Yes, Trump’s ‘Mexico City’ abortion policy puts global health money at risk

The claim by a US senator that President Donald Trump’s memorandum to reinstate the so-called Mexico City policy "puts at risk 15 times more funding" is mostly correct.

Among the flurry of policies US President Donald Trump put in force in his first week was to reimpose a ban on taxpayer dollars going to overseas groups that have anything to do with abortion.

The so-called Mexico City policy was born under President Ronald Reagan and since then, with partisan regularity, Republican presidents invoke it and Democratic ones reject it.

In a speech last week, a Democratic senator warned that Trump’s version was even more extreme than those of his Republican predecessors.

“Previously, under President Reagan and the Bush administrations, this policy applied only to family planning funding,” Jeanne Shaheen said. “But under President Trump’s order, it applies to every programme that falls under global health assistance. This means that it puts at risk 15 times more funding and millions more women and families.”

Our partner Politifact compared the policies of all four Republican presidents and found that on paper, Shaheen’s number is largely correct, but there’s uncertainty surrounding Trump’s policy.

The first Mexico City policy

When US President George W. Bush expanded the reach of the Mexico City policy in 2003, he excluded the President's Emergency Program for AIDS Relief (PEPFAR). This programme provided assistance to the mother of Baron Mosima Loyiso Tantoh, whom Bush is holding. Photo: AFP/Mandel Ngan
When US President George W. Bush expanded the reach of the Mexico City policy in 2003, he excluded the President’s Emergency Program for AIDS Relief (PEPFAR). This programme provided assistance to the mother of Baron Mosima Loyiso Tantoh, whom Bush is holding. Photo: AFP/Mandel Ngan

Reagan administration officials announced a new US family planning policy at the 1984 International Conference on Population in Mexico City.

It required all non-governmental organisations, foreign and domestic, receiving aid from the United States to agree that they would not perform or actively promote abortion as a method of family planning in other countries.

This applied to US family planning programmes run by the US Agency for International Development (USAID).

President George H. W. Bush left the Reagan policy in place. President Bill Clinton rescinded it, and President George W. Bush brought it back with the focus still on family planning through the US Agency for International Development.

But in 2003, Bush expanded the reach of the policy, instructing the secretary of state to apply it to “all assistance for voluntary population planning”. Even as he did that, Bush excluded a number of groups and programmes.

“Such organisations do not include multilateral organisations that are associations of governments,” Bush wrote. “This policy shall not apply to foreign assistance furnished pursuant to the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.”

With those words, Bush exempted some of the largest and highest profile global health programmes. Those programmes, experts told Politifact, dwarfed any other programmes at the state department that Bush’s order might have affected.

Unclear how Trump administration will interpret order

Trump’s presidential memorandum to reinstate the Mexico City policy is broader. In addition to the head of USAID, it is addressed to the departments of state and health and human services.

“I direct the secretary of state, in coordination with the secretary of health and human services, to the extent allowable by law, to implement a plan to extend the requirements of the reinstated memorandum to global health assistance furnished by all departments or agencies.”

The operative phrase is “global health assistance furnished by all departments or agencies”. Trump’s order provides no exceptions.

It’s unclear exactly how the Trump administration will interpret those words. We asked the White House press office for details and did not hear back. The experts we reached told us they too were in the dark.

Global health funding close to US$10 billion per year

The pipeline of family planning and global health programmes in the US is more complicated than you might expect. US government agencies often contract with nonprofits which in turn subcontract out to smaller organisations in countries around the world.

Director of global health policy at the Kaiser Family Foundation, Jennifer Kates, said this makes it difficult to know the real impact of the order.

“Not all of the organisations that directly or indirectly receive US government global health support carry out the activities prohibited by the policy, but figuring that out will take some time,” Kates told us.

However, Kates said that in theory, Trump’s policy puts a lot more funding on the line.

“Whereas family planning assistance represents about US$600 million per year, global health funding overall is close to US$10 billion,” Kates said.

HIV/AIDS & malaria programmes may be affected

Data gathered by the Institute for Health Metrics and Evaluation allows us to tease out exactly which programmes Bush exempted from the Mexico City policy, but that Trump has included (see this IHME data graphic).

Remember, Bush kept money for HIV/AIDS, malaria and tuberculosis off the table, as well as US support for programmes involving multiple nations, the big ones being the Global Fund and United Nations programmes.

Add all of those up and you get US$9.7 billion. That’s about 15 times as much money as the United States spends on family planning assistance, which was the core programme affected across all three previous Republican administrations.

Shaheen said millions of women and families might be affected. In spending, the single largest global health programme is the President’s Emergency Plan for AIDS Relief, or PEPFAR. According to the latest report to the US Congress, PEPFAR treated 9.5 million people in 2015, at a cost of about US$6.8 billion.

Trump, along with his secretary of state nominee Rex Tillerson and UN ambassador Nikki Haley, has voiced support for PEPFAR. But in theory, since many HIV/AIDS programmes include a family planning component, the programmes that touch those people might be affected by Trump’s Mexico City policy.

If the policy extends to malaria programmes, the numbers climb dramatically. In 2015, American dollars protected over 16 million people with indoor spraying and many more through the distribution of nearly 30 million bed nets.

Conclusion: The claim is mostly correct

Senator Jeanne Shaheen said Trump’s Mexico City policy has a much broader reach compared to past Republican presidents, putting 15 times as much money “at risk”, as well as millions of women and families.

On paper, the numbers support that comparison. Previous Republican administrations applied the abortion funding policy to family planning programmes, which amount today to about US$600 million.

Trump included all global health spending, which is nearly $10 billion. There is no question Trump’s approach is broader and that millions more people could be affected.

The White House has not clarified how it will interpret the policy. Its reach could be much narrower than the full scope of global programmes, but Shaheen included the caveat that certain dollars were “at risk”, not that they definitely would be affected.

It’s also true that organisations facing funding cuts could drop activities related to abortion and the funds would continue to flow.

Given what we know so far, Politifact rated this claim mostly correct.

This report was first published by Politifact. See how it appeared on their website.

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