The Biden-Harris administration announced on March 18 that it is actively working to rescind the Mexico City Policy. According to the announcement, President Biden issued a “Memorandum on Protecting Women’s Health at Home and Abroad” on Jan. 28, directing the Department of Health and Human Services (HHS) to review the 2019 Title X Final Rule.
The move capped off weeks of anticipation following an announcement by Biden’s administration declaring that policies which deter access to women’s reproductive health would be reversed upon his taking office. The Mexico City Policy, named for where the rule was originally created, is widely known as the Global Gag rule. The policy is known as such because it essentially gags healthcare workers by removing their freedom of speech to provide complete counseling or make certain referrals or recommendations in terms of reproductive health. The policy thus restricts access to abortions not only in the U.S. but around the world by threatening healthcare providers with cuts in program assistance should they perform or promote abortions.
The memorandum also directed HHS to ensure that undue restrictions are not put on women’s access to medical information or on the use of federal funds. According to the announcement, HHS will now conduct a review and create a new Notice of Proposed Rulemaking (NPRM) that is expected to be published in the Federal Register no later than April 15, 2021.
While the administration cannot rewrite the Title X rule by executive order, it can rewrite the Mexico City Policy. First enacted by Ronald Reagan in 1984, the Mexico City Policy has been edited, repealed, and reinstated in subsequent decades. When Donald Trump took office in 2017, he brought the Global Gag Rule back as one of his many attempts to restrict abortion access and birth control across the U.S. However, Trump’s edit of the rule impacted not only the U.S., but foreign countries as well. He added further restrictions to include governmental organizations which were previously exempt from the policy.
The policy is a provision under the Title X Family Planning Program, a federal grant program created in 1970 to provide family planning services and preventative health to those in need. Services under the program included not only abortion access but contraception counseling, breast and cervical cancer screenings, and testing and treatment for sexually transmitted infections.
According to the Family Planning Annual Report 2016 National Summary, “Title X providers serve a vulnerable population, most of whom are female, low income, and young. In 2016, Title X-funded providers served more than 4.0 million family planning users (i.e., clients) through almost 6.7 million family planning encounters.” More than 3,000 clinical sites including public health departments and nonprofits were dependent on this program to serve people and families prior to the Trump administration.
Under the Trump administration, healthcare providers with Title X funding were prohibited from referring patients for abortion care under the Global Gag Rule. Additionally, the policy blocked Planned Parenthood health centers from receiving funding through Title X. Despite the rule being denounced by multiple medical associations and the public, it was upheld. Trump’s administration even cut international aid to the United Nations Population Fund, the lead provider of family-planning services, in 2017 despite there being no evidence that the agency ever engaged in performing excessive abortions. The administration threatened to not only close but stop funding any healthcare facility on the basis that abortions were made accessible or even recommended there.
“Across the country and around the world, people—particularly women, Black, Indigenous, and other people of color, LGBTQ+ people, and those with low incomes—have been denied access to reproductive health care,” a statement from the White House read when Biden took office. The Biden-Harris administration will “protect and expand access to comprehensive reproductive health care” domestically and globally by immediately rescinding the gag rule, according to the memo, which also covers actions to strengthen and expand the Affordable Care Act and Medicaid.
According to the Guttmacher Institute in 2016, every $10 million the U.S. cut in aid to international organizations meant about 440,000 fewer people would receive contraception.
“The past four years of Trump’s Global Gag Rule have been detrimental to reproductive health services and rights globally,” Melvine Ouyo, a former clinic director for Family Health Options Kenya, the country’s largest health care provider, said in a statement for the Center for Reproductive Rights. “The policy’s impacts not only have been devastating to marginalized communities, but also to health care providers, organizations and their partnerships, leading to clinic closures, staff layoffs, family planning program cuts, and generally disrupting the public health system.”
While the announcement to rescind the Global Gag Rule has been praised by organizations and advocates globally, more can and must be done. For years the Global Gag Rule has been renounced and then reinforced. Passing an act like the Global Health, Empowerment, and Rights Act (Global HER Act) would not only make the reversal of the Global Gag Rule permanent but allow for better access to reproductive health by expanding abortion access. “We must pass the #GlobalHERAct to ensure that access to critical sexual and reproductive health services in other countries is not dictated by a US president. #EndGlobalGag,” Guttmacher Institute tweeted.
Title X services serve not only patients with low incomes who are otherwise unable to access services, but many people of color who already face disparities in the healthcare system. Reproductive rights are fundamental human rights. Every person should have the ability to determine when, how, and whether or not they want to start a family. Health care should be available not only when you need it but at an affordable cost.
Policies that ban or limit abortion do not decrease the number of abortions; instead, they restrict a woman’s right to their bodily autonomy and increase the number of unsafe abortions and maternal health problems that occur.
Threatening and eliminating access to providers like Planned Parenthood not only impacts access to abortion but health screenings and other services provided. Healthcare providers should not be forced to choose between funding and correctly servicing their patients. We must end the Global Gag Rule to ensure that no one's access to reproductive health is ever threatened.