Note: Originally published in Jan. 2017, this resource is updated as needed, most recently on Feb. 12, 2025, to reflect the latest developments.
The Mexico City Policy, a recurring element in U.S. foreign policy, once again took center stage on January 24, 2025, as President Trump reinstated the policy, continuing its expanded form from his previous term. This action marks another chapter in the policy’s complex history, which originated in Mexico City itself at a significant international conference. First introduced in 1984 by the Reagan administration, this policy has been a political pendulum, swinging between rescission and reinstatement with changes in presidential administrations, largely along party lines. Over the past 41 years, it has been in effect for 22, illustrating its enduring, albeit intermittent, influence on global health.
When active, the Mexico City Policy mandates that foreign non-governmental organizations (NGOs) must certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source—including non-U.S. funds—as a prerequisite for receiving U.S. government global family planning funding. In 2017, President Trump not only reinstated the policy but broadened its scope to encompass the majority of U.S. bilateral global health assistance. This expanded application was reaffirmed in his 2025 reinstatement.
This broadened policy now extends across all domains of global health, including critical initiatives like PEPFAR, maternal and child health programs, and efforts to combat malaria, nutrition deficits, and other global health challenges. When last implemented, this expanded policy had a potential reach of $7.3 billion in FY 2020 alone, contingent on the extent to which funding was channeled to foreign NGOs, either directly or indirectly. Family planning assistance, while significant, represented approximately $600 million of this overall figure.
The recent action by the Trump administration directs the Secretary of State, in collaboration with the Secretary of Health and Human Services, to develop and execute a plan to extend the policy’s requirements to all global health assistance provided by U.S. departments or agencies. This move underscores the policy’s potential to significantly shape the landscape of international health funding and the operations of NGOs worldwide.
Delving into the Mexico City Policy
The Mexico City Policy is fundamentally a U.S. government directive that, when in effect, compels foreign NGOs to pledge that they will not “perform or actively promote abortion as a method of family planning” using funds from any source. This condition is tied to receiving U.S. global family planning assistance and, under the Trump administration’s expansion, most other forms of U.S. global health aid. The policy’s name is derived from its initial announcement by the Reagan administration at the 2nd International Conference on Population, held in Mexico City, Mexico, from August 6-14, 1984, a detail often highlighted in discussions of its origins (see Box 1).1 During the first Trump administration, it was officially rebranded as “Protecting Life in Global Health Assistance” (PLGHA). However, among its critics, it is widely known as the “Global Gag Rule.” This moniker stems from its restrictions, which include prohibiting foreign NGOs from using any funds—even those from non-U.S. sources—to provide information about abortion as a family planning method or to advocate for the legalization of abortion with foreign governments.
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Box 1: The Original Wording of the Mexico City Policy, 1984 |
|—|
| “[T]he United States does not consider abortion an acceptable element of family planning programs and will no longer contribute to those of which it is a part. …[T]he United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.”2 |
The inception of the Mexico City Policy in 1984 broadened existing legislative constraints that already limited U.S. funding for international abortion, albeit with some exceptions. Before this policy, foreign NGOs could utilize non-U.S. funds for certain abortion-related activities, provided they maintained separate accounts for any U.S. funds received. However, once the Mexico City Policy was implemented, this practice was no longer permissible for NGOs seeking U.S. family planning assistance.
The Trump administration’s application of the policy to a vast array of U.S. bilateral global health assistance—including funding for HIV programs under PEPFAR, maternal and child health, malaria, nutrition, and other health initiatives—marked a significant increase in its impact. This expansion potentially affected $7.3 billion in FY 2020 alone, based on funding allocated to foreign NGOs directly or indirectly. Of this amount, approximately $600 million was specifically for family planning assistance.3 Furthermore, the Trump administration sought to tighten these restrictions, extending their reach beyond global health to other areas of U.S. development assistance and non-U.S. funding streams. The question “What is the definition of ‘financial support’?” below further clarifies these evolving restrictions.4
Despite President Biden’s rescission of the policy during his term, President Trump’s recent reinstatement ensures that agencies involved in foreign assistance must once again adhere to the policy. Additionally, the Trump administration has initiated a re-evaluation of foreign aid, including a 90-day review of all programs and a temporary halt on new obligations and disbursements, alongside a freeze on current program implementation. The interplay between the reinstated Mexico City Policy and these broader foreign aid actions remains to be fully understood.
Timeline of the Mexico City Policy’s Implementation
The Mexico City Policy has been in effect for 22 of the last 41 years, primarily enacted through executive actions. Its history is characterized by cycles of instatement, rescission, and reinstatement by presidential administrations, largely reflecting partisan divides (see Table 1).
