Expert Panel Discusses Threats to Reproductive Rights

Anti-rights movements are growing—and removing protections over abortion rights is just the start.  The new Trump administration will officially take office on January 20. This is expected to come with many changes, although the specifics remain to be seen.  

A major concern is scaling back reproductive rights even further than during Trump’s previous tenure in office. To start the conversation around how to better prepare and organize this time around, the Department of Population and Family (PopFam) held a webinar on December 12th to discuss the potential expansion of the Global Gag Rule and its implications for reproductive rights and the global health landscape.  

The panel brought together experts in the field, including researchers, advocates, and leaders. The speaker line-up consisted of Sara Casey (an assistant professor in PopFam), Esther Kimani (Founder and Executive Director of the Zamara Foundation), Nabeeha Kazi Hutchins (President and CEO of PAI), Rachel Clement (Senior director of U.S. Government Strategy at PAI), and Beth Schlachter (Senior Director of US External Relations at MSI Reproductive Choices), with PopFam Chair Thoai Ngo serving as moderator.  

Going Back to the Start 

The Global Gag Rule (GGR) is a policy that originated 40 years ago under the Reagan administration. The goal of the policy is to scale back or prevent any abortion-related services provided globally.   

“The Global Gag Rule prohibits foreign nongovernmental organizations from receiving U.S. government funding if they provide, advocate for, or refer to abortion services,” said Ngo in his opening. “Importantly, while U.S. funding never directly supports abortion services overseas, the GGR requires NGOs to agree not to engage in any abortion-related activities, even using their funds.”  

Initially termed the Mexico City Policy, it was later renamed the Protecting Life in Global Health Assistance Policy in 2017. Since its introduction, it has been an on-again, off-again policy. Historically, Republic presidents have enacted the policy, and it is then reversed when the administration changes hands. It has been intermittently in place for a total of 21 years since it was first signed into action in 1984.  

The policy is not new, but it was expanded under the Trump-Pence administration. Previously, only family planning aid was affected by the policy. In 2017, nearly all global health funding was impacted. This amounted to $11 billion, a significant increase from the $400 to $500 million encompassed under former iterations of the GGR where only family planning assistance was impacted.  

The expanded GGR disrupted critical health services beyond abortion. It affected programs addressing contraception, HIV/AIDS (including PEPFAR), maternal and child health, tuberculosis, malaria, and more.  

The true toll of the GGR is felt by women and girls who are denied essential health services.  For instance, MSI Reproductive Choices estimated that the expansion of GGR under the Trump-Pence Administration left 8 million women unserved across its global programs, resulting in 20,000 unnecessary maternal deaths. “These are the real-life implications of the policy,” Beth Schlachter noted. 

A Movement Built Over Time 

The U.S. is the largest global health funder, providing 66 percent of global aid  for sexual, reproductive, and maternal health services. Given this heavy reliance on U.S. government funding, each reversal and reinstatement of the GGR becomes a “shock to the system” for public health programs in low- and middle-income countries (LMICs).  But this singular policy is not the whole story.  

Schlachter explained: “The Global Gag Rule is just a part of a broader effort by Republicans, particularly under the first Trump administration, to expand a different kind of a normative standard and a defunding of the existing system to impose their worldview on the rest of us.”  

The anti-rights movement has continued to grow and prepare for its next phase.  

“The opposition funds long-term,” said Nabeeha Kazi Hutchins. “They are funding with a very specific, coordinated approach to dismantle and derail rights.”  

Advocacy, on the other hand, she says, is more reactionary and responds with a short-term view.  

Kazi Hutchins added: “Fundamentally, the mindset and the orientation needs to shift to recognize that it’s apples to oranges when we talk about our response, even when we're talking about trying to get ahead of mitigating some of the harm.”  

Panelists urged governments and philanthropic donors to step up their investments and take bold, decisive action. Protecting and advancing sexual and reproductive health and rights (SRHR) is critical to ensuring progress toward gender equity in this new era—especially when we have the science, expertise, and leadership of the reproductive justice community to guide us.  

A Chilling Effect Was Felt Around the World

The impact of the GGR goes far beyond abortion services. Health facilities and programs were completely shut down, and ultimately, “it's the clients that suffer,” said Sara Casey, who studied the impact of the GGR in Nepal, Kenya, and Madagascar.  

Her team also observed a “chilling effect”, where organizations would self-censor or overinterpret the policy to ensure compliance and avoid losing funding. A knock-on effect of this is that it “ engendered mistrust between organizations that previously collaborated.”

Trust is a crucial part of service provision and has often been built up over time, not just between organizations but also within communities.  

“It’s hard to earn that trust back again,” said Schlachter. “These are not fractures in a system that are easily overcome. It takes years and sometimes generations to rebuild that kind of trust.”  

Esther Kimani said she had seen the effects of this herself in Kenya, with women losing access to contraceptives as local clinics were forced to close down.  

“The policy created divisions,” she said.   

It forced local groups on the ground to make a choice: Maintain longstanding partnerships and provide crucial family planning services or risk losing U.S. funding and potentially shutter entire operations depriving communities of other necessary healthcare.  

Kimani said the solution is to reduce reliance on foreign aid and advocate for local governments to allocate more resources to these services.  

Expected Expansion and the Role of Advocacy 

“The Global Gag Rule has continued to disproportionately harm marginalized communities,” said Kimani. “As advocates, all of us, we should be able to advocate to have in place policies that continue to protect, and respect reproductive justice instead of those that do the opposite."  

The GGR is expected to get even worse in its 2025 iteration.   

Ngo asserted: “Looking ahead, it is likely that the new U.S. administration will extend GGR policy to include U.S. NGOs, bilateral programs, and multilateral organizations, further amplifying its negative impact.”  Under the new administration, the expanded GGR could impact more than $51 billion in U.S. foreign aid.  

Clement said we should expect to see an expansion of abstinence-only messaging, as well as greater prioritization of family planning within the context of heterosexual marriages. This will lead to increases in unintended adolescent pregnancies and maternal deaths.  

She highlighted that we should also expect local funding to be tainted, as “what the U.S. government does abroad is sort of a test for what we can do at home."

Hutchins noted that eproductive freedom is highly valued in the U.S., and people continuously vote to protect those rights domestically when the issue is on the ballot.

She concluded: “We need to hold our political leaders and those elected officials accountable to ensure the decisions that they influence and make for communities abroad are aligned to what we would want for ourselves in our own country.”

Key Takeaways

• Since 1984, the Global Gag Rule has been enacted and reversed depending on which political party is in office.  

• In 2016, the Trump-Pence administration dramatically expanded its scope, affecting $11 billion in U.S. government global health funding.  

• This led to severe cutbacks in sexual and reproductive health services in LMICs, fracturing longstanding partnerships, creating mistrust between organizations and communities, and damaging health systems.  

• This policy is the result of a decades-long anti-rights movement that has been working in the background, and the advocacy and philanthropic funding response needs to shift its mindset away from a short-term view.  

• Advocates should also encourage local governments in LMICs to invest in these services to weaken the impact that U.S. policies have on public health programs in these places.  

• Until now, GGR has focused on curbing reproductive rights internationally, but more domestic repercussions are expected in the coming years—meaning we need to hold leaders accountable now.