Background: In January 2017, President Trump reinstated and expanded the Mexico City Policy. In the past, it had required foreign non-governmental organizations (NGOs) to certify that they would not “perform or actively promote abortion as a method of family planning” using funds from any source as a condition for receiving U.S. family planning assistance. In a significant expansion, it now applies to almost all U.S. global health bilateral assistance, including PEPFAR. Among the many questions about the policy''s impact is its effect on HIV programs and services. This study sought to estimate the number of NGO recipients of PEPFAR funding who could be subject to the policy as well as the amount of funding they receive.
Methods: We analyzed data from ForeignAssistance.gov over the most recent three-year period for which such data were available (FY 2013 - FY 2015) to identify NGO recipients of bilateral HIV assistance as a proxy for the current number of recipients. We also calculated the amount of funding they receive and number of countries they work in. We further stratified these countries by the legality of abortion.
Results: We identified 470 foreign NGO prime recipients of PEPFAR bilateral HIV funding, who received $873 million. In addition, we identified 274 U.S. NGO prime recipients, accounting for $5.5 billion, who would be required to ensure that any foreign NGO sub-recipients were in compliance. Overall, this funding supported programs in 61 countries. Of these, 36 allow for legal abortion in at least one case not permitted by the policy and 24 do not; one country was not classifiable. These estimates should be considered minimums since we were unable to identify NGO sub-recipients of HIV support, who represent a much greater number and are also affected by the policy.
Conclusions: The expansion of the Mexico City Policy to encompass almost all U.S. bilateral global health assistance, including PEPFAR, greatly extends its reach. While it is still too early to know its ultimate impact on the ground, our analysis indicates that the expanded policy will likely affect hundreds of NGO recipients of PEPFAR support.