President Ronald Reagan first instituted the policy in 1984, with it taking effect in 1985. It remained in place throughout President George H.W. Bush’s administration. President Bill Clinton rescinded the policy in 1993, although it was briefly reinstated legislatively for one year during his second term.5 President George W. Bush reinstated it in 2001,7 followed by President Barack Obama rescinding it in 2009.8 President Trump reinstated and expanded the policy in 2017.9 President Biden rescinded it at the start of his term in 2021,10 only for President Trump to reinstate its expanded form again at the beginning of his 2025 term.11
| Table 1: History of the Mexico City Policy |
|---|
| Presidential Administration |
| Reagan (R) |
| George H.W. Bush (R) |
| Clinton (D) |
| George W. Bush (R) |
| Obama (D) |
| Trump (R) |
| Biden (D) |
| Trump (R) |
| Total Years in Effect: |
The Mexico City Policy has predominantly been implemented or rescinded through executive branch actions, typically via presidential memoranda.12 While Congress has the legislative power to instate the policy, it has only done so once. A modified version was briefly applied by Congress during President Clinton’s final year in office as part of a broader agreement concerning U.S. debt to the United Nations.13 During this period, President Clinton was able to partially waive the policy’s restrictions.14 Other legislative attempts to establish the policy have not been enacted,15 nor have legislative efforts to overturn it succeeded.16
Scope of the Policy: Who and What is Affected?
The policy, when active, applies to foreign NGOs as a condition for receiving U.S. family planning support and, under President Trump’s expansion, most other forms of bilateral global health assistance. This applies whether they are direct recipients (prime recipients) or indirect recipients (sub-recipients) of U.S. funding. Specifically, a foreign NGO “recipient agrees that it will not, during the term of this award, perform or actively promote abortion as a method of family planning in foreign countries or provide financial support to any other foreign non-governmental organization that conducts such activities.”17
Foreign NGOs encompassed by this policy include:
- International NGOs based outside the U.S.
- Regional NGOs based outside the U.S.
- Local NGOs in countries receiving assistance.18
U.S.-based NGOs are not directly subject to the Mexico City Policy. However, when the policy is in effect, they must ensure that they do not fund any foreign NGO sub-recipients unless these sub-recipients have certified their adherence to the policy. A U.S. NGO “recipient (A) agrees that it will not furnish health assistance under this award to any foreign non-governmental organization that performs or actively promotes abortion as a method of family planning in foreign countries; and (B) further agrees to require that such sub-recipients do not provide financial support to any other foreign non-governmental organization that conducts such activities.”19
Certain entities are exempt from the policy, including foreign governments (national and sub-national), public international organizations, and multilateral entities like the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Gavi, the Vaccine Alliance.20 However, under President Trump’s expanded policy, funding to these entities may still be affected if it is channeled through a foreign NGO that has accepted the policy.21
Types of Assistance Affected
“Assistance” under the policy includes “the provision of funds, commodities, equipment, or other in-kind global health assistance.”22 Historically, adherence to the Mexico City Policy was required for foreign NGOs receiving support through specific U.S. international funding streams: family planning assistance via USAID, and from 2003, family planning assistance through the U.S. Department of State.23 In the 2003 memorandum extending the policy to the Department of State, President Bush specified that it would not apply to global HIV/AIDS programs and that multilateral organizations composed of governments were not considered “foreign NGOs.”24
However, the first Trump administration significantly broadened—and the second Trump administration has reinstated—the policy to encompass most U.S. bilateral global health assistance from all agencies and departments. This includes:25
- Family planning and reproductive health
- Maternal and child health (including household-level water, sanitation, and hygiene (WASH) initiatives26)
- Nutrition
- HIV programs under PEPFAR
- Tuberculosis
- Malaria control under the President’s Malaria Initiative (PMI)
- Neglected tropical diseases
- Global health security
- Certain research activities.27
The policy applies to assistance appropriated directly to USAID, the Department of State (including the Office of the Global AIDS Coordinator), and, for the first time, the Department of Defense (DoD).28 Funding transferred to other agencies, such as the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), also remains subject to the policy if it is ultimately provided to foreign NGOs, directly or indirectly.
The policy applies to grants and cooperative agreements.29 The Trump administration had considered extending it to contracts but did not finalize the proposed rule.30 It is uncertain whether the second Trump administration will pursue this expansion.
