The Global Gag Rule’s Harm Has Persisted for 40 Years

The Global Gag Rule (GGR) prevents foreign non-governmental organizations that receive U.S. foreign assistance funds from providing, advocating for, counseling on, or referring for abortion services—and has successfully done so for 40 years. Beirne Roose-Snyder, Senior Director at the Preclusion Project, and Bergen Cooper, Senior Research Advisor at the Preclusion Project and Chief Operating Officer with the Torchlight Collective, sit down to talk with us about the history of this destructive policy, its long and heart-wrenching impacts, and what the future of the GGR might look like.  

The GGR, introduced in 1984 by President Ronald Raegan, is a presidential memorandum that is either reinstated or revoked depending on which political party is in the Oval Office. In 2017, the rule was expanded by the Trump administration to apply to all global heath assistance funding. The GGR has, and continues to, affect LGBTQI populations, people living in rural areas, people living with disabilities, sex workers, and healthcare providers, when accessing or providing abortion, contraception, gender-based violence care, HIV /AIDS care, STI care, and more. With the possibility of a change in administration coming soon, the GGR under Project 2025 may extend its reach farther and worsen outcomes.

Links from this episode

Beirne Roose-Snyder on X
Bergen Cooper on X
It’s Time to End the 40-Year Legacy of the Global Gag Rule
The Preclusion Project

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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: Hi rePROs. How's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So y'all, I am back! I had a great leadership training that I went to and also had a ton of fun at Disney for my add-on trip. You know, I have to say the only downside--it was so much fun--was that the weather was just brutal. It was so hot and so humid. Like, the high each day was 90, and in the mornings it was like 80% humidity. Like, it was just disgusting. It was, like, walk outside, immediately start sweating. I joked around that. I became more Powerade than person as the days went on, like, having to drink so much Powerade to try and stay hydrated. It was wild, but it was so much fun. My friend and I went to Mickey's not-so-scary Halloween party and dressed up as villains. She went as Cruella Deville and I went as Ursula. My mom helped me put this really fun skirt together with tulle, and it was really cute. I will see if I have a picture that I can have Elena share so y'all can see. It was a lot of fun. Yeah. But it was just so great to just, like, take a step away from everything. Like, it was like a whole week where, I mean, I checked emails just to make sure, like there was nothing urgent that needed responding to, but like, I wasn't on social other than to, like, post pictures and just like to take this giant step back. It was really nice to just kinda get away from all of the things. It was really needed. I mean, the downside was I came back at midnight on Monday night, so I had to jump straight into work and was, like, exhausted from the heat. Like, man, the heat just took it out of me. The last day I had to leave the park early because I just couldn't do it anymore. My body was just like, no, we're done four days of walking around in this humidity and heat and we're done. So, go back to the hotel, sit in the air conditioning and then you can go home. So, it was rough. My feet are still tired. I'm tired, but it was a lot of fun and it was just the trip I needed to just get away from all the things. But yeah, it was a good trip. I'm so glad that my friend came with and we had so much fun and took so many silly pictures, y'all, so many silly pictures. Honestly, if you're gonna go and do Disney, if you don't like, do all the silly pictures, like what's the point? I don't know. It was just so much fun. Let's see, my cats have been super clingy since I got back. I get it. They missed me, but like, oh, so much attention is being demanded at all times, like, crying outside the bathroom door if I'm taking a shower. Attention, demanding, like, oh, it's been, it's been rough. Lots of snuggles demanded, but they're cute. I don't mind snuggling, but just like, maybe not while I'm working. Yeah, maybe not. With that, I think let's turn to this week's interview. Last month marked the 40th anniversary of the Global Gag Rule. So, it felt like a good time to take a step back and talk about 40 years of the Global Gag Rule. What is it, what are we seeing? Why are we talking about it now, beyond it being the anniversary, and how could we make sure to end this policy once and for all? And y'all, I could not think of two better people to come and have that conversation than Beirne Roose-Snyder and Bergen Cooper with the Preclusion Project. So with that, let's go to my interview with Beirne and Bergen.

Jennie: Hi Beirne and Bergen, thank you so much for being here.

Beirne: Hi Jennie.

Bergen: Hi. So happy to be here with you.

Jennie: I'm so excited. Like, I could not think of two better people to talk about to--I guess mark, celebrate feels all sorts of wrong--mark the 40th anniversary of the Global Gag Rule.

Bergen: Yeah. Yeah. It's sad that that is what we're known for, but happy to be here to talk to you about it and putting an end to it.

