The Trump global gag rule: an attack on U.S. family planning and global health aid

Ann M. Starrs
The time is now. Will you stand up for reproductive health and rights?

First published on The Lancet:

In a Comment published in The Lancet, Guttmacher President and CEO Ann M. Starrs discusses the many harms of the global gag rule, a policy imposed by President Trump that will disrupt U.S. international family planning programs as well as U.S. global health aid more broadly.

The article is excerpted below and the full Comment is available at The Lancet (with citations and free of charge): “The Trump global gag rule: an attack on U.S. family planning and global health aid.”

Excerpt from the lancet comment

On Jan 23, 2017, on his fourth day in office, President Donald Trump signed an executive order imposing the global gag rule, an antiabortion policy that under other conservative presidential administrations has caused serious disruptions to US overseas family planning efforts. Alarmingly, Trump’s order goes even further than in the past, with potentially devastating effect….[T]he gag rule now applies not only to US bilateral family planning assistance (US$575 million for fiscal year 2016), but also to all "global health assistance furnished by all departments or agencies"—encompassing an estimated $9.5 billion in foreign aid.


[W]hen last in effect, the gag rule crippled family planning programmes. Many foreign NGOs [nongovernmental organizations], as a matter of principle and out of dedication to the patients they serve, refused to let the US Government muzzle their abortion advocacy efforts or dictate what services or counselling they provided using their non-US funds. These health providers were forced to reduce staff and services, or even shut clinics. As a result, many thousands of women no longer had access to family planning and reproductive health services from these clinics—sometimes the only provider of such services in the local community.


Moreover, there is no evidence that the global gag rule has ever resulted in its stated aim of reducing abortion. The first study to measure the effect of the gag rule showed that this policy could actually have resulted in an increase in abortions. Another study assessed the gag rule in Ghana and found that because of declines in the availability of contraceptive services, both fertility and abortion rates were higher during the gag rule years than during non-gag rule years in rural and poor populations. This is consistent with anecdotal data that the gag rule’s main effect has been to reduce women’s access to quality contraceptive services, thereby increasing the probability of unintended pregnancy and making recourse to abortion more likely.


By expanding the gag rule to the full scope of US global health aid, hundreds more national and local NGOs will be forced to choose between drastic funding cuts (if they decline to sign the gag rule) or denying their patients the information and services that are their right (if they sign, and can no longer provide or discuss abortion). Millions of women living in low-resource settings may now be unable to obtain the care they need, when they need it.