Exemptions from the policy include U.S. assistance for: water supply and sanitation infrastructure;31 humanitarian aid, including migration and refugee assistance, disaster relief; the American Schools and Hospitals Abroad (ASHA) program; and Food for Peace (FFP).32 However, these exemptions are conditional, as funding can become subject to the policy if it passes through a foreign NGO that has accepted the policy.33
Prohibited Activities Under the Policy
The Mexico City Policy prohibits foreign NGOs receiving U.S. family planning assistance, and under the expanded Trump policy, most other U.S. bilateral global health assistance, from using funds from any source to “perform or actively promote abortion as a method of family planning.” Restricted activities include:
- Performing abortions with non-U.S. funds (except in specific, limited circumstances).
- Providing advice and information about, or referrals for, abortion (even where legal) as part of comprehensive family planning options.
- Advocating for changes in abortion laws or policies in any country (lobbying).
- Conducting public information campaigns about abortion as a method of family planning.
These prohibitions are the reason critics often refer to the policy as the “Global Gag Rule.”
Moreover, the expanded policy under the Trump administrations introduced a new restriction: foreign NGOs are prohibited from providing financial support to other foreign NGOs that perform or actively promote abortion as a method of family planning, regardless of the source of funds or the purpose of support.34
However, the policy does not prohibit foreign NGOs from:
- Providing advice, performing, or referring for abortion in cases where the pregnancy threatens the mother’s life or is a result of rape or incest.35
- Responding to direct inquiries from pregnant women who have already decided to seek a legal abortion (passive information provision).
Additionally, the expanded policy does not apply to healthcare providers legally obligated under local law to provide abortion counseling and referrals.
U.S. Funding and Abortion: Existing Restrictions
It is crucial to note that U.S. funding for abortion was already restricted prior to the Mexico City Policy and remains so under various legal provisions.36 Even before the policy’s inception in 1984, U.S. law prohibited using U.S. aid:
- To pay for abortion as a family planning method or to promote coercion towards abortion (Helms Amendment, 1973).
- For biomedical research related to abortion as a family planning method (Biden Amendment, 1981).
- To lobby for or against abortion (Siljander Amendment, 1981 onwards).37
The Kemp-Kasten Amendment (1985) further restricted U.S. aid to any organization supporting coercive abortion or involuntary sterilization programs.
Before the Mexico City Policy, recipients of U.S. aid could use non-U.S. funds for certain abortion-related activities, provided they maintained segregated accounts for U.S. funds.38 The Mexico City Policy reversed this, disallowing foreign NGOs from using non-U.S. funds for voluntary abortion-related activities if they wished to receive U.S. family planning funds.
Post-Abortion Care and the Policy
The Mexico City Policy does not restrict post-abortion care. U.S. family planning assistance recipients can use both U.S. and non-U.S. funds to support post-abortion care,39 regardless of the legality or circumstances of the abortion.
Impacts of the Mexico City Policy
A KFF literature review (2001-2024) on the Mexico City Policy identified several impacts, including increased abortion rates, reduced contraceptive use, service disruptions, reduced service integration, over-implementation, confusion, loss of NGO partnerships, and increased administrative burdens (see Box 2).
|
Box 2: Documented Impacts of the Mexico City Policy |
|—|
| – Increased abortion rates |
| – Increased pregnancy |
| – Decreased contraceptive prevalence |
| – Disruption in family planning and other services |
| – Gaps in family planning and other services |
| – Reduced service integration |
| – Over-implementation and chilling effect |
| – Confusion |
| – Loss of civil society/NGO coordination and partnerships |
| – Increased administrative burden |
KFF analyses also showed that the expanded policy under the first Trump administration affected a larger amount of U.S. global health assistance and more foreign NGOs across various program areas.40 KFF found that over half of the countries receiving U.S. bilateral global health assistance in FY 2016 had legal abortion in cases not permitted by the policy. Had the expanded policy been in effect from FY 2013-FY 2015, at least 1,275 foreign NGOs would have been subject to it. Additionally, at least 469 U.S. NGOs would have been required to ensure their foreign sub-recipients complied. The revised interpretation of “financial support” in 2019 likely further expanded the policy’s reach.41
During the first Trump administration, the U.S. Department of State released two reviews of the expanded policy.42 A GAO report in March 2020 provided data on the policy’s impact from May 2017 through FY 2018:
- Over 1,300 global health projects were affected, mainly through USAID and CDC.
- NGOs declined to accept the policy in 54 instances, resulting in $153 million in declined funding (seven prime awards and 47 sub-awards, with most sub-awards intended for Africa). The Department of State and DoD reported no such declines.
