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Charlotte Lozier Institute

Phone: 202-223-8073
Fax: 571-312-0544

2776 S. Arlington Mill Dr.
#803
Arlington, VA 22206

Life & the LawAbortion

Why the Global Protect Life Rule is Right for the U.S. and Nations around the World (2025 Update)

This is Issue 107 in the On Point Series. 

Note: This is an update to a paper of the same title, previously published in 2020.

Executive Summary:

  • The Mexico City Policy (MCP), first introduced by the Reagan administration in 1984, prohibited U.S. funds for family planning from going to any foreign nongovernmental organization that “performs or actively promotes abortion as a method of family planning.”
  • Since its initial enforcement, the MCP has been revoked during Democrat administrations and reinstated during Republican administrations.
  • In 2017, President Trump restored the MCP and expanded it through Protecting Life in Global Health Assistance (PLGHA), commonly known as the “Global Protect Life Rule.” The Rule updated and significantly expanded limitations on U.S. abortion-related funding, as well as significantly decreasing the amount of taxpayer dollars going to organizations that actively promote or perform abortion.
  • However, in January 2021, President Biden rescinded the Global Protect Life Rule and resumed channeling U.S. funding to international organizations that perform or promote abortion.
  • On January 24, 2025, President Trump restored the Global Protect Life Rule from his first administration to ensure that U.S. taxpayer funding is no longer used to promote abortion overseas.
  • The U.S. has shown it can continue to meet critical healthcare needs for women while refusing to pay for the killing of unborn babies. With a shift of U.S. funding from abortion giants to organizations addressing basic healthcare needs, women can be better served—including in maternal health and mortality.

 

I. Introduction

In January 2017, President Donald Trump took a bold and unprecedented executive action[1] to restore the Mexico City Policy and extend its reach through Protecting Life in Global Health Assistance (PLGHA), commonly known as the “Global Protect Life Rule.” With this action, President Trump updated and significantly expanded the scope of limitations on U.S. abortion-related funding, also significantly decreasing the amount of taxpayer dollars going to organizations that actively promote or perform abortion. U.S. foreign aid was better funneled to alternative foreign organizations that are providing necessary healthcare in developing countries, while also respecting these countries’ cultural values and national sovereignty.

In January 2021, President Joe Biden rescinded the Global Protect Life Rule and resumed channeling U.S. funding to international organizations that perform or promote abortion. [2] The new Trump administration, however, reinstated the Global Protect Life Rule on January 24, 2025, to ensure that U.S. taxpayer funding is no longer used to promote abortion overseas.[3]

 II. Background and History

a. From Mexico City Policy to the Global Protect Life Rule

The Mexico City Policy (MCP) was first introduced by the Reagan administration at the 1984 UN International Conference on Population Development (ICPD) in Mexico City. The MCP prohibited U.S. funds for family planning from going to any foreign nongovernmental organization[4] (NGO) that “performs or actively promotes abortion as a method of family planning.”[5]  The U.S. policy statement at the 1984 ICPD directs: “U.S. support for family planning programs is based on respect for human life, enhancement of human dignity, and strengthening of the family. Attempts to use abortion, involuntary sterilization, or other coercive measures in family planning must be shunned.”[6]

Under the MCP foreign NGOs must agree, as a condition of receiving U.S. funds, that they will neither perform nor actively promote abortion as a method of family planning with any source of funding, including non-U.S. funds.[7] Before MCP,[8] and during periods in which it was not in effect, including the Biden administration, a foreign NGO could still receive U.S. funds for family planning if they used non-U.S. funds to engage in certain voluntary abortion-related activities using a segregated account for U.S. funds. The MCP does not permit this.[9]

An organization which “actively promotes abortion as a method of family planning” means a commitment of “resources, financial or other, in a substantial or continuing effort to increase the availability or use of abortion as a method of family planning.”[10] This includes advising women that abortion is an available option or encouraging them to consider it, operating a family planning center that advises or gives information on the benefits and availability of abortion, conducting campaigns to inform the public about the benefits or availability of abortion, or lobbying a government to legalize or make abortion available.[11]

Before the MCP, the 1973 Helms Amendment to the Foreign Assistance Act was instated to prohibit U.S. foreign aid from being directly used for abortion as a method of family planning or for encouraging the practice of abortion. However, with the Helms Amendment, U.S. funds can still be used indirectly to support organizations, clinics, and salaries connected with promoting or performing abortion. Eight years later, the 1981 Siljander Amendment was added to prohibit U.S. aid from being directly used to lobby for or against abortion. Unlike the Helms and Siljander Amendments, which are laws enacted by Congress and remain in place today, the Mexico City Policy has (for the most part) been implemented and/or reversed through the executive branch. Since the Reagan administration, the MCP has been revoked during Democrat administrations and reinstated during Republican administrations,[12] and has been in effect for approximately 21 of the past 40 years.[13]

As President Trump took office in January 2017, he reinstated the Mexico City Policy and updated it to further extend its provisions through Protecting Life in Global Heath Assistance (PLGHA), commonly known as the Global Protect Life Rule. While the MCP only applied to family planning funds provided through the U.S. Agency for International Development (USAID) and the State Department, the Global Protect Life Rule extended funding limitations to include U.S. global health assistance provided by all U.S. government departments or agencies.[14] This global health assistance is for programs[15] such as “HIV/AIDS, maternal and child health, malaria, global health security, family planning and reproductive health.”[16]

During the previous Trump administration, the Global Protect Life Rule applied to approximately $8.8 billion in annual funds appropriated to the State Department, USAID and the Department of Defense, of which $6 billion was funding for HIV under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program. Before President Trump instated PLGHA, MCP applied to only approximately $600 million, appropriated annually to the State Department and USAID for family planning assistance.[17] Created in 2003 as an emergency fund originally supporting only 50,000 people in sub-Saharan Africa, PEPFAR is now an ongoing international assistance program in 55 countries providing HIV treatment for 20.6 million people.[18] PEPFAR funding was $6.5 billion in FY 2024.[19] Such a significant increase in foreign aid since 1984 created a need to expand the provisions of MCP to cover a broader scope of funding and programming. This has been accomplished through the Global Protect Life Rule.