Jennie: Okay, before we get started, let's do quick introductions. Beirne, do you wanna go first?

Beirne: Sure. So happy to be here again with you, Jennie. My name is Beirne Roose-Snyder. I use she/her pronouns and I'm the senior director at the Preclusion Project, an independent project that works to make lawyers and organizations and donors and activists more resilient to US anti-gender policies including and especially the Global Gag Rule.

Jennie: Bergen.

Bergen: Hi, my name is Bergen Cooper. My pronouns are she and her. I'm the senior research advisor with the Preclusion Project. I'm also the Chief Operating Officer with the Torchlight Collective, a multidisciplinary international human rights consulting firm. Okay.

Jennie: So, I'm so excited you're here, even if it's to talk about not great things.

Bergen: Yep, yep. We're happy to be here with you. [Laughs]

Jennie: It's been a while since we've talked Global Gag Rule on the podcast, so I figure it's been 40 years. Maybe we should talk about what it is and a little bit of the history before we talk about anything else.

Beirne: I'd be happy to, I'll sort of start off with the, the most basic structure of the global gag rule is it is a presidential action that then becomes a contract provision that restricts different types of US global health assistance. So, this is an announcement by a president that then gets distilled down into impacting our health programs all around the world. And what it particularly does is it says that if you receive US money, you cannot provide or promote or do public education about abortion as a method of family planning. And it first went into effect in 1984 and people know it as a policy that comes back and forth. It's oftentimes talked about as being a switch that gets turned on and off with Republican administrations and democratic administrations over the last 40 years. It doesn't always get a lot of focus in the United States as a voting issue because the people harmed by the policy, both those on a programmatic level, but also those on a level of the health services they're able to get. They're not US voters. And so, it oftentimes sort of doesn't get the attention it needs, but it's a way that the US has been exporting our anti-abortion policies and restrictions to destabilize and make less efficient global health money around the world. And I'll go into a little bit more detail about the history of it since we are talking about the 40 years because it is a really sort of extraordinary thing that happened in 1984 and then has these ripple effects as it's become part of American partisanship. And it actually began in August of 1984 as a moment at the United Nations International Conference on Population. This was the second, I think, UN ICP. It was before it was PD I think. And the first one in 1974, or the previous one in 1974 had been in Bucharest. And this one was in Mexico City in 1984. And this is why it's often times called the Mexico City Policy is because it arose at the conference on population in Mexico City in 1984. I think it's really valuable for listeners to sort of understand that because we've also talked about 1994 and that conference on population and development in Cairo as being this massive watershed moment for sexual and reproductive health and rights and also for reproductive justice. But before that watershed in Cairo 10 years before, we have the Reagan administration using this conference on population as another political moment for them on the Cold War population dynamics and economics. So, where this Mexico City policy came from, it's not about health or rights, it's actually coming from a place of sold sort of Cold War fears about population dynamics in, and I'm quoting here, "the Third World" and how US wanted to use their economic power in response to it. So, even the language as a method of family planning, it only really pops up in the US sense based on Title X. And that was language inserted by the Catholic bishops and then it's also used in the Cold War context as an accusation of how the USSR used abortion quote "as a method of family planning." So, all of the policy is really rooted in this really stressed economic and population bulge politics and was not in any way about individual health or rights about bodily autonomy, about good healthcare, wasn't really about maternal mortality or morbidity. And it really was a direct quote from the original policy statement from the Reagan administration was that, you know, "by helping developing countries slow their population growth through support for effective voluntary family planning programs in conjunction with sound economic policies, US population assistance contributes to stronger saving and investment rates, speeds the development of effective markets and related employment opportunities, reduces the potential resource requirements of programs to improve the health and education of the people and hastens the achievement of every country's graduation from the need for external assistance." So, even from the very beginning, this was viewed as a political and economic tool, not ever about outcomes or health and rights. So, that's the sort of very Reagan history of it and we see it in place as applied this restriction to US family planning during the Reagan administration and then George H. W. Bush's administration. So we see it in place from 1984 to 1993. Then Clinton put out his own presidential memorandum that revoked the 1984 one. There was a weird budget year in there that is probably worth its own podcast on the politics of it where Clinton needed to put, attach it to a funding bill the last year of his administration and then it came back into place for George W. Bush. So from January, 2001 to January of 2009, it was back in place, still applying to about $500 million in US international family planning assistance a year. Then it was removed--again through a presidential memorandum--by President Obama in January of 2009 through January 2017. And then in January 2017, not only did the Trump Pence administration reintroduce it, but they also expanded it to all of global health assistance. So, now we have this abortion-related speech association service provision restriction, not just applying to US family planning assistance, but also applying to all of global health assistance that included PEPFAR, maternal child health money. And what we really saw was, you know, almost 15 times the amount of money was impacted in those four years than it had been in previous administrations. So, in January of 2021, we saw the Biden administration, again, remove the policy, it's not in place right now. And for the first time since Reagan really, put the removal of the policy into some kind of context and that context was around the rights--the right to health, the right to information, the right to bodily autonomy for women and girls around the world. And that was the first time that was put in really a rights-based context of why we need to get rid of the policy. So, that's where we are right now is the policy has been removed by the Biden administration, but it continues to be a political switch that can go back and forth depending on the administration.

