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The Trump administration has announced a policy that significantly broadens the reach of the current Global Gag Rule. If recipients of United States foreign assistance comply with these new restrictions, the consequences for global health and human rights will be profound This expanded Global Gag Rule lays bare an ultra-conservative, anti-rights agenda targeting women, minorities and marginalised communities. It must be challenged and rejected by everyone committed to health, dignity and human rights.
The expanded Global Gag Rule is draconian in both scope and intent. It not only targets abortion care and access but also undermines Diversity, Equity and Inclusion initiatives and LGBTQI+ rights. It also extends across all forms of U.S. foreign assistance, including humanitarian aid, bilateral cooperation, support for U.S. NGOs and funding for multilateral institutions. In practice any government or organisation seeking U.S. funding to meet the growing health or humanitarian needs is now expected to comply with U.S. ideological conditions, rather than the needs and rights of the communities they serve.
How “America First” becomes “Rights Last”
The fear is that the expansion of the Global Gag Rule will be closely tied to the recently launched “America First Global Health Strategy”. Presented at the end of September 2025, this strategy serves as a vehicle for advancing U.S. political interests around the world under the guise of health policy and financing.
The dismantling of USAID has already caused widespread harm: more than 45 million women and girls have lost access to contraceptive care and clinics around the world have been forced to close. Now, the Trump administration is further reshaping global health policy through new government agreements that embed ideological conditions and deepen political control.
Since December, the Trump administration has been imposing conditions on recipient countries through multi-year bilateral agreements, beginning on the African continent. These negotiations have largely excluded national stakeholders, such as ministries of health, academia, health professionals and civil society, and the terms imposed are not guided by national or regional interests.
Alarmingly, the agreements include controversial data-sharing provisions that align with U.S. law, with no reference to national legal frameworks – raising serious concerns about sovereignty and data security. In Kenya, public pressure forced the government to publish the signed agreement, triggering broad scrutiny by civil society and legal action that has led the High Court to temporarily halt its implementation.
Although the practical implications of the expanded Global Gag Rule have yet to be fully realised, there are grave concerns that the restrictions may also apply to bilateral agreements that are due to be negotiated in Latin America and Asia.
Marieke van der Plas (executive director Rutgers):
“We strongly oppose the announced expansion of the Global Gag Rule. Its scope is unprecedented and deeply alarming. By forcing recipients from U.S. funding to abandon diversity, gender equality and inclusion efforts – and to stop providing abortion care – the current U.S. Administration is pressuring recipients to choose between an American ideological agenda or essential funding.
“This will cost lives, destabilise public health systems and reverse hard-won gains in equality, sexual and reproductive health and rights and global solidarity.
We call on countries committed to protecting the health, safety, wellbeing and rights of their population to use their diplomatic influence to halt the harmful effects of this policy.”
Expanding the GGR threatens lives and reverses progress
The Trump administration’s latest actions risk worsening the global unsafe abortion crisis and driving maternal mortality rates even higher. In West and Central Africa alone every nine seconds a woman puts her live at risk with an unsafe abortion. Millions of women and girls facing an unintended pregnancy have no option but unsafe procedures, often with severe complications or resulting in death.
New research by Rutgers and partners reveals the overwhelming barriers women and girls in this region face when seeking care, support, and justice. Many African governments are committed to improving policies and removing procedural barriers to safe care. But political will is not enough, because these improvements require sustained funding and support. Without reliable resources, even governments that are genuinely committed to reform struggle to make their intentions a reality.
Already, the governments of Zambia, Zimbabwe, and the Democratic Republic of the Congo are moving to reduce donor dependency by increasing domestic investment in family planning, taking responsibility for the health and rights of their populations.
Standing firm against coercion and funding threats
Around the world, sexual and reproductive rights organisations have made it clear they will not capitulate to the coercion of the U.S. administration.
The attacks on Diversity, Equity and Inclusion and abortion rights have, instead, galvanised activists, NGOs, and grassroots movements, strengthening ties across borders. Far from weakening global commitments to equality, this pressure campaign by the U.S. is forging an even more determined and united front — a movement that does not accept political intimidation. A movement that refuses to sacrifice health, human rights, dignity and inclusion.
Questions and answers on the expansion of the Global Gag Rule
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What is the Global Gag Rule?
The Global Gag Rule, officially known as the Mexico City Policy, is a U.S. policy that prohibits organisations outside the U.S. that receive international U.S. funding from providing information, offering safe abortion services, or advocating for safe abortion. Even when they use non-US funds for these activities.
The Global Gag Rule, first introduced in 1984, has since been enforced under Republican administrations and repealed during Democratic administrations. Under the first Trump administration, the Global Gag Rule was expanded and became applicable most of the US global health assistance budget. It was renamed as “Protecting Life in Global Health Assistance (PLGHA)”.
