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October 26, 2018
Protecting Life in Global Health
Assistance Policy
A Trump Administration policy announced in early 2017
Department of Defense (DOD) and the U.S. Centers for
reinstated and expanded earlier policies restricting U.S.
Disease Control and Prevention (CDC), whereas the
international family planning assistance. The new policy
Mexico City policy applied only to family assistance
and related global health issues remain subject to ongoing
programs funded by USAID and the State Department. The
debate in Congress.
Administration also announced that it would conduct a
comprehensive review of the policy.
Abortion-Related Restrictions on U.S.
Foreign Assistance: Background
PLGHA Policy Review and Implementation Issues
In August 1984 at the International Conference on
The State Department conducted a six-month review and
Population in Mexico City, the Reagan Administration
released its findings in February 2018. The department
announced a new policy, which would prohibit foreign
concluded that it was too early “to assess the full range of
nongovernmental organizations (NGOs) from receiving
benefits and challenges” of the PLGHA and committed to
funds from the U.S. Agency for International Development
conduct another review in December 2018. During the six-
(USAID) without certifying in writing that they would not
month review, the Department surveyed over 700 prime
promote or perform abortion as a method of family
partners, of which 729 accepted the policy and four
planning as an implementer of USAID family planning
declined to adhere to it. The Kaiser Family Foundation
assistance programs. The new policy, dubbed “Mexico City
(KFF) noted, however, that the initial survey reached a
Policy” (MCP), was instituted and rescinded across
fraction of prime partners and estimated that at least 1,300
Administrations mostly along party lines (Figure 1). For
NGOs could be affected by the policy. Some reports on the
more information on executive and legislative abortion-
impact of the policy have emerged. Marie Stopes
related restrictions on U.S. foreign assistance, see CRS
International, a former implementer of U.S. family planning
Report R41360, Abortion and Family Planning-Related
and reproductive health programs, had refused to comply
Provisions in U.S. Foreign Assistance Law and Policy, by
with the policy. The organization had received about $30
Luisa Blanchfield.
million annually for family planning programs and has
announced that without U.S. funding it has closed half of its
Protecting Life in Global Health Assistance
outreach locations that provide contraception in Zimbabwe
(PLGHA): Background
and all of its operations in Madagascar due to lack of funds.
On January 23, 2017, President Donald J. Trump issued a
In the review, the State Department noted three key areas
memorandum reinstating the Mexico City policy and
where there was a “need for further guidance regarding the
extending the conditions to include all global health
PLGHA policy to improve a common understanding of its
programs receiving U.S. assistance. There was some
intent, implementation, compliance, and oversight.”
confusion among observers about whether the
Administration intended for the policy to apply to all global
Financial Support Provision. The PLGHA indicates
health programs. The last time that the policy was applied,
that foreign NGOs that receive U.S. global health
under the George W. Bush Administration, it applied only
assistance will not “perform or actively promote
to family planning programs and included several
abortion as a method of family planning in foreign
exceptions, such as funding provided through the
countries or provide financial support to any other
President’s Emergency Plan for AIDS Relief (PEPFAR)
foreign non-governmental organization that conducts
and assistance provided to treat conditions that threatened
such activities” (italics added). A number of large NGOs
the life of the mother and post-abortion care.
with multiple activities across health and development
areas sought additional guidance regarding application
In May 2017, the Department of State issued a press release
of “financial support,” particularly whether the financial
that provided additional information on the expanded policy
support provision applied to the NGO or the activity.
and named it Protecting Life in Global Health Assistance
(PLGHA). The press release explained that PLGHA was to
Termination Provision. According to the PLGHA,
apply to all global health programs, including HIV/AIDS,
health assistance “must be terminated if the recipient
though abortion referrals in cases of rape, incest, or
violates any undertaking” required by the provision. A
endangerment of the life of the mother were not prohibited
number of those surveyed asserted that since the
under PLGHA. The Administration also noted in a press
expanded policy applied to NGOs that may not have had
briefing that PLGHA would apply to all U.S. agencies
experience with the Mexico City Policy, some may
implementing global health programs, including the
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Protecting Life in Global Health Assistance Policy
inadvertently violate the policy and requested some
particularly maternal and infant morbidity and mortality, as
discretion should an unintended violation occur.
well as HIV/AIDS.