Humanitarian assistance, however, was not affected by the updated and expanded policy. This includes State Department migration or refugee-assistance programs, USAID disaster and humanitarian-relief programs, and Department of Defense disaster and humanitarian relief.[20]

In addition, Mexico City Policy and PLGHA funding limitations do not apply to:

  • Performing or referring for abortion in the case of rape, incest or when the life of the mother is in danger.[21],[22]
  • Treating “injuries or illnesses caused by illegal or legal abortions, such as emergency treatment for complications from spontaneous or induced abortion … nor does it prohibit post-abortion care.”[23],[24]
  • Giving information in response to questions about abortion, or “passive” referrals for “safe, legal abortion” when “the question is specifically asked by a woman who is already pregnant (and) … clearly states that she has already decided to have a legal abortion, and the family planning counselor reasonably believes that the ethics of the medical profession in the country requires a response regarding where it may be obtained safely.”[25]

Although U.S. NGOs are not directly affected by the Global Protect Life Rule, it does apply to subawards given to a foreign NGO by a U.S. NGO. Specifically, under PLGHA, U.S. NGOs are prohibited from giving global health assistance to a foreign NGO if that foreign NGO performs or actively promotes abortion as a method of family planning, even with non-U.S. funding, or gives funding to another foreign NGO that does the same.[26]

b. PLGHA Review

In August 2020, the State Department, HHS, and USAID released a report on the effects of PLGHA.[27] This report was designed as a follow-up to an initial six-month review published in February 2018 and provided a more comprehensive analysis of the impact of PLGHA on U.S. global health assistance.

The 2020 report found that out of 1,340 “prime awardees” of U.S. funding, only eight declined to agree to the stipulations of PLGHA. While there were a few instances in which these declinations resulted in a negative impact on health care services, “In most cases in which a recipient or sub-recipient declined to agree to the terms of PLGHA, USAID and/or the prime partner successfully transitioned activities to ensure the continuity of global health assistance.” Of the 47 sub-awardees that declined to comply with PLGHA, just 31 involved delivery of actual health services to clients. Of these 31, only 12 reported experiencing an interruption in services.[28]

c. Closing “Backdoor Loopholes” for Funding Abortion Overseas

On March 26, 2019, Secretary of State Mike Pompeo announced a “strict prohibition” on “backdoor funding schemes and end-runs” used by organizations to get around the funding limitations of PLGHA.[29] This prohibition meant that the U.S. would no longer fund foreign organizations who subcontract with or provide financial assistance (either with U.S. or non-U.S. funding) to other organizations in the global abortion industry. This action would protect “more unborn babies around the world than ever before” and enforce U.S. commitment to limit taxpayer funding of abortion overseas.

In addition, Sec. Pompeo announced the State Department would enforce the 1981 Siljander Amendment and prohibit tax dollars from being used to lobby for or against abortion. Once implemented, the enforcement directly reduced funding to the Organization of American States (OAS) in proportion to its expenditures on abortion-related activities.

III. Impact of the Global Protect Life Rule on Healthcare Funding, U.S. Taxpayers, and Developing Nations

This is a policy that is designed fundamentally to protect human beings … this is decent, this is right.

Sec. Mike Pompeo, March 2019[30]

a. U.S. Global Healthcare Funding under the Global Protect Life Rule

Along with its commitment to reject abortion as an acceptable element of family planning and no longer contribute funds to abortion-related programs,[31] the U.S. maintained its commitment to support necessary healthcare programming in vulnerable nations around the world.

Although the Global Protect Life Rule is applicable to a large amount of U.S. healthcare funding, the U.S. government made clear that the amount of global health assistance made available through U.S. foreign aid would not be reduced while the rule was in effect. Instead, the government officially stated that all U.S. departments and agencies “will reprogram to other organizations any funding they would have awarded to NGOs that do not agree to the conditions set on the acceptance of U.S. funding under Protecting Life in Global Health Assistance.”[32]

Even so, the review of PLGHA shows that the majority of prime partners eligible for PLGHA funding agreed to and accepted the policy.[33] In addition, the U.S. remained the number one country donor of international family planning and reproductive healthcare, providing $575 million dollars per year.[34]

Two organizations that devote large amounts of time and resources to the promotion of abortion in developing nations, MSI Reproductive Choices (formerly known as Marie Stopes International) and International Planned Parenthood Federation, refused to comply with the Global Protect Life Rule.[35] Due to the implementation of the rule in 2017, MSI (whose core mission includes providing and legalizing abortion)[36] estimated that it lost approximately $30 million in U.S. funds a year for family planning programs.[37] International Planned Parenthood Federation predicted a loss of up to $100 million dollars in U.S. funding “over the course of the policy.”[38]

Opponents of MCP and the Global Protect Life Rule claim that the loss of funding to organizations which refuse to comply with the policy hurts the reproductive healthcare of women in developing nations. However, only a few studies, based on questionable data, have been conducted to understand the effects of the Mexico City Policy on reproductive care. A study done by the World Health Organization 2011,[39] and a subsequent expansion of the study in 2019,[40] claims to find “a substantial increase in abortions across sub-Saharan Africa among women affected by the US Mexico City Policy” due to foreign organizations’ reduced “ability to supply modern contraceptives.”[41]

According to the study, when the policy was in effect between 2001 and 2008, “coverage of modern contraception fell and the proportion of women reporting pregnancy and abortions increased, in relative terms, among women in countries more reliant on U.S. funding.” However, according to statistical sources used in the study,[42] total global use of modern contraception actually increased[43] by 8.5% after the MCP took effect and between the years of 1990 and 2010. In Africa, modern contraception use increased by 13.5%, with a 3.2% decrease in what has been described as an “unmet need for family planning” in less-developed countries.[44] The study also showed that the use of contraception in sub-Saharan Africa doubled between 1995 to 2000, from 13.5% to 26.9%, and more than doubled by 2014 to 29.9%.[45]

An increase in contraceptive use in sub-Saharan Africa would obviously negate the final claims of this study: that MCP causes a decline in contraceptive use leading to more abortions. In addition, although the study claims the MCP had a larger impact on African countries more dependent on U.S. family planning funds, contraceptive use rates increased in similar amounts in both sets of countries studied—those more reliant on U.S. funds and those less reliant on U.S. funds.

