One of Donald Trump’s first acts as president was to re-instate the “Global Gag Rule.” This is a rule that has been imposed by Republican presidents since the 1980s and stipulates that no US funding for global reproductive health care be used to inform patients about abortion–even where abortion is legal. NGOs must adhere to this policy or risk losing US funding.

Since Ronald Reagan introduced this policy more than 30 years ago, it has very much been caught up in domestic American politics of abortion, with Republicans imposing the restriction and Democrats lifting it. As expected Donald Trump signed the order days after being inaugurated, but the exact wording of this order left open the prospect that Donald Trump’s version of the Global Gag Rule would be far more expansive than previous administrations’. At the time, there was some debate about whether this vast expansion was intentional, or like other executive orders issued in his first week in office, merely sloppily written.

That confusion was cleared up yesterday when the State Department yesterday confirmed that, indeed, a massive expansion of the Global Gag Rule is underway. Whereas previous iterations of the Global Gag Rule only affected funds earmarked for reproductive health, the Trump version encapsulates all US global health programs. This includes programs for AIDS, Malaria, Measles, cancer care, diabetes, child nutrition — everything except emergency humanitarian relief.

In monetary terms, this expands the scope of the Global Gag Rule from about $600 million in reproductive health assistance to $8.8 billion in global health assistance around the world, including the $6 billion anti-AIDS program created by President George W. Bush known as PEPfAR.

This expansion could have big implications for nearly every global health NGO in the world or another —  even if they themselves do not receive US funds directly. Through grants, contracts, subcontracts or even office or hospital sharing arrangements pretty much every health care provider in some of the poorest places on the planet will be affected by this rule.

The global health organization Population Action International issued this stern warning upon learning the news.

The expansion of the Global Gag Rule by President Trump threatens to exclude some of the most effective—and in some cases, only—local health providers in 60 low and middle income countries. Without funding, these organizations will be unable to provide integrated maternal health care with contraceptive services, HIV prevention, care and treatment services, or counsel women on their potential risks of Zika infection, among many other services, leaving communities and entire health systems devastated.

This rule comes at a time when the global health community — with the support of the United States — has trended towards integrating health services to provide more holistic care for individuals and communities. Integrating health services tends to be less expensive and provide better results than keeping various aspects of health care delivery siloed from each other.

“If a mother is coming in for nutrition support or vaccines for her child, she would be coming to the same rural clinic that provides a suite of services to the community,” says Loyce Pace of the Global Health Council. “The clinic may also be providing abortion referrals or abortion counseling with non-US funds. But if they don’t comply with the expansion of this policy, they would no longer be able to provide that suite of health services.”

“So now, we might be tasked with decoupling those dollars in a way that does not make sense,” says Pace. “There is not another district hospital down the street that does not provide abortion counseling.”

Pace says research could also be affected. If researchers testing new vaccines for things like Zika or Tuberculosis are working in hospitals that also provide abortion counseling or services, their funding could be imperiled.

Still, this policy is moving forward. And as a result, we can probably expect big disruptions in the health services for people who need it the most.

 

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