Family Planning (FP)

President Trump reinstated and expanded the Mexico City Policy, often known as the Global Gag Rule, and renamed it the Protecting Life in Global Health Assistance (PLGHA) policy. When in place under previous administrations, the policy applied only to international family planning assistance, whereas Trump’s version of the policy "extend(s) the requirements... to global health assistance furnished by all departments or agencies." Research has documented the harms of this policy in previous administrations when the policy was in effect, and the expansion of this policy via this 2017 Presidential Memorandum demonstrated a disregard for evidence and international human rights norms. This policy spurred a chain of events that significantly reduced community and government engagement in HIV prevention, care, and treatment programs and prohibits beneficiaries from accessing key services in many countries that receive U.S. global health assistance. The expansion of the PLGHA policy was against evidence, need, and human rights principles and was not gender transformative; this policy was gender blind, as it did not discuss the role of gender norms on the promotion of SRHR through U.S. global health assistance programs.

The United States National Action Plan on Women, Peace, and Security described what the U.S. continues to do to empower women as equal partners in preventing conflict and building peace in countries threatened and affected by war, violence, and insecurity. The Plan moderately promoted SRHR by calling for better access to "clinical care and reproductive health services such as family planning…", although this is the extent to which it discussed family planning. It did not include safe abortion care or contraceptive use in its list of SRH services supported with U.S. funds under this commitment. However, it did discuss the structural, cultural, and safety barriers that prevent women in conflict-ridden areas from accessing the family planning care they want and need. The Plan is grounded in human rights and is responsive to need in that it acknowledged the impact of discrimination and poor accessibility on SRHR. Additionally, the Plan is moderately gender transformative as it called for increased gender equality and inclusivity in all initiatives, especially regarding “members of marginalized groups, including youth, ethnic, racial or religious minorities, persons with disabilities, displaced persons and indigenous peoples, lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, and people from all socioeconomic strata.” It also discussed the distinct needs of ex-combatants and former violent extremists who are female, and specifically stated that these women have a difficult time adhering to traditional gender norms upon their return from combat. This National Action Plan supported the U.S. government's ability to promote SRHR with regard to family planning programs and funding.

The Department of State Implementation Plan for the U.S. Adolescent Girls Strategy was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. The Plan was evidence-based and grounded in human rights with a strategic objective to expand girls’ access to education, health, and services, which included "preserv[ing] the rights of married and pregnant girls and adolescent mothers to attend school, institut[ing] comprehensive sexuality education in national curricula, and remov[ing] barriers to sexual and reproductive health and rights and comprehensive, accessible, youth-friendly health services." Additionally, this Plan outlined the joint responsibility that all governments have in prioritizing adolescent health and rights, promoting accountability of SRH programs, and addressing the lack of access to or availability of education and health services, which would include family planning. This Plan also repeatedly addressed the distinct health needs of adolescent girls that are displaced by insecurity, conflict, or natural disaster. However, it did not address the cultural or structural barriers (i.e., government policies that hinder access to SRHR, stigmatizing attitudes of healthcare providers, and prohibitively high cost of services) that prevent key underserved populations, such as sex workers and women living with disabilities, from accessing family planning services. Additionally, this Plan is gender accommodating because it acknowledged—but does not work to change—existing gender norms and inequities that prevent AGYW from accessing family planning services.

The Standard Provisions for U.S. Non-governmental organization (NGO) Recipients outlined the standard provisions for all global health activities conducted by U.S. NGOs that received global health assistance funds from USAID. This document is part of the Automated Directive System (ADS), which is the standard operating procedure for USAID. The Standard Provisions provided the first instructions for the implementation of the Protecting Life in Global Health Assistance (PLGHA) policy and explained the requirements of foreign NGOs that receive U.S. global health assistance funds. This partial revision of ADS Chapter 303maa was responsive to need and provided guidance for implementing PLGHA for USAID staff and implementing partners since the Trump Administration’s expansion of the Mexico City Policy. The Standard Provisions explained the limitations placed on U.S.-based NGOs: U.S.-based NGOs that receive U.S. global health assistance funding may not provide any health assistance to foreign NGOs who perform or promote abortion as a method of family planning and must ensure that their sub-grantees do not sub-grant to foreign NGOs that violate the PLGHA policy. While USAID did not have control over the policy language itself, USAID could control the guidance they released regarding the implementation of the policy. The Standard Provisions also stated that foreign NGOs that receive U.S. global health assistance funds cannot perform or actively promote abortions as a method of family planning or provide funding to other foreign NGOs that do so. If a foreign NGO is found to be in violation of the policy, the provisions stated that their funding will be terminated. Though this updated Standard Provision was responsive to need, this document did not include adequate guidance or definitions regarding terms such as “financial support” and “passive referral.”

The Standard Provisions for non-U.S. NGO Recipients outlined the standard provisions for all global health activities conducted by international NGOs that received global health assistance funds from USAID. This document is part of the ADS, which is the standard operating procedure for USAID. The Standard Provisions provided the first instructions for the implementation of the PLGHA policy and explained the requirements of foreign NGOs that receive U.S. global health assistance funds. This partial revision of ADS Chapter 303mab was responsive to need and provided guidance for implementing the PLGHA policy for USAID staff and implementing partners since the Trump Administration’s expansion of the Mexico City Policy. The Standard Provisions stated that foreign NGOs that receive U.S. global health assistance funds cannot perform or actively promote abortions as a method of family planning or provide funding to other foreign NGOs that do so. If a foreign NGO is found to be in violation of the policy, the provisions stated that their funding will be terminated. The Standard Provisions also explained the limitations placed on U.S.-based NGOs: U.S.-based NGOs that receive U.S. global health assistance funding may not provide any health assistance to foreign NGOs who perform or promote abortion as a method of family planning and must ensure that their sub-grantees do not sub-grant to foreign NGOs that violate the PLGHA policy. While USAID did not have control over the policy language itself, USAID could control the guidance they released regarding the implementation of the policy. Though this updated Standard Provision was responsive to need, this document did not include adequate guidance or definitions regarding terms such as “financial support” and “passive referral.”

The USAID Adolescent Girl Strategy Implementation Plan was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. The plan moderately promoted SRHR, noting the importance of using USAID’s “whole-of-girl” approach to reduce gender disparities and GBV and increase capacity of women and girls through USAID’s programs. Though it did not explicitly describe USAID’s family planning programs, this Plan provided a high-level overview of the programs, best practices, and indicators that were used to measure USAID’s progress in implementing the Adolescent Girl Strategy across all USAID programs. The Plan was responsive to need and based in evidence. The Implementation Plan also referenced USAID’s ongoing work on gender (e.g., implementing USAID’s 2012 Gender Equality and Female Empowerment Policy) and directly acknowledged the importance of incorporating activities that foster gender equity in all USAID programs. This plan supported the ability of USAID to implement family planning programs that moderately promoted SRHR.