If, indeed, abortion rates climbed in time periods during which MCP was implemented, then better research needs to be done to see why and how this can be negated. However, according to statistician Dr. Michael New, who reviewed the 2011 study, “there are also legitimate concerns about the quality of the abortion data the study analyzes.”[46] Out of the 300 potential data points used in the study, 42% are missing. In addition, large fluctuations in the incidence of abortion reported by the study are unlikely and “do not inspire confidence in the quality and reliability of public-health data from many of these African countries.” Other research employing a similar methodology has relied on abortion data of dubious quality, with one study analyzing data collected via a retrospective survey that did not differentiate between abortion and miscarriage (though the study authors themselves did attempt to differentiate miscarriages from abortions in the dataset via indirect means).[47]

After the implementation of PLGHA in 2017, several studies claimed that the new policy would lead to an increase in unintended pregnancy, abortion, and HIV. One study predicted large increases in HIV as a result of PLGHA, but analyzed data only for the period 1990-2015, extrapolating to 2017-2021.[48] Another suggested that the negative impact of PLGHA would be “significant” because of the extent of the funding to which it applied.[49]

In reality, subsequent research suggests those fears were largely unfounded. A survey of providers shortly after PLGHA went into effect in 2017 found that just 28% reported a decline in services, with most of the missing services related to sexual and reproductive health information and pregnancy counseling, provision of information on abortion, and community trainings and advocacy.[50]

Furthermore, a study of sub-Saharan Africa found that while contraceptive usage declined slightly and births increased, unintended pregnancies actually declined and abortions held steady.[51] The above-mentioned August 2020 State Department review of PLGHA notes that while there were some interruptions to services, groups declining funds under PLGHA were largely replaced by other providers, and data from the World Health Organization shows that HIV infections and deaths continued to decline over the period in which PLGHA was first in effect.[52]

The U.S. has shown it can continue to meet the most critical healthcare needs for women while refusing to pay for the killing of unborn babies. With a shift of U.S. funding from abortion giants to organizations addressing basic healthcare needs, women can be better served—including in maternal health and mortality. The shift in U.S. funding away from abortion is consistent with the desires of American taxpayers, and with the moral, cultural and religious beliefs of the majority of people around the world, strengthening U.S.-foreign relations.

b. Why the Global Protect Life Rule Is Good for America

Most Americans, even those who self-identify as “pro-choice,” do not want to pay for abortions in other countries. According to a 2025 national survey, an overwhelming majority of Americans (73%) oppose or strongly oppose using U.S. tax dollars to support abortion in other countries.[53] A majority opposition is evident across all political parties and regardless of views on abortion. Fifty-five percent of Democrats, 88% of Republicans, and 78% of Independents “oppose or strongly oppose” using U.S. foreign aid to fund abortions overseas. In addition, 63% of those who identify as “pro-choice” and 88% of those who are “pro-life” say they “oppose or strongly oppose” supporting abortion in other countries.

c. Why the Global Protect Life Rule Is Good for Countries U.S. Aid Aims to Help

In addition, abortion is not morally or culturally acceptable within the cultures of many countries, particularly in countries targeted by U.S. foreign aid. A study conducted by Pew Research Center in 2014 demonstrates that in 26 out of 40 countries surveyed, the majority of respondents believe abortion is “morally unacceptable.”[54] Most of the countries with this belief lie in sub-Saharan Africa, Latin America, and the Muslim-majority countries of Asia and the Middle East. In all six of the African countries surveyed, the majority of people believe abortion is morally wrong — 92% Ghanaians, 88% Ugandans, 82% Kenyans, 80% Nigerians, 61% South Africans, and 52% Senegalese.[55] In fact, almost 80% of countries in Africa have a law which prohibits or restricts abortion in some way.[56] In a similar survey of 27 countries conducted by Pew Research Center in 2024, majorities of adults in all three African countries surveyed (South Africa, Kenya, and Nigeria) believed that abortion should be illegal in all or most cases.[57]

U.S. refusal to contribute to the promotion of abortion in these countries can be a boon for U.S. public diplomacy.[58] In his 2015 address to the 70th UN General Assembly, Pope Francis warned against Western powers promoting values that are “alien” to citizens of developing countries, calling it “Ideological Colonialization,”[59] a dangerous concept also referred to as “Imperial Culturalism.” Pope Francis reminded member states to recognize “a moral law written into human nature itself, one which includes … an absolute respect for life in all its states and dimensions.”[60] Nigerian-born Obianuju Ekeocha echoed this in her speech at the UN in 2016, saying, “At the core of my people’s value system is the profound recognition that human life is precious, paramount and supreme.”[61] Unfortunately, the most marginalized and vulnerable nations sometimes feel coerced to accept Western “progressive” social values in order to receive Western aid.

