Four Days In, Trump Reinstated the Global Gag Rule

The global gag rule, which prevents non-governmental organizations who receive U.S. global health funding from providing, counseling on, referring for, or advocating for abortion in their own country and using their own, private resources, has been reinstated by President Trump. Lori Adelman, Executive Director of Planned Parenthood Global, and Caitlin Horrigan, Senior Director of Global Advocacy at Planned Parenthood Federation of America, sits down to talk with us about what the expanded global gag rule is, what it means for health practitioners and patients abroad, and how it can be repealed.

When the global gag rule is in place, there is a deep disrupting in health service delivery, bolstering an anti-human rights agenda globally, undermining trust in medical providers, and weakening civil society allies. Communities have less access to centralized, essential care, which can force people to turn to unsafe methods of abortion. Thankfully, there are policy solutions. The Global Health, Empowerment, and Rights Act (Global HER Act), which was reintroduced this week, would take away presidential power to reinstate the global gag rule.

Links from this episode

Planned Parenthood Global
Planned Parenthood Federation of America
Cringewatchers
Planned Parenthood Condemns Trump’s Reinstatement of the Deadly Global Gag Rule 
Overwhelming Majority of Americans Concerned About the Global Gag Rule's  Dangerous Health Consequences, According to New Research Released on International Women’s Day 
Assessing the Global Gag Rule: Harms to Health, Communities, and Advocacy
A Second Trump Presidency Could be Deadly for Women Overseas

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Welcome to rePROs Fight Back a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

Jennie: Hi rePROs. How's everybody holding up? I'm your host Jennie Wetter and my pronouns are she/her. So y'all, before we get to all of the chaos, let's do a little bit of housekeeping. It's been a while. Are you following us on social media? Elena, our amazing social media fellow, has been designing some amazing new graphics. They have done wonderful audiograms. You can get little snippets from the podcast episodes that you can share on social. They have just done an outstanding job. So, you should definitely be following us on all the social media platforms. You can find us at rePROs Fight Back on Facebook, Twitter, Bluesky, LinkedIn, or @reprosfb on Instagram. Definitely worth a follow. Also, if you really liked the podcast, it would really help us out if you took a moment to rate and review the podcast on your favorite podcast platform, shared it with friends you thought might be interested in the podcast, all the things. And then if you really love the podcast, did you know that you can donate and support the podcast? We also have wonderful swag you can get for your donations. For a $25 donation, you get these really fun stickers that we had designed by Liberal Jane. I love them. So, you'll get all of those and a postcard they also designed, or if you donate for $50, you'll get all of that plus our wonderful bag that says, "abortion is a human right, not a dirty word." I love that bag. It's in a comic book font. It's really fun. So, highly recommend. So, if you support us, make sure that you are following us on social, that you rate and review us. If you get a chance, tell your friends about us. And if you want, please donate. It helps us keep the podcast going. Okay, I guess that's enough housekeeping. And now we can turn to just, like, all of the chaos. Y'all, this two weeks has just been a whirlwind of chaos. There's just no better way to describe it. Policies are flying fast and furious that are gonna devastate people's lives, like, so hard to keep up on all the things. It changes from hour to hour and it's so hard to keep up. We are going to do our best to make sure that we are doing episodes on the ones that are relevant to sexual and reproductive health and rights and as much as we can, as soon as I can find people to come and talk about them. Right now we're working on finding somebody to come and talk about all of the anti-trans executive actions. There have been so many, it's just been a real onslaught of attack on transgender rights and it is just heartbreaking. And to our trans friends: we see you, we support you. We are here in this fight with you. We will be talking about all of those things in an episode coming up soon. We're working on it. Yeah. And between that and the 90 day pause on all foreign assistance—y'all, it is bad, it is cutting off programs that are lifesaving for so many people. Whether it's global health programs like pepfar, which is an HIV program, the family planning program, humanitarian assistance or mine-clearing, like all this foreign assistance work that is saving lives around the world has been paused. And that is just absolutely devastating. Again, this is another one of those where it's just, like, kind of chaotic and changing from time to time. So, you know, between now when I'm recording it and when you're hearing it, maybe that has changed some. Again, it's one of those policies that we'll try to have somebody on the podcast in the near future to talk about what is going on, to understand what this policy is going to mean for people's lives around the world. It's just pretty devastating. Yeah, there's just so much happening and executive actions and executive orders are flying fast and furious and they're so many that are just gonna be devastating to so many people in the US and around the world. And it's just...I can't keep up. Like, even with just the ones related to the things I work on, it's hard to keep up. So, I can't imagine trying to keep up with the full suite and there's just so much happening and we all need to make sure that we are fighting when we are able and telling people about what is happening, taking care of ourselves at the same time, again, I know it sounds so trite, but this is really, it's gonna be a really long marathon and so you need to step back when you need to and not burn yourselves out. And I am saying that just as much for myself, who has a really hard time not just going all in and burning myself out 'cause I always feel like I need to do more, but it is really important to take those steps back when you can. You know, I've talked about as much as I'm able and work to, like, encouraging our rePROs team to take mental health days when they need them so that they can rest and recharge. I'm trying to be better about making sure that I'm taking them too, so they know that it's okay. So, really thinking about what you can do for yourself and supporting the people around you is really important right now. Yeah, there's just so much happening. I think with that, let's go to this week's episode 'cause I'm really excited to talk to our two wonderful guests about the global gag rule, which is one of those policies that was reinstated during the first week of the Trump administration and have two wonderful people on to talk about it. Lori Adelman, who's the Executive Director of Planned Planned Parenthood Global and Caitlin Horrigan with Planned Parenthood Federation of America. I'm really excited to talk to the two of them about what is happening and how you can get involved. So with that, let's go to my interview with Caitlin and Lori.