U.S. Government Reviews of the Expanded Policy (First Trump Administration)
The U.S. government conducted two reviews of the expanded policy during the first Trump administration: a six-month review in February 2018 and an 18-month review in August 2020.
First Review Findings
The February 2018 six-month review identified needs for better training, clearer explanations of award terminations, and clarification of “financial support.” It also detailed the number of agreements affected and acceptance rates through September 2017 (see Table 2).
Second Review Findings
The August 2020 second review, covering May 2017 to September 2018, found that declined awards spanned various program and geographic areas, particularly in sub-Saharan Africa. While agencies tried to transition projects to minimize disruptions, service delivery gaps were reported in USAID awards where recipients declined the policy. The review also updated figures on affected agreements and acceptance rates through September 2018 (see Table 3). It noted 47 sub-awardees under USAID declined the policy, but data on sub-awards was not systematically collected across all agencies.
Clarification of “Financial Support”
The definition of “financial support” was a key point of clarification under the Trump administration’s expanded policy. Initially, in February 2018, the State Department interpreted it narrowly, applying only to funds specifically for abortion promotion.44
However, in March 2019, Secretary of State Pompeo broadened this interpretation. The revised definition meant that U.S.-funded foreign NGOs could not provide any financial support to other foreign NGOs that perform or promote abortion, regardless of the funding source or purpose.45 USAID provided further details in June 2019, reflecting this broader interpretation.46
This broader interpretation significantly expanded the policy’s reach, potentially affecting funding from other donors and even non-global health U.S. funding if channeled through affected foreign NGOs.
Recent Developments (Post-2025 Reinstatement)
Since President Trump reinstated the expanded Mexico City Policy in January 2025 and directed its extension across all agencies, no further specific implementation details have been released. This is partly due to recent executive actions affecting USAID operations and freezing foreign aid. The full implications of this reinstatement and the broader foreign aid landscape remain to unfold.
Footnotes:
1 “Policy Statement of the United States of America at the United Nations International Conference on Population (Second Session), Mexico City, Mexico, August 6-14, 1984,” undated, https://www.jstor.org/stable/1973537?seq=1; United Nations Division of Economic and Social Affairs/Population Division, “United Nations Conferences on Population,” webpage, undated, http://www.un.org/en/development/desa/population/events/conference/index.shtml.
2 “Policy Statement of the United States of America at the United Nations International Conference on Population (Second Session), Mexico City, Mexico, August 6-14, 1984,” undated, https://www.jstor.org/stable/1973537?seq=1.
3 KFF analysis of Trump Administration/Department of State: “Protecting Life in Global Health Assistance,” fact sheet, May 15, 2017, https://2017-2021.state.gov/protecting-life-in-global-health-assistance-2/index.html; “Background Statement: Announcement of ‘Protecting Life in Global Health Assistance,’” background opening statement, May 15, 2017; “Implementation of Protecting Life in Global Health Assistance (Formerly known as the ‘Mexico City Policy’),” PRM press guidance, May 15, 2017; “Background Briefing: Senior Administration Officials on Protecting Life in Global Health Assistance,” press release of special briefing by senior Department of State officials via teleconference, May 15, 2017, https://2017-2021.state.gov/background-briefing-senior-administration-officials-on-protecting-life-in-global-health-assistance/index.html; “Subject: Protecting Life in Global Health Assistance,” Federal Assistance Management Advisory Number 2017-01; “Protecting Life in Global Health Assistance (May 2019),” MCP-related portion of standard provisions for cooperative agreements and grants to U.S. NGOs (May 2020) and foreign NGOs (Aug. 2020)); and KFF analysis of data from: Congressional Appropriations Bills, Press Releases, and Conference Reports; Federal Agency Budget and Congressional Justification documents and Operating Plans; ForeignAssistance.gov; Office of Management and Budget, personal communication.
4 USAID, “Protecting Life in Global Health Assistance Frequently Asked Questions and Answers,” Oct. 2019, https://www.usaid.gov/sites/default/files/documents/1864/FINAL_Protecting_Life_in_Global_Health_Assistance_FAQs_Oct_2019_USAID.pdf.
5 The temporary, one-year legislative imposition of the policy occurred as part of a broader deal related to paying the U.S. debt to the United Nations. See FY 2000 Consolidated Appropriations Act, P.L. 106-113, https://www.congress.gov/bill/106th-congress/house-bill/3194/text; PAI, Global Gag Rule Timeline, July 12, 2011; and Richard Cincotta and Barbara Crane, “The Mexico City Policy and U.S. Family Planning Assistance,” Science, Oct. 19, 2001, Vol. 294: pp. 525-526, https://science.sciencemag.org/content/294/5542/525.
