I write today to inform you of how the Mexico City Policy, reinstated by President Trump last Monday, will impact the activities of the Bill & Melinda Gates Institute and our partners worldwide.
The reinstatement of the Mexico City Policy, referred to as the Global Gag Rule by its opponents, was expected. But what sets this executive order apart from previous such policies is that its scope has been extended to include all global health funding across multiple foreign assistance accounts. While the details of how this version of the Mexico City Policy will be applied are not known, we know enough now to state that they will profoundly and negatively impact the work of the foreign NGO health community.
The Mexico City Policy was announced in 1984 at the UN Conference on Population and Development in Mexico City. It was carried over by the first Bush Administration, rescinded by President Clinton, reinstated by President George W. Bush and again rescinded by President Obama. Revisiting the Policy has become a rite of passage for new administrations, with great symbolic importance for supporters and opponents of international family planning and reproductive health and rights. But it is far more than a symbol.
Basically, the Mexico City Policy of the Reagan/Bush years required that, in order for NGOs to receive international family planning funding from the US government, their foreign NGO partners must not provide or promote “abortion as a method of family planning”—even if their work was funded through a separate source, and abortion was legal in the NGO’s country. Importantly, this restriction only applied to funds in U.S. Agency for International Development (USAID) and the Department of State’s population/family planning accounts. Other development accounts, such as PEPFAR, were exempted.
This time, the President has invoked the 1985 Kemp-Kasten Amendment, which prohibits the funding of any organization that the President determines supports or participates in the management of a program of coercive abortion or involuntary sterilization. It has served as the basis for de-funding or reducing funding to UNFPA for its support of China’s family planning program. Under the Clinton and Obama Administrations UNFPA was funded, although not always to the full amount appropriated by Congress.
Organizations such as PAI and Marie Stopes International (MSI) have released analyses of the Mexico City Policy’s impact. PAI estimates that in its expanded form, the policy will impact at least $9.5 billion for global health assistance, which is “more than 16 times the amount of funding … than if GGR was applied only to bilateral family planning assistance.”1 MSI has stated it will not sign on to the policy and so will not receive USAID funding; without alternative funding, MSI estimates that “this loss of our services during Trump’s first term, between 2017 and 2020, could result in 6.5 million unintended pregnancies, 2.2 million abortions, 2.1 million unsafe abortions, and 21,700 maternal deaths.”2
The Bill & Melinda Gates Institute does not receive any US government funds. Therefore, we are not directly affected by the reinstatement of the policy. Unfortunately, many of our partners around the world will be required to comply with the policy, and will be de-funded if they do not agree. Since our work builds on and leverages the investments made by USAID, we will surely feel the policy’s impacts.
As the implications of this presidential action become clear, we will keep you informed about developments and ways the Institute seeks to minimize its negative impact.
We stand with our colleagues in family planning and reproductive health who continue to lead on the front lines, and we remain committed to our vision of a world where evidence, science and scholarship drive positive change for women and men, communities and countries worldwide.
Jose “Oying” Rimon II
Director, Bill & Melinda Gates Institute for Population and Reproductive Health
I’m concerned about the impact that the expansion of the Mexico City policy could have on millions of women and girls around the world. I’ve spent the past 16 years talking to women in developing countries who’ve told me—again and again—that their futures depend on the ability to use contraceptives.
I’ve been to places where every woman I met has lost a child to disease. I’ve been to places where every person I talked to knows a woman who died in childbirth. And the more I learned, the more I started to appreciate the everyday battles of women like Sharmila, a mother of four who lives in Bihar.
Sharmila’s family wanted her to follow tradition and have her next child right away, but a health worker explained to her that her children would be healthier and have a better chance of survival if she planned and spaced her pregnancies. Hearing that, Sharmila decided to use contraceptives and convinced her husband to support her decision. It was an act of courage—and an act of love to her four kids.
For many women in the world’s poorest places, contraceptives are nothing less than a chance to keep themselves and their children alive. I became an advocate for contraceptives because I couldn’t turn my back on women like Sharmila. And I’m going to keep sharing their stories as long as I live.