Global Citizen is a community of people like you

People who want to learn about and take action on the world’s biggest challenges. Extreme poverty ends with you.

Girls & Women

The Real Effects of the Global Gag Rule, According to a Women’s Health Expert

Image: Sala Lewis, PAI. Ghana August 2016.

US President Donald Trump’s expansion of the Global Gag Rule, a policy that cuts US foreign aid for health organizations that even mention abortion in their operations, poses a danger to to the health of millions of women around the world. 

The rule, when instituted by other Republican presidents, cut off funding for family planning groups that mentioned abortion. But Trump’s version goes much further, potentially cutting off aid for all health organizations that discuss abortion with their clients — even those that provide cancer screening, HIV/AIDS treatment and prevention, and contraceptives that are vital to the health and well-being of families.

It’s a tricky, touchy, and complex policy that leaves quite the mess to untangle. 

One organization trying to understand those implications is PAI —  a family planning and women’s reproductive rightsadvocacy and research organization. 

Global Citizen spoke with Suzanne Ehlers, President and CEO of PAI, to clarify key points on the policy and grasp just how drastic Trump’s changes might be.

Suzanne Ehlers PAI CEO headshot.jpgImage: Courtesy of PAI


GC: What is the potential impact of the new Global Gag Rule policy? 

SE: First, I think luckily and very positively this reinstatement of the new Global Gag Rule under President Trump has gotten a ton of attention. I’m so grateful for it, and I think it’s really been an issue that has ignited people’s passion and activism more so than we saw 16 years ago when President Bush reinstated it in 2001. 

The potential impact of Trump’s Global Gag Rule is quite daunting since the policy has been extended or expanded to impact all of global health assistance—and not just family planning assistance as it has in the past. That means funding for other health areas such as HIV, TB, malaria and even emerging disease threats such as Zika are now implicated. For some context, the U.S. spends about $575 million annually on family planning assistance. By contrast, it spends $9.5 billion on global health assistance. So we know that the impact runs the risk of being much bigger than under previous iterations.

PAI Nakuru Kenya July 2016 Sala Lewis -281.jpgImage: Sala Lewis, PAI. Nakuru Kenya July 2016.

GC: What are some common misconceptions about the Global Gag Rule? 

SE: There’s a couple of misnomers about the Global Gag Rule. So because it’s on global health assistance, it prevents any recipient of US government resources, who works on any set of health issues, be it a [PAI] partner in Malawi working on tuberculosis or a partner in Kenya working on malaria, do any work on the issue of abortion at all. 

And by ‘any work,’ I mean not just provide abortion but to also refer. So if you have an HIV organization with a woman who is HIV positive, and she finds herself pregnant, she may choose or want information about how she could terminate that pregnancy, if she’s not yet prepared to give birth. That organization, because they receive US government funding, is no longer able to provide that women with any kind of live-saving referral or information about availabilities of service for her. The idea, applied to US groups, would be completely unconstitutional. 


The idea, applied to US groups, would be completely unconstitutional. 

PAI Nakuru Kenya July 2016 Sala Lewis -216.jpgImage: Sala Lewis, PAI. Nakuru Kenya July 2016.

GC: What do we not yet know about the impact of the Global Gag Rule? 

SE: What we don’t yet know is how different global health issues with the Mexico City policy will be impacted. But the family planning community has a lot of experience with this. For instance, back when President Bush reinstated it, we saw that clinics would close their doors because they were quite dependent on US government funding. 

Clinics couldn’t afford to do their jobs in the most effective and productive ways while being censored by the Mexico City policy. They would not comply with the requirements, and they would no longer receive US government funding assistance. Clinics would shut down. Women in those parts of the world would be without access to services. I think we can imagine that that type of impact will only be magnified as this applies to global health assistance. 

In many parts of the world — though the US has a privileged perch on this — there may be only one health clinic that’s available in rural parts of the country. A woman may be going there for TB, or anti-diarrheal treatment for her baby… or possibly for access to birth control. If that clinic receives any part of US government funding for any part of their organizational portfolio and in any way, shape, or form that]relates to the issue of abortion —  that clinic is now at risk. 

GC: What was financial and health impact of the Global Gag Rule like under the Reagan or Bush Administration? 

SE: There are a few examples that PAI has documented. When the Mathare Valley clinic closed in Kenya, services for STI screening and treatment and HIV testing and counseling, along with other basic reproductive health care ended for a community of 300,000 people — with no other clinic nearby.