Jennie: I have to say I've been working on this for, like, 15 years, but the thing I love about Beirne is that I still learned new things listening to her talk. That's always like, I wanna be Beirne and know all the things when I grow up.

Bergen: It's a good thing to wanna be when you grow up. I support this, I second it.

Jennie: Right? Okay. So, that was like such a great history. And I think one other thing I wanna flag just for people who aren't as familiar, Beirne mentioned PEPFAR and that's global AIDS funding, just if people are not as familiar with that.

Beirne: Yes. So, that's our global AIDS funding. And I should have also taken a moment to really say Bergen and I, Jennie, we're all gonna be calling it the Global Gag Rule and we're gonna be calling it the Global Gag Rule throughout time and space, from 1984 until now. But the administrations originally called it the Mexico City policy, which is not fair to Mexico City. They have very progressive abortion laws. And then in the Trump administration, when they expanded it, they have renamed it Protecting Life in Global Health Assistance Advocates. Activists continue to call it the Global Gag Rule, even as it's expanded and even as it's impacted more people and more money, it continues to, at its core, be a restriction on how you can talk, who can speak, what type of research you can do, what type of services you can provide, and it continues to gag both medical providers and organizations. Jennie: Okay. I think the next big bucket--now that we know what it is--impacts. Like, what are the impacts that we have seen from this policy being in place?

