Under Trump there has been a takeover of global public health services

The Mexico City policy (global gag rule) prohibits foreign organizations that receive U.S. government funding for health services from engaging in abortion-related services or advocacy. 

The policy that prohibits public health professionals from talking about or working on abortion is a longtime political football. Ronald Reagan first introduced it in 1984. Since then, whenever there is a Democratic president the rule is rescinded and then when a Republican is in power it is typically reinstated.

{mosads}Almost everyone assumed that President Trump would simply follow the course of his Republican predecessors; they were only half right. Not only does Trump’s expansion of the global gag rule disrupt the work of reproductive health groups, it has also opened the door for an evangelical takeover of public health services worldwide.

One of the reasons the global gag rule is so destructive, is because it prohibits organizations from engaging in abortion-related services, referrals, or advocacy, even when using their own money — money not provided to them by the U.S. government.   

Under previous Republican administrations, the rule was limited to funds specifically dedicated to family planning. Even then, it was a public health disaster. The policy failed to reduce rates of abortion globally and, in fact, led more unsafe abortions and higher rates of maternal mortality. 

The Trump administration has expanded this old policy to apply to all $8.8 billion of U.S. global health funding. As a result, the impact it will have on health services and advocacy will be all the more widespread and devastating. For instance, the policy now also applies to all U.S. funding for HIV treatment and prevention — which accounts for nearly half of all HIV/AIDS funding globally.

Hundreds of organizations are now being forced to make an impossible choice: either abandon their commitment to reproductive health and rights by signing the rule, or refuse and lose their U.S. funding and risk having to shut down other life-saving health services.

When faced with this choice, many progressive groups will be forced to walk away from U.S. government support. Once that happens, and with a larger pot of money now available, overtly anti-abortion and anti-LGBTQI groups that are waiting in the wings can step in to grab that money and take over health services across the globe. 

The U.S. government is actively aiding conservative Christian groups in their quests to scoop up U.S. taxpayer money. In July, during its Ministerial to Advance Religious Freedom, the State Department offered faith-based organizations a tutorial in applying for government contracts to provide health services abroad, and reinforced that having conscientious objections to providing comprehensive sexual and reproductive health care is not only not a barrier to getting funded, but is actually preferable. Groups like the Family Research Council, which reject evidence-based health interventions that conflict with their Christian ideology, attended the gathering.

Gaining access to these funds fulfills a long-standing goal of the far-right and religious conservatives. For years, U.S.-based evangelical groups have sought to globalize their extreme views on sex, reproductive health, and LGBTQI rights. Over time, they have cultivated an international network of allies to aid them, often in countries where human rights abuses are commonplace, particularly when it comes to women and sexual minorities. 

Glimpses of this network surface periodically. In 2009, American anti-gay activist Scott Lively helped organize a conference in Kampala, Uganda, called, “Seminar on Exposing the Homosexuals’ Agenda.” Just a few months later, Ugandan legislators introduced a bill that established lengthy prison sentences for LGBTQI people, including life sentences for what it called “aggravated homosexuality.”

Americans like Lively and U.S.-based evangelical groups, such as Family Watch International, and the International Organization for the Family, have meticulously cultivated these networks of support in receptive countries like Uganda, Nigeria, and Russia. In these places, they’ve found willing co-conspirators, both in government and in grassroots evangelical circles, many funded by U.S. evangelical groups. All they’ve lacked is a U.S. president ready to funnel them a steady stream of money.

The Trump administration’s expansion of the global gag rule frees up this money, which can now be transferred to conservative religious groups if current health providers refuse to comply with the policy.

It will come out of the pockets of long-established, highly respected public health organizations. For instance, International Planned Parenthood Federation (IPPF) estimates it will be forced to forego $100 million during Trump’s term.

These groups don’t only offer abortion procedures — they provide prenatal care, health screening, youth education on prevention of sexually transmitted infections, and emergency response during humanitarian crises.  

During the Ebola outbreak, for instance, IPPF provided basic health care in Liberia when the country’s clinics were focused on the crisis. The expansion of this policy is intended not only to stop abortion, but also to break the backs of these organizations.

Evangelical recipients will use their newfound funding to scale up their operations, as they indicated in May at the African Regional World Congress of Families conference in Nairobi. Leaders from far-right U.S.-based organizations like Family Watch International stood side by side with high-ranking members of African governments, evangelical groups, and conservative media. “We have a new man in town, President Trump, and he is cleaning house,” one speaker declared, referencing the global gag rule. 

This is why Trump is popular with evangelicals. His administration has redacted abortion statistics from official reports, and even banned phrases like “sexual and reproductive health.” By positioning “religious freedom” against the responsibility to provide comprehensive, non-discriminatory health care — both at home and abroad — Trump has created a vehicle that will allow the Christian Right distort global health services for a wide range of communities.

The damage will linger for years, as the ultra-conservative groups receiving funding today use that money to bolster their capacity, broaden their reach into countries, and increase their political leverage. All the while, they will be given free rein to provide ideologically driven health services even as legitimate health providers will be forced to close down, never to reopen. The creep of conservative ideology into the global health system is ongoing; it will not be easily reversed. 

Heather Benjamin is a program officer at the Open Society Foundations, where she focuses on global health and human rights financing and harmful influences on health-related policy making.