The Case for Ending the “Global Gag Rule” and the Helms Amendment

Elizabeth A. Sully, Guttmacher Institute Zara Ahmed, Guttmacher Institute
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First published online:

On January 28, 2021, President Biden rescinded the "global gag rule." While that was an important move, it was just the first step in restoring U.S. leadership on global sexual and reproductive health and rights. In order to truly support global progress, the White House and Congress must work together to permanently repeal the global gag rule. In addition, they must allow U.S. funds to be used for the full range of reproductive health services, including safe abortion care, by repealing the Helms Amendment.

Ending both policies would have massive benefits in terms of unsafe abortions averted and maternal lives saved, as well as substantial cost savings for health systems around the world.

Ending the Global Gag Rule for Good

The global gag rule prevents foreign nongovernmental organizations from using their own, non-U.S. funds to provide abortion services, information, counseling, referrals or advocacy. Since it was first created in 1984, the policy has historically been put in place by Republican presidents and rescinded by Democratic ones. The Trump administration put the global gag rule on steroids, massively expanding it multiple times and making additional attempts to do so even as it was leaving office.

Although President Biden has rescinded the global gag rule, that is only a short-term solution to the long-term problem of this devastating policy. The new administration and Congress have a unique opportunity to end the global gag rule permanently by supporting and passing the Global Health, Empowerment and Rights (Global HER) Act, which was reintroduced in the House and Senate on the same day as President’s Biden executive action. The bill would prevent future presidents from unilaterally reinstating the global gag rule via executive action and end the policy’s intermittent use. With 177 cosponsors in the House of Representatives and 46 in the Senate just two weeks after reintroduction, passing the Global HER Act is politically feasible, if leadership makes it a priority. Enacting the bill would end U.S. interference in what organizations do with their own money, but would not address restrictions on whether U.S. money can be used to fund global abortion services.

Leading on Access to Safe Abortion

Even without the global gag rule, the United States cannot be a global leader on sexual and reproductive health and rights as long as its hands are tied by the Helms Amendment. Since 1973, the amendment has in effect prohibited U.S. foreign assistance funding from supporting safe abortion services around the world.

This draconian policy applies even in countries where abortion is legal, forcing the United States to undermine local health systems, providers and patients by failing to support people’s right to access a legal health service. This is particularly shameful because the United States has a strong programmatic presence in low- and middle-income countries, including where abortion is legal. Abortion is a health care service needed by people everywhere, but the abortion rate in low- and middle-income countries is two to three times greater than the rate in high-income countries.

These countries are also where abortions are more likely to be unsafe (i.e., not performed by a trained provider or using a World Health Organization–recommended method). The failure of the United States and other countries to fully support access to safe abortion services contributes to the more than 35 million unsafe abortions that occur annually in low- and middle-income countries, leading to 23,000 preventable maternal deaths. But it does not have to be this way. The Abortion Is Health Care Everywhere Act, which was introduced in Congress for the first time in July 2020 and will be reintroduced shortly, would permanently end the Helms Amendment and allow the United States to support the full range of sexual and reproductive health services that people want and need.

The Global Benefits of Repealing Helms

Making abortion services safe and accessible saves lives and benefits communities. A new analysis, building on a 2020 Guttmacher Institute project, shows the impact if the Helms Amendment were to be repealed and U.S. support helped ensure that all abortions were provided safely in the countries where abortion is legal on at least some grounds and where the United States is already supporting family planning programs:

  • There would be 19 million fewer unsafe abortions each year.
  • There would be 17,000 fewer maternal deaths each year.
  • The overall number of maternal deaths due to abortion in these countries would decline by 98%.
  • There would be 12 million fewer women each year who have abortion-related complications requiring medical treatment.

Ending the Helms Amendment would not only prevent unsafe abortions and their negative health effects. The policy change would also have positive financial implications for the health systems in the 33 countries that would initially benefit from U.S. aid to ensure full access to safe abortions:

  • The cost of providing postabortion care would decline by 89%.
  • The cost of providing safe abortion services would only increase by 19%.
  • There would be a net savings of $641 million annually for the health system.

The impact of ending the Helms Amendment could be even greater, as this analysis only includes countries where abortion is currently legal on at least some grounds, where the U.S. Agency for International Development (USAID) has a presence, and where it supports family planning services. If additional countries liberalize abortion laws or USAID expands its work to other nations, even more individuals and communities would benefit. In addition, Helms repeal will have programmatic benefits to other global health funding streams.

The global gag rule and the Helms Amendment have spread like a cancer through U.S. foreign assistance. Now is the time for the White House and Congress to root out these twin malignant policies, not just from family planning and reproductive health funding, but from all U.S. global health initiatives.


Sources: The estimates in this analysis were based on Sully E et al., Adding It Up: Investing in Sexual and Reproductive Health 2019, New York: Guttmacher Institute, 2020. Sources and methodological details can be found in the accompanying methodology report

Thanks to Ann Biddlecom, Rachel Murro and Anna Popinchalk for their assistance with this new analysis.