What The Hell America!

It is well past time for Republican congressional leaders to join their Democratic counterparts to reassert Congress’ constitutional authority.

Since 2001, the arrival of each new Republican president has been met with apprehension by advocates of global sexual and reproductive health and rights (SRHR). Every Republican administration since the Reagan era has denied funding to foreign non-governmental organizations (NGOs) that provide abortion services, counseling and referral or lobby for liberalization of abortion laws, even if done with non-U.S. government funds.

The expectation is that shortly after Inauguration Day, Republican administrations will reinstate the global gag rule (GGR) as a defining executive branch policy. President Donald Trump did not deviate from that pattern at the start of his second term.

This time, his reinstatement of the GGR was quickly buried by an onslaught of executive orders (EO) and presidential memoranda that have turned U.S. foreign policy in the post-World War II era on its head. The Trump administration has effectively dismantled the U.S. Agency for International Development (USAID) and over 60 years of U.S. government investments in low- and middle-income countries, thereby threatening the U.S.’ ability to lead on the world stage and undermining its national security and economic prosperity. (This week, a federal judge ruled that the USAID cuts likely violated the Constitution “in multiple ways” and ordered agency functions be partially restored, though that relief could end up only being temporary.)

In a sense, the reinstatement of the GGR is the least of our problems right now, as it is questionable how many functioning U.S.-funded global health programs may still exist to be affected.

Although it has become somewhat cliché to invoke William Butler Yeats’ 1919 poem “The Second Coming” in times of international chaos and uncertainty, its message is timely in the present moment:

Things fall apart; the centre cannot hold;

Mere anarchy is loosed upon the world,

The blood-dimmed tide is loosed, and everywhere The ceremony of innocence is drowned;

The best lack all conviction, while the worst

Are full of passionate intensity.

In Yeats’ taxonomy, as it applies to the future of U.S. foreign assistance today, the worst are the world’s richest man, Elon Musk, and his adolescent tech vandals of the so-called “Department of Government Efficiency” (DOGE). They are in league with Pete Marocco, the director of the State Department’s Office of Foreign Assistance, who was delegated the task of deconstructing USAID by the feckless Secretary of State Marco Rubio.

DOGE is not, in fact, an official arm of the U.S. government—the Senate has not confirmed Musk, and the legality of both DOGE and its leader is highly questionable.

In opposition stand Democratic champions of foreign assistance on Capitol Hill, who are not lacking in conviction but, as the minority party in Congress, have been forced to watch in dismay the destruction of USAID without the legislative and legal tools to beat back the ongoing onslaught, at least so far.

It is hardly surprising that opponents of government spending focused on gutting foreign aid first, which they perceive to be an easy target with no domestic political constituency, before moving on to wreck other Cabinet departments and agencies.

It is well past time for Republican congressional leaders to join their Democratic counterparts to reassert Congress’ constitutional authority.

It is the role of Congress to make the laws establishing and governing the U.S. foreign assistance program and appropriating funding to it. Without congressional authorization, irreparable harm is being done to millions of people around the world by incompetent and unqualified DOGE operatives and Trump political appointees at State, operating with impunity and guided by extreme ideologies and questionable motives.

Some of that harm already cannot be undone.

Journalists have well covered these seismic shifts in U.S. foreign aid as USAID became the first target of DOGE’s campaign to root out alleged “waste, fraud, and abuse” in the federal government and they have detailed the illegal actions and cruel tactics employed in shuttering USAID and casting aside its staff.

This analysis will instead look at how SRHR issues fit into the messaging used to attack USAID and foreign aid and how international family planning and reproductive health (FP/RH) programs were singled out in implementing funding freezes and terminating agreements with NGO partners.

SRHR Disinformation Used to Demonize USAID

The Trump administration has argued that the agency is out of step with its “America first” objectives. In doing so, Trump and Musk have made false claims and spread conspiracy theories about rampant fraud and waste at the agency, many of which were hatched on social media.

The most widely publicized and now thoroughly debunked lie was that USAID had sent between $50 and $100 million—depending on the the source—worth of condoms to Gaza.

White House press spokesperson Karoline Leavitt got the ball rolling at her inaugural briefing on Jan. 28, announcing that the Trump administration had prevented a “preposterous waste of taxpayer money” with the imposition of the freeze on foreign aid funds by derailing a plan in which “there was about to be $50 million taxpayer dollars that went out the door to fund condoms in Gaza.”

Less than a week later, on Feb. 3, Trump doubled down and embellished that “some of the numbers are horrible, what [Musk] found…100—think of it, $100 million on condoms to Hamas, condoms to Hamas, and many other things that are frankly even more ridiculous.”

