Global health organisations have reacted with anger to the new US foreign aid policy, which prohibits all aid recipients, bar military, from performing or promoting abortion, “gender ideology”, or “diversity, equity and inclusion” (DEI).

“Catastrophic”, “bullying”, “draconian” and “ideologically driven” – are some of their reactions to the Promoting Human Flourishing in Foreign Assistance (PHFFA) policy, announced by US Vice-President JD Vance at an anti-abortion event last Friday evening.

The policy’s three parts were published in the Federal Register on Tuesday as Protecting Life in Foreign Assistance, Combating Gender Ideology in Foreign Assistance and Combating Discriminatory Equity Ideology in Foreign Assistance Rules.

The new rules apply to all foreign and US NGOs and “international organisations”. 

However, in countries that allow abortion, their governments and parastatals will need to place any US funds in “a segregated account” to ensure they’re not used for abortions and related activities.

Governments and parastatals “may” also be required to agree that they won’t use US funds to promote or engage in “gender ideology” or DEI.

The US State Department defines “gender ideology” activities as those that provide or promote “sex rejecting procedures” (defined broadly to include puberty blockers, hormones, surgeries); promote or counsel social transition; use materials that discuss changing one’s sex or pronoun usage not aligned with biological sex; lobby foreign governments on gender identity issues; and support drag queen workshops, performances, or similar activities”.

Aid recipients are also compelled to agree to US officials popping in unannounced to inspect their documents and activities, and speak to people receiving their services.

Imposing ‘extremist ideology’

Successive Republican governments have imposed a “Global Gag Rule” on foreign NGOs receiving global health aid, barring them from using this money for abortion-related activities since it was first introduced by the Reagan administration in 1984.

However, the Trump administration is the first to extend this to all non-military foreign assistance, including humanitarian assistance, and to widen the scope to include US NGOs, international organisations and – potentially – governments.

“Bullying countries into complying with anti-rights and extremist ideology is despicable and unacceptable. The imperialist goals of this administration are on full display in these conditions to foreign assistance,” Anu Kumar, CEO of the global reproductive justice organisation, Ipas, told a media briefing this week.

An estimated $30-47 billion in aid is affected, and this “catastrophic expansion” is going to be especially harmful to “women, young people, girls and LGBTQI+ people”, added Ipas senior researcher Jamie Vernaelde.

“There is an agenda here from the US government to push these ideologies across to other countries, both through direct government-to-government funding, but also forcing multilateral organisations to be subject to the ideology of one specific country.”

Impact on Kenya

The bilateral Memorandums of Understanding (MOU) that the US has signed with 15 African countries as part of its “America First Global Health Strategy” all commit countries to complying with the Global Gag Rule.

“What we’ve realised is this inclusion of the Global Gag Rule in the MOUs was basically a Trojan horse, in the sense that now the governments have signed, they are obligated now to  implement these expanded conditions, for example, on gender ideology,” said Ipas’s Kenya director Dr Musoba Kitui.

Kitui said that 40,000 health workers had already lost their jobs in his country since the closure of the US Agency for International Development (USAID), leading to the “weakening of the health system”.

Many African governments “are very, very desperate” to inject some cash into their health systems since the closure of USAID, and were willing to sign bilateral MOUs with the US, despite some of the unfavourable conditions.

Kenya’s MOU would be complex to implement, and there is “no way the US can monitor compliance without seeing patient records,” added Kitui, highlighting a huge concern about patient privacy that has resulted in the MOU being challenged in court.

However, “this MOU grants US personnel diplomatic immunity, insulating them from any local courts against judicial processes for any violations of data privacy, or even crippling the health system for that matter”.

“Sexual and reproductive health is not a diplomatic bargaining chip. It’s a fundamental human rights and essential health care services must be separate from political agendas. What is really important is to protect the progress that we have made over the years, including in countries like Kenya,” Kitui stressed.

Impact on humanitarian aid

Jean-Claude Mulunda, from Ipas in the Democratic Republic of Congo (DRC), said that his organisation assisted displaced people in camps with family planning services, abortion care and also supports survivors of gender-based violence (GBV). 

With the demise of USAID, “rape kits” for GBV survivors, with medicine to protect women and girls against sexually transmitted infections and pregnancy, are no longer available.

“Ipas is trying, with our limited funds, to buy unit-by-unit, the different medicines in these kits,” said Mulunda.

“Many women who are victim of rape can’t access abortion care, even though the country has signed the Maputo Protocol which allows access to abortion in case of rape.” 

The more onerous aid conditions are going to make it even harder for displaced women to access sexual and reproductive services.

“The risk of unsafe abortion is elevated in humanitarian settings where it’s even harder for people to access medical services,” said Médecins Sans Frontières (MSF).

“In 2023, MSF provided more than 31,000 consultations for post-abortion care, most of which were due to complications related to unsafe abortion. With the reinstatement of the Global Gag Rule, MSF expects these already troubling numbers to increase.”

The new policy, PHFFA, “escalates a pattern established across both Trump administrations: the systematic subordination of scientific evidence and patient needs to ideological and political objectives,” added MSF. 

“Versions of the Global Gag Rule have been introduced by Republican administrations since 1984, and extensive research has repeatedly documented that the policy disrupts health services and causes cascading adverse health outcomes in low- and middle-income countries, with the chilling impact enduring even when the policy has been rescinded.” 

MSF added that the State Department’s definitions of “gender ideology” and “discriminatory equity ideology” are so broad “that it is likely to result in barring or limiting access to essential health services for LGBTQIA+ individuals, women and girls, racial and ethnic minorities, and other marginalized groups”. 

‘Abdication of decency’

“President Trump and his anti-abortion administration would rather let people starve to death in the wake of famine and war than let anyone in the world get an abortion – or even receive information about it,” said Rachana Desai Martin, chief US program officer at the Center for Reproductive Rights. 

“People are already dying because of this administration’s slashing of foreign assistance. Now, they’re making it harder for doctors and aid workers to provide food, water, and lifesaving medical care. This isn’t about saving lives – it’s a stunning abdication of basic human decency.”

“Trump’s expansion [of the Global Gag Rule] continues on a path of instrumentalising those most marginalised. It marks increasing attempts to capture global health and human rights with a deeply regressive act of imperialism masquerading as foreign policy,” said Mina Barling, International Planned Parenthood Federation’s global director of external relations. 

“This is yet another attack on national sovereignty and colonial intervention through the curtailing of sexual and reproductive rights.”

“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,” said Marieke van der Plas, executive director of the Dutch reproductive rights organisation, Rutgers.

“Now, the Trump administration is further reshaping global health policy through new government agreements that embed ideological conditions and deepen political control.”

“By blocking US funding to any entity that does not conform to his extreme ideological agenda, the administration is exporting MAGA culture wars overseas and turning lifesaving aid into a political tool,” said the Senate Foreign Relations Democrats. 

“This order goes far beyond anything we’ve seen before. It will shrink global resources to fight disease, respond to humanitarian crises and protect women and girls from violence, while forcing many of our trusted partners to shut their doors or betray their missions. In doing so, it also leaves Americans more vulnerable to infectious diseases and health threats that do not respect borders.”

Image Credits: saac Billy/ UN Photo.