The Global Gag Rule The death trap for comprehensive sexual and reproductive healthcare and way to overcome the US Gag Rule

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Mainul Haque


Global Gag Rule, Mexico City Policy, Comprehensive, Sexual Reproductive Health Care, Trap, Developing Countries, Low Middle-Income Countries, LMICs


The United States of America (USA) is one of the largest bilateral donors in the field of global health assistance. There are beneficiaries in 70 countries around the world. In 2015, the USA released US$638 million for the improvement of global health status by promoting family planning services. Unfortunately, in 2017, Trump administration reinstated Mexico City Policy/Global Gag Rule (GGR). This policy pre-vents non-US nongovernmental organizations (NGOs) from receiving US health financial assistance if they have any relationship with abortion-related services. This restriction pushed millions of lives into great danger due to the lack of comprehensive family planning services, especially lack of abortion-related services. This article has attempted to let the readers know about the impacts of GGR around the world and how global leaders are trying to overcome the harmful effects of this rule. Finally, it proposes some solutions to the impacts of the extension of Mexico City Policy.

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1. Human Rights Watch. Trump’s “Mexico City Policy” or “Global Gag Rule.” 2018 [cited 2019 Aug 15]. Available from: news /2018/02 /14/trumps-mexico-city-policy-or-global-gag-rule
2. Marie Stopes International. The Global Gag Rule: A world without choice. 2019 [cited 2019 Jun 25]. Available from: what-we-do/our-approach/policy-and-advocacy/ the-global-gag-rule-a-world-without-choice/
3. Global Health Policy. The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies. Henry J Kaiser Family Foundation; 2019 [cited 2019 Aug 15]. Available from: https://www.kff. org/global-health-policy/fact-sheet/the -u-s-government-and-international-family-plan-ning-reproductive-health-statutory-requirements-and-policies/
4. The Henry J Kaiser Family Foundation. Donor Government Funding for Family Planning in 2016. 2017 [cited 2019 Jun 28]. Available from: report/donor-government-funding-for-family-planning-in-2016/view/footnotes/
5. The Henry J Kaiser Family Foundation. The U.S. Government and Global Health. 2019 [cited 2019 Jun 28]. Available from: -s-government-and -global-health/
6. Haddad LB, Nour NM. Unsafe abortion: unnecessary maternal mortality. Rev Obstet Gynecol. 2009;2(2):122–6.
7. Rasch V. Unsafe abortion and post-abortion care—An overview. Acta Obstet Gynecol Scand. 2011 Jul;90(7):692–700. 1600-0412.2011.01165.x
8. Médecins Sans Frontières. Unsafe abortion: A forgotten emergency. Women’s Health. 2019 [cited 2019 Aug 15]. Available from: https://www.msf. org/unsafe-abortion-forgotten-emergency -womens-health
9. The Lancet (Editorial). The Devastating Impact of Trump’s global gag rule. Lancet. 2019;393(10189):2359. doi: 10.1016/S0140-6736 (19)31355-8.
10. Global Health Policy. The Mexico City Policy: An explainer. 2019 [cited 2020 May 2]. Available from: fact-sheet/mexico-city-policy-explainer/
11. Borger J. Trump expands global gag rule that blocks US aid for abortion groups. The Guardian. 2019 [cited 2020 May 2]. Available from: https:// mar/26/trump-global-gag-rule-us-aid-abortion
12. EngenderHealth. The Global Gag Rule. 2019 [cited 2019 Aug 15]. Available from: https://www. -gag-rule/
13. Berer M. Abortion law and policy around the world: In search of decriminalization. Health Hum Rights. 2017;19(1):13–27.
