule is not in place, some organizations have been reluctant to take U.S. funding or partner with U.S. organizations for fear that support could be subsequently cut off at the whims of politicians in Washington, D.C. 

The Global Gag Rule is not — and has never been — about U.S. taxpayer funding for abortion. Although unsafe abortion is a leading cause of maternal morbidity and mortality in low-income countries, the Helms amendment has restricted the use of U.S. assistance for abortion as a method of family planning since 1973. The Global Gag Rule denied NGOs outside of the United States receiving U.S. assistance the right to use their own, non-U.S. funds to provide information, referrals or services for legal abortion or to advocate for the legalization of abortion in their country.

No. Whether centered on misuse or subsidy, fungibility arguments are arbitrary and nonfactual rationales for the Global Gag Rule. 

The fungibility-as-subsidy argument claims that taxpayer funds that go to organizations performing abortions or abortion-related services free up other financial resources for such work, thereby acting as a subsidy. However, this argument is discriminatory and selectively applied. For example, under Trump’s Global Gag Rule, non-U.S. NGOs were rendered ineligible to receive U.S. global health assistance if the organization used funding from any other source to perform abortion, counsel or refer for abortion or advocate to make abortion legal or more available in their own countries. In contrast, USAID allows funding for faith-based organizations, that need only separate their proscribed religious activities from agency-funded development and health programs to remain eligible.  

The fungibility-as-fraud argument implies that a non-U.S. NGO receiving U.S. global health assistance funds could use those funds inappropriately for abortion services, counseling and referral or advocacy in support of abortion law reform. Not only is this claim incorrect, but it also undermines the integrity of the U.S. aid system and its implementing partners. The U.S. government has a complicated vetting process, coupled with very strict compliance requirements for recipients of aid. Furthermore, all U.S. aid is ultimately overseen by Congress. If an aid recipient misuses funds for any purpose, there are immediate actions taken to protect the integrity of U.S. global health assistance, including reporting the violations to the congressional committees with jurisdiction over assistance in a timely and complete manner. 

Recent polling shows that a majority of Americans do not support the Global Gag Rule—70%, in fact. A bipartisan survey conducted by Lake Research Partners and American Viewpoint, commissioned by PAI and the Center for Health and Gender Equity (CHANGE), revealed that across age, education level, gender, race, political party and even abortion stance,  not only do most voters oppose the U.S. government’s efforts to restrict NGOs’ abortion-related efforts in other countries, a solid majority also believes that the United States should actively help improve the health of women and girls around the world—which is the antithesis of the reality of global health assistance under the global gag rule.

Previous iterations of the Global Gag Rule had only applied to family planning assistance from the State Department and USAID. Both Trump administrations approved a plan to expand the policy’s scope, which impacted global health assistance from the State Department, USAID, Department of Health and Human Services and Department of Defense. PAI has detailed the specific restrictions imposed by the expanded Global Gag Rule in order to protect and preserve critical lifesaving health care services to the maximum extent allowable under the policy. 

Assuming this latest iteration replicates the Trump-Pence administration’s version, non-U.S. NGOs working on U.S.-funded programs to address issues including maternal and child health, nutrition, HIV, malaria, tuberculosis and other infectious diseases, as well as family planning, were forced to comply with the Global Gag Rule to remain eligible to receive U.S. assistance. Even though most of those organizations did not directly work on abortion or family planning issues, their work was impacted by the expanded policy — whether they chose to comply or not. The expansion implicated about 15 times the amount of funding compared to when the policy was only applied to bilateral family planning assistance. That was nearly half of all bilateral economic assistance from the United States.  

It is important to note that, as of January 2025, standard provision language has not been provided to implementing partners. In 2019, Secretary of State Mike Pompeo announced a new interpretation of the “financial support” language included in the standard provisions implementing the Global Gag Rule. The change prohibited non-U.S. NGOs compliant with the policy as either a direct recipient or subrecipient of U.S. global health assistance from providing any financial support to any other non-U.S. NGO that conducts activities restricted under the Global Gag Rule. This interpretation had enormous implications for a variety of donors, ranging from other non-U.S. bilateral donor governments to private foundations, even to other U.S. government funding streams outside of global health. 

Non-U.S. NGOs receiving U.S. global health assistance ensured compliance with the Global Gag Rule when they accepted the new provision in their grants or cooperative agreements to obtain U.S. funds.

U.S.-based NGOs receiving U.S. global health assistance were responsible for enforcing Trump’s Global Gag Rule with their non-U.S. NGO grantees on behalf of the U.S. government. 

The expanded interpretation with respect to “financial support” released in 2019 was implemented in the same way. This interpretation placed an enormous administrative burden on compliant non-U.S. NGOs required to conduct due diligence on subrecipients of any financial support they provide — regardless of source of funding or activity to be funded.

Under Trump’s first expanded Global Gag Rule, post-abortion care, as well as abortion services or counseling and referral for abortion “not as a method of family planning” — that is, in the cases of life endangerment, rape and incest — were not subject to the policy’s restrictions.

While it may take years to fully comprehend the impact of the policy’s expansion under the Trump-Vance administration, PAI’s documentation across several countries shows that the expanded Global Gag Rule disrupted services and referral networks, damaged integrated health programs and diverted resources away from direct service delivery. It stalled progress on national sexual and reproductive health and rights policies and forced closures of projects serving vulnerable communities including youth, people living with HIV/AIDS and rural populations, among others. The Global Gag Rule also created contraceptive commodity insecurity and undermined donor-funded projects.

To learn more, read PAI’s summary of the Global Gag Rule’s wide-ranging impacts.

No. Any changes to international family planning and global health assistance budgets result separately from the congressional appropriations process.  

U.S. global health assistance funding has stagnated since 2010. Despite ever-increasing global health needs, the Trump-Pence administration proposed a 24% decrease in global health spending for fiscal year 2020. However, Congress has the ultimate say regarding funding levels, and in 2019, approved a spending package of $11 billion for U.S. global health assistance.