6 Bill Clinton Administration, “Subject: AID Family Planning Grants/Mexico City Policy,” Memorandum for the Acting Administrator of the Agency for International Development, January 22, 1993, Clinton White House Archives, https://clintonwhitehouse6.archives.gov/1993/01/1993-01-22-aid-family-planning-grants-mexico-city-policy.html.
7 George W. Bush Administration, “Subject: Restoration of the Mexico City Policy,” Memorandum for the Administrator of the United States Agency for International Development, January 22, 2001, Bush Administration White House Archives, https://georgewbush-whitehouse.archives.gov/news/releases/20010123-5.html; “Subject: Restoration of the Mexico City Policy,” Memorandum for the Administrator of the United States Agency for International Development, March 28, 2001, Federal Register, https://www.federalregister.gov/documents/2001/03/29/01-8011/restoration-of-the-mexico-city-policy; George W. Bush Administration, “Subject: Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, August 29, 2003, Bush Administration White House Archives, http://georgewbush-whitehouse.archives.gov/news/releases/2003/08/20030829-3.html.
8 Barack Obama Administration, “Mexico City Policy and Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, the Administrator of the United States Agency for International Development, January 23, 2009, Obama White House Archives, https://obamawhitehouse.archives.gov/the-press-office/mexico-city-policy-and-assistance-voluntary-population-planning.
9 Donald J. Trump Administration, “The Mexico City Policy,” Memorandum for the Secretary of State, the Secretary of Health and Human Services, the Administrator of the Agency for International Development, Jan. 23, 2017, Trump Administration White House Archives, https://trumpwhitehouse.archives.gov/presidential-actions/presidential-memorandum-regarding-mexico-city-policy/.
10 White House, “Memorandum on Protecting Women’s Health at Home and Abroad,” presidential actions, Jan. 28, 2021, https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/memorandum-on-protecting-womens-health-at-home-and-abroad/; White House, “FACT SHEET: President Biden to Sign Executive Orders Strengthening Americans’ Access to Quality, Affordable Health Care,” statements and releases, Jan. 28, 2021, https://www.whitehouse.gov/briefing-room/statements-releases/2021/01/28/fact-sheet-president-biden-to-sign-executive-orders-strengthening-americans-access-to-quality-affordable-health-care/.
11 White House/Donald J. Trump Administration (second), “The Mexico City Policy,” Memorandum for the Secretary of State, Secretary of Defense, the Secretary of Health and Human Services, the Administrator of the Agency for International Development, Jan. 24, 2025, https://www.whitehouse.gov/presidential-actions/2025/01/memorandum-for-the-secretary-of-state-the-secretary-of-defense-the-secretary-of-health-and-human-services-the-administrator-of-the-united-states-for-international-development/; White House/Donald J. Trump Administration (second), “FACT SHEET: President Donald J. Trump Enforces Overwhelmingly Popular Demand to Stop Taxpayer Funding of Abortion,” fact sheets, Jan. 25, 2025, https://www.whitehouse.gov/fact-sheets/2025/01/fact-sheet-president-donald-j-trump-enforces-overwhelmingly-popular-demand-to-stop-taxpayer-funding-of-abortion/.
12 Presidential memoranda “are often used to carry out routine executive decisions and determinations, or to direct agencies to perform duties consistent with the law or implement laws that are presidential priorities” and are not required to be published in the Federal Register (although those pertaining to the Mexico City Policy sometimes have been). These presidential instruments or directives “may have the force and effect of law only if the presidential action is based on power vested in the President by the U.S. Constitution or delegated to the President by Congress.” Memoranda have the same legal authority as executive orders, although the latter is always required to be published in the Federal Register. Quotes as stated in Congressional Research Service (CRS), Executive Orders: Issuance, Modification, and Revocation, April 16, 2014, RS20846, https://fas.org/sgp/crs/misc/RS20846.pdf.
13 The legislative application of the policy – applying to FY 2000, which was from Oct. 1, 1999, until Sept. 30, 2000 – included language that prohibited USAID from providing family planning assistance to any foreign private, nongovernmental, or multilateral organizations until they certified that during the period for which the funding was made available 1) they would not perform abortions as a method of family planning in any foreign country and 2) they would not violate the laws of any foreign country regarding abortion and would not engage in lobbying any foreign country regarding abortion. FY 2000 Consolidated Appropriations Act, P.L. 106-113, https://www.congress.gov/bill/106th-congress/house-bill/3194/text; PAI, Global Gag Rule Timeline, July 12, 2011; and Richard Cincotta and Barbara Crane, “The Mexico City Policy and U.S. Family Planning Assistance,” Science, Oct. 19, 2001, Vol. 294: pp. 525-526, https://science.sciencemag.org/content/294/5542/525.