Advocacy groups contend that there is no mechanism
for following up with questions about compliance. U.S.
PLGHA: Congressional Issues
agencies in the field have allegedly been unable to
Since the Mexico City Policy was first established, some
provide further guidance than what had been issued
Members on both sides of the issue have introduced
through e-training.
legislation to permanently enact or repeal the policy. In the
115th Congress, H.R. 671 and S. 210, the Global Health,
Application to Training and Technical Assistance.
Empowerment, and Rights Act, were introduced to specify
Furnishing health assistance, according to the PLGHA,
that foreign NGOs that provide health or medical services,
does not include “the participation of an individual in
including counseling and referral services, shall not be
the general training programs of the recipient or sub-
ineligible from receiving U.S. funding if such services do
recipient.” Several implementers of U.S. global health
not violate the laws of the country in which they are being
programs provide training and technical assistance to
provided and if they would not violate U.S. federal law (the
private sector nurses or doctors and expressed confusion
PLGHA is a policy, not a law). Some congressional
about whether PLGHA applies to such trainings and
Members opposing PLGHA have also requested that the
assistance.
Government Accountability Office (GAO) review the
policy and determine whether it would be subject to the
Some global health advocacy groups reported cases where
Congressional Review Act, an oversight tool Congress can
confusion about these and other issues have affected service
use to overturn certain agency actions. (For more
delivery. In June 2017, the International Women’s Health
information on the Congressional Review Act, see CRS In
Coalition conducted interviews and monitored media
Focus IF10023, The Congressional Review Act (CRA).)
reports in recipient countries and found high levels of
GAO concluded that agencies implementing presidential
confusion about policy implementation. In certain
policymaking are not subject to review under CRA.
instances, according to the organization, groups stopped
providing information on reproductive health services that
Supporters of the PLGHA maintain that although existing
were in compliance with the PLGHA policy, such as post-
laws ban U.S. funds from being used to perform or promote
abortion care. In September 2018, USAID issued a
abortions abroad, the PLGHA policy closes any loopholes
document, Protecting Life in Global Health Assistance:
for potentially shifting available funds. The House
Frequently Asked Questions and Answers, which addressed
Appropriations Committee report for FY2019 State,
some of these questions, though some questions remain,
Foreign Operations appropriations included language that,
particularly related to the termination provision.
among other things, prohibits the use of funds for any
foreign NGO that promotes or performs abortion, except in
Opponents to the PLGHA policy assert that unsafe
case of rape or incest or when the life of the mother would
abortions (and related maternal deaths) may increase due to
be endangered if the fetus were carried to term. The bill
decreased family planning services and under widespread
also includes language that prohibits discriminating against
confusion about the type of partnerships and services
grantees with religious or conscientious commitment to
permitted under the new policy. A 2011 study on the
offer only natural family planning.
Mexico City Policy found, for example, that abortion rates
rose in countries with high exposure to the MCP and that
Documents cited in this report are available to
contraception use declined over the same period in those
congressional clients upon request. Monyai Chavers, CRS
countries. Further studies would be needed to determine
Research Associate, contributed to this report.
whether the PLGHA has actually suppressed access to
services aimed at addressing key global health issues,
Figure 1. International Abortion/Family Planning-Related Policies, by Administration
Source: Created by CRS.
Tiaji Salaam-Blyther, Specialist in Global Health
Sara M. Tharakan, Analyst in Global Health and
International Development
IF11013
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Protecting Life in Global Health Assistance Policy
Disclaimer
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