The Mexico City Policy: An Explainer

• On January 27, 2026, the Trump administration released details of the latest iteration of the Mexico City Policy (MCP), now part of a broader umbrella called “Promoting Human Flourishing in Foreign Assistance (PHFFA),” significantly expanding the policy to encompass more funding, more organizations, and new policy areas.
• First announced in 1984 by the Reagan administration, the Mexico City Policy has been rescinded and reinstated by subsequent administrations along party lines and has been in effect for 23 of the past 42 years.
• Historically, when in effect, the policy 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 (including non-U.S. funds) as a condition of receiving U.S. government global family planning funding. This was expanded by President Trump in 2017 to encompass the vast majority of U.S. bilateral global health assistance (including PEPFAR, maternal and child health, malaria, nutrition, and other U.S. global health programs). The latest expansion now includes most non-military foreign assistance and applies to U.S. NGOs, international organizations, and foreign governments, as well as foreign NGOs. In addition to abortion, it prohibits the promotion of “discriminatory equity ideology” and “gender ideology.”
• KFF estimates have found that almost $40 billion could now be subject to the policy restrictions, billions more than during the first Trump administration ($7.3 billion).
• While the full reach of this latest expansion will be shaped by broader changes to the U.S. foreign aid portfolio, potential legal challenges, and additional applications to other agencies and funding streams, it already extends well beyond the reach of what was in place during the first Trump administration.

The Mexico City Policy is a U.S. government policy that – when in effect – has required foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S. funds) as a condition of receiving U.S. global family planning assistance and, as expanded by the first Trump administration, most other U.S. global health assistance. The latest expansion, by the second Trump administration, applies to significantly more funding (most non-military foreign assistance), many more organizations (beyond foreign NGOs), and new services and activities (beyond abortion).The policy was first announced by the Reagan administration at the 2nd International Conference on Population, which was held in Mexico City, Mexico, on August 6-14, 1984 (hence its name; see Box 1).¹ It was renamed “Protecting Life in Global Health Assistance” (PLGHA) in 2017, and now “Protecting Life in Foreign Assistance” (PLFA) as part of the broader “Promoting Human Flourishing in Foreign Assistance (PHFFA)” Policy umbrella. Among opponents, it is also known as the “Global Gag Rule,” because, in addition to prohibiting service delivery, it also prohibits the promotion of restricted activities, including through lobbying, referrals, and public information campaigns.

When first instituted in 1984, the Mexico City Policy marked an expansion of existing legislative restrictions that already prohibited U.S. funding for abortion internationally. Prior to the policy, foreign NGOs could use non-U.S. funds to engage in certain voluntary abortion-related activities as long as they maintained segregated accounts for any U.S. money received, but after the Mexico City Policy, they were no longer permitted to do so if they wanted to receive U.S. family planning assistance. During those years, U.S. funding for family planning ranged from approximately $300-$600 million annually.

When the policy was expanded by President Trump in 2017 to include the vast majority of U.S. bilateral global health assistance, including funding for HIV under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), maternal and child health, malaria, nutrition, and other programs, it increased the funding that could be subject to restrictions to more than $7 billion.³ At that time, the Trump administration also moved to further tighten restrictions in how it defined “financial support,” reaching other areas of U.S. development assistance beyond global health and other non-U.S. funding streams. See “What is the definition of ‘financial support’?” below.⁴

Although President Biden rescinded the policy, President Trump reinstated the MCP through a presidential memorandum on January 24, 2025, directing the Secretary of State to “to implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments or agencies,” which would reach beyond the 2017 expansion. Some organizations and members of Congress had also called for the policy to be expanded to apply to all foreign assistance, and last year, it was reported that the administration intended to include new areas of restrictions related to DEI and gender.

On January 27, 2026, the policy details were released under three separate, but inter-related final rules (interim final rules were first posted on January 23) as part of the PHFFA umbrella (see Box 2). The rules cite the presidential memorandum on the MCP and eight other presidential actions issued in January and February of 2025 that addressed foreign aid, DEI, and gender issues to “ensure that foreign aid is aligned with administration policy and promotes human flourishing.” As such, the PHFFA applies to most non-military foreign assistance and most recipients of foreign aid (not just foreign NGOs). In addition to abortion, it prohibits promoting “discriminatory equity ideology,” including activities related to diversity, equity, and inclusion (DEI), and promoting “gender ideology,” including providing gender affirming care, seeking legal protections based on gender identity, and other related services and activities. The rules indicate that the State Department will work with other agencies that administer foreign assistance to expand the policy further.