IV. Three Facts about Abortion and Women’s Empowerment

In spite of the fact that an overwhelming majority of Americans oppose international abortion funding, and in spite of the fact that the U.S. continues to fully provide global healthcare assistance, abortion activists still demand that U.S. funds should go to organizations actively promoting or performing abortion. Western-based organizations such as International Planned Parenthood Federation,[62] MSI Reproductive Choices,[63] Ipas,[64] the World Health Organization,[65] the UN Population Fund,[66] and the Gates Foundation[67] spend millions of dollars toward the promotion of abortion under the premise of “ensuring rights and choices” and as an integral part of reducing maternal mortality rates[68] in places such as Africa, Asia, and Latin America.[69] Additionally, the UN Population Fund, although officially claiming not to fund or promote abortion, provides “maternal health supplies” that includes the abortion drugs mifepristone and misoprostol.[70] The same UNFPA “Supplies Partnership” 2020 annual report lists as one of its “achievements” that “8 countries conducted national quantification for Comprehensive Abortion Care (CAC) supplies including mifeprestone [sic] and misoprostol.”[71]

a. Abortion Is Not an International Right

Contrary to assertions of “pro-choice” advocates, abortion is not an international right. According to international consensus at the United Nations (UN) and the Organization of American States (OAS), the legalization of abortion is under the discretion and national sovereignty of member states. As the 1994 UN ICPD Programme of Action recognizes: “Any measures or changes related to abortion within the health system can only be determined at the national or local level according to the national legislative process” (8.25). The Programme also states that “governments should take the appropriate steps to help women avoid abortion, which in no case should be promoted as a method of family planning” (8.25 and 7.24).

In addition, U.S. presidents and other senior government officials have made it clear that the U.S. position, under both Democrat and Republican administrations, was not, nor has it ever been, to create an international right to abortion.[72]

During the first Trump administration, the U.S. championed the Geneva Consensus Declaration at the United Nations, joining 33 other nations in reaffirming the right to life and emphasizing that abortion should never be promoted as a family planning method and that abortion policy should be determined by each individual country.[73] Under the Biden administration, the U.S. was removed from the declaration; however, on January 24, 2025, the U.S. State Department announced the U.S.’s intent to rejoin,[74] and the United States Mission to the United Nations confirmed that the U.S. has officially rejoined the Geneva Consensus Declaration as a member nation.[75] Many of the current signatories are recipients of U.S. family planning aid.[76]

b. Abortion is Not Integral to Decreasing Maternal Mortality

According to the United Nations Population Fund, there were approximately 287,000 maternal deaths in 2020.[77] A 2014 study[78] found that 52% of maternal deaths were attributable to one of the three leading causes of maternal deaths: hemorrhaging (the leading cause at 27%), hypertensive disorders, and sepsis; 28% of women died from indirect causes such as HIV. Only 8% of maternal deaths were attributable to abortion, a category that included miscarriage and ectopic pregnancy.

Deaths from both “safe” and “unsafe” abortion are known to be drastically undercounted.[79] However, multiple studies from nations with national registries of pregnancy outcomes and deaths show that mortality is higher in the year following an abortion than following a birth, undermining claims that abortion access will lower maternal mortality.[80] According to the American Association of Pro-Life Obstetricians and Gynecologists, the promotion of legalized abortion under “the guise of ‘decreasing unsafe abortion’” is a “dangerous diversion of financial resources from interventions known to reduce maternal mortality … [such as] prenatal care, skilled birth attendants, antibiotics and oxytocics [drugs to reduce hemorrhaging].”[81] Two obstetricians who lead an NGO promoting maternal health in Africa say Western aid has failed to focus on the causes responsible for 90% of maternal deaths — causes that “have been effectively treated in the developing world for nearly one hundred years”:

Vast resources, which should have been directed to…essential obstetrical care, have gone to a different agenda — so called “reproductive health.” Rather than focus on the real causes and solutions to maternal mortality, (we have) become entangled within a “reproductive rights”  agenda, which emphasizes access to contraception and promotes abortion. In the middle of the night, a woman bleeding to death from a post-partum hemorrhage cannot be saved by a contraceptive device or a reproductive health mandate. An asphyxiated newborn cannot be resuscitated by the failed intent to prevent his or her conception.[82]

c. Abortion Does Not Empower Women and Girls in Developing Countries

Kenyan-born Ann Mutave Kioko has advocated at the UN for African women and girls, calling on foreign aid-donor countries to stop promoting abortion in developing countries and address the real needs of women.

At a UN panel during the 63rd Commission on the Status of Women in 2019,[83]  Kioko contradicted the premise that African women need or want abortion services: “Contrary to what the negotiators of some countries argue here or … push on countries in the developing world, a young girl in a village like mine … does not need policies that prioritize abortion. … It is time we brought the women in the grassroots to the table. They will tell you they don’t need abortion … to be empowered. The women carrying water cans, the women carrying their daughters on their back to go to hospital or to get health care, they will never tell you they need such kind of priorities.” Kioko ended by summing up what African women believe the priorities of Western foreign aid should be: “[Women] need fully equipped health centers, they need good schools, they need clothing, they need food on their tables! They need electricity. And they need to be imparted with proper skills so they can be good career women. … I keep looking forward to that day the UN and those who are speaking and working for the women of the world will get the priorities of the women at the grassroots correct.”

V. Funds Directed to Organizations that Perform and Promote Abortion While the Rule was Rescinded

After the Global Protect Life Rule was rescinded under the Biden administration, pro-abortion organizations once again became eligible for U.S. global health assistance funds. In November 2023, USAID awarded $45 million over five years to International Planned Parenthood Federation as part of USAID’s Expand Family Planning and Sexual and Reproductive Health activity (ExpandPF).[84] IPPF’s 2023 annual report shows that the organization received the first installment of $340,000 from USAID that year.[85]

Although the report does not indicate exactly how the ExpandPF funds were spent, it reflects IPPF’s overall emphasis on abortion provision and promotion. IPPF member organizations convened a new consortium to expand abortion throughout all of Africa, with a mission of promoting a “vision of universal abortion rights” throughout the continent. In Central America, IPPF expanded abortion to rural women, performing more than 500 abortions under the new initiative in 2023. In New Zealand, an IPPF member rolled out “abortion by phone” to make abortion drugs more broadly available. IPPF provided abortion funding in war-torn Ukraine, including training in abortion for 633 clinical service providers. IPPF also advocated for abortion at the United Nations and “played a critical role” in enshrining abortion in the French constitution.[86]

