WASHINGTON — President-elect Donald Trump’s first actions upon taking office in January could set the tone for how much he plans to leave the issue of regulating abortion to the states.

Presidents typically make two key global family planning decisions during their first week in office: whether to fund the United Nations Population Fund, known as UNFPA, and whether to fund foreign nongovernmental organizations that perform, refer for or provide counseling for abortion abroad.

While the U.S. does not pay for abortion abroad, nongovernmental organizations can use separate funding for abortion-related activities and still be eligible for foreign assistance from the U.S. Whether or not the aforementioned two policies are in place are at the sole discretion of the president.

The U.S. largely withheld funding to UNFPA under President Ronald Reagan, both Bush administrations and during Trump’s first term. Trump issued a memorandum on Jan. 23, 2017, that blocked funding to these nongovernmental organizations — a policy known as the “Mexico City policy” by proponents and the “global gag rule” by its opponents — and cut UNFPA funding.

His administration subsequently expanded the Mexico City policy in May 2017 to apply to more international health assistance programs and again in March 2019 to include umbrella organizations of smaller groups.

Upon taking office in January 2021, President Joe Biden reversed the Trump actions.

In the months leading up to this year’s election, Trump has repeatedly called for leaving abortion regulations to the states. But he has been largely silent on how it would play out on the global level. Based on historical precedent, it’s likely that Trump would reinstate his earlier regulations.

Global health officials and advocates are readying for possible outcomes, based on precedent and think tank blueprints.

“We are cognizant, based on the past, that when a Republican administration comes into power, the analogy that’s used is the light switch is turned off,” said Sarah Craven, director of UNFPA’s Washington, D.C., office. “We are, you know, looking at what has happened in the past and preparing for all scenarios.”

“We fully anticipate, if not Day 1, certainly first week, the new Trump administration will issue a presidential memorandum reinstating some version of what we call the global gag rule,” said Craig Lasher, a senior fellow with Population Action International, adding that the same memo would likely have instructions to the incoming secretaries of State and Health and Human Services and the U.S. Agency for International Development administrator to implement a version of the rule.

Project 2025, the conservative-led presidential transition project, has called for expanding the Mexico City policy to all global health assistance, including humanitarian relief and multilateral organizations, which would drastically extend the reach of the policy on programming in other countries. It also calls for USAID to issue penalties, including a ban on future federal funding for abortion-related violations, and suggested guardrails to global health funding.

While Trump has attempted to distance himself from Project 2025, he’s tapped at least one of its authors – Brendan Carr to head the Federal Communications Commission — for a high-level agency position, with other authors serving in advisory roles or on the short list for yet-to-be-named roles.

“They’ve been very clear in their advertising about their intentions through Project 2025 despite any disavowals,” said Ipas Director of Global Policy and Research Gillian Kane. IPAS is an international nongovernmental organization that seeks increased access to safe abortions and contraception.

The first Trump administration also ended funding for the United Nations’ Human Rights Council and the United Nations Educational, Scientific and Cultural Organization and attempted to withdraw from the World Health Organization — meaning scaling back U.N. support would have precedent.

UNFPA

Since UNFPA is an intergovernmental organization, it does not fall under the purview of the Mexico City policy.

Republican opposition to the UNFPA — the United Nations’ maternal and reproductive health agency — stems from criticism of the program’s operation in China. The long-standing concerns resulted in the creation of the Kemp-Kasten amendment, an annual appropriations rider that has blocked using federal funds to support “coercive abortion or involuntary sterilization.”

Republicans say the program cannot be funded because of this amendment. Democrats argue there has been no evidence that UNFPA has engaged in prohibited activities in China and should not apply. The debate over UNFPA has been a long-standing challenge.

“We’ve worked collaboratively with the U.S. government throughout our history, and we’re confident we will continue to do so,” said Craven, adding that UNFPA is “committed to finding common ground with all member states, including the incoming Trump administration.”

The U.S. was UNFPA’s top country donor in 2022 and 2023, factoring in multiple funding streams, per the organization. Using provisional data, the agency expects total U.S. funding to exceed $181 million for calendar year 2024.

The agency receives about $32.5 million appropriated annually through the International Organizations and Programs account and a larger sum targeted at humanitarian efforts. That total is the highest overall funding for the agency, meaning a funding cut next year would be felt on a larger scale.

“We certainly have been so appreciative of the United States’ financial support these past four years,” said Craven. “I think part of what’s important about the relationship that we’ve had with the United States is the ability, not just for the funding, but the technical partnership.”

When funding is cut, she said it can also result in a “chilling effect on the partnership, at the technical collaborative level.”

Reps. Chrissy Houlahan, D-Pa., and Chip Roy, R-Texas, have offered competing bills that would either authorize funding for the agency or barit from receiving U.S. support.

Neither have seen movement, but the House-passed fiscal 2025 State-Foreign Operations appropriations bill would zero out all funding for the United Nations and block UNFPA funding. The Senate bill, as amended, would increase funding for UNFPA and bilateral global health assistance related to reproductive health.

Nongovernmental organization funding

Advocates foresee the next administration building on precedent on who can receive global aid.

In addition to the Kemp-Kasten rider, two long-standing federal appropriations riders already limit U.S. federal funding of abortions abroad: the Helms amendment, which blocks using federal funds to pay for or encourage abortions, and the Siljander amendment, which prevents using federal funds to lobby for abortion.

“It’s a virtual certainty that he will continue to extend the restrictions to all global health assistance — whether or not it gets expanded beyond that is an open question. However, I think we feel pretty confident that they’ll at least close the loophole for health programs under humanitarian assistance,” said Lasher.

Legislation from Sen. Mike Lee, R-Utah and Rep. Virginia Foxx, R-N.C., also seeks to broaden the scope of foreign organizations impacted by the policy. Sen. Marco Rubio, R-Fla., a co-sponsor of the Senate bill, is Trump’s secretary of State pick.

Lasher said the first White House budget request under Trump in fiscal 2018 sought to cut all global bilateral and multilateral family planning and reproductive health funding. The subsequent three White House budget proposals called for a $305.5 million cut from enacted levels in fiscal 2019, and a $287 million cut from enacted funding in fiscal 2020 and fiscal 2021.

Kane also expects Trump to take early action to reinstate U.S. support for the Geneva Consensus Declaration, a nonbinding document created in 2020 that has countries affirm their commitment to opposing abortion and advancing the health of women and children. Biden withdrew the U.S. sponsorship in January 2021.

“That’s going to be one of the first,” said Kane, adding she worries the administration may use implicit threats to pressure poorer countries to sign the declaration.

Valerie Huber, a Project 2025 contributor and former Trump HHS official, has worked on advancing the objectives of the Geneva Consensus through the Protego program in The Institute for Women’s Health, where she is the president and CEO.

Guatemala joined the Geneva Consensus in 2021 and three U.S. senators wrote to the nation’s new president in 2024 urging the country to remain signed on.

“I think that’s where they’re going to use, like, the power of the purse,” said Kane.

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