Jennie: Hi Lori. Hi Caitlin. Thank you so much for being here today.

Lori: Hi Jennie. So good to be here.

Caitlin: Hi Jennie. Thanks for having us.

Jennie: Always excited to have y'all on. Before we get started, let's take a quick second and do introductions. And do you want to do, like, your name, pronouns, anything else you wanna include? Lori, would you like to go first?

Lori: Sure. So, I'm Lori Adelman and I use she, her, and hers for my pronouns. I am the Executive Director of Planned Parenthood Global. So, we are the international arm of PPFA, which folks probably already know and hopefully very much love or else they really deeply hate. And then in which case, you're probably not listening to this podcast. I also have a background in feminist media. So, I have my own podcast called Cringe Watchers with another SRHR friend and champion—SRHR being sexual and reproductive health and rights advocacy—and so Leila, with my colleague Leila Darabi, which is very much aligned with the ethos of this podcast. And I work closely with Caitlin, your other guest today. Jennie: Just to flag. It's called Cringe Watchers, and everybody should definitely check it out.

Lori: Thank you, Jennie.

Jennie: Okay, Caitlin.

Caitlin: Hi all. I'm Caitlin Horrigan. I use she/her pronouns and I'm the senior Director of global advocacy at Planned Parenthood Federation of America, PPFA for short. And in that role I am an advocate for the US government to do everything they can in foreign policy and foreign funding to advance sexual and reproductive health and rights around the world. So, I'm joining you from the front lines in Washington DC where we've had quite a tumultuous few weeks.

Jennie: Yeah, I think the important thing we need to do at the start is, like, we are recording this on Wednesday, January 29th. It has been chaos for, like, this first week and a half and who knows what's gonna happen between the time we record and when y'all listen to it on Tuesday. So, it just seems really important to be, like, it's Wednesday at, like, 2:30, so things can change between now and then. Okay. So, the big thing we have—I mean, again, so many things happen, there are so many things we can talk about—the slice of the pie we're gonna tackle today is the global gag rule. And I think a lot of our audience may be familiar with it, but there may be people who aren't as familiar. So it seems like a good chance to be like, what is the global gag rule?

