In 2006, in the west African country of Ghana, five organizations from the United States and the U.K. formed a coalition with the singular mission of expanding access to abortion and contraception in Ghana. Included in this coalition were pro-abortion heavyweights Marie Stopes International and Ipas. The coalition also included two well-funded and well-resourced U.S. non-governmental organizations (NGOs): the Population Council and EngenderHealth.
The project was benignly called Reducing Maternal Morbidity and Mortality (or “R3M”), though the project sought to engage in intensive advocacy efforts to influence key leaders in Ghana—including physicians, police officers, the Ghanaian Attorney General and the Minister of Justice— to increase abortion access.
Abortion is illegal in Ghana except in cases of rape, incest, fetal disability, and in cases of life, physical health, and mental health of the mother. A Pew Research Center survey from 2013 found that an overwhelming 92% of Ghanaians find abortion “morally unacceptable.”
In 2007, the coalition began a trial phase of the R3M project and soon after, the program was fully rolled out in three administrative regions in southern Ghana, including Accra, the nation’s capital city.
By the end of 2012, the project had trained 320 midwives and physicians on how to perform abortions. The program had renovated 70 family planning and abortion clinics, built 7 new abortion clinics, and built 2 brand new reproductive health centers to serve as abortion training centers. The program had successfully convinced law and journalism schools in the country to change their curriculum to teach that abortion access is tied to maternal mortality. For its own part, the Population Council also developed training protocols and handbooks on abortion for clinical health workers and medical students and trained health care workers how to perform abortions.
All in all, according to the Population Council’s estimates, the R3M project was responsible for the execution of 122,545 abortions in Ghana.
However, throughout the life of the R3M project, both the Population Council and EngenderHealth were recipients of multiple and substantially sizable U.S. foreign aid grants. This occurred in spite of the fact that, during the first two years of the R3M project, the second Bush administration was in office and the Mexico City Policy was in effect.
How did this happen? Wasn’t the Mexico City Policy supposed to stop funding groups involved in abortion-related activities and groups once and for all?
Partially yes and partially no.
The Mexico City Policy was first introduced in 1984 under the Reagan administration at the International Conference on Population in Mexico City, the namesake from which the policy gets its name. The original Mexico City Policy from the Reagan administration banned U.S. foreign family planning funding for foreign NGOs that perform or promote abortion abroad as a method of family planning. But the policy has never banned U.S. funds from going to domestic NGOs that do exactly the same thing.
In other words, the policy blocks U.S. foreign aid dollars from funding foreign organizations that promote abortion such as the International Planned Parenthood Federation (IPPF) and Marie Stopes International. IPPF, for example, claims that it has lost $100 million in funding from the U.S. government under the Mexico City Policy put in place by the Trump administration. But the Mexico City Policy does not apply to U.S. based NGOs like the Population Council and EngenderHealth, despite their involvement in promoting abortion in projects such as the Ghanaian abortion scheme described above.
According to the United States Agency for International Development’s (USAID) Foreign Aid Explorer, between 2001-2008 when the Bush Mexico City Policy was in place, the Population Council received $127.9 million in U.S. government family planning and reproductive health funding as a first-tier prime grant recipient, while EngenderHealth received $86.3 million in family planning grants as a primary recipient. And these totals do not even include the amount of U.S. government funding these organizations may have received through subgrants and subcontracts.
Under current regulations, U.S. NGOs involved in promoting abortion can still receive grant money for other activities like family planning, reproductive health, HIV prevention, maternal health, or water and sanitation projects. The only restriction is that no part of the grant can be used directly to pay for abortion-related activities. But they can still continue to perform or promote abortion as much as they wish in foreign countries using their own money and still be eligible for recieving funding from the government.This loophole has allowed hundreds of millions of dollars to continue to flow into the coffers of organizations headquartered in the U.S. that perform or promote abortion in foreign countries, despite the Mexico City Policy.
My research shows that the amount of USAID Global Health funding that U.S.-based abortion-promoting NGOs continue to receive dwarfs the amount of money that notorious foreign abortion-promoting NGOs such like IPPF and Marie Stopes International have ever received, even when the Mexico City Policy was not in effect. In fact, the Mexico City Policy does not even come close to cutting even half of all U.S. foreign aid funding for organizations that promote abortion overseas.
Progress Made, More Progress Needed
When President Trump reinstated the Mexico City Policy as one of his first acts as president on January 23, 2017, the policy was significantly expanded to apply to all U.S. global health assistance. All previous versions of the Mexico City Policy under prior administrations had only applied to U.S. family planning funding, a mere subset of global health assistance. The expansion made the new Mexico City Policy, now called “Protecting Life in Global Health Assistance” (PLGHA), applicable to approximately $8.8 billion of U.S. foreign aid per year. By comparison, Congressional appropriations for family planning/reproductive health have stood at “no less than” $575 million per year since 2011.
On March 26, 2019, Secretary of State Mike Pompeo again significantly expanded the Mexico City Policy, this time prohibiting U.S. global health assistance from being awarded to any foreign NGO that gives financial support of any kind to any other foreign NGO that performs or promotes abortion as a method of family planning. The policy expansion ends U.S. government funding of foreign aid organizations that provide large donations to international abortion providers such as IPPF and Marie Stopes International.
