Health groups around the world are celebrating the end of a harmful policy banning US funding for overseas aid organisations that facilitate or promote abortion, which was scrapped by the US president, Joe Biden, in a presidential memorandum on Thursday.
Reproductive rights advocates are urging the new administration to now go further and permanently repeal the Mexico City policy – known as the “global gag rule” – to prevent it being reinstated by a future Republican president. The policy has been blamed for contributing to thousands of maternal deaths in the developing world over the past four years.
The gag rule prevents overseas organisations that receive American aid from using their own money to provide information about abortion, or carry out abortions. First adopted by the Reagan administration in 1984, it has been repealed by every Democratic administration and reinstated by every Republican one in the years since.
In a short appearance in the Oval Office on Thursday afternoon, Biden said he ended the policy as part of an effort to “protect women’s health at home and abroad”.
But Donald Trump went further than previous Republican presidents. The policy usually applies to family planning organisations. But the Trump administration expanded the policy to include all global health programmes, including programmes that address HIV, nutrition, malaria and cholera.
Widening the rule increased the pool of aid funds it affected from roughly $600m to about $12bn (£8.7bn), according to the Guttmacher Institute, a health policy research group.
“We can breathe,” said Serra Sippel, the president of the Center for Health and Gender Equity, of Biden’s plans to repeal the policy. “There’s just so much hope and optimism in Washington DC right now. We have a lot of work to do, but it’s so much better.”
The consequences of Thursday’s memorandum will ripple out from Washington into more than 70 countries including some of the poorest places in the world, where essential women’s health operations were abruptly halted or scaled down after Trump reinstated the rule in January 2017.
In Zimbabwe, a women’s health team run by Abebe Shibru, from the organisation MSI Reproductive Choices, cut its operations by 60%. “We reduced our outreach from 700,000 women to about 300,000,” Shibru, who now heads the organisation’s Ethiopian operations, told the Guardian.
“Women missed out on information, they had no access to family planning, and in return they were exposed to unintended pregnancy and unsafe abortion, which contributed to higher maternal mortality.”
Zimbabwe’s teenage pregnancy rate increased by 2% over the past four years, according to Unicef data, a trend Shibru said was exacerbated by cuts as a result of the gag rule.
“We were not providing services to rural women, so they had no choice but to get pregnant against their wish,” he said.
Pledging conferences attracted hundreds of millions of dollars in donations from governments and private groups to try to bridge the gap in American funding, but could not meet the total shortfall.
An assessment of the rule’s impact released last year, surveying health organisations in Nigeria, Kenya, South Africa and Nepal, found a sector in “crisis” with confusion over what was banned and permitted using US aid, a growing stigma around reproductive health services and widespread closures and scaling downs of programmes.
Trump’s ban also spawned a new wave of activism, including a new grassroots movement, SheDecides, which is pressuring policymakers around the world to commit to upholding reproductive and sexual health rights.
Zara Ahmed, the associate director of federal issues at the Guttmacher Institute, said repealing the gag rule “is just the first step in undoing [the US’s] current status as the greatest global hindrance to reproductive health”.
“We are glad that the Biden-Harris administration is addressing the global gag rule … But let’s be clear, repealing the global gag rule is the bare minimum this administration can do to address the harm caused by the previous administration’s coercive and spiteful approach to foreign policy,” she said.
“The Biden-Harris administration can, and must, take a comprehensive approach to unravelling the dangerous, punitive and coercive policies the outgoing administration has woven into our foreign policy, and it must take action to address longstanding harmful policies like the Helms amendment.”
The Helms amendment has been widely misinterpreted as a total ban on US funding used for abortion overseas, when in fact it can be used to support abortion in cases of rape, incest or a woman’s life being in danger. A bill to permanently repeal it was introduced last year.
On Thursday, the Global Health, Empowerment and Rights Act (Global Her Act) to permanently repeal the global gag rule will be introduced for the third time in Congress. The bill, co-sponsored by the new vice-president, Kamala Harris, has received cross-party support, and hopes are high it will pass.
“It’s not automatic and it’s not going to be easy but we’re starting in a very strong place to get the act passed,” said Sippel. “If not the bill itself, but the language of the bill incorporated into another bill. Getting rid of the GGR, that’s what we’re striving for.”
Sippel also called on the Biden administration to disavow the “Geneva consensus declaration” – an anti-abortion policy Trump promoted last year – to “signal to the world that abortion and LGBTQ rights and sexual and reproductive rights are important, and to state that loudly to the world”.
She added that some activists wanted the Biden administration to issue a formal apology for US policies on sexual and reproductive health and rights over the past four years.
Biden also ordered funding restored to the UN population fund, UNFPA, which Trump stopped.
The agency’s executive director, Natalia Kanem, hailed the “enormous” impact of the decision.
“Ending funding to UNFPA has become a political football, far removed from the tragic reality it leads to on the ground. Women’s bodies are not political bargaining chips, and their right to plan their pregnancies, give birth safely and live free from violence should be something we can all agree on,” she said.