Caitlin: Sure. I can tackle that one. And I had the same thought, Jennie. Sadly, most of your regular listeners probably know this policy quite well because I know you've talked about it here and that's 'cause it's a policy that's been kicking around for over 40 years and has been enforced or lifted every time there's a change in the US presidency. So, we're here today talking about it because President Trump just again, forced this policy on the world which bans non-US non-governmental organizations who receive US global health program funding from providing counseling, referring or even advocating for abortion in their own country, using their own private resources. And so, when we talk about this, you know, we're talking about programs that are meant to expand access to contraception, to prevent and treat HIV, to combat malaria, to improve maternal and child health—huge global challenges. And we're disqualifying essential organizations who know how to do this work and reach the communities most at need. I think it's worth mentioning that this version of the policy that we've seen reintroduced just now with Trump's second term, same version we saw in the first term, they radically expanded this policy. So, it's always been bad to be clear, any version of a gag rule is bad, but they have taken a bad policy and made it so much worse and really expanded the harms radically that we know all too well. I wish for a day where I don't have to explain it anymore, where it's dead and gone. [laughs]

Jennie: Right?

Lori: Yeah, that's absolutely right. And Caitlin, I'm always just so grateful to hear you explain this even though I've probably heard you explain it over a hundred times now. [chuckles] But no, you're such a deep pool of knowledge on this awful, awful policy. And there's a couple things that I just like to reiterate to folks who are just, like, learning about this or just to reiterate for myself because it makes me really mad. So one, this policy applies even if you only take a dollar of US funding. And so, you could be wanting to use your own budget to work on abortion, let's say, and keep, try to keep that separate from the US funding that is not possible under this policy. And for me, what that means is this policy is also incredibly anti-democratic. And it is fundamentally restricting not only free speech but the autonomy of communities around the world to make their own informed decisions and actions about their own lives. And so that is something that really bothers me. And the other thing that I think it's kind of so important to understand is that there are already laws that prevent federal funds from going towards abortion. I do not agree with those laws.

Caitlin: Here, here.

Lori: I think those laws should also be abolished. But let's say there's one of you out there who thinks, "oh, well, you know, we might as well not be spending our federal dollars on this," that's not what this policy is. And so that's, those are just two of the misconceptions that I do hear going around about the policy and two things that I think make it even that much more egregious. But to your point, Caitlin, it's egregious enough.

Jennie: Yeah, I think one of the things I think about a lot, particularly around like how the first round of the Trump administration vastly expanded it. As Caitlin said, it was always bad, but following, when Trump expanded it, it was after eight years of the Obama administration doing work to integrate health services. So, all of a sudden you have this expansion when you started to see clinics bring all their services together. So, you know, money that may be going for, like Caitlin said, to malaria, you had this clinic that was now a one-stop shop where you could go and get any of the care you needed would also maybe get flagged by this. So, it just, it was so harmful and, like we're saying, it was harmful when it was only family planning money, but like the harm became so much greater.

Caitlin: Yeah, that's exactly right, Jennie. And you don't have to have traveled the world to understand and appreciate why integrated care is good for healthcare and good for real people's lives. Like, we all benefit when we can go to the doctor and get multiple needs met and trust that our providers can give us real information to make decisions about our own bodies and future. So, that's a good thing in healthcare and it's a travesty that this policy is trying to unwind that and make people run all around town to get care and information. That should be a basic human right.

Lori: Exactly. And we know of course which people we're talking about that are the hardest hit by that. So, maybe if you have a little more flexibility in your work from home at an office job, okay, you can make two different stops to get your HIV and your SRHR care. But if you are someone who is already living at the margins, you're already facing multiple overlapping barriers to care—you are an adolescent, you're living in a rural area, you are living with a low income, you're living with HIV/AIDS, that additional stop or that bifurcation of care is not actually just a barrier. It can often be a death sentence. And that's actually what we're talking about with this policy.

Jennie: Oh, that's like a great transition 'cause I was gonna, my next question was gonna be: let's talk about the impacts. So, what do we, what have we seen from when the global gag rule is in place? And honestly, even when it's not, it has trailing impacts.

Lori: One of the things that I think is so pernicious about this is the way that it weakens civil society and really causes deep fissures in our movement between those who end up signing and those who end up not signing the gag rule even where they may have otherwise continued to be close allies and partners and share mission alignment. So, Planned Parenthood has commissioned studies and we have major findings on the gag rule's impact, and that's number one, a weakened civil society of course. Secondly, we see a deep disruption of health service delivery and I'm sure so many of our partners around the world can talk about that. And lastly, it's really bolstering and emboldening an anti-human rights agenda worldwide. And we see a chilling effect where unfortunately the message is sent that this is the values of the American people and therefore, we tend to see copycats, we tend to see opposition leaders taking this and, and running with it and using this to further an anti-rights and anti-health agenda. And so, those are sort of three areas that are unfortunately where we're seeing deep impact.