With the latest expansion, KFF estimates have found that as much as $39.8 billion in U.S. foreign aid and almost 2,600 prime recipient organizations may be affected (this number should be considered a floor since the policy requirements are passed down when funding is sub-awarded to another organization).

The Mexico City Policy has been in effect for 23 of the past 42 years, primarily through executive action, and has been instated, rescinded, and reinstated by presidential administrations along party lines (see Table 1). 

The policy was first instituted in 1984 (taking effect in 1985) by President Ronald Reagan and continued to be in effect through President George H.W. Bush’s administration. It was rescinded by President Bill Clinton in 1993 (although it was reinstated legislatively for one year during his second term;⁵ see below).⁶ The policy was reinstated by President George W. Bush in 2001,⁷ rescinded by President Barack Obama in 2009,⁸ and reinstated and expanded by President Trump in 2017.⁹ It was rescinded by President Biden in 2021.¹⁰ President Trump then reinstated the policy from his first term in January 2025, noting an intention to expand it further, with final rules released in January 2026.¹¹

The Mexico City Policy has, for the most part, been instituted or rescinded through executive branch action (typically via presidential memoranda¹²). While Congress has the ability to institute the policy through legislation, this has happened only once in the past when  a modified version of the policy was briefly applied by Congress during President Clinton’s last year in office as part of a broader arrangement to pay the U.S. debt to the United Nations.¹³ (At that time, President Clinton was able to partially waive the policy’s restrictions.¹⁴)Other attempts to institute the policy through legislation have not been enacted into law,¹⁵ nor have legislative attempts to overturn the policy.¹⁶ See Table 1.

Under the PHFFA, the types of organizations now subject to the policy, albeit with different applications, include:

• Foreign NGOs,¹⁷ which include:
  • international NGOs that are based outside the U.S.,
  • regional NGOs that are based outside the U.S., and
  • local NGOs in assisted countries.
• U.S. NGOs,¹⁸
• Foreign governments¹⁹ and parastatals²⁰ (note: the State Department will assess whether or not to apply the policy based on foreign policy considerations), and
• International organizations (note: applies to voluntary contributions; international organizations who are recipients of only U.S. assessed contributions are not subject to the policy).²¹

A waiver of the policy or its elements in specific cases is allowed if, in the Secretary of State’s judgment, such a waiver is necessary for national security or foreign policy purposes; see “Are waivers or exemptions allowed?”.

When in place, the policy applies to these organizations as a condition of receiving most non-military U.S. foreign assistance, either directly (as the main – or prime – recipient of U.S. funding) or, for foreign NGOs, U.S. NGOs, and international organizations, indirectly (as a recipient of U.S. funding through an agreement with the prime recipient; referred to as a sub-recipient); see “To what assistance does the PHFFA apply?” below.

Importantly, some aspects of the policy are applied differently based on organization type:

• The strongest restrictions apply to foreign NGOs and international organizations, which are required to agree that outside the U.S. they will not provide or promote abortion as a method of family planning, promote gender ideology, promote discriminatory equity ideology, or engage in unlawful DEI-related discrimination with any funding, from any source; they also must agree not to provide financial support to any other foreign NGO or international organization that engages in such activities. See “What is the definition of ‘financial support’?” below.
• A U.S. NGO is required to agree that it will not provide abortion as a method of family planning outside the U.S. (including with non-Federal funds) and that it will not, “within the scope of any program, project, or activity funded by foreign assistance,” provide or promote abortion as a method of family planning, promote gender ideology, promote discriminatory equity ideology, or engage in unlawful DEI-related discrimination. It is also required to “ensure the physical and financial separation of their foreign assistance-funded programs, projects, and activities from the provision or promotion of” prohibited activities; if such separation is made, a U.S. NGO may carry out prohibited promotion activities with non-Federal funds. In addition, U.S. NGOs “are not subject to an additional requirement not to provide financial support using non-Federal funds to other organizations that provide or promote abortions outside the United States.”
• A foreign government or parastatal is subject to the policy if the State Department decides to apply the policy – in whole or in part – to an award based on foreign policy considerations; specifically, foreign governments and parastatals may have to agree to not use U.S. foreign assistance award funds to provide or promote abortion as a method of family planning, promote gender ideology, promote discriminatory equity ideology, or engage in unlawful DEI-related discrimination. If it is applied, foreign governments and parastatals “will be required to place any foreign assistance funds under the award in a segregated account to ensure that such funds may not be used to support such activity to the extent the foreign government conducts or supports such activity.” Thus, a foreign government may carry out prohibited activities with non-Federal funds, and they are not subject to the financial support requirement.

