What the Election Could Mean for the Mexico City Policy and U.S. Foreign Aid

Overview

The outcome of the next presidential election will have significant implications for U.S. global health programs and policy, as well as U.S. international engagement more broadly. Among other things, if President Trump is elected, he is expected to reinstate the expanded Mexico City Policy (MCP) from his first term, which applied to most U.S. global health assistance. Moreover, there are indications that the policy could be expanded even further, as recommended by Project 2025 (a series of proposals for a new administration from a broad coalition of conservative organizations) – specifically, one of its proposals recommends expanding the MCP to include virtually all U.S. foreign assistance. Members of Congress have also introduced legislation to this effect for the past several years. Given that Project 2025’s proposals are widely seen as a blueprint for a next Trump administration, this analysis outlines the potential reach of such a proposal, looking at the amount of funding, the number of organizations, the range of foreign assistance sectors, and other variables that could be affected. Among the key findings:

• In FY 2022, more than $51 billion in U.S. foreign aid, spanning almost 180 countries, was obligated to non-USG prime recipients, the funding most likely to be directly implicated by the expansion proposal (additional funding could be subject to the policy if it were ultimately provided, directly or indirectly, to non-USG recipients).
• Notably, this is tens of billions more than the amount of global health assistance likely implicated under the Trump administration’s previously expanded policy ($7.3 billion in FY 2020), and significantly more than the amount of family planning assistance implicated by the policy, when in place, during earlier administrations (between $300-$600 million).
• More than half of the $51 billion (58%) was provided to multilateral organizations, recipients that have, to date, not been subject to the policy before. Indeed, nine of the top 10-funded prime recipients were multilateral organizations.
• By sector, humanitarian assistance accounted for the largest share of funding, followed by economic development, two sectors that would be newly subject to the policy under the expansion proposal. Health was the third largest sector.
• There were more than 2,400 non-USG prime recipients of U.S. foreign aid in FY 2022, those subject to the policy under the proposal, a significantly higher number than for health alone (662 prime recipients). This number should be considered a floor, since any sub-recipients of U.S. foreign aid would also be subject to the MCP. Although most funding was provided to multilaterals, most prime recipients were foreign entities (61%); U.S.-based entities accounted for 35%
• Whether or not the full extent of the expansion proposal could be instituted (for example, there would likely be legal challenges to some aspects of the proposal, which could limit its reach), it would represent a significant expansion in terms of funding and number of organizations, well beyond the reach of the expanded policy that was in place during the Trump administration.

Background

The Mexico City Policy (MCP) is a U.S. government (USG) policy that – when in effect – has required foreign non-governmental organizations (NGOs)¹  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, when in place under the Trump administration (called “Protecting Life in Global Health Assistance”), most other U.S. global health assistance. First announced in 1984 by the Reagan administration, the MCP has been rescinded and reinstated by subsequent administrations along party lines since and has been in effect for 21 of the past 40 years. It has also been steadily expanded to apply to additional types of U.S. foreign assistance and recipients over time (see Table 1). Should it be implemented, the Project 2025 proposal –“Protecting Life in Foreign Assistance” – would mark the most significant expansion of the policy to date. Specifically, the proposal seeks to:

• apply the MCP to all U.S. foreign assistance (not just global health assistance² ) provided to non-USG recipients, including sectors (such as humanitarian aid) and agencies (such as global health funding appropriated to Department of Health and Human Services agencies) that have not been subject to the policy before;
• expand recipients subject to the policy to also include multilateral organizations (such as the Global Fund to Fight AIDS, Tuberculosis and Malaria), foreign governments, and U.S.-based NGOs (not just foreign NGOs); and
• include funding provided through contracts (not just grants and cooperative agreements).

Findings

To assess the potential reach of the Project 2025 proposal, this analysis looks at U.S. government foreign assistance obligation data for FY 2022 (the most recent year for which complete obligation data by sector are available) to quantify the amount of funding and number and type of prime recipients that could be affected. Obligations were analyzed because the MCP applies to funding once obligated to a recipient. Data were obtained from foreignassistance.gov, the U.S. government’s centralized data portal for budgetary and financial data provided by more than 20 federal agencies that manage foreign assistance programs. The analysis focused on funding obligations provided to non-USG recipients, as this is the funding most likely to be subject to the MCP expansion proposal (see Box 1 for key terms, Methodology for more detail, and Appendix for detailed data).