Caitlin: Yeah, and I'll just pick up and add, you know, I think we started by naming those who are most disproportionately impacted and harmed by this policy. And I know we're not gonna get into all the other bad things that the Trump administration has done already, but just to say, right, this is not the only attack that they are experiencing. There were so many harmful executive orders aimed at those very same communities. So, the compounding impact and harm, right? It's not just about the gag rule, it's about all those ways that their health and dignity and rights are being attacked by this administration. I think Lori's exactly right, and I think many people of course understand this as an anti-abortion policy, but maybe underappreciate how much the harms hit so many other services. And again, that's 'cause of the point you brought up Jennie, that care is integrated. Providers aren't just out there offering one service. So, when clinics close—and there's lots of documented examples of where health centers have had to close, or nurses have been laid off as a result of the policy—communities lose access to a whole entry point for services and care contraception. Again, HIV maternal and child health, like, you name it, they're losing it. And it doesn't take a PhD researcher to tell you that when people lose access to care, more people are experiencing unintended pregnancies, and in the areas of the world where the US is working, of course that's meaning more unsafe abortion and ultimately more people dying. And we talk about those service delivery impacts a lot. I think what Lori brought up is so right, like, it's just as destructive and less understood the impact on, you know, destroying coalitions who are trying to work together to tackle big challenges and really stifling that local advocacy effort, which seems like it should be a core American value. People should be able to speak up and participate in public policy debates happening in their own country. But the gag actively blocks healthcare providers from doing just that. And the only other thing I think that's worth noting because, you know, we've been dealing with this policy for 40 years, I think it's even worse now because we've seen a really welcome global trend where so many countries are stepping forward to liberalize access to reproductive healthcare, including abortion—the US obviously a clear and notable outlier in going backwards—but now what the gag rule means when it comes into place is it's really holding people back from getting care that is legally available in their country. And even information about where they could access that care. So, in some ways I think that global gag rule—as the world makes progress and expands and liberalizes access, the global gag rule is even worse 'cause it's holding people back from that hard-fought for local gains.

Jennie: Yeah, I think the other thing I think about is how it undermines trust in the healthcare system. If you're going to a provider and you are pregnant and don't want to be, and you're asking them for information that they can't give you, like, that undermines trust in the provider, you may not go back. And it's hard to, like, okay then the policy ends that doesn't magically bring the people back to the healthcare system. The clinics don't immediately reopen. Like, I just find the harms just kind of continue to ripple out.

Lori: Yeah. We know this in the US, and we know this globally, it is deeply unpopular, confusing and unhelpful for politicians to be interfering with personal healthcare decisions. You do not want politics in that room with you. It does erode trust. Imagine trying to roll out a vaccine delivery program and this is something that has eroded trust in the community or is undermining clarity about who can provide what services and when. That's just really unacceptable. And we see for an administration that claims to be focused so much on efficiency, that this policy creates new financial and operational challenges for both complying and non-complying organizations. And especially has a very confusing effect on not only civilian populations, but on people who are very well-versed and trained to understand these things. It's still very unclear how they should be implementing this and why. So, we tend to see an over implementation or a lot of misinformation that is also gonna be undermining long-term trust and the strengthening of the overall healthcare system.

Caitlin: Yeah. And thinking about that trust message, Lori and Jennie, that you both mentioned, I think that's spot on. And it also really undercuts one of the messages that I always hear from Republican administrations who say, "well, the global gag rule doesn't really shift, doesn't reduce our funding, right? We're just shifting to a different partner." The idea that that trust transfers to a different partner at the community level, I think is so wrong. And I think it's especially true when you think about the special care and services that young people need or that LGBT communities need. They're not just gonna pick up and show up for healthcare wherever the US government tells them to, simply because they've decided to upend the partnership. People are gonna lose services. So, I think that that trust message is so key and underappreciated.

Jennie: Yeah. It's so frustrating to be back in this position again where we know people are going to suffer and not be able to access the care they need. And yeah, it just feels, like, helpless to do things to fix it, which is so frustrating 'cause we spend so much of our time trying to end this policy and make sure it doesn't come back. So, what do we need to do to ensure that we can, like, get rid of it once and for all?

