The Supreme Court handed down the Roe v. Wade decision on January 22, 1973, making abortion legal in the United States. Today, the Federal Government uses abortion as a factor in deciding which countries or organizations receive U.S. foreign assistance. Federal policies on funding or supporting abortion or family planning programs abroad drive legislation and debate.

Decisions over how U.S. funds should be used abroad have been perpetually contentious, and administrations have rescinded and re-instituted them. A September 12, 2018, Congressional Research Service report, Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Law and Policy, says:

        The Executive Branch has also engaged in the debate over international abortion and family planning. In 1984, President Ronald Reagan issued what has become known as the “Mexico City policy,” which required foreign nongovernmental organizations [NGOs] receiving USAID [United States Agency for International Development] family planning assistance to certify that they would not perform or actively promote abortion as a method of family planning, even if such activities were conducted with non-U.S. funds. The policy was rescinded by President Bill Clinton and re-instituted and expanded by President George W. Bush to include State Department activities. In January 2009, President Barack Obama rescinded the policy. It was reinstated and expanded by President Trump in January 2017, and renamed “Protecting Life in Global Health Assistance” [PLGHA].        

The Mexico City policy — sometimes referred to as the global gag rule — prohibits family planning assistance to any foreign NGO that engages in abortion referrals, even if no U.S. funds are used for them. PLGHA, like former versions of the policy, makes exceptions in cases of rape, incest, and situations threatening the mother’s life.

A White House memorandum from January 23, 2017, states:

        I direct the Secretary of State, in coordination with the Secretary of Health and Human Services, to the extent allowable by law, to implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments or agencies. I further direct the Secretary of State to take all necessary actions, to the extent permitted by law, to ensure that U.S. taxpayer dollars do not fund organizations or programs that support or participate in the management of a program of coercive abortion or involuntary sterilization.        

Any foreign NGO recipient agrees that accepting U.S. support means that it cannot “perform or actively promote abortion as a method of family planning.” It also agrees that it will not fund any sub-recipients unless those organizations have also agreed to the policy.

Opponents of the Mexico City policy argue that it is restrictive and violates women’s rights. In August 2019, Planned Parenthood, a nonprofit organization that provides comprehensive reproductive and complimentary health care services and advocates public policies that ensure access to such services, said it would remove itself from the Federal Government’s Title IX program helping low-income people access family planning rather than heed the rule prohibiting abortion referrals.

In a coalition statement opposing the Mexico City policy, Planned Parenthood Global wrote on its website:

        While the [1973] Helms Amendment [to the Foreign Assistance Act] restricts U.S. foreign assistance funding for abortions “as a method of family planning,” the global gag rule goes a step further by blocking aid to foreign organizations who use their own non-U.S. funds to provide information, referrals, or services for legal abortion or to advocate for access to abortion services in their own country. The global gag rule causes serious harm in countries around the world. The policy interferes with the doctor-patient relationship by restricting medical information health care providers may offer, limits free speech by prohibiting local citizens from participating in public policy debates, and impedes women’s access to family planning by cutting off funding for many of the most experienced health care providers who chose to prioritize quality reproductive-health services and counseling over funding that restricts care and censors information.        

For more on this topic, see the March 2019 issue of Congressional Digest on “Gender Equality in the Constitution” and the article “Family Planning Funding” in the April 2019 issue.