Mexico City Policy Six Month Review

Advocates call for review of “Global Gag” rule to be more comprehensive, consultative, transparent, and action-oriented 

When the Department of State announced guidance as to how the U.S. Government would apply provisions of the expanded Mexico City Policy (also known as the global gag rule) in May 2017, it indicated that there would be a comprehensive, six-month review of the impact of the policy, focused on compliance, implementation, and new issues that may affect its roll out. That review was released on February 7, 2018.

The sixth month review presents an incomplete and insufficient analysis of the impact of the global gag rule. 

In fact, the Department of State acknowledges in the report that many awards, particularly within PEPFAR, had not been made by the September 30, 2017 evaluation date. The review states this “six-month review takes place early in the policy’s implementation, when affected U.S. government departments and agencies have added a significant portion of the funding affected by the policy to grants and cooperative agreements only recently.”

While the report indicates that only four prime recipients of global health assistance have refused to comply with the global gag rule, it must be noted that according to the Kaiser Family Foundation,^[1] most prime recipients are U.S.-based organizations who are not required to sign the policy, underscoring that looking at this initial count of prime recipients is incomplete. Furthermore, more than 500 prime recipients of U.S. global health assistance had not yet had to determine if they will comply with the policy.

State Department officials claimed that services are continuing across the board without disruption. However, civil society comments (which have not been made public) indicate that global health implementing organizations report harmful impact on their ability to provide services at a community level.

The review was not conducted in a meaningful period to adequately assess impact or elicit thorough feedback from implementing organizations and civil society.

• Ongoing review of the global gag rule is necessary to continue to monitor impact of the policy on health care access worldwide.
• Annual reviews of the impact across all global health programs must be conducted, and the State Department should ensure these reviews are comprehensive, consultative, transparent, and action oriented.

The global gag rule is a harmful policy that negatively impacts the health and lives of communities worldwide.

• It threatens to exclude some of the most effective health organizations and crucial advocates for marginalized peoples’ rights in 60 low and middle income countries. These are organizations that have the infrastructure, expertise and community trust in areas we must reach in order to achieve our global health goals. In some cases, they are the only health care provider serving a given community.
• The policy will have devastating consequences on the health of all people, particularly women and girls and LGBT people who are often the most marginalized in their countries.
• The global gag rule will put life-saving health services, particularly sexual and reproductive health services, out of reach for people and communities who already have limited access to affordable, high quality healthcare.
• Over 160 diverse groups – representing domestic and global reproductive health and justice, human rights, public health, HIV/AIDS, LGBT, faith-based, labor, environmental, maternal and child health, youth, anti- trafficking, development, academic, medical, and refugee organizations – have joined in opposition to the global gag rule.

The State Department indicated that it will conduct an additional review of the global gag rule implementation by December 15, 2018. The Coalition for Children Affected by AIDS will continue to monitor this issue and provide updates as they become available. In the meantime, we urge all global HIV/AIDS stakeholders to add your voice to the call for a comprehensive, consultative, transparent, and action-oriented review of this policy going forward.