Caitlin: Well, there are a lot of things that we can do. I mean, one tangible thing I'll flag is that there is actually a piece of legislation that was immediately reintroduced after Trump reinstated the policy that would permanently end the global gag rule and really take that power away from the president to turn on a dime and upend global programs around the world. So, that's the Global Health Empowerment and Rights Act. We shorthand call it the Global HER Act 'cause we love an acronym in this space, but it was just reintroduced in the House and Senate and PPFA and so many partners who work across health, human rights, gender equality issues, are really proud to support that legislation. And it's really linked to our core belief that politicians should not be interfering with personal healthcare decisions, whether in the US or around the world. And I think it's worth noting that it's also in line with what we know the American people want. We did polling last year that found that the global gag rule is really deeply unpopular with Americans. I mean, truly across every demographic. And people had really deep serious concerns about the harmful impacts of the policy, especially on worsening healthcare. And I think it's personal now for Americans in a way that perhaps it wasn't always before. With two years living without the right to abortion post-Dobbs, people get what this means, what abortion restrictions and losing access to care means. And we saw an extension of that empathy when they were looking at a policy like the global gag rule. And that's why you see strong majorities of Americans wanting to end the policy for good, which hopefully someday will happen and we can stop working on it and we can talk about something else on the podcast.

Jennie: Yeah. Wouldn't that be nice? I was just thinking, you know, and you talk about how deeply unpopular it is with all of the chaos of this last week and a half at this point, and it coming out late Friday, like we were not in theory working anymore. It got lost in, like, all of the chaos and, try as all of us might to push to make sure that people were aware of it, it was one of those things that felt like it really got lost in the shuffle between all of the million of other crisis chaos points there were last week.

Lori: Yeah, I think that's true. And I think, you know, the fact that I believe Trump signed this on a plane this time around at the same time that he also was about to land in California and signed a bunch of other messed up things, to your point, Jennie, on that same plane ride as well. But I wish I could say that I think that's the only reason this didn't get a lot of attention, [laughs] having, I know we're all world weary and-

Jennie: True, true.

Lori: -and battle tested in this work, but you know, I think I've lived through this before and I can't say that the literacy among Americans on this work is where it could be, right? And I wish we could have taken advantage earlier on to- of prior opportunities to make this a little bit harder to do. But I just don't know that there's as much engagement as there could and should be. But maybe now is the moment because again, if you're someone who believes in child health, if you're someone who believes in HIV prevention, if you're someone who believes in humanitarian support, this is a policy to be paying attention to. And I do think with COVID-19, we also were reminded and deeply connected to how all of our fates are linked and tied. And I think this, this move has made all of us less safe, more susceptible to illness, all kinds of illness and preventable ones at that. And so, that's something that I hope if we can even appeal to people's understandable self-interest, this is a policy that I think could come into sharp relief in this moment for that reason.

Jennie: Yeah, I'm holding out hope. It's one of those, like, foreign assistance not getting as much attention in general, so it makes sense even if it shouldn't that it kind of flies under the radar. So, now we've talked about how we should, could get rid of the policy and I like to think that that's not enough. So, what else should we be doing?

Lori: Well, I don't know about you all, but the past few weeks it's been a little bit hard to, like, step back and dream. I've been really mired in the day-to-day work of responding and reacting to a slew of awful updates and actions. But at some point I really feel like it's important for our movement, and I use that word very broadly and with a big tent approach to really imagine what resilience could look like and do some future proofing that like, takes into account the most evil possibilities that could, could happen to us. And really think about getting innovative and getting ruthless in how we structure our work and how we think about being able to scale up and scale back really, you know, quickly or to move resources where they need to be moved in, in new and innovative ways. So, that's just a conversation that I'm gonna put out there and invite folks to join 'cause I think we need new voices. We need, you know, really we need folks with a lot of experience. We need folks who are brand new to these conversations to all really come to this work and be excited to think boldly together and take some risks together 'cause I think that's also gonna be important for pushing back. And so I know at Planned Parenthood we're also having those conversations, not this week, but but we are having those conversations and I'm excited to kind of be able to share more about that in the future in a way that isn't reacting moment to moment, but is is really about thinking super long term and having that our own 30 year agenda that's gonna knock someone else's, you know, kind of socks off.

