Biden Administration Starts to Unwind Abortion Policy Exported Abroad

Rescinding the global "gag rule," also known as the Mexico City policy, is a start. Here's what the administration can do next to advance abortion rights.

[PHOTO: Joe Biden at desk signing with pen. John Kerry and Kamala Harris stand a distance away]
The repercussions of the gag rule reached far and wide, creating lasting effects on the lives of people who were unable to access the full spectrum of care during its enforcement. Mandel Ngan/AFP via Getty Images

Today, President Biden signed a presidential memorandum to rescind the global “gag rule,” also called the Mexico City policy. The gag rule prevents U.S. aid to nongovernmental organizations overseas if they conduct abortion-related counseling, referrals, or advocacy.

From its first implementation in 1984, the global gag rule has slashed NGO’s ability to provide informed health care without risking the loss of much-needed U.S. aid. Now more than ever, having both popular support and political power, the Biden administration must go above and beyond repealing the global gag rule to protect, ensure, and expand abortion access and reproductive health care.

The global gag rule has been enforced by all Republican administrations since Reagan and rescinded by all Democratic administrations, but the version Trump signed in 2017 came with a particularly draconian set of restrictions. Trump expanded the gag rule’s scope to all U.S. global health assistance, not just family-planning organizations. This meant that initiatives addressing HIV and AIDS, child and maternal health care, water sanitation, nutrition, or infectious diseases would lose funding if they couldn’t certify that they did not participate in any abortion-related activity. Furthermore, if an NGO receiving any global health funding from the United States were to award a grant to another organization, that organization had to also prove to the U.S. government that it doesn’t support abortion-related activities—even if no U.S. dollars trickled down to them at all.

The repercussions of the gag rule reached far and wide, creating lasting effects on the lives of people who were unable to access the full spectrum of care during its enforcement. In 2017, $8.8 billion of global health aid flowing to more than 70 countries was subject to the gag rule. With the United States being the largest funder of international health initiatives, organizations working on the ground within their communities were vulnerable to losing their biggest pot of resources at the expense of providing accurate medical services and care.

For example, providers whose work was funded under U.S. global health programs would need to violate the patient-provider relationship due to the gag on discussing abortion as a possible avenue of reproductive health care. Advocates working with organizations to legalize or decriminalize abortion in their countries are censored from enacting change, and in places where abortion is already legal, people are unable to make use of their legal right to pursue the termination of a pregnancy.

Most frighteningly, the most recent iteration of the global gag rule has shown that the presidency is able to wield its power to affect other critical areas of care, like HIV and malaria, if doing so can act as an added deterrent to abortion-related activities.

The United States’ barriers to abortion care are not only reserved for its international partners.

Even with the repeal of the global gag rule, the narrower Helms Amendment of the Foreign Assistance Act will continue to restrict U.S. foreign aid funding from being used directly for abortion procedures. You can look at the Helms Amendment as the international counterpart to the domestic Hyde Amendment, a 1976 rider to the annual congressional budget crafted in response to the Roe v. Wade decision, which legalized abortion. Just like the global gag rule and the Helms Amendment, the Hyde Amendment blocks federal funding from going toward abortions, which means anyone insured under a federal program—like Medicaid, Medicare, Indian Health Services, or the military’s TRICARE—is unable to use their health insurance to cover their abortion.

There is simply no other medical procedure that experiences such restrictions, and while rescinding the global gag rule reaffirms the care and autonomy that communities and people considering and seeking abortions internationally deserve, President Joe Biden’s campaign promise to ensure informed and supportive access to abortion will not be fulfilled by a single presidential memo.

President Biden must prove his dedication to supporting all pregnant people choosing between all pregnancy outcomes, including abortion, by urging Congress to repeal the Helms and Hyde amendments and signing new, clean foreign aid and federal budget bills into law.

Access to reproductive health care should have never been subject to the political pendulum, but as decadeslong advocacy from domestic and international partners alike comes to a boil, the unignorable reality is that expanding access to abortion on the federal level is now undeniably within reach, full stop. In addition to rescinding the global gag rule, President Biden can do what no other president has done and establish himself and his administration as true bringers of progress and change by working to end the Helms and Hyde amendments.