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The Trump administration today released new anti-abortion rules — including a policy name change — that will apply to almost $9 billion in global health funding, including a massive HIV/AIDS prevention program, the State Department announced on Monday.
The rules — dubbed the "Protecting Life in Global Health Assistance" plan, and approved by Secretary of State Rex Tillerson — restrict any foreign nongovernmental organization receiving US global health aid from using any of their other funding to "perform or actively promote abortions as a method of family planning," according to a senior administration official who briefed the press on the plan.
"Referrals for the termination of a pregnancy in cases of rape, incest, or endangerment of the life of the woman are not prohibited under this policy," the official added.
The Tillerson plan is a dramatic expansion of the Mexico City Policy, a Reagan-era restriction that's since been suspended by every Democrat in the White House and revived by every Republican. President Donald Trump signed a memo bringing back the restrictions on Jan. 23.
This expanded policy newly affects several agencies, including the Department of Defense, and programs like the President's Malaria Initiative and PEPFAR, short for the President's Emergency Plan for AIDS Relief. Both programs were started by George W. Bush.
PEPFAR accounts for $6 billion of the $8.8 billion in funds affected by the new policy, according to the administration official.
Humanitarian and disaster relief funding at USAID, the State Department, and the Department of Defense are exempted, officials said, as are State Department funds for migration and refugee assistance.
National and local governments and multilateral institutions, like the Global Fund, are also exempted.
The announcement left unclear when exactly foreign organizations will feel the effects of the policy but promised "a thorough and comprehensive review," focusing especially on newly affected programs, within six months.
Critics say the expansion is more about ideology than about global health.
"The big concern that people have about US taxpayer money funding abortions is in and of itself such a fallacy that it’s really hard to understand why they feel the need to go so much further than addressing that specific issue," said Dr. Caitlin Bernard, a fellow with Physicians for Reproductive Health and at the Department of Obstetrics and Gynecology at Washington University in St. Louis.
"The laws already existing have already made that impossible," she said, referring to the 1973 Helms Amendment, which prohibits US funding for abortions overseas.
"You can only surmise that they're trying to do this because of an ideological standpoint," Bernard said.
Jonathan Rucks, advocacy director at PAI, a reproductive health organization in Washington, DC, was more direct. "This is so political. It's red meat to their base; it's not one iota about protecting anyone's life," he said.
Reproductive health experts point out that abortions actually increased the last time Mexico City restrictions were in place. A 20-country study by the Stanford University School of Medicine, published by the World Health Organization in 2011, found that abortion rates actually went up 40% during the last iteration of the policy. In countries most heavily affected by the rule, contraceptive use dropped, and a woman's odds of having an unsafe abortion were more than two times higher.
It's as yet unclear whether the policy's expansion will amplify those outcomes. Administration officials say they'll be monitoring both implementation and outcomes.
But Serra Sippel, president of the Center for Health and Gender Equity in Washington, DC, said post-facto monitoring isn't enough.
"There’s no indication that the Trump administration has conducted any
assessment of the impact of this expansion," said Sippel. "It has nothing to do with evidence. It has nothing to do with global health."
The policy guidance comes down a day after Trump issued a statement for Women's Health Week, "recogniz[ing] the importance of providing women access to the best, evidence-based health information and care."