According to USASpending.gov, starting in FY 2023, USAID has obligated more than $3 million over a five-year period to Population Services Zimbabwe, an affiliate of MSI Reproductive Choices.[87] MSI was active in pressuring the Zimbabwean Ministry of Health and Childcare to publish revised guidelines on abortion to expand access to the procedure.[88]

Additionally, MSI received over $3 million in funding from IPPF in 2023, and also provides funding to IPPF in turn.[89] Both organizations collaborate on the Women’s Integrated Sexual Health (WISH) program, which is funded by the U.K.,[90] demonstrating how government funding can underwrite organizational bottom lines and enable funds to trickle to other like-minded groups.[91]

IPPF estimated that, if the Global Protect Life Rule were reinstated (as it now has been under the current Trump administration), it would lose $60 million in funding,[92] and MSI anticipates a loss of $14 million.[93] As was the case during the first Trump administration, these funds can now be redirected to awardees that are willing to abide by the terms of the Global Protect Life Rule.

VI. Conclusion

In 1984, the Reagan administration took decisive action by instating the Mexico City Policy to respect human life and enhance human dignity, no longer contributing U.S. tax dollars to the indirect international funding of abortion as a method of family planning. Thirty-five years later, the Trump administration continued to uphold this commitment through Protecting Life in Global Health Assistance, or the Global Protect Life Rule, having significantly expanded the scope of the policy from $600 million in annual family planning funds to $8.8 billion in annual global healthcare assistance. After the Biden administration rescinded the rule and funneled taxpayer dollars to international abortion organizations, the new Trump administration, having reinstated the Rule, now has an opportunity to build on the work of the first four Trump years.

The Global Protect Life Rule greatly decreases the amount of U.S. taxpayer dollars that are used for abortion-related services in foreign countries, redirecting U.S. aid to organizations providing necessary healthcare. At the same time, the Global Protect Life Rule directly reflects the desires of U.S. taxpayers, upholds international consensus on abortion, and respects the cultural values of the countries that U.S. foreign aid seeks to help.


[1] Presidential Memorandum. January 23, 2017. Web accessed January 15, 2025 at https://trumpwhitehouse.archives.gov/presidential-actions/presidential-memorandum-regarding-mexico-city-policy/.

[2] Biden rescinds abortion restrictions on US foreign aid. January 28, 2021. AP News. Web accessed January 27, 2025 at https://apnews.com/article/joe-biden-donald-trump-ronald-reagan-mexico-health-07bbd77ae3abc37804d4970e473d06ca.

[3] Memorandum for the Secretary of State, the Secretary of Defense, the Secretary of Health and Human Services, the Administrator of the United States for International Development. January 24, 2025. Web accessed February 3, 2025 at https://www.whitehouse.gov/presidential-actions/2025/01/memorandum-for-the-secretary-of-state-the-secretary-of-defense-the-secretary-of-health-and-human-services-the-administrator-of-the-united-states-for-international-development/; Fact Sheet: President Donald J. Trump Enforces Overwhelmingly Popular Demand to Stop Taxpayer Funding of Abortion. January 25, 2025. Whitehouse.gov. Web accessed January 27, 2025 at https://www.whitehouse.gov/fact-sheets/2025/01/fact-sheet-president-donald-j-trump-enforces-overwhelmingly-popular-demand-to-stop-taxpayer-funding-of-abortion/.

[4] HHS states: “Global health assistance to national or sub-national governments, public international organizations, and other multilateral entities in which sovereign nations participate is not subject to this policy. For example, this includes funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria; GAVI, the Vaccine Alliance; and United Nations organizations such as the Joint United Nations Programme on HIV/AIDS and the World Health Organization.” HHS. Protecting Life in Global Health Assistance Frequently Asked Questions. August 27, 2018. https://grants.nih.gov/grants/files/hhs-interagency-plgha-faqs.pdf.

[5] Restoration of the Mexico City Policy, 66 Federal Register 17303 (Mar. 28, 2001) at 17306, Secs. I. (e)(1). Web accessed February 25, 2020 at: https://www.federalregister.gov/documents/2001/03/29/01-8011/restoration-of-the-mexico-city-policy.

[6] Policy Statement of the United States of America at the United Nations International Conference on Population (second session) Mexico, D.F. August 16-13, 1984. Web accessed January 16, 2025 at https://web.archive.org/web/20230908063653/https://www.uib.no/sites/w3.uib.no/files/attachments/mexico_city_policy_1984.pdf.

[7] HHS. Protecting Life in Global Health Assistance Frequently Asked Questions. August 27, 2018. https://grants.nih.gov/grants/files/hhs-interagency-plgha-faqs.pdf, p. 18.

[8] Under the Helms Amendment of 1973

[9] Congressional Research Service, International Family Planning: The “Mexico City” Policy, updated April 2, 2001, RL30830, p.3. https://www.everycrsreport.com/reports/RL30830.html.

[10] Restoration of the Mexico City Policy, 66 Federal Register 17303 (Mar. 28, 2001) at 17306, Secs. I. (e)(10)(iii) web accessed January 17, 2025 at: https://www.federalregister.gov/documents/2001/03/29/01-8011/restoration-of-the-mexico-city-policy.

[11] Restoration of the Mexico City Policy, 66 Federal Register 17303 (Mar. 28, 2001) at 17306, Secs. I. (e)(10)(iii)(A) (I-IV).

[12] Congressional Research Service. Updated July 15, 2022. Abortion and Family Planning-Related Provisions in US Foreign Assistance Law and Policy. R41360.  Found at: https://crsreports.congress.gov/product/pdf/R/R41360.

[13] KFF Factsheet. October 25, 2024. https://www.kff.org/global-health-policy/fact-sheet/mexico-city-policy-explainer/# (see Table 1). A portion of the policy was temporarily imposed legislatively for one year.

