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).

Table 1 Expansion of the Mexico City Policy Over Time
	Phase 1^	Phase 2	Phase 3	Project 2025 Proposal
President/Term	Ronald Reagan, 1985-1989 George H.W. Bush,1989-1993	George W. Bush, 2001-2009	Donald Trump, 2017-2021	Donald Trump, 2024-2028 (if elected)
Sector	Family Planning Assistance	Family Planning Assistance	Global Health Assistance, including PEPFAR	Foreign Assistance, including Humanitarian Assistance
Agency	USAID	USAID/State Department	USAID/State Department/DoD#	All Agencies (more than 20)
Type of Award	Grants & Cooperative Agreements	Grants & Cooperative Agreements	Grants & Cooperative Agreements+	Grants, Cooperative Agreements, Contracts
Bilateral/Multilateral	Bilateral	Bilateral	Bilateral	Bilateral/Multilateral
Recipients	Foreign NGOs	Foreign NGOs	Foreign NGOs*	U.S. and Foreign NGOs, Foreign Governments, Multilaterals
^ While the MCP has generally been implemented through Presidential Executive Action, there was a temporary, one-year legislative imposition during President Bill Clinton’s second term (FY 2000),3 which included an option for the president to partially waive restrictions, as President Clinton chose to do, but only against not more than $15 million of total USAID family planning funds. # When such funding was transferred to another agency, such as the Centers for Disease Control and Prevention (CDC) or National Institutes of Health (NIH), it remained subject to the policy, to the extent that such funding was ultimately provided to foreign NGOs, directly or indirectly. + The Trump administration had sought to apply the policy to contracts and issued a proposed rule to this effect,4 but it was not finalized prior to leaving office. (Note that “grants under contracts” were subject to the policy.) *Clarified in 2019 that under the policy, U.S.-supported foreign NGOs could not provide any type of financial support, no matter the source of funds, to any other foreign NGO that performs or actively promotes abortion as a method of family planning.

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).

Methodology

This analysis looks at FY 2022 foreign assistance obligation data, downloaded from foreignassistance.gov on January 29, 2024. ForeignAssistance.gov is 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. Obligations are binding agreements that will result in outlays of funding, immediately or sometime in the future. The MCP, when in place, is applied to funding that is obligated to recipients, as a condition of their awards. Data on funding amounts and recipients were analyzed by agency, sector, location, and type of entity. To the extent possible, COVID-19 emergency funding was excluded from this analysis, as it represented one-time funding for a particular event. Recipients were categorized into the following groups (see table below) based on classifications already present in the ForeignAssistance.gov data as well as background research, where such classifications were not provided. Each recipient was reviewed, and the review sought to correct any mis-categorization in the original data and remove duplicates. “Other/Unknown” recipients were those that could not be easily identified as belonging to a particular recipient type/sub-type. Where it was not possible to identify a recipient as a single, implementing entity, they were excluded from analysis looking at the number of unique recipients.

Recipient Type	Recipient Sub-Type
Educational Institution	Foreign Educational Institution
	U.S. Educational Institution
Government	Foreign Government
	U.S. Government
Multilateral	Multilateral – United Nations
	Multilateral – World Bank Group
	Multilateral – Other
Non-Profit	Foreign Non-Profit
	U.S. Non-Profit
Other/Unknown	Foreign Other/Unknown
	Other/Unknown
	U.S. Other/Unknown
Private Sector	Foreign Private Sector
	U.S. Private Sector