In the face of vigorous fact-checking by CNN, AP and other media outlets, who noted that USAID’s worldwide male condom procurement budget in FY 2023 was only $7.1 million and no money had been spent on condoms in the Middle East in the preceding three fiscal years under Biden, even Elon Musk was forced to acknowledge when asked by a reporter on Feb. 11 about the allegation, “Some of the things that I say will be incorrect, and should be corrected.” Unfortunately, the lie continues to float around in the ether and is probably still believed by many in Trump’s credulous MAGA base.

In another example of casting outrage bait, following Trump’s address to a joint session of Congress this month, the White House reissued a Feb. 3 fact sheet composed of a list of “ridiculous—and, in many cases, malicious—pet projects of entrenched bureaucrats, with next-to-no oversight” that included “funding to print ‘personalized’ contraceptives [sic] birth control devices in developing countries.”

As described, on its face, it does sound outlandish. In reality, USAID funded the University of Texas at Austin to develop personalized 3D-printed intrauterine devices (IUDs) to reduce pain for users of the device to ensure higher continuation rates. It bears noting that innovative investments by USAID’s Office of Population and Reproductive Health over the last several decades has contributed to the research and development of almost all of the modern contraceptive methods available in America today.

Foreign Aid Freeze

On Day 1 of the Trump administration, amongst an avalanche of EOs signed on Jan. 20, an EO entitled Reevaluating and Realigning United States Foreign Aid mandated a “90-day pause in foreign development assistance” to assess alignment with the administration’s priorities and decide whether to continue, modify, or cease programs.

The EO’s stated purpose: “The United States foreign aid industry and bureaucracy are not aligned with American interests and in many cases antithetical to American values. They serve to destabilize world peace by promoting ideas in foreign countries that are directly inverse to harmonious and stable relations internal to and among countries.”

Any new administration during a transition has the prerogative to review existing U.S. foreign assistance and national security programs funded by the international affairs budget to ensure alignment with its agenda and foreign policy priorities.

Under the EO, departments and agencies “shall immediately pause all new obligations and disbursement of development assistance funds…pending reviews of such programs for programmatic efficiency and consistency with United States foreign policy,” implying that previously obligated funding may still be disbursed to pay for work already performed under a grant or contract.

Stop Work Order

On Jan. 24, an unclassified cable drafted by Marocco and approved by Rubio was distributed to State Department’s main offices and all diplomatic and consular posts. It placed a 90-day freeze on new foreign assistance obligations and disbursements and instructed contracting and agreement officers to immediately issue stop-work orders. the freeze would remain in effect until the secretary, following a review, decided whether to “continue, modify, or terminate” programs.

In addition, no new requests for proposals, applications, or any other kind of solicitation or request for foreign aid funding are to be issued or processed by the State Department or USAID until reviewed and approved by the “F” Bureau headed by Marocco, as “consistent with the President’s policy.” Limited exemptions from the pause were granted to programs or expenses for foreign military support for Israel and Egypt and emergency food assistance.

That same day, the Office of Management and Budget attempted to impose a similar funding freeze blocking disbursements of federal funds across the entire government. The order faced a swift and successful legal challenge in the face of public outcry and complaints from Representatives and Senators as well as state and local government leaders—including Republicans—about the unavailability of approved funds for domestic programs benefiting their constituents.

A preliminary injunction is in effect, preventing a blanket freeze on the disbursement of other types of federal financial assistance. However, foreign assistance is not covered under this order.

Subsequent legal challenges to the foreign aid stop work order, and the government’s refusal to pay NGOs, businesses and contractors for work already performed, are now working their way through the federal courts. Earlier this month, in a 5-4 ruling, the U.S. Supreme Court rejected an appeal by the government of a district court judge’s order requiring USAID to pay out nearly $2 billion in unpaid bills and invoices. This sent the case back to the judge, who ruled on March 10 that Trump had exceeded his constitutional and statutory authority in refusing to spend congressionally appropriated foreign aid funds and ordering that NGOs and businesses be paid back monies owed at a rate of at least 300 payments per day.

Global Gag Rule Reinstatement

The same day that the State Department issued the stop-work order, Trump signed a presidential memorandum that reinstated the GGR. The text of the presidential memorandum is virtually identical to the Trump memo from 2017—only the names of the memoranda and dates have been changed.

The memorandum instructs the Secretary of State, the Secretary of Defense, the Secretary of Health and Human Services, and the USAID Administrator to “implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments or agencies.” By referencing his 2017 memorandum, the GGR eligibility conditions will only apply to assistance provided to foreign NGOs—at least for the time being.