[14] The Mexico City Policy. Presidential Memorandum. Federal Register/Vol. 82., No. 15/Wednesday, January 25, 2017. 8495. Web accessed February 23, 2020 at https://www.federalregister.gov/documents/2017/01/25/2017-01843/the-mexico-city-policy.

[15] HHS. Protecting Life in Global Health Assistance Frequently Asked Questions. See p. 5: “[For The Department of Health and Human Services (HHS), global health assistance at this time includes funding transferred to HHS from the Department of State, USAID, or the U.S. Department of Defense (DoD) for international health programs, such as those for HIV/AIDS, maternal and child health, tuberculosis, malaria, and global health security. PLGHA applies to global health assistance provided to, or implemented by, foreign NGOs, including those to which a U.S. NGO issues a subaward with such funds.] [For DoD, global health assistance applies to the Defense HIV/AIDS Prevention Program, which works around the world to reduce the transmission and impact of HIV/AIDS in partner militaries, in close coordination with the U.S. President’s Emergency Plan for AIDS Relief.] …  This policy applies to awards for PEPFAR and PMI.”

[16] HHS. Protecting Life in Global Health Assistance Frequently Asked Questions.

[17] Background Briefing: Senior State Department Officials on Protecting Life in Global Health Assistance. May 15, 2017. Web accessed January 16, 2025 at: https://2017-2021.state.gov/background-briefing-senior-administration-officials-on-protecting-life-in-global-health-assistance/.

[18] HIV.gov. PEPFAR & Global AIDS. What is PEPFAR? Web accessed February 27, 2020 at: https://www.hiv.gov/federal-response/pepfar-global-aids/pepfar; PEPFAR Latest Global Program Results(Dec. 2024), https://www.state.gov/wp-content/uploads/2024/11/PEPFAR-Program-Results-Fact-Sheet-December-2024.pdf; PEPFAR Celebrates 20th Anniversary (January 2023), https://www.hiv.gov/blog/pepfar-celebrates-20th-anniversary.

[19] The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), KFF.org, https://www.kff.org/global-health-policy/fact-sheet/the-u-s-presidents-emergency-plan-for-aids-relief-pepfar/.

[20] HHS. Protecting Life in Global Health Assistance Frequently Asked Questions.

[21] Restoration of the Mexico City Policy, 66 Federal Register 17303 (Mar. 28, 2001) at 17306, Secs. I. (e)(10)(iii)(A) (I-IV).

[22] HHS. Protecting Life in Global Health Assistance Frequently Asked Questions.

[23] Restoration of the Mexico City Policy, 66 Federal Register 17303 (Mar. 28, 2001) at 17306, Secs. I. (e)(10)(iii)(A) (I-IV).

[24] HHS. Protecting Life in Global Health Assistance Frequently Asked Questions.

[25] Restoration of the Mexico City Policy, 66 Federal Register 17303 (Mar. 28, 2001) at 17306, Secs. I. (e)(10)(iii)(A) (I-IV).

[26] HHS. Protecting Life in Global Health Assistance Frequently Asked Questions.

[27] Review of the Implementation of the Protecting Life in Global Health Assistance Policy. usaid.gov. https://2017-2020.usaid.gov/open/plgha/2019.

[28] Ibid.

[29] Remarks to the Press. Michael R. Pompeo, Secretary of State. March 26, 2019. Web accessed January 16, 2025 at https://2017-2021.state.gov/remarks-to-the-press-7/.

[30] Ibid.

[31] Policy Statement of the United States of America at the United Nations International Conference on Population (second session) Mexico, D.F. August 16-13, 1984. Web accessed February 22, 2020 at https://www.uib.no/sites/w3.uib.no/files/attachments/mexico_city_policy_1984.pdf.

[32] Protecting Life in Global Health Assistance Six-Month Review. February 6, 2018. Web accessed via U.S. Dept of State website at: https://2017-2021.state.gov/wp-content/uploads/2019/06/PLGHA-6-month-review-final-for-posting.pdf Pp. 4-5.

[33] Review of the Implementation of the Protecting Life in Global Health Assistance Policy: Executive Summary. USAID.gov. https://2017-2020.usaid.gov/open/plgha/2019.

[34] Congressional Research Service. February 6, 2020. U.S. Bilateral International Family Planning and Reproductive Health Programs: Background and Selected Issues. R46215. Web accessed January 16, 2025 at: https://crsreports.congress.gov/product/pdf/R/R46215/2.

[35] Planned Parenthood and Marie Stopes Have Refused to Comply with Trump’s Pro-Life Policy.  Dr. Susan Berry. February 8, 2018. Breitbart. https://www.breitbart.com/politics/2018/02/08/planned-parenthood-and-marie-stopes-have-refused-to-comply-with-trumps-pro-life-policy/.

[36] MSI Reproductive Choices. Who We Are. Website: https://www.msichoices.org/what-we-do/.

[37] Congressional Research Service. Protecting Life in Global Health Assistance Policy. In Focus. October 26, 2018, https://www.everycrsreport.com/files/2018-10-26_IF11013_f16305d70873c821f9954fd4f00f30eed145de6c.pdf, p. 1; See also International Planned Parenthood Federation. Policy Briefing: The Impact of the Global Gag Rule. January 2019, https://www.ippf.org/sites/default/files/2019-01/IPPF%20GGR%20Policy%20Briefing%20-%20January%202019.pdf, p. 2.

[38] Ibid. See also IPPF.org. Global Gag Rule. Web accessed January 17, 2025 at https://www.ippf.org/news/global-gag-rule-expansion-will-leave-fatal-legacy-generations.

[39] Benadavid, E. et al. (2011) United States aid policy and induced abortion in sub-Saharan Africa. World Health Organization. Found at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3260902/.

[40] Brooks, N., et al. (2019) US Aid Policy in Sub-Saharan Africa: An Analysis of the Mexico City Policy. The Lancet. June 27, 2019. Vol. 7 Issue 8. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30267-0/fulltext.

[41] Brooks et al.

