reshape global health

US President Donald Trump has reinstated a funding ban that targets international abortion services with it likely to have ripple effects across the world.

Health clinics and nonprofits in developing countries are preparing for whiplash as the so-called Mexico City Policy comes into effect, which will curb access to contraception, abortion, and other sexual health services.

It also leaves European governments in a tight spot as they decide which programmes to support and which to leave by the wayside.

Here’s what you need to know about the Mexico City Policy and how it could reshape global health in the coming years.

?What is the Mexico City Policy

The Mexico City Policy – also called the “global gag rule” – prevents the US from funding any foreign nongovernmental organisations (NGOs) that perform abortions, offer abortion counselling, or provide information on abortion, even if they use their own money to do so

The rule was created in the 1980s and American presidents have flip-flopped on it ever since, with Republicans implementing it and Democrats rescinding it.

Regardless of who is in office, a separate US law prevents the country from funding overseas abortions directly.

Trump expanded the policy in his first term. It previously applied to family planning programmes, but he made the ban a condition for groups receiving any US global health assistance, including those focused on HIV, malaria, nutrition, tuberculosis, and maternal and child health.

The rule applies not only to organisations that receive US funding directly but also to all the groups they work with.

?Why does the US rule matter

The US is the biggest funder of global health worldwide, providing €15.1 billion in 2022, according to a Berlin-based tracker.

That eclipsed the next three biggest donors: Germany (€4.2 billion), Japan (€3.1 billion), and the United Kingdom (€2 billion).

When it comes to reproductive health and family planning programmes, the US allocated about €680.8 million, more than the next three countries combined (the UK, the Netherlands, and Germany together spent €635.3 million).

That means US funding policies play a major role in setting the global health agenda.

Who will be affected by the ban?

The last time Trump issued the ban in 2017, only four of the US’s 733 main partner organisations declined to sign the policy, according to the US State Department.

One was the UK-based MSI Reproductive Choices, which said it “has never, and will never” sign the gag rule.

This time around, the organisation expects to lose $14 million (€13.4 million) in US funding, forcing it to slash contraception services in five African countries

Much of that burden will be in Zimbabwe, where MSI provides 20 per cent of all contraceptive services, according to Sarah Shaw, the group’s associate director of advocacy.

“We won’t go where the government is already delivering [services] so if you take us out of the equation, it’s going to be really significant for those women,” Shaw told Euronews Health.

Meanwhile, Michael Jennings, a professor of global development at SOAS University of London, said organisations that agree to the gag rule will likely be “over-cautious” and wind down their sexual and reproductive health services out of concern that they could lose US funding, in what he described as a “chilling effect”.

What are the health consequences?

When the Mexico City Policy has been in place, sexual and reproductive health services have closed in places like Kenya and Uganda.

The ban leads to less contraception use and higher rates of pregnancy and abortion, according to a 2024 review.

“It has the opposite effect of what it intends to do,” Jennings told Euronews Health

The policy has spillover effects across healthcare. One study estimated that between 2017 and 2021 – Trump’s first term – the rule led to 108,000 additional maternal and child deaths and 360,000 new HIV infections in 30 countries.

Frances Longley, head of the International Federation of Gynecology and Obstetrics (FIGO) said the funding cuts are so disruptive because clinics that provide abortion and related services also offer contraception, smear tests, HIV treatment, and prenatal and infant care.

With the gag rule in place, doctors “will be dealing with an entirely preventable increase in women and babies whose lives they cannot save, and punitive restrictions on their rights to speak out about it,” Longley told Euronews Health.

How does Europe fit in?

Some countries, such as the Netherlands, Sweden, and the UK, already earmark a large chunk of their global health budgets for family planning and reproductive health services.

But European countries and organisations could face more pressure to plug the funding gaps left by the Mexico City Policy

When the gag rule was last implemented in 2017, a group of governments, NGOs, and private donors in nine EU countries – Belgium, Cyprus, Denmark, Finland, France, Luxembourg, the Netherlands, Slovenia, and Sweden – raised €460 million to mitigate the shortfall.

Shaw said MSI is already in talks with potential donors, but that “Europe’s a very different place to what it was in 2017,” citing financial concerns around the war in Ukraine and NATO.

European leaders are also grappling with other health funding shortages after Trump said he will pull the US out of the World Health Organization (WHO) and pause all foreign aid for 90 days to reassess whether it aligns with his policy goals.

“Other donors – not just European, but also Japan, South Korea, and others – will also be expected to pick up some of the slack,” Jennings said, but “it won’t all be picked up”.