Originally implemented in the United States by President Ronald Reagan in 1984, the Mexico City policy (or more commonly known as the “Global Gag Rule”) focuses on denying U.S. funding to foreign NGOs (or Non-Governmental Organizations) that promote, offer, or even discuss abortion services, even when they use non-U.S. funds. Despite being a domestic political decision, this policy has a significant impact that disrupts healthcare globally, far beyond American borders.
Over the past 40 years, this particular policy has been introduced, reinstated, and rescinded several times by various presidents. Throughout this constant flux in this policy, many presidents have updated its terms. Most notably, in 2017, President Trump re-implemented and broadly expanded the Mexico City policy under the name Protecting Lives in Global Health Assistance (PLGHA). This update places extensive restrictions on all global health assistance, including programs for HIV/AIDS, maternal and child health, and other infectious diseases. Most recently, in January 2025, during his second term, President Trump reinstated the larger, expanded policy after President Biden overturned it in 2021.
Although the original goal of this policy was to lower abortion rates, it has had terrible effects on maternal health outcomes and conditions. If an agency chose not to comply with U.S. rules, it would be forced to shut down key operations, fire staff, and cut essential services, including prenatal care and birth control distribution, due to losing key funds. Unwanted pregnancy and unsafe abortions are direct risks associated with this. A 2019 study in The Lancet Global Health found that under the policy, nations most dependent on U.S. aid saw a 40% rise in abortion rates, mostly as women lost access to contraception and reproductive education. According to the Guttmacher Institute, one of the main causes of maternal mortality (or death among mothers) is unsafe and dangerous abortions, which account for 13% of all maternal deaths globally. Although this policy was written to reduce abortions, this policy makes their conditions even worse.
The PLGHA-expanded version of the policy’s harm goes beyond reproductive care. When NGOs refuse to comply, it negatively impacts child nutrition services, HIV/AIDS programs, and malaria prevention initiatives. After losing the funds, U.S.-funded clinics in Uganda were forced to reduce the reach of HIV care services. Cutting the provision of counseling and antiretroviral therapy puts young women, who account for two-thirds of new infections in sub-Saharan Africa, at greater risk. The disruptions in services were also spread in a 2020 report by the Center for Health and Gender Equity (CHANGE) that included lower maternal care access and fewer sessions of counseling for survivors of sexual violence.
The “Global Gag Rule” and its reinstatement in January 2025 has once again destabilized healthcare programs in low and middle-income nations since NGOs had to decide between complying with U.S. restrictions or losing crucial funding, resulting in fragmented care and service gaps. This policy’s unpredictable enforcement undermines long-term health planning and proves how a single policy can have catastrophic consequences for global health.
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