[42] UN Population Division’s World Contraceptive Use dataset, https://www.un.org/development/desa/pd/data/world-contraceptive-use.

[43] An increase in contraception use has been associated with a decrease in maternal mortality rates. See “USAID Family Planning and Reproductive Health Program Overview,” January 2024. https://www.usaid.gov/sites/default/files/2024-01/USAID%20Family%20Planning%20and%20Reproductive%20Health%20Program%20Overview%20-%20Jan%202024.pdf.

[44] Alkema, L. et. al, 2013. National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. The Lancet. Vol. 381, Issue 9878, pp. 1642-1652, found on p. 1645.

[45] Brooks et al.

[46] New, Michael. January 25, 2017. “World Health Organization’s Study on Mexico City Policy is Flawed,” National Review. Web accessed at https://www.nationalreview.com/corner/mexico-city-policy-who-study-abortion-rate-africa-wrong/.

[47] Van der Muelen Rodgers Y. Chapter 6: Impact of the Global Gag Rule: new estimates. In: Van der Muelen Rodgers Y, The Global Gag Rule and Women’s Reproductive Health. Oxford University Press; 2018.

[48] Kavakli KC, Rotondi V. US foreign aid restrictions and maternal and children’s health: Evidence from the “Mexico City Policy”. Proc Natl Acad Sci U S A. 2022;119(19):e2123177119. doi:10.1073/pnas.2123177119.

[49] Schaaf M, Maistrellis E, Thomas H, Cooper B; GGR Research Working Group . ‘Protecting Life in Global Health Assistance’? Towards a framework for assessing the health systems impact of the expanded Global Gag Rule. BMJ Glob Health. 2019;4(5):e001786. doi:10.1136/bmjgh-2019-001786.

[50] Sherwood J, Roemer M, Honermann B, Jones A, Millett G, Decker MR. Restrictions on US global health assistance reduce key health services in supported countries. Health Aff (Millwood). 2020;39(9):1557-1565. doi:10.1377/hlthaff.2020.00061.

[51] Sully EA, Seme A, Shiferaw S, Chiu DW, Bell SO, Giorgio M. Impact of the global gag rule on women’s contraceptive use and reproductive health outcomes in Ethiopia: a pre-post and difference-in-difference analysis. BMJ Open. 2023;13(5):e063099. doi:10.1136/bmjopen-2022-063099.

[52] HIV data and statistics. World Health Organization. Published 2024. Accessed January 20, 2025. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics.

[53] Knights of Columbus/Marist poll. January 7 through January 9, 2025. Accessed January 23, 2025. https://www.kofc.org/en/resources/communications/polls/2025-marist-poll-results-all-crosstabulations.pdf.

[54] Pew Research Center. Global Views on Morality. Abortion. Web accessed January 21, 2025 at https://web.archive.org/web/20190211022240/http://www.pewglobal.org/2014/04/15/global-morality/table/abortion/.

[55] Pew Research Center (2014)

[56] Ekeocha, Obianuju (2018) Target Africa. Ignatius Press, San Francisco. p. 101. See also Center for Reproductive Rights. Maputo Protocol at 20: Progress on Abortion Rights in Africa. Accessed January 20, 2025. https://reproductiverights.org/wp-content/uploads/2023/06/CRR_Maputo-Protocol_4pg_web.pdf.

[57] Support for legal abortion is widespread in many places, especially in Europe. Janell Fetterolf and Laura Clancy. Pew Research Center. May 15, 2024. https://www.pewresearch.org/short-reads/2024/05/15/support-for-legal-abortion-is-widespread-in-many-countries-especially-in-europe/.

[58] Garrison, Shea. February 15, 2019. “Trump UN Social Policy Strengthens U.S.-Foreign Relations: Reject Neocolonialism and Uphold National Sovereignty”. Counterpoint 002. Concerned Women for America. Web accessed at: https://concernedwomen.org/trump-un-social-policy-strengthens-u-s-foreign-relations-reject-neocolonialism-and-uphold-national-sovereignty/.

[59] BBC News. September 2015. Pope Frances Stresses ‘right to environment’ in UN Speech. https://www.bbc.com/news/world-us-canada-34360928.

[60] Meeting with the Members of the General Assembly of the United Nations Organization. Address of the Holy Father. United Nations Headquarters, New York. Friday 25, 2015. Found at: http://w2.vatican.va/content/francesco/en/speeches/2015/september/documents/papa-francesco_20150925_onu-visita.html.

[61] United Nations panel (2016) “Best Practices for Maternal Health in Africa” found at: https://www.youtube.com/watch?v=C87sGuXXntw.

[62] https://www.ippf.org

[63] https://www.msichoices.org/

[64] https://www.ipas.org

[65] World Health Organization (2022) Abortion care guideline. https://www.who.int/publications/i/item/9789240039483.

[66] United Nations Population Fund. Assessment 04: human rights standards on comprehensive abortion care. Accessed January 20, 2025. https://www.unfpa.org/universal-sexual-reproductive-health-rights-calculator/human-rights-standards-on-comprehensive-abortion-care.

[67] Parsons T. Gates foundation commits $40 million to improve reproductive health in the developing world. Accessed January 20, 2025. https://www.gatesfoundation.org/ideas/media-center/press-releases/2003/06/bloomberg-school-of-public-health-receives-grant.

[68] Yoshihara SDF. Lost in translation: the failure of the international reproductive rights norm. Ave Maria Law Review. 2017;11(2):367-409. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2992609.

[69] World Health Organization. Abortion (2024). https://www.who.int/news-room/fact-sheets/detail/abortion.

[70] United Nations Population Fund. Welcome to the UNFPA supplies partnership 2021-2030. Accessed January 20, 2025. https://www.unfpa.org/sites/default/files/pub-pdf/Welcome_to_the_UNFPA_Supplies_Partnership_2021-2030.pdf.

