What Recent Policy Changes Has the White House Made to Funding the HIV/AIDS Epidemic Globally?

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amfAR

The Foundation for AIDS Research

Overview

On January 23, 2017, President Trump reinstated and significantly expanded the Mexico City Policy (MCP), which prohibits non- U.S.-based nongovernmental organizations (NGOs) from receiving U.S. global health funding if they perform, counsel on, or refer for abortion, or advocate for its liberalization outside of limited exceptions. Whereas the MCP historically only implicated family planning funding, the expanded MCP (EMCP) now applies to all federal global health assistance funding. As such, the EMCP now applies to HIV funding through the President’s Emergency Plan for AIDS Relief (PEPFAR), implicating hundreds of new implementing partners (IPs) that were previously exempt. While the EMCP’s impact on PEPFAR IPs is not yet known, previous iterations of the MCP prompted service reductions and clinic closures among family planning providers. In order to understand if and how PEPFAR IPs may be affected, amfAR, in collaboration with Johns Hopkins University, launched a confidential electronic survey and key-informant interviews with PEPFAR IPs to document any changes in organizational operations and service delivery prompted by the EMCP.

Background on the Mexico City Policy
• Since the 1970s, the Helms Amendment has prevented any U.S. foreign assistance funding from being used for abortion services, even during the Clinton and Obama administration years when the MCP was not in effect. In contrast to the Helms Amendment, however, the MCP extends restrictions to organizational activities as a whole, even those supported by non-U.S. funding.  Specifically, the EMCP restricts a nonU.S.-based NGO from engaging in the following activities while receiving U.S. global health assistance: 1) abortion services; 2) counseling on abortion; 3) referring for abortion; and 4) advocating for the liberalization of abortion access.  Limited exceptions in the cases of rape, incest, or if carrying the pregnancy to term would endanger a woman’s
life, are allowed in the EMCP language.

1 Additionally, abortion counseling/referrals are allowed if a woman has explicitly stated her intention to access a legal abortion and is seeking information, or if she lives in a country where local law protects her right to full informed consent on reproductive decisions including abortion services.  However, restrictions do apply in all other cases including when a women’s health is at risk or when fetal abnormalities are detected.
• On his second day in office (January 23, 2017), President Trump reinstated and announced an intention to expand the MCP via presidential memorandum. The EMCP, formally titled Protecting Life in Global Health Assistance and released in May 2017, prohibits non-U.S.-based/foreign nongovernmental organizations (fNGOs) from receiving any form of U.S. global health assistance unless the organization certifies that it will comply with the EMCP.
• Prior iterations of the MCP only applied to U.S. global health assistance for family planning (FP), a budget line of approximately $600 million. The EMCP now applies to nearly all U.S. global health assistance, including PEPFAR, a budget of approximately $8.8 billion. This dramatic expansion means that hundreds of additional organizations must choose between complying with these restrictions and losing their U.S. funding.
• The MCP is found to be an unconstitutional restriction of U.S.-based organizations’ right to free speech, so the Policy only applies to non-U.S.-based organizations. However, U.S.-based organizations are required to ensure that all of their fNGO sub-partners comply with the Policy

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