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Abstract
During his first week in office, US President Donald J Trump issued a presidential memorandum to reinstate and broaden the reach of the Mexico City policy. The Mexico City policy (which was in place from 1985–1993, 1999–2000 and 2001–2009) barred foreign non-governmental organisations (NGOs) that received US government family planning (FP) assistance from using US funds or their own funds for performing, providing counselling, referring or advocating for safe abortions as a method of FP. The renamed policy, Protecting Life in Global Health Assistance (PLGHA), expands the Mexico City policy by applying it to most US global health assistance. Thus, foreign NGOs receiving US global health assistance of nearly any type must agree to the policy, regardless of whether they work in reproductive health. This article summarises academic and grey literature on the impact of previous iterations of the Mexico City policy, and initial research on impacts of the expanded policy. It builds on this analysis to propose a hypothesis regarding the potential impact of PLGHA on health systems. Because PLGHA applies to much more funding than it did in its previous iterations, and because health services have generally become more integrated in the past decade, we hypothesise that the health systems impacts of PLGHA could be significant. We present this hypothesis as a tool that may be useful to others’ and to our own research on the impact of PLGHA and similar exogenous overseas development assistance policy changes.
- health policy
- health systems
- maternal health
- public health
- hiv
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Footnotes
Handling editor Seye Abimbola
Collaborators Members of the GGR Research Working Group: Bergen Cooper, CHANGE, Washington DC, USA; Dennis Juko, CEHURD, Kampala, Uganda; Elizabeth Sully, Guttmacher Institute, New York City, USA; Emily Maistrellis, Columbia University Mailman School of Public Health, New York City, USA; Hana Thomas, Columbia University Mailman School of Public Health, New York City, USA; Heidi Quinn, International Planned Parenthood Federation, London, England; Isaiah Oyango, International Planned Parenthood Federation Africa Regional Office, Nairobi, Kenya; Jamie Vernalde, PAI, Washington, DC, USA; Jennifer Britton, Columbia University Mailman School of Public Health, New York City, USA; Jennifer Redner, American Jewish World Service, Washington, DC, USA; Jennifer Sherwood, amfAR, Baltimore, USA; Katy Footman, Marie Stopes International, London, England; Kathryn Roberts, International Planned Parenthood Federation Western Hemisphere, Mexico City, Mexico; Latanya Mapp Frett, Global Fund for Women, San Francisco, USA; Luisa Orza, International Alliance for HIV/AIDS, London, England; Lynn Freedman, Columbia University Mailman School of Public Health, New York City, USA; Maggie Giorgio, Guttmacher Institute, New York City, USA; Margo Mullinax, American Jewish World Service, New York City, USA; Kate Hesel, Planned Parenthood Federation of America, New York City, USA; Marta Schaaf, Columbia University Mailman School of Public Health, New York City, USA; Pari Chowdhary, CARE, Atlanta, USA; Patty Skuster, Ipas, Philadelphia, USA; Roger Rochat, Emory University, Atlanta, USA; Sara Casey, Columbia University Mailman School of Public Health, New York City, USA; Sara van Belle, Institute of Tropical Medicine, Antwerp, Belgium; Sruthi Chandrasekaran, Ibis Reproductive Health, Cambridge, USA; Saumya Ramarao, Population Council, New York City, USA; Simone Santos, AMODEFA, Harare, Zimbabwe; Terry McGovern, Columbia University Mailman School of Public Health, New York City, USA; Vanessa Rios, International Women’s Health Coalition, New York City, USA; Yana Rogers, Rutgers University, New York City, USA.
Contributors This manuscript was conceived by EM, BC, MS, and the members of the Global Gag Rule Research Working Group. EM and HT undertook the bulk of the research and analysis that is described in the paper. MS took the lead on drafting the paper, and EM drafted certain sections. BC provided particular expertise on legal and policy issues related to PLGHA. All members of the writing team contributed substantially over multiple revisions of the paper.
Funding The David & Lucile Packard Foundation and the William + Flora Hewlett Foundation provided partial support for this Analysis.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No additional data are available.