[71] UNFPA Supplies Annual Report 2020 | United Nations Population Fund. Accessed January 21, 2025.  https://www.unfpa.org/publications/unfpa-supplies-annual-report-2020. Download “EN,” see pg. 14.

[72] President Donald J. Trump. 74th Address to the United Nations General Assembly. September 2019, https://trumpwhitehouse.archives.gov/briefings-statements/remarks-president-trump-74th-session-united-nations-general-assembly/; Vice President Al Gore. Speech at the National Press Club. August 26, 1994; Ambassador Michael Kozak. State Department Press Conference. March 11, 2019. https://2017-2021.state.gov/ambassador-michael-kozak-bureau-of-democracy-human-rights-and-labor-on-the-release-of-the-2018-country-reports-on-human-rights-practices/.

[73] Geneva Consensus Declaration on Promoting Women’s Health and Strengthening the Family. December 2, 2020. Accessed January 20, 2025. https://documents.un.org/doc/undoc/gen/n20/344/30/pdf/n2034430.pdf.

[74] Secretary of State Marco Rubio. United States Renewed Membership in the Geneva Consensus Declaration on Promoting Women’s Health and Strengthening the Family. January 24, 2025. Accessed January 27, 2025. https://www.state.gov/united-states-renewed-membership-in-the-geneva-consensus-declaration-on-promoting-womens-health-and-strengthening-the-family/.

[75] United States Mission to the United Nations. Exec 2025-08. January 24, 2025. Accessed January 27, 2025. https://www.theiwh.org/wp-content/uploads/2025/01/Diplomatic-Note-Rejoining-the-Geneva-Consensus-Declaration-Coalition-EXEC-2025-08.pdf.

[76] The Geneva Consensus Declaration. Institute for Women’s Health. Accessed January 20, 2025. https://www.theiwh.org/the-gcd/.

[77] Maternal health. United Nations Population Fund. Accessed January 20, 2025. https://www.unfpa.org/maternal-health.

[78] Say, Lale, et al. (2014) “Global Causes of Maternal Death: A WHO systematic analysis.” Lancet Global Health 2014. Web accessed January 16, 2025, at https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70227-X/fulltext.

[79] Say et al.; Studnicki J, Reardon D, Harrison D, et al. Improving the metrics and data reporting for maternal mortality: a challenge to public health surveillance and effective prevention. Online J Public Health Inform. 2019;11(2):e17. doi:10.5210/ojphi.v11i2.10012.

[80] Skop I. Fact check: “abortion is 14 times safer than childbirth.” Charlotte Lozier Institute. Published April 25, 2024. Accessed January 20, 2025. https://lozierinstitute.org/fact-check-abortion-is-14-times-safer-than-childbirth/.

[81] American Association of Pro-Life Obstetricians and Gynecologists. AAPLOG objection to inclusion of “Universal Access to Reproductive Healthcare” as a part of MDG 5-Letter to UN High Commissioner on Human Rights. November 7, 2009. https://aaplog.org/aaplog-objection-to-inclusion-of-universal-access-to-reproductive-healthcare-as-a-part-of-mdg-5-letter-to-un-high-commissioner-on-human-rights/.

[82] Mulcaire-Jones, George; Scanlon, Robert. (2011) “Safe passages Pro-Life Response to the Tragedy of Maternal Deaths.” GWHR Symposium. The Linacre Quarterly 78(2) (May 2011): 202-210. Pp. 202-203.

[83] UN Web TV. March 19, 2019. “Protecting Femininity and Human Dignity in Women’s Empowerment and Gender Equality Policies Today – CSW63 Side Event” Web accessed January 17, 2025 at: https://web.archive.org/web/20190614023038/http://webtv.un.org/watch/protecting-femininity-and-human-dignity-in-womens-empowerment-and-gender-equality-policies-today-csw63-side-event/6015807691001/.

[84] IPPF is awarded USAID-funded ExpandPF. International Planned Parenthood Federation. Published November 24, 2023. Accessed January 20, 2025. https://www.ippf.org/news/ippf-awarded-usaid-funded-expandpf.

[85] IPPF in 2023: annual report and financial statements. International Planned Parenthood Federation. Published October 14, 2024. Accessed January 20, 2025. https://www.ippf.org/resource/ippf-2023-annual-report-and-financial-statements.

[86] Ibid.

[87] Population Services Zimbabwe. USA Spending. Accessed January 20, 2025. https://www.usaspending.gov/award/ASST_NON_72061323CA00008_7200.

[88] Zimbabwe passes revised comprehensive abortion care guidelines. MSI United States. Accessed January 20, 2025. https://www.msiunitedstates.org/zimbabwe-passes-revised-comprehensive-abortion-care-guidelines/.

[89] Choose choice: 2023 annual report and financial statements. MSI Reproductive Choices. Accessed January 20, 2025. https://www.msichoices.org/wp-content/uploads/2024/07/MSI_Full-Annual-Report-2023_WEB.pdf; IPPF 2023 annual report and financial statements.

[90] WISH: New flagship health programme to transform the lives of millions of women and girls. MSI Choices. Published November 13, 2018. Accessed January 20, 2025.

https://www.msichoices.org/latest/new-flagship-health-programme-to-transform-the-lives-of-millions-of-women-and-girls/.

[91] Duffy K. Your taxes are funding abortion on-demand overseas. Christian Concern. Published November 23, 2020. Accessed January 20, 2025. https://christianconcern.com/comment/your-taxes-are-funding-abortion-on-demand-overseas/.

[92] The Global Gag Rule. International Planned Parenthood Federation. Accessed January 20, 2025. https://www.ippf.org/global-gag-rule.

[93] US election: ‘The world’s poorest women and girls will pay the price’ if Global Gag Rule is reimposed. MSI Reproductive Choices. Published November 6, 2024. Accessed January 20, 2025. https://www.msichoices.org/latest/us-election-the-worlds-poorest-women-and-girls-will-pay-the-price-if-global-gag-rule-is-reimposed/.

 

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