14. Guillaume A, Rossier C. L’avortement dans le monde. État des lieux des législations, mesures, tendances et conséquences. Population. 2018 [cited 2020 May 2];73(2):217–306. Available from:
15. Mavodza C, Goldman R, Cooper B. The impacts of the global gag rule on global health: A scoping review. Glob Health Res Policy. 2019;4:26. https://
16. Cocks T. From Burkina to Zimbabwe, U.S. aid cuts squeeze family planning services. World News. The Reuters. [cited 2020 May 2]. Available from: -impact-birthcontrol/from-burkina-to-zimbabwe -u-s-aid-cuts-squeeze-family-planning-services-idUSKCN1IN0OV
17. Boseley S. How Trump signed a global death war-rant for women. The Guardian. 2017 [cited 2020 May 2]. Available from: https://www.theguardian. c o m / g l o b a l - d e v e l o p m e n t / 2 0 1 7 / j u l / 2 1 / trump-global-death-warrant-women-family-planning-population-reproductive-rights-mexico-city-policy
18. Holland JL. Abolishing abortion: The history of the pro-life movement in America. The Organization of American Historians; 2019 [cited 2019 Aug 15]. Available from: november-2016/abolishing-abortion-the -history-of-the-pro-life-movement-in-america/
19. Acevedo Z. Abortion in early America. Women Health. 1979;4(2):159–67.
20. BBC. Historical attitudes to abortion. Ethics Guide. 2014 [cited 2020 May 2]. Available from:
21. Stern LG. Abortion: Reform and the law. J Criminal Law Criminol. 1968;59(1):84–94.
22. Cook RJ, Dickens BM. Human rights dynamics of abortion law reform. Hum Rights Q. 2003; 25(1):1–59.
23. Cassidy K. The right to life movement: Sources, development, and strategies. J Policy Hist. 1995;7(1):128–59. s0898030600004176
24. Mohr JC. Abortion in America: The origins and evolutions of national policy, 1800–900. Oxford: Oxford University Press; 1978.
25. Neuhaus RJ. The pro-life movement as the poli-tics of the 1960s. Wall Street J. 2009 [cited 2020 May 2]. Available from: articles/SB123145161559565713
26. Moro A, Invernizzi N. The thalidomide tragedy: The struggle for victims’ rights and improved pharmaceutical regulation. Hist Cienc Saude Manguinhos. 2017;24(3):603–22. https://doi. org/10.1590/S0104-59702017000300004.
27. Kim JH, Scialli AR. Thalidomide: The tragedy of birth defects and the effective treatment of dis-ease. Toxicol Sci. 2011;122(1):1–6. https://doi. org/10.1093/toxsci/kfr088.
28. Vargesson N. Thalidomide-induced teratogenesis: History and mechanisms. Birth Defects Res C Embryo Today. 2015;105(2):140–56. https://doi. org/10.1002/bdrc.21096
29. Devereux M. Dangerous pregnancies: Mothers, disabilities, and abortion in modern America. J  Clin  Invest. 2011;121(3):826. 10.1172/JCI46158
30. Force R. Legal problems of abortion law reform. Admin Law Rev. 1967;19(4):394–382.
31. Veitch E, Tracey R. Abortion in the common law world. Am J Comp Law. 1974;12(4):652–96.
32. Williams DK. The partisan trajectory of the American pro-life movement: How a liberal Catholic Campaign became a conservative evangelical cause. Religions. 2015;6(2):451–75.
33. Green E. The progressive roots of the pro-life movement. The Atlantic. 2016 [cited 2020 May 2]. Available from: -unborn/435369/
34. Petchesky R. Antiabortion, antifeminism, and the rise of the new right. Femin Stud. 1981;7(2):206– 46.
35. Rosoff JI. The Hyde Amendment and the future. Fam Plann Perspect. 1980;12(4):172.
36. Arnold SB. Reproductive rights denied: The Hyde Amendment and access to abortion for Native American women using Indian health service facilities. Am J Public Health. 2014; 104(10):1892–3. 2014.302084