On the 23 January 2026, the PLGHA has been further expanded and will now become applicable to all forms of U.S. foreign assistance, including humanitarian aid, bilateral cooperation, support for U.S. NGOs and funding for multilateral institutions. It not only targets abortion care and access but now also undermines Diversity, Equity and Inclusion initiatives and LGBTQI+ rights The policy is still referred to as the “Global Gag Rule” because it literally “gags” (silences) health and human rights organisations, service providers and health professionals around the world.
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How has the second Trump presidency affected sexual and reproductive health and rights around the world?
The Trump administration has attacked sexual and reproductive health and rights in the United States and worldwide.
Next to the reinstatement of the Global Gag Rule, the Trump administration has dismantled USAID early 2025. This has caused widespread harm: more than 45 million women and girls have lost access to contraceptive care, maternal mortality rates increased and public health systems have been badly affected. IPPF has recently informed that hundreds of clinics — especially in Africa and the Arab world — were forced to close, and hundreds of health workers lost their jobs. Around $80 million+ in funding was cut or withdrawn from IPPF partners, affecting service delivery sites and projects. The consequences of this maladministration are unprecedented: unintended pregnancies, unsafe abortions, and increased health risks, particularly for vulnerable groups.
The recent withdrawal of U.S. funding or participation from key global institutions have also worsened gaps in support for SRHR worldwide. The Trump administration’s actions already negatively impacted agencies like the United Nations Population Fund (UNFPA), a major provider of safe maternal care and family planning worldwide. Decisions to pull out of or disengage with international health cooperation and agreements reduce global coordination on reproductive health.
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Why should I care about the Global Gag Rule expansion and other executive orders (if I don’t live in the U.S.)?
Even if you don’t live in the U.S., these policies matter because their effects are global. Executive actions like the expanded Global Gag Rule and proposals such as Project 2025 tie U.S. aid to ideological conditions, creating a ripple effect around the world.
When aid is conditional, governments elsewhere may feel legitimized to restrict reproductive rights, LGBTQI+ healthcare, or gender equality. Policymakers may cite U.S. positions to justify regressive laws. Rights are not lost all at once; they are often eroded gradually as such policies become normalised.
At the individual level, this can mean reduced access to essential health services, limited support for marginalized communities, and constrained choices around reproductive health. Even policies “over there” translate into real impacts on people’s lives and the systems they rely on, no matter where they live.
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What is the “America First Global Health Strategy” about?
The “America First Global Health Strategy” was presented at the end of September 2025. This strategy serves as a vehicle for advancing U.S. political interests around the world under the guise of health policy and financing. The strategy is focussed on preventing pandemics and controlling the spread of HIV and AIDs, TB, malaria, and polio, and preventing disease to reach the U.S. There is no reference to family planning or sexual health in the strategy, and priority is given to bilateral funding and faith-based organisations.
The strategy ties economic and political conditions to health financing, including on American access to data, minerals and pathogen of the recipient countries. The strategy is being rolled out through bilateral agreements with governments from 71 countries.
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Why are the bilateral health agreements that the Trump administration is currently negotiating so controversial?
The Trump administration is reshaping global health policy through multi-year bilateral funding agreements that embed ideological conditions and increase U.S. political control over recipient countries. As of January 2026, 14 African countries have already signed such agreements.
With the expanded Global Gag Rule, it is likely that upcoming agreements with Latin American and Asian countries will also be subject to these restrictions, raising concerns about access to sexual and reproductive health services.
A particularly controversial aspect is the data-sharing clause, which adheres only to U.S. law and ignores national legislation. This poses serious questions for sovereignty, privacy, and data security. In Kenya, public pressure led to the agreement being published, with civil society scrutiny, petitions, and a High Court challenge that issued orders restraining the government from implementing it. Most other countries’ agreements remain unpublished, limiting transparency and the ability of civil society to hold governments accountable.
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What is Project 2025 and why is it important for me to know about it?
Project 2025 is a detailed roadmap developed by influential ultra-conservative U.S. groups outlining their policy agenda and serving as a blueprint for the second Trump presidency. The plan includes specific policy recommendations to implement an ultra-conservative agenda, including restrictions on access to sexual and reproductive health services, particularly abortion, both in the U.S. and worldwide. It pushes for many harmful policy changes at different levels of government. This could have lasting effects on health, rights and services. The expansion of the Global Gag Rule is a key component of Project 2025.
For organisations working in the field of sexual and reproductive health and rights it is important to understand how these policies could impact funding and resources for their programmes.
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What is the Geneva Consensus Declaration?
The Geneva Consensus Declaration is a global anti-SRHR manifesto that was developed in 2020 under the first Trump administration and signed by 40 countries. It opposes LGBTQI+ rights and denies all access to safe abortion. It was never officially endorsed at the UN and is non-binding. The Biden-administration withdrew the US from the declaration during his presidency; however, Trump has signed it once again on 24 January 2025.
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Where can I find more information on the Global Gag Rule, Project 2025 or the America First Global Health Strategy?
Here are some suggested readings into the expanded Global Gag Rule, the America First Global Health Strategy and the bilateral agreements: