US ‘undermining global health’ by threatening to strip funding from aid projects that do not fit its political agenda

The Trump administration plans to export its “war on woke” by forcing foreign governments, non-governmental organisations and international bodies to abandon working on diversity, equity and inclusion or face being stripped of US funding.

The plans have been called an attack on other nations’ sovereignty and one health organisation warned of “unimaginable effects” including a rise in deaths and violence, as safe clinics for vulnerable groups close.

Under the Mexico City policy, also known as the “global gag rule”, foreign health organisations that provide information, referrals or services for abortion are already denied US funds, but the policy will now be extended to those deemed to promote what is loosely termed “gender ideology” or any initiatives to promote diversity, equity and inclusion (DEI).

Governments and major multilateral organisations such as UN agencies are likely to fall under the policy for the first time and will face “very hard choices” over whether to stick with policies and programmes that fight discrimination, at the risk of losing a major source of funding, global health experts said.

While US officials have yet to set out what they mean by DEI initiatives, there is scope for it to include vast swathes of healthcare and support for people in crisis.

Young women and teenage girls in Africa account for a disproportionate number of new HIV infections, but programmes specifically supporting them could fall under the DEI umbrella. Vaccination programmes that rely specifically on training female workers, who can go into women’s homes to provide care where men could not, might collapse.

Washington is negotiating new bilateral agreements with dozens of countries, and campaigners have urged governments to reject any US money that comes with those conditions.

The global gag rule has been implemented under every Republican president since Reagan. It means any foreign organisations receiving US global health funding must certify that neither it, nor any other NGO with which it works, promotes or provides abortion, even with money from other donors.

The Trump administration reportedly plans to expand its scope so that it also covers “gender ideology and diversity, equity and inclusion activities”.

While not yet formally announced by the US state department, reports suggest the expanded rule would also apply to US-based NGOs, foreign governments, the UN and multilateral organisations for the first time, as well as all non-military foreign aid.

Approached for confirmation, a senior state department official said: “The state department continues to advance President Trump’s American First foreign policy.

“The department will soon take additional steps to close loopholes that allowed taxpayer funding for promotion of abortion in previous iterations of the Mexico City policy and expand the scope of the policy to ensure every penny of US foreign assistance prioritises American values, not the woke agenda,” the official said.

An anti-abortion protest in Washington. The global gag rule threatens access to reproductive health services globally, as provided by Planned Parenthood. Photograph: E Hockstein/Reuters

Beth Schlachter, MSI’s senior director for US external relations, called the reports “deeply concerning”.

She said: “Such a move, which goes far beyond previous restrictions, would be an insidious encroachment on sovereignty, pressuring governments to change their own laws and policies in exchange for US funding, despite repeated claims to respect national autonomy.

“It risks causing real human suffering, undermining global health and destabilising decades of partnerships and progress,” she said.

Shortly after taking office, Trump pledged to “terminate every diversity, equity and inclusion program across the entire federal government”. The administration has also attacked DEI policies in overseas businesses with US government contracts, in academia and scientific research, and in multilateral organisations such as Unicef.

Rajat Khosla, director of the Partnership of Maternal, Newborn and Child Health, said the interventions had already created a “chilling effect” and an expanded global gag rule would have “unimaginable effects”.

The America First global health strategy published by the US state department in September set out plans to create more bilateral agreements with aid-recipient countries in place of working via NGOs. Khosla added: “For countries desperate for external aid, this would present some very hard choices.”

Beirne Roose-Snyder, senior policy fellow of the Council for Global Equality, said equity initiatives played a big role in successful health programmes globally, which often required “special intentional effort” to target specific groups, such as LGBTQ+ people.

She stressed that the restrictions were not “about what can be done with US funds” but sought to control what organisations and governments did outside US-funded work.

Roose-Snyder said the new rules looked likely to apply even to humanitarian spending. “The administration wants to be able to do ‘ideological purity’ testing before helping after [a natural disaster, such as] a tsunami,” she said.

She said key questions about the definition of “promotion of gender ideology” and DEI had yet to be answered, urging organisations to wait until they had formal notification before making any changes.

Yumnah Hattas, gender justice lead at Frontline Aids, said the expanded plans were “in line with the rising transnational anti-rights movement” and would mean “human rights will be violated at a large scale”.

She said the global gag rule historically had forced abortions to go underground and led to women dying. The extension had the potential to affect areas including “access to contraception, HIV prevention and gender-based violence services”, she said, predicting increases in pregnancies, sexually transmitted infections and HIV, and domestic violence.

Hattas said: “We need to be going to governments and saying, ‘refuse US government funding, find the funds within your own government.’”

Such a stance was “complicated and difficult and painful”, she acknowledged, but added: “If you ignore the US government, then it doesn’t matter any more. Then the global impact of the global gag rule no longer exists because it was rejected by the globe.”