Back in January, one of President Trump’s first official actions was to reinstate and expand the global gag rule, a harmful policy that hijacks U.S. global health assistance in the name of anti-choice politics. The strikingly named “Protecting Life” implementation plan that followed in May brought the dangers of this new Trump-Tillerson initiative into sharp focus. In preparation for the State Department’s upcoming six-month review, People For the American Way, Global Health Council, Planned Parenthood, and more than 100 other organizations are renewing their shared commitment to global health and have outlined a clear set of departmental recommendations. You can view the joint statement here.

Civil Society Recommendations for the 6-month Review of the Mexico City Policy

Given the expansive nature of the new policy, the Department will undertake a thorough and comprehensive review of the effectiveness and impact of the policy’s application over the next six months, which could include identifying implementation issues, and any other new information affecting implementation going forward. Newly covered programs, including PEPFAR, the President’s Malaria Initiative, and other global health programs, will be given special attention under this review. – State Department Fact Sheet, May 15, 2017

On January 23, 2017, President Trump reinstated and expanded the Mexico City Policy which requires foreign non-governmental organizations to certify that they will not use their own funds to provide information, referrals, or services for legal abortion or to advocate for access to abortion services in their own country as a condition of receiving U.S. global health assistance. Given the significant expansion in scope, the State Department committed to conducting a “thorough and comprehensive” six month review of the impact of the policy on all covered programs on May 15th, 2017. This review provides an important opportunity to assess the impact of the expanded policy on all global health programs supported by the U.S. and make changes as needed, particularly in the context of the evolving foreign aid landscape since the narrower version of the policy was last in effect from 2001 to 2009.

U.S. global health programs have saved and improved millions of lives and transformed families, communities, and countries. U.S. aid, delivered through a wide variety of partners, advances U.S. health goals and supports broader development, economic, and strategic interests that benefit the U.S. and recipient countries alike. As the U.S. continues to invest in vital global health programs, the State Department must ensure that policies do not undermine the ability to meet these goals and effectively and efficiently deliver care for those in need.

In light of the large amount of taxpayer funding, organizations, and individuals impacted by the policy, it is critical that the State Department continue to monitor its impact on a long-term basis. Since the implementation of the policy will be rolled out incrementally over time, care must be taken to ensure that impacts are measured where and when the policy is fully implemented and in effect. While the six month review is an important first step, we call on the State Department to conduct reviews on an annual basis while the policy is in place in order to capture and understand ongoing and long term impacts, including on health outcomes, and make appropriate course corrections to mitigate any harm or implementation issues. The review should also build upon and incorporate research documenting the impact of the policy when previously implemented.

In order to be meaningful, the State Department should ensure that the six month and subsequent annual reviews are:

• Comprehensive: The review should include all programs and funding streams impacted by the current policy.
• Transparent: A written review should be made publicly available and include details about the process and data sources that informed it.
• Consultative: A wide variety of stakeholders should be invited to provide feedback and data, including staff from impacted agencies, implementing organizations, donor and host country governments, and civil society in the U.S. and in aid recipient countries.
• Action Oriented: The review should clearly articulate the State Department’s plans to swiftly address issues surfaced in the review.

In addition to considering broad implementation issues across all global health assistance, the six month and subsequent reviews must pay particular attention to whether the policy disproportionately impacts certain people, places, services, and organizations. The review should examine the specific impact of the policy based on the following:

• Population: Adolescents and young women, LGBT individuals, people living with HIV, and other marginalized communities may be uniquely impacted by the policy and are key to successful global health programs and broader U.S. goals.
• Geography: Some countries or regions within countries may be more significantly impacted by the policy because of incongruence with local laws or the absence of alternative service providers.
• Intervention: The policy may create gaps in the availability of particular types of services including, but not limited to, HIV treatment, a full range of contraceptive methods, maternal and newborn care, HIV testing, and post-rape care, or undermine the level to which U.S. funded services are able to remain integrated and the provision of high quality and efficiently delivered care.
• Type of Organization: Organizations who work at the community-level, work to hold their governments accountable, conduct evidence-based research, and specialize in care for marginalized communities are important partners in delivering on our goals and the impact on them should be closely examined.