Jennie: Ugh. I love that. Like, we spend, so we have to focus on, like, the details and, like, where the next attack is coming from, whether that's global gag rule or worrying about what's gonna happen to the gender programs or things like that. Worrying about seeing anti-trans stuff really expand in the global space. And it's so easy to get caught up in like protecting the ground we already have and like fighting tooth and nail for a standstill, which is so hard to be inspired by at times that it's so exciting to like, think about the dreaming big and, like, planning for, like, a much more positive vision of 30 years from now. But it's so easy to get caught up in the next thing that's on fire or trying to make sure that everything doesn't burn down at the same time that it can be hard to dream big. But I love the idea. Okay, so we talked about what needs to happen. We need to get the Global HER Act passed and signed. How could our audience get involved in this fight? Like, how can they take action to either help make people aware of the global gag rule, but also to make it go away?

Caitlin: Well, I love that you always end with a call to action because it's easy to complain about all the problems of the world. But we do have the ability to make a difference, and the totality of this agenda is not inevitable, and we have to hold them accountable at every stage. So, a simple thing I think is just speaking out about the policy, right? Like, don't let it go quietly. I hate seeing, too, those articles that were like, "oh, this is the Democratic, Republican norm. This is just what they do." Like, it is unacceptable and I hate that a policy like this has been normalized as just, like, the status quo that we accept and expect, right? So don't let them off the hook in that way. Let's be loud, let's be clear about what it is. I think the media, well-intentioned, sometimes just gets it wrong, right? Conflates it with other confusing restrictions. So, also being really clear about what it does, what it doesn't, and that you don't want to see politicians playing politics with people's health, their lives. And that holds true for your own community, right? For local domestic things, but it also extends to what you wanna see the US showing up around the world. I think that's a really powerful message to lift up.

Lori: I would plus one that I think that's really well-put, Caitlin. And I, one thing that I would ask for people to do is spread true information, battle misinformation, and don't further stigmatize abortion in doing so. So, I've seen probably a little bit more hand wringing about the potential threats to or end of PEPFAR. And obviously PEPFAR—super amazing, important program, don't want that to end, don't want- not sure what's going on with this 90 day pause and, you know, watching that space very closely. But I am also a little bit nervous about a false distinction between GGR as like a quote unquote, you know, "abortion problem,” and then all of these sort of other foreign assistance related EOs as sort of the global health problem. And I think that's where we really need folks to kind of rise up and push back and don't let any type of abortion stigma stop you from sharing the right information and sharing your right viewpoint about the global gag rule in and of itself being so incredibly comprehensive and so incredibly harmful and deadly.

Jennie: I think the only thing I would add is making sure when you're talking about it, even our champions when they're talking about it, if you're gonna repeat the, like, "the US doesn't pay for abortion services," being clear that, like, but that also has to change, right? We need to get rid of the Helms amendment.

Lori: Yes.

Jennie: Like, definitely seeing some people who maybe sit on committees that should know better talking about it today was a little frustrating.

Caitlin: Here, here. Yep. Room, room for improvement in so many spaces, friends and enemies.

Lori: It's, it's so refreshing to talk to you both because it's like I have very technical pet peeves that very few people can relate to.

Caitlin: [Laughs]

Lori: So, thank you for letting those be aired out today in a safe space.

Caitlin: Yeah. Let your inner wonk fly. [Laughs]

Jennie: Exactly. Well, Caitlin, Lori, thank you so much for being here. I had a wonderful time talking to you about a terrible policy.

Lori: Thanks Jennie, for the platform that you've created. I truly appreciate it.

Caitlin: Yeah. Grateful for you always lifting up the important things of the day. Thanks Jennie.

Jennie: Aw, thanks.

Jennie: Okay, y'all, I hope you enjoyed my conversation with Caitlin and Lori. I had such a lovely time talking to them about this really, really terrible policy. Like I said, we are going to be working to try and get somebody to come on to talk about some of the anti-trans EOs, hopefully next week, but it may not be until the week after. But we are working to get people to come on to talk about all the things that are happening to make sure that you are able to stay up to date on what's happening, but more importantly, how you can get involved in the fight to fight back.