Bergen: Yeah, it's a great question, Jennie. And the impacts are long and far reaching. So, by the time this has aired, we have released a new data brief that covers 40 years of impact of the Global Gag Rule. And you know, as Beirne framed, we think of this originally as an economic policy and maybe somebody frames it as an abortion policy. And some of us frame it as a free speech policy. And when push comes to shove, when you're looking at impacts, what you'll see is impacts across all areas of people and of work, which is extremely challenging as we think about how to organize and talk about the far reaching impact. And you'll see on the data brief how we chose to break down the impacts, and excuse me as I go into a long list here, because the impacts of the global gag rule are really, it's a long list. So, we have a documented impact of the policy on international human rights principles, sexual and reproductive health and rights services and outcomes, wrongful implementation of the policy on advocacy, on partnerships, on coalition spaces, on national sovereignty, on different populations like LGBTQI populations, people living in rural areas, people living with disabilities, sex workers, on healthcare providers, of course on abortion, on contraception, on mortality, on gender-based violence, on HIV/AIDS and other sexually transmitted infections. I'm gonna keep going. The list goes on, on maternal and child health, on humanitarian funding, on humanitarian programs, on nutrition, on water and sanitation and hygiene, on research, and of course on COVID-19. And as Beirne mentioned, when the policy was revoked under President Biden, we still continued to see impacts and so we have data on the impacts of the policy post revocation. Jennie, I appreciate the coverage that that repro fight back has dedicated to the Global Gag Rule. And I'm glad that you and I have had opportunities to talk about the policy in the past, but since we've talked about it, new data has been published Beirne and I were thinking about, you know, does there need to be another data brief? Does there need to be another fact sheet? And the truth is, we've had at least 15 new articles published recently on the impact of the data. And some of this I'd like to flag for you today, because oftentimes when the policy comes into place, we have conversations with reporters and they want the numbers. They wanna say how many people died because of the policy. And for a while, that wasn't how the research was set up. That data takes a lot longer to gather. We add qualitative research much earlier into implementation of the policy under the Trump administration. But some of that quantitative data does take longer and it has been published now. So, in terms of mortality, we have data that shows that for countries with an above median reliance on US family planning, so they're relying on more US family planning. The switch from a Democrat to a Republican presidency is associated with an 8% increase in maternal mortality. So, to put an 8% increase in perspective, that's eroding a fifth of the average worldwide decline in maternal mortality that had been achieved since 1990 using data from 134 countries. And this is from 1990 to 2015, researchers found that the Global Gag Rule is associated with a higher child mortality rates. Again, the strongest impact is shown in countries that have a heavier reliance on US funding for family planning. We did have stories of death, specific death from the policy to young women in Kenya died from unsafe self-induced abortion because an organization, in order to keep providing HIV services under the Global Gag Rule, under Trump's global gag rule, could not offer information or referrals for safe abortion. And I mentioned that this was an organization that had to keep providing funding for HIV services. We continue to have data around the impact of this policy on HIV and AIDS. Again, research though again, was using data from 34 countries between 1990 and 2015, they found that the Global Gag Rule is associated with a HIV incidence. Again, strongest impact in countries that have the heavier reliance on US family planning programs. In terms of maternal and child health, researchers found that after the Global Gag Rule was revoked under the Obama administration, countries with high exposure to the policy during George w Bush's administration had significant improvements in infant neonatal under five mortality. They had lower fertility rates and increased birth rates. So, what we're seeing in the data is when the policy is in place, it is hurting mortality, it is hurting child health. And then when it's revoked, we can actually see the improvements coming along the lines of health and of course abortion. You know, I mean, I understand that people wanna know the impact on abortion and if the policy was put in place to reduce abortion, it is a gross failure. We have- one of the more popular citations is26 countries in Sub-Saharan Africa indicate that they saw approximately 40% increase in likelihood of abortion under President George W. Bush compared to when it was removed by President Clinton and Obama. So, we're seeing increases in abortion when the policy is in place. We see this in Sub-Saharan Africa. We see this in Latin America as well. And there's also one thing that in terms of, when I was talking about the impacts that I didn't mention, which is the chilling effect, we see that organizations over implement or self-censor their speech related to sexual and reproductive health and rights and sometimes unnecessarily end or curtail programs including service provision or joining a coalition meeting or joining an advocacy space in fear of having their funding revoked. I'll pause there. I will tell you that this data sheet is 20 pages of bullet points of the impact. So, to spare your audience, I won't go through every single one, but happy to jump into more details and I know Beirne spends so much of her time talking to folks around the world about the impact. So Beirne, if there's other points that you wanna be sure to add in, please jump in if there's other points that you want me to refer to.

Beirne: I mean I think you are so precise and you're so correct about all of this and the big top lines, both the ones that sort of make some, some intuitive sense and some of the ones that are a little, take a little bit more on unpacking. I think the top line though, that we just have to sort of put front and center again and again, is that there is no data, there is no evidence suggesting health benefits or health positive outcomes or efficacy of foreign assistance funds. There's no data anywhere that says anything good about 40 years of the Global Gag Rule. This is not a piece where we say our bit and then someone says, well, we've got all our data on the other side. There isn't data on the other side. There is a belief in the fact that there are bad people, bad organizations that provide and promote abortion, that work on abortion somewhere in the world and that they should be isolated and cut off. That is the whole belief system that goes into the Global Gag Rule. There's no assertion that anything good comes for health services for individuals, for any kind of data-driven outcome.

Jennie: I, you know, one of the things I often think about is not just how harmful this policy is when it's in effect, but like the long tail of, like, seeing the harm even after it's gone. But I guess that kind of leads me into my next question of thinking about, so it's not in effect, it's not been in effect since Biden went into office. Other than it being the four 40th anniversary, like why are we talking about it right now?

Beirne: Well, Jennie, I joined you back in I think January or February to talk about Project 2025. And that is a big reason why we're talking about it Now. We know that when the next conservative president comes into power, the stated ambition is not just to bring it back to the Trump era, which was as Bergen just described, catastrophic to health gains in maternal mortality, in child mortality in HIV, new HIV infections. Not just bring it back to that Trump era, but to use this, this space in foreign policy to push even further. And so right now--and we see this both in a senate bill, we see it in negotiations and pushes happening in the House of Representatives, and we see it stated very plainly in Project 2025--the intention for the next step is to expand this, the global gag rule directly to US-based organizations, to government, to government funds, to multilateral organizations and to all of US foreign assistance. So, that includes humanitarian aid, democracy rights and labor education, just development assistance broadly and humanitarian assistance broadly. So, We are at a precipice where we know what the last 40 years have brought in terms of instability, pulling back global health progress, bad, bad outcomes, incredible disorienting chaos at a clinic level and an organizational and country level. And we know that what they intend to do is now put that onto steroids for the next conservative administration. So, we are unfortunately on a really, we are on the precipice of that switch and which way it's gonna turn, if it's gonna turn, is the open question this fall.