It remains to be seen whether Trump will expand the eligibility restrictions to additional types of foreign aid beyond global health and/or funding recipients previously exempt (e.g., U.S. NGOs, public international organizations, and “bilateral government-to-government agreements,” as called for in Project 2025) and funding mechanisms to which the GGR restrictions have not been applied in the past (e.g., contracts). As an executive branch policy, there is nothing to preclude Trump from expanding the application of the policy further in the future.

The quiet manner in which Trump reinstated the GGR puzzled some long-time observers, particularly given the Friday evening timing. Usually, Republican administrations like to offer the so-called March for Life policy wins that advance the antiabortion agenda, but even though Vice President Vance addressed the march earlier that day, the president had not yet signed, and the vice president did not mention the GGR from the podium.

The memorandum further directs the Secretary of State “to take all necessary actions, to the extent permitted by law, to ensure that U.S. taxpayer dollars do not fund organizations or programs that support or participate in the management of a program of coercive abortion or involuntary sterilization,” in effect calling for the enforcement of the Kemp-Kasten amendment. The amendment has been invoked by Republican presidents since Reagan to withhold U.S. funding from the United Nations Population Fund (UNFPA), the UN’s sexual and reproductive health organization, using UNFPA’s country program in the People’s Republic of China, where human rights abuses have occurred, as the pretext.

Waiver for “Life-Saving Humanitarian Assistance”

Eight days after the issuance of the original EO on reevaluating and realigning U.S. foreign assistance, Secretary of State Rubio signed an “Emergency Humanitarian Waiver to the Foreign Assistance Pause” to allow the continuation of “life-saving humanitarian assistance” during the 90-day review period based on an opaque waiver application process.

The temporary waiver granted on Jan. 28 allows existing “life-saving” programs to continue or resume if stopped. As defined in the text of Rubio’s memo, the waiver is available for the provision of “core life-saving medicine, medical services, food, shelter, and subsistence assistance, as well as supplies and reasonable administrative costs as necessary to deliver such assistance.”

Maddeningly and contrary to all available evidence, the waiver specifically exempts family planning and reproductive health services from coverage, branding them as “non-life saving” and stating that “this waiver does not apply to activities that involve abortions, family planning, conferences, administrative costs…, gender or DEI ideology programs, transgender surgeries, or other non-life saving assistance.”

According to an analysis by the Guttmacher Institute, the 90-day pause in U.S. government bilateral and multilateral family planning funding alone will cause an estimated 11.7 million women to be denied contraceptive services, resulting in 4.2 million unintended pregnancies and over 8,000 maternal deaths from complications during pregnancy and childbirth.

A recent separate but related Guttmacher analysis found that U.S. investments in international FP/RH programs in FY 2024 serve 47.6 million women and couples with modern contraceptive care each year, preventing 17.1 million unintended pregnancies, 7.6 million unplanned births, and 5.2 million unsafe abortions, which in turn saves the lives of 34,000 women and girls who otherwise would have died from complications of pregnancy and childbirth.

Likewise, a Feb. 28 statement from UNFPA Executive Director Natalia Kanem noted that U.S. government support over the last four years under the Biden administration for the provision of critical maternal health care, protection from gender-based violence and other life-saving care in over 25 crisis-stricken countries and territories.

By expanding expanding access to voluntary family planning, this support has prevented more than 17,000 maternal deaths, 9 million unintended pregnancies and nearly 3 million unsafe abortions, while reaching over 13 million women and young people with sexual and reproductive health services like cervical cancer screening, contraception counseling and prenatal and safe childbirth care.

Despite the issuance of the emergency humanitarian waiver, the only program for which a specific waiver has been announced is the President’s Emergency Plan for AIDS Relief (PEPFAR)—albeit one limited to “life-saving HIV care and treatment services,” including procurement and distribution of antiretroviral drugs, testing, treatment and prevention of opportunistic infections (i.e., tuberculosis) and prevention of mother-to-child transmission. The limited PEPFAR waiver was issued on Feb. 1. No other blanket waivers are known to have been announced for other global health sectors, such as maternal and child health or nutrition programs (even though the original Rubio waiver stated that additional waivers or exceptions not covered may be sought from the State Department working through U.S. government agency partners.)

In granting these limited waivers for certain types of HIV activities, implementing partners are required to accept additional terms and conditions on the existing contracts that are heavily focused on ensuring no funds are provided for abortion, family planning, or activities that are contrary to other EOs such as gender, DEI “ideology,” and transgender surgeries.