37. Kumar A. Disgust, stigma, and the politics of abortion. Fem Psychol. 2018;28(4):530–8. https://
38. McKeegan M. The politics of abortion: A historical perspective. Womens Health Issues. 1993;3(3):127–31.
39. Kissling F. Religion and abortion: Roman Catholicism lost in the pelvic zone. Womens Health Issues. 1993;3(3):132–7. https://doi. org/10.1016/s1049-3867(05)80246-4
40. Staggenborg S. The survival of the pro-choice movement. J Policy Hist. 1995;7(1):160–76.
41. Meyer DS, Staggenborg S. Opposing movement strategies in U.S. abortion politics. In: Coy PG, editor. Research in social movements, conflicts, and change. Bingley: Emerald Group Publishing Limited; 2008;28:207–38. S0163-786X(08)28007-9
42. Ann HK. The violent transformation of a social movement: Women and anti-abortion activism. Ph.D. (Doctor of Philosophy) Thesis. University of Iowa; 2011. yp0cfs5k
43. Jacobson M, Royer H. Aftershocks: The Impact of clinic violence on abortion services. Am Econ J-Appl Econ. 2011;3(1):189–223. https://doi. org/10.2307/25760251
44. Winter A. Anti-abortion extremism and violence in the United States. In: Michael G, editor. Extremism in America. Reprint edition. Gainesville, FL: University Press of Florida, 2015. p. 218–248.
45. Center for Health and gender equity. Prescribing Chaos in Global Health. 2018 [cited 2019 Aug 22]. Available from: files/uploads/change/publications/Prescribing_ Chaos_in_Global_Health_full_report.pdf
46. Center for Health and Gender Equity. Fact Sheet. Global Gag Rule. 2018 [cited 2019 Aug 24]. Available from: files/uploads/change/publications/CHANGE_ GGR_fact_sheet.pdf
47. US Abortion Restrictions on Foreign Aid and Their Impact on Free Speech and Free Association: The Helms Amendment, Siljander Amendment, and the Global Gag Rule Violate International Law; 2018 [cited 2019 Jul 5]. Available from: Restrictions.pdf
48. Guttmacher Policy Review. The Global Contraceptive Shortfall: U.S. Contributions and U.S. Hindrances. 2006 [cited 2019 Aug 10]. Available from: gpr/2006/05/global-contraceptive -shortfall-us -contributions-and-us-hindrances
49. Slaymaker E, Scott RH, Palmer MJ, et al. Trends in sexual activity and demand for and use of modern contraceptive methods in 74 countries: A retrospective analysis of nationally representative surveys. Lancet Glob Health. 2020;8 (4):e567–79. (20)30060-7
50. World Health Organization. The unmet need for social context in family planning. 2020 [cited 2020 May 2]. Available from: news-room/detail/10-03-2020-the-unmet-need-for-social-context-in-family-planning
51. USAID. Family planning and reproductive health. 2020 [cited 2020 May 2]. Available from:
52. USAID. Central contraceptives procurement (CCP). 2020 [cited 2020 May 2]. Available from: central-contraceptives-procurement-ccp
53. Coburn BJ, Okano JT, Blower S. Current drivers and geographic patterns of HIV in Lesotho: Implications for treatment and prevention in Sub-Saharan Africa. BMC Med. 2013;11:224. https://
54. Belle JA, Ferriera SB, Jordaan A. Attitude of Lesotho health care workers towards HIV/AIDS and impact of HIV/AIDS on the population structure. Afr Health Sci. 2013;13(4):1117–25.
55. Shisana O, Rehle T, Simbayi LC, et al. South African National HIV prevalence, incidence, and behaviour survey, 2012. Cape Town: HSRC Press; 2014.
56. Idele P, Gillespie A, Porth T, et al. Epidemiology of HIV and AIDS among adolescents: Current status, inequities, and data gaps. J Acquir Immune Defic Syndr. 2014;66(Suppl 2):S144–53. https://
57. van der Meulen Rodgers Y. The global gag rule and women’s reproductive health: Rhetoric versus reality. New York: Oxford University Press; 2018.