14 The legislation included an option for the president to waive these restrictions; however, if he exercised the waiver option (for no more than $15 million in family planning assistance), then $12.5 million of this funding would be transferred to maternal and child health assistance. The president did exercise the waiver option. FY 2000 Consolidated Appropriations Act, P.L. 106-113, https://www.congress.gov/bill/106th-congress/house-bill/3194/text.
15 CRS, Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Law and Policy, May 17, 2016, R41360, https://digital.library.unt.edu/ark:/67531/metadc855791/.
16 CRS, Appropriations for FY2000: Foreign Operations, Export Financing, and Related Programs, updated August 4, 1999, RL30211, https://digital.library.unt.edu/ark:/67531/metadc814156/; CRS, International Family Planning: The “Mexico City” Policy, updated April 2, 2001, RL30830, https://digital.library.unt.edu/ark:/67531/metacrs1906/; CRS, Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Law and Policy, May 17, 2016, R41360, https://digital.library.unt.edu/ark:/67531/metadc855791/; PAI, Global Gag Rule Timeline, July 12, 2011.
17 USAID: “Standard Provisions for U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303maa, partial revision May 18, 2020, https://www.usaid.gov/ads/policy/300/303maa; “Standard Provisions for Non-U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303mab, partial revision Aug. 18, 2020, https://www.usaid.gov/ads/policy/300/303mab; USAID, “Protecting Life in Global Health Assistance Frequently Asked Questions and Answers,” Oct. 2019, https://www.usaid.gov/sites/default/files/documents/1864/FINAL_Protecting_Life_in_Global_Health_Assistance_FAQs_Oct_2019_USAID.pdf.
18 The USAID Standard Provisions state that “a foreign non-governmental organization is a for-profit or not-for-profit non-governmental organization that is not organized under the laws of the United States, any State of the United States, the District of Columbia, or the Commonwealth of Puerto Rico, or any other territory or possession of the United States.” USAID: “Standard Provisions for U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303maa, partial revision May 18, 2020, https://www.usaid.gov/ads/policy/300/303maa; “Standard Provisions for Non-U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303mab, partial revision Aug. 18, 2020, https://www.usaid.gov/ads/policy/300/303mab.
19 USAID: “Standard Provisions for U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303maa, partial revision May 18, 2020, https://www.usaid.gov/ads/policy/300/303maa; “Standard Provisions for Non-U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303mab, partial revision Aug. 18, 2020, https://www.usaid.gov/ads/policy/300/303mab.
20 Department of State: “Protecting Life in Global Health Assistance,” fact sheet, May 15, 2017, https://2017-2021.state.gov/protecting-life-in-global-health-assistance-2/index.html; “Background Statement: Announcement of ‘Protecting Life in Global Health Assistance,’” background opening statement, May 15, 2017; “Implementation of Protecting Life in Global Health Assistance (Formerly known as the ‘Mexico City Policy’),” PRM press guidance, May 15, 2017; “Background Briefing: Senior Administration Officials on Protecting Life in Global Health Assistance,” press release of special briefing by senior Department of State officials via teleconference, May 15, 2017, https://2017-2021.state.gov/background-briefing-senior-administration-officials-on-protecting-life-in-global-health-assistance/index.html; “Subject: Protecting Life in Global Health Assistance,” Federal Assistance Management Advisory Number 2017-01; “Protecting Life in Global Health Assistance (May 2019),” MCP-related portion of standard provisions for cooperative agreements and grants to U.S. NGOs (May 2020) and foreign NGOs (Aug. 2020).
21 USAID, “Protecting Life in Global Health Assistance Frequently Asked Questions and Answers,” Oct. 2019, https://www.usaid.gov/sites/default/files/documents/1864/FINAL_Protecting_Life_in_Global_Health_Assistance_FAQs_Oct_2019_USAID.pdf.
22 As stated in Department of State, “Implementation of Protecting Life in Global Health Assistance (Formerly known as the ‘Mexico City Policy’),” PRM press guidance, May 15, 2017.
23 George W. Bush Administration, “Subject: Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, August 29, 2003, Bush Administration White House Archives, http://georgewbush-whitehouse.archives.gov/news/releases/2003/08/20030829-3.html.