In Ghana, the country’s oldest and largest provider of reproductive health services, lost $200,000 in USAID funding in 2003 when they rejected the Gag Rule. As a result, PPAG laid off 67 key staff members and reduced nursing staff by 44 percent, leading to a 40 percent reduction in family planning use by those served by the organization. More than 1,327 communities in Ghana were affected by the cuts.

MDM - youth friendly 6_hires.jpgImage: Courtesy of PAI


In many parts of the world — though the US has a privileged perch on this — there may be only one health clinic that’s available in rural parts of the country. 

GC: What could the 10-year impact of this policy look like? 

SE: I think we’re underestimating the degree to which a strong US voice on an issue like human rights keeps countries around the world aligned behind that vision.

When you have a US government that all of a sudden is starting to infringe on women’s health, or the rights of immigrant communities here in the US, you begin to give cover, unwittingly, for an erosion of human rights across the globe. That feels very big picture, for me, but when you’re talking 10-year horizon I think we will see a real deterioration of the human rights agenda at the global level. 

I also think we’ve seen President Trump’s rhetoric around increasing defense spending and military spending and we know at the budget level that has to come at the expense of other kinds of spending. 

On the issue of women, PAI is clear: we want women to have access to contraception, and be able to control this aspect of their lives. The reason is simple, this is a human rights issue. 

If you look at all the ways women's health and women’s rights link to a woman’s ability to educate herself, access her own education, protect herself from gender based violence, stop the forcing of early marriage of her daughters, or the ability of a woman to be an agent of change or peacemaker at a decision making table — all of that is eroded and undermined when we have women’s most basic health needs not being met. 

And then, on a 10-year horizon, I think ‘Wow, how far in the dark ages are we going to go back?’ 

PAI Ghana August 2016 Sala Lewis 1248.jpgImage: Sala Lewis, PAI. Ghana August 2016.

GC: What about the long-run? 

SE: I don’t think it’s too much to say this, given what we’ve seen from the Trump Administration so far, and what we know of Vice President [Mike] Pence in his political career up to in this point, but PAI is settling on the notion that this reinstatement of the Global Gag Rule is actually part of a much bigger strategy, essentially an ideology of women’s inequality, and lack of women’s human rights moving forward. I feel like it’s that fundamental. 

For those who don’t place access to contraception squarely in the middle of a woman’s experience for her own freedoms, liberties, and autonomy, that may not ring true. Yet, for those of us who know that so much hinges on a woman’s ability to maintain, keep, and advance her sexual and reproductive health, I don’t think it’s an overstatement to say that’s what this feels like. 


...this reinstatement [of the Global Gag Rule] is actually part of a much bigger strategy, essentially an ideology of women’s inequality, and lack of women’s human rights moving forward. I feel like it’s that fundamental.

GC: What advice do you have for Global Citizens eager to see change on the this policy?

SE: I think what we’ve all learned as Global Citizens, in the past weeks, is the power of voice and action. At the individual, community, state, and national level, events like the Women’s March, a day without immigrants, or even signing a global petition that’s able to attract millions of signatures — it matters. 

Let’s not let ourselves get tired too quickly with the positive impact we’re having. And with that also comes the responsibility to inform and educate ourselves. 

Youth theatre group 1_hires.jpgImage: Courtesy of PAI. Youth programs as part of family planning are central to educating the next generation.

GC: What can we as Global Citizens do? 

SE: On the issue of international development, there is still this widespread perception that the US give 20% of its budget to countries overseas. In fact, international development is barely 1% of the US budget. And when people hear the story of it’s effectiveness they say ‘Oh my god! Maybe we should be giving 20%.’ As Global Citizens, there's a really important message there about human security: we’re all intertwined with each other. 

On the Global Gag Rule specifically, PAI’s bread and butter, I would love to see Global Citizens lift their voices in a way that encourages more unity across health issues. Believe it or not, there’s sometimes a disagreement between those of us who work on family planning and child health and safe pregnancy. To the untrained eye there’s only one woman at the center of that. So why aren’t we dedicated to protecting her needs at whatever stage of life she’s at, in whatever choices she is making.

PAI Nakuru Kenya July 2016 Sala Lewis -306.jpgImage: Sala Lewis, PAI. Nakuru Kenya July 2016.


This interview has been edited and condensed for clarity.