• Of the $67.5 billion of U.S. foreign assistance obligated in FY 2022, $51.5 billion (76%) was provided to non-USG prime recipients, the funding most likely subject to the expanded MCP proposal. The remainder – funding provided to U.S. government agencies ($15.1 billion, or 22%) or unknown recipients ($850 million, or 2%) – would only be subject to the policy if funding were subsequently awarded to a non-USG recipient.⁶ 
• Notably, this is tens of billions more than the amount of global health assistance likely implicated under the Trump administration’s previously expanded policy ($7.3 billion in FY 2020), and significantly more than the amount of family planning assistance implicated by the policy, when in place, during earlier administrations (between $300-$600 million). See Box 2.
• The majority of funding was provided to multilateral organizations ($29.8 billion, or 58%), which would be newly subject to the policy under the proposal. The non-profit sector received the next largest amount of funding ($11.1 billion, or 22%), followed by the private sector ($8.6 billion, or 17%). Smaller amounts were provided to foreign governments ($862 million, or 1.7%) and educational institutions ($1.2 billion, or 2.3%) (see Figure 1).
• U.S.-based recipients received $15.1 billion (29%). These included U.S. NGOs (newly subject to the policy). Foreign recipients, both governments and NGOs, received $6.6 billion (13%); foreign governments would also be newly subject to the policy.
• Collectively, the $51.5 billion in foreign assistance was provided to 178 countries, with more countries likely reached through “regional” and “worldwide” activities.⁷  This is significantly more countries than would be reached with global health assistance alone (93 countries).

• The humanitarian assistance sector accounted for the largest share of funding ($16.4 billion, or 32% in FY 2022), followed by economic development ($12.1 billion, or 23%), two sectors that would be newly subject to the policy (see Figure 2). Health was the third largest sector, with $10.6 billion (21%); remaining sectors accounted for $4.6 billion (9%) or less, each.
• There were 2,437 non-USG prime recipients of U.S. foreign assistance in FY 2022; most⁹  (2,091, or 86%) would be subject to the policy for the first time. This number should be considered a floor, since any sub-recipients of U.S. foreign aid would also be subject to the MCP.
• Whereas most funding was provided to multilateral organizations, most recipients (61%, or 1,490) were foreign-based organizations. Just over a third (35%, or 844) were U.S.-based organizations. Multilateral organizations accounted for the remaining 4% (103) (see Figure 3).
• The majority of recipients (1,347, or 55%) were non-profits, followed by private sector organizations (758, or 31%). The next largest group was educational institutions (160, or 7%).
• The sectors with the largest numbers of non-USG recipients in FY 2022 were health (662) and economic development (635). The next largest sector was program support (476), followed by democracy, human rights, and governance (367); the environment and humanitarian assistance sectors each had 312 recipients (see Figure 4).
• The top 10 highest-funded recipients accounted for nearly half (47%, or $24.2 billion) of all funding provided to non-USG prime recipients in FY 2022 (see Figure 5). Nine of the top 10-funded recipients were multilateral organizations, though this varied by sector. For example, in the humanitarian assistance sector, the top 10 were split between multilaterals and non-profits, and in the health sector, four of the top 10 were U.S. non-profits (see Appendix Tables 5-6).

1. Per USAID Standard Provisions, when the MCP provision was included, “a foreign non-governmental organization is a for-profit or not-for-profit non-governmental organization that is not organized under the laws of the United States, any State of the United States, the District of Columbia, or the Commonwealth of Puerto Rico, or any other territory or possession of the United States.” See USAID, “Standard Provisions for U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303maa, partial revision May 18, 2020; “Standard Provisions for Non-U.S. Nongovernmental Organizations: A Mandatory Reference for ADS Chapter 303,” ADS Reference 303mab, partial revision Aug. 18, 2020. ↩︎
2. Specifically, funding appropriated to the U.S. Agency for International Development (USAID), the Department of State, and the Department of Defense. ↩︎
3. The policy included language that prohibited USAID from providing family planning assistance to any foreign private, nongovernmental, or multilateral organization until they certified that during the period for which the funding was made available 1) they would not perform abortions as a method of family planning in any foreign country and 2) they would not violate the laws of any foreign country regarding abortion and would not engage in lobbying any foreign country regarding abortion. ↩︎
4. See FAR Case 2018–002, https://www.federalregister.gov/documents/2020/09/14/2020-17551/federal-acquisition-regulation-protecting-life-in-global-health-assistance. ↩︎
5. In this analysis, NGOs include some U.S. public universities within the U.S. educational institution category, as well as some foreign public universities within the foreign educational institution category. It is possible that U.S. public universities could be exempted from the MCP if considered part of the U.S. government. ↩︎
6. The analysis excluded approximately $2.9 billion in FY 2022 foreign aid funding that was identifiable as emergency COVID-19 assistance since it inflates the amount of foreign aid funding that may be subject to MCP in the event of reinstatement. However, it is notable that most of this COVID-19 funding was directed to non-USG recipients who also already received other foreign aid funding, suggesting their numbers are already accounted for in this analysis. Included in the total used for analysis is supplemental funding provided to Afghanistan and the Ukraine. ↩︎
7. Number of countries represents countries that received funding directly from the U.S. government; additional countries may be reached through regional and worldwide programming. ↩︎
8. U.S. NGOs have not been directly subject to the Mexico City Policy but, when in place in the past, must also agree to ensure that they do not provide funding to any foreign NGO sub-recipients unless those sub-recipients have first certified adherence to the policy. See KFF, The Mexico City Policy: An Explainer. ↩︎
9. Includes number of foreign governments, multilaterals, and U.S. NGOs that received foreign assistance as well as the number of foreign NGOs that received non-health assistance only. ↩︎