In spite of these two significant expansions of the historic Mexico City Policy, one major loophole remains. The Trump administration needs to close the loophole that allows U.S. NGOs who perform or promote abortion in foreign countries to receive government funding for other projects. Fortunately a movement to do just that is now underway.
On January 23rd, 19 U.S. Senators and 41 members of Congress signed a letter addressed to Secretary of State Mike Pompeo, asking the Secretary to extend the Mexico City Policy to U.S. NGOs.
Many U.S. NGOs that promote abortion receive substantial funding from the U.S. government. The table below shows how much global health funding and subaward funding the U.S. government has given to these selected organizations since President Trump’s new Protecting Life in Global Health Assistance policy went into effect on May 15, 2017.
|1. U.S. global health obligations since May 15, 2017 furnished through federal accounts which the Protecting Life and Global Health Assistance policy (PLGHA) (a.k.a. the “Mexico City Policy”) are believed to be applicable to (contact author for details). Only includes first-tier prime awards. Source: Foreign Assistance Dashboard.|
|2. All subgrants and subcontracts received by the organization since May 15, 2017 according to USAspending.gov. Not all subawards reported here would be affected by PLGHA if it were made applicable to U.S. NGOs. Since USAspending.gov does not report federal accounts for transactions, it is impossible to ascertain whether PLGHA would apply to them.|
One such organization is Population Services International (PSI). PSI is a non-profit, non-governmental international health organization based in Washington, D.C. that works in over 50 countries to increase access to health services through social marketing enterprises and communication strategies. PSI is one of the U.S. government’s go-to organizations for implementing family planning and global health programming.
PSI openly promotes abortion as one its core global health activities. PSI’s website clearly states that the organization “train[s] providers in offering safe abortion services,” including through the abortion pill, misoprostol, and manual vacuum aspiration (MVA), a device that suctions the unborn through a tube using a manually-operated vacuum pump. Until recently, PSI had a webpage solely devoted to describing its MVA-related activities in which it had said plainly “We procure manual vacuum aspiration equipment.”
PSI also co-operates a project called Ignite where it seeks to increase demand for contraception and abortion in several developing countries. In Mozambique, PSI’s Ignite program in 2017 began operating family planning clinics in 50 secondary schools and enlisted 390 student “peer educators” to promote clinic services to the student body. Peer educators and clinic staff were trained by PSI to talk to students about abortion and to tell them where they can get an abortion. Following outcry from parents, PSI was forced to close its in-school clinics which were later moved to off-campus locations immediately in front of the schools.
Since the Trump administration began enforcing its Protecting Life in Global Health Assistance policy, Population Services International has been awarded over $265.7 million from the U.S. government in prime grants in global health programs, according to the Foreign Assistance Dashboard. In addition, PSI was also awarded received $33 million in subgrants and $23.8 million in subcontracts during this time, according to USAspending.gov.
Another U.S. NGO deeply involved in promoting abortion abroad is Pathfinder International. According to Pathfinder International’s website, the organization lobbies foreign governments to increase access to abortion, seeking to “Collaborate with governments in building the capacity of health systems to ensure quality, comprehensive abortion services.”
Pathfinder International currently runs a project in Mozambique and Tanzania where it “supports public health facilities to offer a wide range of quality contraceptive and safe abortion services” and where it works to “ensure availability” of abortion.
In 2018, Pathfinder International launched a campaign to advocate for abortion in Côte d’Ivoire, Burkina Faso, and the Democratic Republic of the Congo.
Population Council also continues to promote abortion. Recently, the Population Council concluded a program in 2018 called STEP-UP, a research project which sought to address the question of “How can access to safe abortion be maximized?” The Population Council is currently working on a project to expand the Bruce quality of care framework to include abortion. The Bruce quality of care framework is a quality assurance protocol used by family planning programs worldwide.
EngenderHealth, another U.S. NGO involved in promoting abortion abroad, is currently engaged in “expanding access to comprehensive abortion care” in Ethiopia through a project called the Access to Reproductive Health Initiative (ABRI). According to EngenderHealth’s website, the ABRI program supports 424 sites that perform abortion in Ethiopia.
From 2012-2017, Woman Care Global International (WCG), a California-based NGO, ran a project called the MAX Program that sought to increase access to abortion in South Africa and Kenya. WCG claims that “Through the MAX program, over 230,000 women received safe abortion services.”
A few U.S. NGOs that the U.S. government frequently partners with on global health programs are not directly involved with performing or lobbying for abortion themselves but are major donors to international abortion providers such as IPPF and Marie Stopes International. An international development non-profit called Pact donated nearly $1.7 million to Marie Stopes International in 2016 and 2017, according to Marie Stopes International’s financial statements. Abt JTA, a wholly owned subsidiary of Abt Associates, Inc., a global health consulting firm that frequently partners with USAID, is one of Marie Stopes International’s biggest donors, having donated approximately $7.7 million to the international abortion provider in 2017 and 2018.
When the Reagan administration first announced the Mexico City Policy at the 1984 International Conference on Population, the U.S. delegation to the conference declared “the United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.”
Thirty-six years later, the promise of the Mexico City Policy has still not been fully realized. U.S. foreign aid funding continues to flow to abortion-promoting NGOs based in the United States.
It is time the Trump administration, the most pro-life administration in recent American history, to rectify this fundamental flaw in the Mexico City Policy.