58. Barot S, Cohen SA. The global gag rule and fights over funding UNFPA: The issues that won’t go away. Guttmacher Policy Rev. 2015;18(2):27–33.
59. Bangs M. How the global gag rule impedes women’s health and reproductive rights. The Century Foundation; 2017 [cited 2020 May 2]. Available from: - i m p e d e s - w o m e n s - h e a l t h - r e p r o d u c -tive-rights/?agreed=1
60. Dansereau E, Schaefer A, Hernández B, et al. Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: A qualitative study of men, women, and adolescents. Reprod Health. 2017;14(1):129. https://doi. org/10.1186/s12978-017-0392-4
61. United Nations Population Fund. Universal Access to Reproductive Health. Progress and Challenges. New York; 2016 [cited 2020 May 2]. Available from: default/files/pub-pdf/UNFPA_Reproductive_ Paper_20160120_online.pdf
62. Tsui AO, McDonald-Mosley R, Burke AE. Family planning and the burden of unintended pregnancies. Epidemiol Rev. 2010;32(1):152–74.
63. Potts M. Can family planning reduce maternal mortality? J Obstet Gynaecol East Cent Africa. 1986;5(1–2):29–35.
64. Sarkar A, Chandra-Mouli V, Jain K, Behera J, Mishra SK, Mehra S. Community based reproductive health interventions for young married couples in resource-constrained settings: A systematic review. BMC Public Health. 2015;15:1037.
65. Aizenman DE. Impacto de la planificacion familiar en la salud materno-infantil. El futuro de la humanidad depende de nuestros hijos [Impact of family planning on maternal-child health. The future of humanity depends on our children]. Profamilia. 1988;4(13):28–33.
66. Cooper CM, Ogutu A, Matiri E, et al. Maximizing opportunities: Family planning and maternal, infant, and young child nutrition integration in Bondo Sub-County, Kenya. Matern Child Health J. 2017;21(10):1880–9. s10995-017-2341-9
67. World Health Organization (WHO). Health and family planning. In Point Fact. 1984;(23):1–4.
68. World Health Organization. Unsafe abortion incidence and mortality. Global and regional levels in 2008 and trends during 1990–2008. Department of Reproductive Health and Research, WHO. Geneva: WHO Press; 2012 [cited 2020 May 2]. Available from: handle/10665/75173/WHO_RHR_12.01_eng.pdf
69. Access denied—US restrictions on inter-national family planning. 2003 [cited 2019 Aug 08]. Available from: https://trumpglobalgagrule.
70. Marie Stopes International. Trump’s Global Gag Rule one year on Marie Stopes International faces $80m funding gap. [cited 2019 Apr 13]. Available from:
71. International Planned Parenthood Federation. The human cost of the Global Gag Rule. 2017 [cited 2019 Apr 13]. Available from: https://www.
72. Population Action International, International Planned Parenthood Federation, Pathfinder International, EngenderHealth. The impact of the global gag rule in Kenya. Access Denied. 2003 [cited 2020 May 2]. Available from:
73. PAI. The harmful impact of The Global Gag Rule. [cited 2019 Apr 13]. Available from: https://
74. Latham SR. Trump’s abortion-promoting aid policy. Hastings Cent Rep. 2017;47(4):7–8. https://
75. Olaniran A, Madaj B, Bar-Zev S, van den Broek N. The roles of community health workers who provide maternal and newborn health services: Case studies from Africa and Asia. BMJ Glob Health. 2019;4(4):e001388. 1136/bmjgh-2019-001388
76. Brooks N, Bendavid E, Miller G. USA aid policy and induced abortion in sub-Saharan Africa: An  analysis of the Mexico City Policy. Lancet. 2019;7(8):e1046–53.