The PHFFA policy applies to most non-military foreign assistance, beyond U.S. global health assistance or U.S. family planning assistance alone (see Table 2).²² Specifically, it applies to foreign assistance administered by the State Department under title III of the annual Department of State, Foreign Operations, and Related Programs (SFOPS) Appropriations Act as well as four other headings within the SFOPS appropriations act: International Narcotics Control and Law Enforcement; Nonproliferation, Anti-Terrorism, Demining and Related Programs; Peacekeeping Operations; and International Organizations and Programs.²³ This extends its reach to other sectors, beyond global health, to include humanitarian assistance; economic development, democracy, human rights, and governance; peace and security; education and social services; and environment.²⁴ Within these accounts, the policy currently applies to two main types of funding instruments used for foreign assistance – grants and cooperative agreements – and also to grants provided under contracts. The administration has stated its intention to apply the policy to contracts, subject to future rule-making.²⁵ This was also sought during President Trump’s first term when a proposed rule to this effect was issued, but it was never finalized.²⁶ The rules also indicate that the State Department will work with other agencies that administer foreign assistance to apply the restrictions to their funding streams.

Foreign NGOs, international organizations, U.S. NGOs, foreign governments, and parastatals must pass down (or “flow down”) the policy requirements under the award terms, as applicable, to sub-recipients of foreign assistance, which would then require the sub-recipients to agree to the policy’s restrictions and then flow down the requirements to other organizations, as applicable, if they sub-award the funding further.

The financial support²⁷ requirement governs any funding, no matter the source of funds, provided by foreign NGOs and international organizations to a foreign NGO or international organization for any purpose, if that foreign NGO or international organization happened to provide or promote prohibited activities (there are some differences based on type of organization; see “To what entities does the PHFFA Policy apply?” above). This approach codifies how the financial support requirement was expanded during the first Trump administration.²⁸

Accordingly, this approach to “financial support” may affect funding provided by other donors (such as other governments and foundations) and non-foreign assistance funding provided by the U.S. government for a wide range of purposes. For example, if this funding is first provided to a foreign NGO or international organization that has accepted the policy (as a recipient of U.S. global health or other non-military foreign assistance), the organization then could not, using another donor’s funding for any purpose, provide support to a foreign NGO that provides or promotes prohibited activities.

Under the expanded Protecting Life in Foreign Assistance (PLFA) policy under PHFFA, foreign NGOs and international organizations “agree that, during the period of the award, [they] will not, outside the United States, provide or promote abortion as a method of family planning, or provide financial support to any other foreign NGO or [international organization] that engages in such activities” (there are some differences based on type of organization; see “To what entities does the PHFFA Policy apply?” above. Restricted activities include (also see Box 3):

• providing abortion as a method of family planning,²⁹
• providing advice and information about and offering referral for abortion – where legal – as part of the full range of family planning options,
• promoting changes in a country’s laws or policies related to abortion as a method of family planning (i.e., engaging in lobbying), and
• conducting public information campaigns about abortion as a method of family planning.³⁰

The prohibition of these activities is why the policy has been referred to by its critics as the “Global Gag Rule.”

The policy also provides information and clarification about other abortion-related matters:

• Allows for exceptions in cases of rape, incest, risk to life of mother: The policy does not prohibit, where consistent with local law, organizations from providing advice and information about, performing, or offering referral for abortion in cases where the pregnancy has either posed a risk to the life of the mother or resulted from incest or rape.³¹ The policy also states that “treatment of an ectopic pregnancy or spontaneous loss of pregnancy (a miscarriage) is not an abortion.”
• Allows for post-abortion care: The policy states that “treatment of injuries or illnesses caused by legal or illegal abortions,” which is known as post-abortion care, is not restricted.
• Prohibits passive referral: The policy now prohibits responding to a question about where a safe, legal abortion may be obtained when a woman who is already pregnant clearly states that she has already decided to have a legal abortion (passively providing information, versus actively providing medically-appropriate information). The policy does permit an exemption to be sought from the State Department where this, or another term, is in conflict with local law. This is an expansion compared to the prior policy where passive referral was permitted and the policy requirements did not apply when healthcare providers had an affirmative duty required under local law to provide counseling about and referrals for abortion as a method of family planning.

Under the new Combating Gender Ideology in Foreign Assistance policy of the PHFFA, foreign NGOs and international organizations “agree that, during the period of the award, [they] will not, outside the United States, promote gender ideology, or provide financial support to any other foreign NGO or [international organization] that promotes gender ideology” (there are some differences based on type of organization; see “To what entities does the PHFFA Policy apply?” above). Gender ideology is defined in the policy as “an ideology that replaces the biological category of sex with an ever-shifting concept of self-assessed gender identity.”³⁵ Restricted activities include:

• providing or promoting gender-affirming care;
• lobbying for legal protections based on gender identity, legalization or availability of gender-affirming care, and lobbying for the continued legality of such activities or to change policies;
• conducting a public information campaign in foreign countries regarding acceptance of “gender ideology” or the benefits and/or availability of gender-affirming care;
• using or teaching sex education materials that include gender ideology; and
• conducting drag queen workshops, performances.