Concerning abortion, the government attorneys chose an interesting formulation that combines the 1973 Helms amendment with the Kemp-Kasten language by referring to “elective or coercive abortions” and unnecessarily adding “involuntary sterilization” to the list of non-life-saving activities excluded for waivers. A Trump EO on enforcing the domestic abortion restrictions in the Hyde Amendment is also invoked.

If an implementing organization were to receive such a waiver, how should it ensure compliance with Trump’s Jan. 24 presidential memorandum reinstating the GGR restrictions on global health assistance provided to foreign NGOs? That is an interesting question since the implicated cabinet secretaries have yet to announce “a plan to extend the requirements of the reinstated Memorandum.”

How’s It Going?

Not well. Even with the alleged availability of waivers and claims that a functioning system is in place to resume the flow of foreign aid funding to exempted life-saving activities, chaos and confusion reign. In a scathing March 2 internal memo obtained by the Washington Post, acting USAID Assistant Administrator for Global Health Nicholas Enrich, a senior career official now placed on administrative leave, stated that “USAID’s failure to implement lifesaving humanitarian assistance under the waiver is the result of political leadership” and that the failure “will no doubt result in preventable death, destabilization, and threats to national security on a massive scale.”

This failure of political leadership is compounded by the fact that there is only a skeleton USAID staff left in the building—actually, there is no building left—to get approved funding out the door with Trump comissars and DOGE apparatchiks having fired or placed on administrative leave almost all of the USAID workforce, including all of the contract employees who served vital roles in administering the global health and humanitarian assistance programs at USAID.

The Enrich memo attributed the difficulty in granting waivers and releasing funding to approved projects to “the refusal to pay for assistance activities conducted or goods and services rendered, the blockage and restriction of access to USAID’s payment systems followed by the creation of new and ineffective processes for payments, the ever-changing guidance as to what qualifies as ‘lifesaving’ and whose approval is needed in making that decision, and most recently, the sweeping terminations of the most critical implementing mechanisms necessary for providing lifesaving services.”

His final point refers to the fact that 90 percent of USAID’s foreign assistance programs and projects received termination notices on the last days of February, some reportedly with the interesting choice to close terminations with the phrase “God Bless America.”

In a Feb. 26 declaration in the court case challenging the foreign aid funding freeze, Pete Marocco, now dual-hatted by Marco Rubio as the acting Deputy USAIDAdministrator, stated that 5,800 USAID grants and contracts and 4,100 State Department grants and contracts—tens of billions of dollars worth—have been terminated and that the “process of individually reviewing each USAID obligation has concluded,” straining credibility and contradicted by the data request described below.

As part of the 90-day review of foreign assistance programs for alignment with the “President’s America First” foreign policy to make America “safer, stronger, and more prosperous,” the Office of Management and Budget (OMB) sent a request for data on Feb. 26 which includes a questionnaire for implementing partners to self-assess their programs on a point scale. Question seven of 36 asks if the organization is “compliant with the latest Mexico City Policy.” Other questions focus on various other right-wing “culture war” priorities. Compilations of responses to the data request by departments and agencies are due on St. Patrick’s Day.

What’s Next?

Members of Congress, including Republicans, may finally be beginning to assert themselves—at least privately—to defend their institution’s constitutional prerogatives and power of the purse against the Trump administration’s foreign aid freeze and dismantling of USAID. They are also pushing back against the refusal of Trump political appointees at the State Department, including former Senate colleague Marco Rubio, to consult on the administration’s actions or even respond to their inquiries and requests for information.

Most noteworthy, a private letter obtained by the Washington Post was sent to Secretary of State Rubio in early February by a bipartisan group of key Senate appropriators, including Trump loyalist Lindsey Graham (R-SC), expressing concern about “reports that food is at risk of rotting in ports, lifesaving medicines are stuck in warehouses, and counterterrorism programs are being suspended,” along with frustration at not being notified and consulted about the foreign aid funding freeze and the cancellation and withholding of congressionally appropriated funds. The letter also requested that Rubio brief the Appropriations Committee “within days” on program terminations and a waiver process lacking “structure and clarity.”

He has yet to appear.

Legal challenges to the foreign aid freeze, refusal to pay money owed, and personnel actions continue to move forward in federal courts with uncertain outcomes. As U.S. democracy hurtles toward a constitutional crisis—if it has not already arrived—even if plaintiffs prevail, it is unclear at this point whether the Trump administration will comply with the lawful rulings and orders of federal judges.