Jennie: Yeah, the thought of it expanding so much further is really kinda scary. Like, you know, one of the things we've been focusing on at rePROs is sexual and reproductive health in humanitarian settings. And the thought of it attaching to that is scary for the impacts it could have on people around the world and all of those ways that it would get added on. But that's just one that has been sitting with me for a little bit.

Bergen: Yeah, absolutely. And I mean you, we have documented the government trying to attach it to humanitarian funding in the past and we have seen humanitarian organizations that were gagged, over-implemented the GGR to avoid being noncompliant--the chilling effect that we talked about before. So, we certainly have seen impact in the humanitarian space even when the policy does not attach to humanitarian funding. So yes, the impact would be far greater and more devastating.

Jennie: Okay. Let's, let's turn to a little bit of hopeful instead. What can we do to make sure that the GGR doesn't come back at all? Like, how do we finally end this?

Beirne: The technical answer is that Congress needs to pass a bill that would keep presidents from being able to put it back in place to sort of take the power of, of this decision out of the hands of the president. In this Congress, that bill is called the Global HER Act. I think it'll probably be a slightly different bill in coming years. It's something that could easily get done, Congress could pass it, a president could sign it, and we could be done with this flip-flopping that has created such incredible instability around sexual and reproductive health and rights and really undermined the local and national goals of countries all around the world. So, Congress has that ability to act if they want to. I would say for listeners, it's not just a question about getting your member of Congress to prioritize or sign the bill. There's a lot of priorities right now and many of your listeners live in districts in which they know the members of Congress are not gonna ever flip a vote on something that's couched as abortion-related. I still think it's worth having meetings in which, ideally in district, in which you are talking about the incredible harm of this policy 'cause foreign policy members of Congress are almost never confronted with meetings about it. Particularly members who are gonna sign off on a letter go, oh yeah, more abortion restrictions. Yeah, I should totally do that. And are never, ever confronted with the data on the policy, increasing abortion on an increasing maternal death and child mortality, on it increasing HIV and reducing efficiency. And so, even if you know that it's gonna be a meeting in which they're not gonna flip their vote, I think for where people can, going in and talking about the data, talking about the harm and the fact that you don't think they should be harming people, especially women and girls around the world in their name, that's a great meeting to take with your member of Congress no matter what. Make them feel bad, make them feel that there are real human repercussions to their incredibly lazy culture wars talking points.

Jennie: Okay. I'm trying to think if there is anything else. I think we hit all the things unless Bergen has anything she would like to see the listeners do.

Bergen: I would like to see them read the entire data sheet and I wanna hear from them. My email's on there. If there is data that you have that I don't, send it my way. If you have questions, I wanna talk to you about it. If you wanna think about how your messaging this, Beirne and I both wanna talk to you about this, I'll be your data friend, reach out.

Jennie: And we'll definitely include a link to this amazing new brief in the show notes so you will have easy access to it.

Bergen: Thank you. Fabulous.

Jennie: Beirne, Bergen as always it was delightful to talk to you about the Global Gag Rule.

Bergen: Thank you so much Jennie. Good to see you.

Beirne: Thank you Jennie. Hopefully, this is the last time we will talk to you about it 'cause 40 years is enough. It started out as you know, an absolute Cold War us versus them policy, it's 40 years later, it's continuing as a US culture war, us versus them policy. It doesn't need to be us versus them. We could have data driven foreign assistance. We could be done with all of this and we could do a little bit to make the world more stable and more responsive to the needs of, of people in their health services. Yes,

Jennie: A policy that is almost as old as me, that is terrible. It's time. It should go.

Beirne: It's time.

Jennie: Okay y'all, I had so much fun talking to Beirne and Bergen and like I said, I've been working on this issue for 15 years and still when I have talked to Beirne and Bergen, I always learn new things, you know, from both of them. Bergen has like, so much is so on top of the research and I always learn so much and Beirne has like all of this policy insight and knows all of these details that I just am always so continually impressed with the two of them. And so I was so excited to get to talk to them about all things GGR. So, I hope you enjoyed our conversation and with that I will see y'all next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprofightback.com or you can find us on social media. We're at rePROs Fight back on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!