The policy also defines sex as “person’s immutable biological classification as either male or female,” which will have likely implications for vulnerable populations served by U.S. foreign assistance programs, including transgender persons.

The policy allows procedures done to “to treat a person with a medically verifiable disorder of sexual development,” “for purposes other than attempting to align an individual’s physical appearance or body with an asserted identity that differs from the individual’s sex,” or “to treat complications of, including any infection, injury, disease, or disorder that has been caused by or exacerbated by, the performance of” gender-affirming care.

Under the new Combating Discriminatory Equity Ideology in Foreign Assistance policy of the PHFFA, foreign NGOs and international organizations “agree that, during the period of the award, [they] will not, outside the United States, promote discriminatory equity ideology, engage in unlawful [diversity, equity, and inclusion-related, or] DEI-related discrimination, or provide financial support to any other foreign NGO or [international organization] that conducts such activities” (there are some differences based on type of organization; see “To what entities does the PHFFA Policy apply?” above). Discriminatory equity ideology is defined in the policy as “an ideology that treats individuals as members of preferred or disfavored groups, rather than as individuals, and minimizes agency, merit, and capability in favor of generalizations,”³⁶ such as that “an individual, by virtue of the individual’s race, color, religion, sex, or national origin, should be discriminated against or receive adverse treatment to achieve diversity, equity, or inclusion.” Restricted activities include:

• promoting discriminatory equity ideology, which includes using or teaching education materials (including books, curricula, and media) that advance such ideology; and
• unlawful DEI-related discrimination, which the policy defines as “discrimination on the basis of race, color, religion, or national origin if such discrimination violates U.S. federal antidiscrimination law or would violate U.S. federal antidiscrimination law if it occurred inside the United States, including the use of those characteristics as a selection criterion or preference for, or basis for exclusion from, employment, contracting, program participation, resource allocation, or similar activities, opportunities, or benefits.”³⁷

The policy does not “address discrimination on the basis of disability or other protected classes, nor does it address … grounds other than race, color, religion, or national origin.”

The rules allow for waivers or exemptions in certain cases as follows:

• Waiver: A waiver of the policy or its elements in specific cases is allowed if, in the Secretary of State’s judgment, such a waiver is necessary for national security or foreign policy purposes. A waiver can be issued either by the Secretary of State or the Under Secretary of State for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, and according to the rules, the State Department will issue guidance on the waiver process.
• Foreign governments/parastatals: The State Department is allowed to exercise discretion, based on foreign policy considerations, in determining whether, and how (in full or in part), to apply the policy terms to the awards of foreign governments and parastatals.
• Local law: The policy permits an exemption to be sought from the State Department where a specific PHFFA award term is in conflict with local law (see, for example, “Prohibits passive referral” above).

A KFF literature review of studies examining the policy, from 2001 to 2024, identified a range of impacts associated with the policy, when in effect, including: increases in abortion rates and reductions in contraceptive prevalence (among other health outcomes); disruption and gaps in services; reduction in service integration; over-implementation and chilling effects; confusion about the policy; loss of civil society/NGO coordination and partnerships; and increased administrative burden (see Box 4). In addition, several studies sought to calculate or estimate the reach of the policy, as measured by amount of funding, countries, and/or NGOs affected.

During the first Trump administration, two official assessments by the State Department were released:

• Initial six-month review of implementation of the policy: released in February 2018, it directed agencies to provide greater support for improving understanding of implementation among affected organizations and provided guidance to clarify terms included in standard provisions of grants and cooperative agreements.
• Second review of the policy, covering the first 18 months of implementation: released in August 2020, it found the awards declined spanned a variety of program areas,³⁸ in addition to cross-cutting awards; spanned geographic areas, but many were for activities in sub-Saharan Africa; and led to gaps or disruptions in service delivery sometimes being reported, despite U.S. efforts to transition projects to another implementer in order to minimize disruption.

Additionally, a report by the U.S. Government Accountability Office (GAO), released in March 2020, found that from May 2017 through FY 2018, the policy had been applied to over 1,300 global health projects, with the vast majority of these through USAID and CDC, and NGOs declined to accept the expanded policy during the first Trump administration in 54 instances, totaling $153 million in declined funding³⁹ across USAID and CDC. The State Department and DoD did not identify any instances where NGOs declined to accept the policy conditions.