77. She Deicides. The story. 2017 [cited 2020 May 3]. Available from: our-story/
78. Morse MM. She Decides. The world can help. United Nations Foundations; 2017 [cited 2020 May 3]. Available from: blog/post/she-decides-the-world-can-help/
79. International Planned Parenthood Federation (IPPF). IPPF celebrates SheDecides Anniversary. 2018 [cited 2020 May 3]. Available from: https:// -anniversary
80. Schaaf M, Maistrellis E, Thomas H, Cooper B. GGR Research Working Group. “Protecting Life in Global Health Assistance”? Towards a frame-work for assessing the health systems impact of the expanded Global Gag Rule. BMJ Glob Health. 2019;4(5):e001786. 1136/bmjgh-2019-001786
81. She Decides. What is SheDecides? 2017 [cited 2019 Jul 15]. Available from:
82. World Health Organization. Family planning/ Contraception. 2018 [cited 2020 May 3]. Available from: /detail/family-planning-contraception
83. Rogo KO, Oucho J, Mwalali P. Maternal Mortality. In: Jamison DT, Feachem RG, Makgoba MW, et al., editors. Disease and mortality in sub-Saharan Africa. 2nd edition. Washington, DC: The International Bank for Reconstruction and Development/The World Bank; 2006 [cited 2020 May 3]. Chapter 16. Available from: https://www.
84. Nour NM. An introduction to maternal mortality. Rev Obstet Gynecol. 2008;1(2):77–81.
85. Pillai G. Reducing deaths from pregnancy and childbirth. Asia Links. 1993;9(5):11–13.
86. Bhutta ZA, Gupta I, de’Silva H, et al. Maternal and child health: Is South Asia ready for change? BMJ. 2004;328(7443):816–9. 1136/bmj.328.7443.816
87. Singh S, Monteiro MF, Levin J. Trends in hospitalization for abortion-related complications in Brazil,  1992–2009: Why the decline in numbers and severity? Int J Gynaecol Obstet. 2012;118 Suppl 2:S99–106. -7292(12)60007-1
88. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33. https://
89. Simoni MK, Mu L, Collins SC. Women’s career priority is associated with attitudes towards family planning and ethical acceptance of reproductive technologies. Hum Reprod. 2017;32(10):2069–75.
90. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Global Health; Committee on Global Health and the Future of the United States. Global Health and the Future Role of the United States. Washington, DC: National Academies Press (US); 2017[cited 2020 May 3]. 5, Investing in Women’s and Children’s Health. Available from:
91. Chen Z, Wu Y. The relationship between education and employment: A theoretical analysis and empirical test. Front Econ China. 2007;2:187– 211.
92. Options. Women’s integrated sexual health programme. [cited 2019 Apr 11]. Available from:’s-integrated-sexual-health-programme
93. Giorgio M, Makumbi F, Kibira SPS, Bell S, Anjur-Dietrich S, Sully E. Investigating the early impact of the Trump Administration’s Global Gag Rule on sexual and reproductive health service delivery in Uganda. PLoS One. 2020;15(4):e0231960. journal.pone.0231960
94. Oppenheim M. Trump’s “global gag rule” killing women by depriving them of crucial abortion advice, report finds. Independent. 2019 [cited 2020 May 3]. Available from: https://www.independent.
95. International Women’s Health Coalition. Crisis in care: Year two impact of Trump’s Global Gag Rule. [cited 2019 Sep 12]. Available from: https://
96. Marie Stopes International. Global Gag Rule increased abortions by 40% in sub-Saharan Africa. 2019 [cited 2020 May 3]. Available from: https://
97. International Planned Parenthood Federation. Policy briefing: The impact of the Global Gag  Rule. [cited 2020 May 3]. Available from: January%202019.pdf
98. Al Jazeera. US global gag rule abortion policy “killing women”: IWHC. [cited 2019 Sep 12]. Available from: global-gag-rule-abortion-policy-killing-women-worldwide-iwhc-190605211959955.html
99. International Planned Parenthood Federation. Assessing the Global Gag Rule. [cited 2019 Sep 12]. Available from: https://www.plannedparenthood. org/uploads/filer_public/81/9d/819d9000-5350-4ea3-b699-1f12d59ec67f/181231-ggr-d09.pdf