We remain committed to supporting U.S. investments in global health to save and improve lives and urge the State Department to conduct a comprehensive annual review of this policy to examine whether it hinders these efforts.

1. Action Against Hunger
2. Advancing Synergy
3. Advocates for Youth
4. AIDS United
5. American Civil Liberties Union
6. American College of Nurse-Midwives
7. American Humanist Association
8. American Jewish World Service (AJWS)
9. amfAR
10. Amnesty International USA
11. Anti-Defamation League
12. Association of Nurses in AIDS Care
13. Association of Reproductive Health Professionals
14. AVAC
15. Better World Campaign
16. Breakthrough
17. CARE USA
18. Catholics for Choice
19. Center for Health and Gender Equity (CHANGE)
20. Center for Reproductive Rights
21. CORE Group
22. Council for Global Equality
23. Elizabeth Glaser Pediatric AIDS Foundation
24. EngenderHealth
25. Feminist Majority Foundation
26. FP2020
27. Friends of the Global Fight Against AIDS, Tuberculosis and Malaria
28. General Board of Church and Society
29. Global Fund for Women
30. Global Health Council
31. Global Justice Institute, Metropolitan Community Churches
32. Global Progressive Hub
33. Global Rights for Women
34. Guttmacher Institute
35. Hadassah, The Women’s Zionist Organization of America, Inc.
36. Health Global Access Project
37. Helen Keller International
38. HIV Medicine Association
39. Human Rights Campaign
40. Human Rights Watch
41. IMA World Health
42. In Our Own Voice: National Black Women’s Reproductive Justice Agenda
43. International Action Network for Gender Equity and Law
44. International AIDS Vaccine Initiative
45. International Cancer Expert Corps
46. International Center for Research on Women (ICRW)
47. International Planned Parenthood Federation
48. International Rescue Committee
49. International Union Against Tuberculosis and Lung Disease
50. International Women’s Convocation
51. International Women’s Health Coalition
52. International Youth Alliance for Family Planning
53. IntraHealth International
54. Ipas
55. Jewish Women International
56. John Snow, Inc. (JSI)
57. Management Sciences for Health
58. Medical Students for Choice Worldwide
59. Muslims for Progressive Values
60. NASTAD
61. National Abortion Federation
62. National Center for Lesbian Rights
63. National Center for Transgender Equality
64. National Council of Jewish Women
65. National Latina Institute for Reproductive Health
66. National LGBTQ Task Force
67. National Network of Abortion Funds
68. National Organization for Women
69. National Partnership for Women & Families
70. National Women’s Law Center
71. NCD Child
72. New Voices for Reproductive Justice
73. Norwegian Refugee Council USA
74. ONE
75. OutRight Action International
76. PAI
77. PATH
78. Pathfinder International
79. People For the American Way
80. Plan International USA
81. Planned Parenthood Federation of America
82. Population Council
83. Population Institute
84. Population Services International
85. Positive Women’s Network-USA
86. Project Concern International
87. Project HOPE
88. Promundo-US
89. Reproaction
90. Reproductive Health Access Project
91. RESULTS
92. Sankar
93. Save the Children
94. Secular Coalition for America
95. Sierra Club
96. The Fellowship of Affirming Ministries
97. The Global Forum on MSM & HIV (MSMGF)
98. The Hunger Project
99. Treatment Action Group
100. Union for Reform Judaism
101. Unitarian Universalist Humanist Association
102. Unitarian Universalist Women’s Federation
103. United Nations Association of the United States of America
104. Universal Access Project
105. WaterAid
106. White Ribbon Alliance
107. Women Graduates-USA
108. Women Watch Afrika, Inc.
109. Women’s Refugee Commission
110. Woodhull Freedom Foundation