America’s culture wars are killing people overseas

“The mark of barbarism is that we treat babies like inconveniences to be discarded,” Vice President JD Vance bellowed to a crowd of zoomer nuns, bagpipers, and white nationalists at the annual March for Life in Washington, DC, last Friday.

The vice president then proceeded to announce a threefold expansion of the Mexico City policy, a decades-old, controversial foreign policy that prohibits organizations from receiving foreign aid if they mention abortion as a family planning option. It was reinstated last year when President Donald Trump resumed office.

While it’s not uncommon for (usually Republican) administrations to reinstate it, this is only the second time the policy — which critics call the “global gag rule” — has been expanded. It now also prohibits talk of “gender ideology” or diversity, equity, and inclusion for all forms of assistance. The extended policy indicates that the administration will now be casting an even wider net against anything deemed woke, including groups that explicitly serve LGBTQ people, like a clinic that serves transgender people, for example, or that explicitly advocate for the rights of marginalized groups, such as funding a local school for an Indigenous community.

“This is about weaponizing U.S. foreign assistance to promote an ideological agenda,” Keifer Buckingham, managing director for the Council for Global Equality, told NPR last week.

The changes come almost exactly one year to the day since Donald Trump issued an executive order freezing billions of dollars in lifesaving aid, setting in motion the final death knell for the United States Agency for International Development (USAID). Researchers now credibly estimate that hundreds of thousands of people have died in the aftermath, as their health clinics closed, their food aid vanished, and their HIV infections went undiagnosed.

And while the Trump administration has moved in recent months to restore some funding for crucial health programs — like PEPFAR and the Global Fund — the expansion of the Mexico City policy means that many of the world’s most vulnerable and marginalized people, particularly mothers and young children, will continue to suffer disproportionately from the consequences of cuts.

In low-income countries, many women’s health organizations end up taking on the brunt of not only local family planning, but also reproductive and maternity care, cervical cancer screenings, HIV treatment, children’s health services, and resources for survivors of domestic and sexual violence. When the Mexico City policy disqualifies these groups from receiving funds, it affects all of those services too, leading to spikes in intimate partner violence, nutritional deficits in children, and HIV infections.

Paradoxically, research has consistently shown that the policy actually increases the number of abortions in countries receiving aid, because it disrupts people’s access to contraceptives. It also makes giving birth much less safe. One study estimated that during the first Trump administration, an additional 108,000 mothers and children died because their local health providers did not pass the rule’s sniff test. This amounted to over 1,300 canceled grants and at least $153 million in lost funding, every dollar of which meant fewer HIV testing kits, malaria nets, and baby formula for people in need.

This time around, the Trump administration has already slashed funding to most of these organizations. Trump slashed upwards of 90 percent of funding for maternal and child health organizations and family planning and reproductive health, compared with 38 percent in cuts to foreign aid overall. While it’s difficult to predict the full toll, it’s clear that hundreds of thousands of mothers and young children will likely die as a result.

The expanded Mexico City policy will now apply not only to foreign-run organizations — as it has in the past — but also to US-based organizations that work overseas, multilaterals like the United Nations, and potentially, foreign governments. It previously applied to a tranche of about $8 billion worth of global health funding, but now applies to over $30 billion of non-military foreign assistance.

Many groups will likely find themselves forced to choose between discontinuing services for some of the vulnerable populations they serve — or forfeiting a vital stream of funding.

If you want to help make sure their work continues, then now is a good time to show your support. MSI Reproductive Choices, a major provider of family planning services in low-income countries, has lost $15 million due to the reinstated Mexico City policy. Project Resource Optimization also has a database filled with specific lifesaving projects — including for maternal and child health — that were previously funded by USAID.

America’s culture wars should never have been a death sentence for hundreds of thousands — if not millions — of women and children in poor countries. But thanks to Trump and his administration’s petty policies, that’s increasingly what they risk becoming.