Assessing the Impact of the Global Gag Rule

The Heilbrunn Department of Population and Family Health (PopFam) was awarded $2 million by the William and Flora Hewlett and the David and Lucile Packard Foundations to study the impact of the expanded Mexico City Policy, also referred to as the Global Gag Rule (GGR), on the health and well-being of women and health providers.

In January 2017, the GGR, was reinstated by the current administration. Previous iterations of this policy prohibited the allocation of United States family planning funding to foreign nongovernmental organizations (NGOs) unless they certified that they would not “perform or actively promote abortion as a method of family planning,” using funds from any source (including non-U.S. funds).  The expanded GGR will apply to all global health assistance that is granted by all U.S. departments or agencies  

Activities prohibited under the current GGR include:

  • Provision of abortion as a method of family planning; 
  • Counseling and referrals for abortion as a method of family planning;
  • Conducting public information campaigns on the benefits or availability of abortion;
  • Advocating for the liberalization of abortion laws or lobbying for the continued legality of abortion.  

Though exempt from the GGR themselves, U.S. NGOs who are recipients of U.S. global health assistance must ensure that their foreign sub-recipients follow the requirements of the policy.  Moreover, this wide-reaching policy has been instituted at a time of deep cuts in U.S. foreign aid, particularly related to sexual and reproductive health (SRH). These policy changes will have devastating impacts on international family planning programs as well as the broader field of U.S. global health assistance. 

Given its implications for health, it is critical to track and document the impact of this expanded GGR on access to contraception and abortion services, and on related SRH and maternal health outcomes such as HIV and STI testing and treatment and antenatal care. As an institution that combines the implementation of rigorous research with on-the-ground programming, and has deep partnerships with academic institutions and community-based organizations and NGOs, PopFam is well positioned to carry out this work.

The primary objective of this research is to answer the question, “How does the GGR affect the provision of and access to SRH services?” To answer this question, we are partnering with Planned Parenthood Global to conduct a rigorous mixed-methods evaluation that will document the influence of the reinstated GGR in three countries with diverse cultural and abortion-related legal contexts: Madagascar, Nepal, and Kenya. 

Findings from this in-depth assessment will illuminate the impact that the GGR has on multiple domains related to funding, policy advocacy, referral networks, and health systems, enabling public health advocates to present comprehensive evidence during policy discussions. As part of this project, we will collaborate closely with research and service delivery experts in each country. We will develop and implement the methods based on their input, and will work to strengthen their capacity to conduct similar research in the future.

For more information on the Global Gag rule, its provisions of and exceptions to the policy, visit:

United States Agency for International Development (USAID). (2017, October 04). Standard Provisions for Non-U.S. Nongovernmental Organizations A Mandatory Reference for ADS Chapter 303

Kaiser Family Foundation. (2017, 06 March). The Mexico City Policy: An Explainer

PAI. (2017, October 5). What You Need to Know About the Protecting Life in Global Health Assistance Restrictions on U.S. Global Health Assistance

Planned Parenthood. End the Global Gag Rule

CHANGE. Global Gag Rule | U.S. Foreign Policy & Funding.

White House Office of the Press Secretary (2017, January 23). Presidential Memorandum Regarding the Mexico City Policy. Washington D.C.