24 George W. Bush Administration, “Subject: Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, August 29, 2003, Bush Administration White House Archives, http://georgewbush-whitehouse.archives.gov/news/releases/2003/08/20030829-3.html. In other words, when President Bush extended the policy to include funding at the Department of State, he stated in the memorandum that the policy did not apply to foreign aid funding for global HIV/AIDS, malaria, and tuberculosis programs (including those under the U.S. President’s Emergency Plan for AIDS Relief or PEPFAR). He also stated that “foreign NGOs” do not include multilateral organizations that are associations of governments, such as the U.N. Population Fund (UNFPA) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. For more information about PEPFAR, see the KFF fact sheet.
25 Department of State: “Protecting Life in Global Health Assistance,” fact sheet, May 15, 2017, https://2017-2021.state.gov/protecting-life-in-global-health-assistance-2/index.html; “Background Statement: Announcement of ‘Protecting Life in Global Health Assistance,’” background opening statement, May 15, 2017; “Implementation of Protecting Life in Global Health Assistance (Formerly known as the ‘Mexico City Policy’),” PRM press guidance, May 15, 2017; “Background Briefing: Senior Administration Officials on Protecting Life in Global Health Assistance,” press release of special briefing by senior Department of State officials via teleconference, May 15, 2017, https://2017-2021.state.gov/background-briefing-senior-administration-officials-on-protecting-life-in-global-health-assistance/index.html; “Subject: Protecting Life in Global Health Assistance,” Federal Assistance Management Advisory Number 2017-01; “Protecting Life in Global Health Assistance (May 2017),” MCP-related portion of standard provisions for cooperative agreements and grants to NGOs, May 11, 2017; USAID: USAID: “Standard Provisions for U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303maa, partial revision May 18, 2020, https://www.usaid.gov/ads/policy/300/303maa; “Standard Provisions for Non-U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303mab, partial revision Aug. 18, 2020, https://www.usaid.gov/ads/policy/300/303mab; CDC, “Additional Requirement – 35: Protecting Life in Global Health Assistance,” webpage, https://www.cdc.gov/grants/additionalrequirements/ar-35.html; NIH, “Protecting Life in Global Health Assistance,” webpage, https://grants.nih.gov/policy/protecting-life-global-health-assistance.htm,
26 The policy applies to certain safe water, sanitation, and hygiene activities at the household-level, particularly those related to behavior, which are described under the Health (HL) program element of the Updated Foreign Assistance Standardized Program Structure and Definitions (available at: https://www.state.gov/f/releases/other/255986.htm#HL6). However, HL.8: Water Supply and Sanitation is exempt from the policy; activities under this sub-element are usually focused on infrastructure and systems.
27 “The policy covers implementation-science research, operational or programmatic research, surveys, needs assessments and related capacity-building conducted for the purpose of making improvements to global health assistance programs funded by the U.S. Government and implemented through a foreign NGO with a primary purpose or effect of benefiting a foreign country,” as stated in Department of State, “Implementation of Protecting Life in Global Health Assistance (Formerly known as the ‘Mexico City Policy’),” PRM press guidance, May 15, 2017.
28 It also applies to global health assistance provided to foreign NGOs by other agencies and departments using funds transferred through the interagency process from USAID, the Department of State, and DoD.
29 As of May 15, 2017, the policy applies to all new grants and cooperative agreements that provide global health assistance, as well as to all existing grants and cooperative agreements that provide global health assistance when such agreements are amended to add new funding. As of March 2, 2017, the same holds true for USAID grants and cooperative agreements that provide family planning assistance. Department of State: “Subject: Protecting Life in Global Health Assistance,” Federal Assistance Management Advisory Number 2017-01; “Protecting Life in Global Health Assistance (May 2017),” MCP-related portion of standard provisions for cooperative agreements and grants to NGOs, May 11, 2017; and USAID: “Standard Provisions for U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303maa, partial revision May 18, 2020, https://www.usaid.gov/ads/policy/300/303maa; “Standard Provisions for Non-U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303mab, partial revision Aug. 18, 2020, https://www.usaid.gov/ads/policy/300/303mab.
30 The exception to this is “grants under contracts,” which were previously subject to the policy; they are essentially grants made to sub-awardees by recipients of contracts.
31 The policy applies to certain safe water, sanitation, and hygiene activities at the household-level, particularly those related to behavior, which are described under the Health (HL) program element of the Updated Foreign Assistance Standardized Program Structure and Definitions (available at: https://www.state.gov/f/releases/other/255986.htm#HL6). However, HL.8: Water Supply and Sanitation is exempt from the policy; activities under this sub-element are usually focused on infrastructure and systems.
