On Jan. 23, Vice President JD Vance launched the Trump administration’s new plan to “promote families and human flourishing.” But rather than being, as he claimed, “pro-life,” these rules will threaten the lives of people around the world, especially women and people who don’t fit into the administration’s narrow, unscientific categories of gender.
The first of the new restrictions on foreign aid announced by Vance extends the existing Mexico City Policy prohibitions on abortion funding to encompass not just global health assistance but all nonmilitary foreign assistance — including U.S.-based nonprofits and government-to-government funding.
Known to critics as the “Global Gag Rule,” recipients receiving funding from the U.S. government are prohibited even from tapping other donors to provide information or education regarding women’s health. This expansion will severely limit access to abortion and the full range of sexual and reproductive health care, even in humanitarian emergencies.
Decades of social science and health research show that curtailing access to safe abortions does not reduce abortions; it just makes them more dangerous. A 2017 World Health Organization report found that unsafe abortions already account for as much as 13.2% of maternal mortality worldwide. The Trump administration’s new rules will increase that needless suffering and death.
In sum, the administration’s grandstanding on abortion discounts the unimaginable suffering that we have seen in women who have died from unsafe abortions — bleeding out in front of their small children or dying alone in a filthy hideaway, overcome by a raging blood infection. The Global Gag Rule also undermines crucial health systems, forcing physicians and health workers to violate their professional oaths by staying silent when they see risks or to delay actions until it is too late to save their patients.
The second new rule announced by Vance applies the administration’s executive order barring so-called gender ideology to foreign assistance, risking trans people’s lives under the pretense of “protecting women.” In truth, the only “radical gender ideology” is the one that pretends that transgender people don’t exist.
The third rule requires foreign aid recipients to certify that they will not support initiatives meant to promote diversity, equity and inclusion, perversely calling consideration of equity “discrimination,” when it is really just fairness. This will coerce organizations to deny the existence of transgender, nonbinary and intersex individuals and limit access to many kinds of vital care and information for LGBTQ+ people and other minority groups.
Health care and other social services to LGBTQ+ communities globally had already been eviscerated by the 2025 U.S. funding freeze and dismantling of the U.S. Agency for International Development, and separating out certain gender-affirming care and related services simply won’t work in many contexts. The result will be further stigma, chilling all kinds of LGBTQ+ health care.
The three rules seem designed to avoid some of the inevitable litigation they will trigger, but will likely run afoul of domestic law in some countries. For example, India’s Supreme Court in 2014 affirmed transgender people’s constitutional right to their self-identified gender — male, female or third gender — and ordered the government to grant legal recognition of the same and to take specific steps to ensure equality and nondiscrimination for transgender people. Will countries have to choose between losing aid or violating their own laws?
President Donald Trump’s changes will affect approximately $30 billion in U.S. foreign assistance, threatening the lives and health of millions of people worldwide. It will apply to all nonmilitary foreign assistance, and restrictions on gender-affirming and other care will extend beyond our borders, putting countless communities at risk.
While always imperfect, U.S. foreign assistance used to provide hope for dignity as well as access to services for marginalized groups across the globe. With these rules, the U.S. has abandoned the planet’s most vulnerable people and is bullying others to assist with its discriminatory dirty work.
