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The Lingering Harm of the Global Gag Rule

The Global Gag Rule (GGR) is a harmful U.S. foreign policy that has devastating health effects globally — disrupting health services and systems and cutting off communities from care. The GGR blocks U.S. global health funding for non-U.S. nongovernmental organizations that provide, refer, counsel or advocate for safe abortion, even with their own non-U.S. funds. The rule forces organizations to choose whether to provide comprehensive sexual and reproductive health care and education and not receive the funding they need or comply with the policy to continue accepting U.S. funds but compromise their care.

While it will take years to fully comprehend the impact of the policy under the Trump-Pence administration, PAI’s documentation across several countries shows that the expanded GGR disrupted services and referral networks, damaged integrated health programs and diverted resources from direct service delivery. It stalled progress on national sexual and reproductive health and rights (SRHR) policies and forced closures of projects serving at-risk communities including women, youth, LGBTQI+ individuals, people living with HIV/AIDS and rural communities, among others. The GGR also created contraceptive commodity insecurity and undermined donor-funded projects.

The evidence tells a powerful story, but there is an additional side that must come forward: the lingering impact these policies have on the overall public health fabric of a country and the autonomy and authority of communities to make the right decisions for their own members.

To better understand the lasting effects of the GGR, PAI surveyed nine civil society organizations and implementing nongovernmental organizations in Ethiopia, Kenya, Malawi, Nigeria, Uganda and Zambia. The evidence was clear: The stroke of President Biden’s pen does not instantaneously undo the harm of a policy designed to deny women and girls access to comprehensive reproductive health services.


Global health systems face significant challenges as they seek to recover from the four years of the Trump-Pence GGR and respond to COVID-19. To promote sustainable progress in global health and to build and maintain long-term partnerships between the U.S. government, local organizations and the communities they serve, permanent repeal of the policy is required. We must end this destructive cycle of widespread fear and confusion about the status of the GGR, which divides civil society, disrupts long-standing partnerships and undercuts the vital work of local organizations. Ending the GGR for good would lift the threat of reinstatement and allow U.S.-funded global health programs to reach their full potential, thus ensuring that the needs and rights of people around the world are fulfilled.