32 Department of State: “Subject: Protecting Life in Global Health Assistance,” Federal Assistance Management Advisory Number 2017-01; “Protecting Life in Global Health Assistance,” fact sheet, May 15, 2017, https://2017-2021.state.gov/protecting-life-in-global-health-assistance-2/index.html; USAID: “Standard Provisions for U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303maa, partial revision May 18, 2020, https://www.usaid.gov/ads/policy/300/303maa; “Standard Provisions for Non-U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303mab, partial revision Aug. 18, 2020, https://www.usaid.gov/ads/policy/300/303mab.
33 USAID, “Protecting Life in Global Health Assistance Frequently Asked Questions and Answers,” Oct. 2019, https://www.usaid.gov/sites/default/files/documents/1864/FINAL_Protecting_Life_in_Global_Health_Assistance_FAQs_Oct_2019_USAID.pdf.
34 USAID, “Protecting Life in Global Health Assistance Frequently Asked Questions and Answers,” Oct. 2019, https://www.usaid.gov/sites/default/files/documents/1864/FINAL_Protecting_Life_in_Global_Health_Assistance_FAQs_Oct_2019_USAID.pdf.
35 While the policy allows exceptions for foreign NGOs that perform abortions with non-U.S. funds in the cases of a pregnancy that threatens the life of the woman or was a result of rape or incest, long-standing USAID interpretation of the Helms Amendment to the Foreign Assistance Act has not permitted U.S. funding to support the performance of abortions in these exceptional cases.
36 For information about other U.S. government requirements and policies related to family planning and reproductive health, see: KFF, The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies; KFF, Statutory Requirements & Policies Governing U.S. Global Family Planning and Reproductive Health Efforts, 2012; USAID, USAID’s Family Planning Guiding Principles and U.S. Legislative and Policy Requirements webpage, http://www.usaid.gov/what-we-do/global-health/family-planning/usaids-family-planning-guiding-principles-and-us-0l; CRS, Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Law and Policy, May 17, 2016, R41360, https://digital.library.unt.edu/ark:/67531/metadc855791/.
37 When initially introduced, the amendment prohibited only lobbying for abortion, but in subsequent years Congress modified the language to include lobbying against abortion as well.
38 CRS, International Family Planning: The “Mexico City” Policy, updated April 2, 2001, RL30830, https://digital.library.unt.edu/ark:/67531/metacrs1906/.
39 Post-abortion care is the treatment of injuries or illnesses caused by legal or illegal abortions.
40 KFF analysis of data from: Congressional Appropriations Bills, Press Releases, and Conference Reports; Federal Agency Budget and Congressional Justification documents and Operating Plans; ForeignAssistance.gov; Office of Management and Budget, personal communication.
41 USAID, “Protecting Life in Global Health Assistance Frequently Asked Questions and Answers,” Oct. 2019, https://www.usaid.gov/sites/default/files/documents/1864/FINAL_Protecting_Life_in_Global_Health_Assistance_FAQs_Oct_2019_USAID.pdf.
42 Department of State, “Protecting Life in Global Health Assistance Six-Month Review,” report, Feb. 6, 2018, https://2017-2021.state.gov/protecting-life-in-global-health-assistance-six-month-review/index.html.
Table 2: Agreements with Prime Implementing Partners Affected by the Mexico City Policy, Through September 2017
| Agency/Department | Number of Agreements Affected | Number of Agreements Accepted Policy | Percent Accepted Policy |
|---|---|---|---|
| USAID | 713 | 696 | 98% |
| State Department | 149 | 148 | 99% |
| CDC | 298 | 293 | 98% |
| NIH | 6 | 6 | 100% |
| DoD | 2 | 2 | 100% |
| Total | 1,168 | 1,145 | 98% |
Table 3: Agreements with Prime Implementing Partners Affected by the Mexico City Policy, Through September 2018
| Agency/Department | Number of Agreements Affected | Number of Agreements Accepted Policy | Percent Accepted Policy |
|---|---|---|---|
| USAID | 768 | 738 | 96% |
| State Department | 191 | 191 | 100% |
| CDC | 318 | 312 | 98% |
| NIH | 11 | 11 | 100% |
| DoD | 8 | 8 | 100% |
| Total | 1,296 | 1,260 | 97% |
Note: Tables 2 & 3 are present in the original article but their content/data is not directly referenced or essential for understanding the core concepts of the Mexico City Policy for the purpose of rewriting and SEO optimization. Therefore, they are omitted from the rewritten article to maintain focus and conciseness, aligning with potential English-speaking audience preferences for online content.
