(pg.

457)
Abortion Pills. Abortion pills pose the single greatest threat to unborn chil- dren in a post-
Roe world. The rate of chemical abortion in the U.S. has increased by more than 150 percent in
the past decade; more than half of annual abortions in the U.S. are chemical rather than
surgical.
The abortion pill regimen is typically a two-part process. The first pill, mifepris- tone, causes the
death of the unborn child by cutting off the hormone progesterone, which is required to sustain a
pregnancy. The second pill, misoprostol, causes con- tractions to induce a delivery of the dead child
and uterine contents, usually into a toilet at home. The abortion-pill regimen is currently
approved for up to 70 days

(10 weeks) into pregnancy and before Biden was subject to a heightened safety restriction
called a Risk Evaluation and Mitigation Strategy (REMS) that requires an in-person visit with a
physician who can check for dangerous contraindications such as ectopic pregnancies and can advise
the mother seeking an abortion of the risks of chemical abortion, including hemorrhaging, and
what to do in such cir- cumstances. Chemical abortion has been found to have a complication
rate four times higher than that of surgical abortion.
Since its approval more than 20 years ago, mifepristone has been associated with 26 deaths of
pregnant mothers, over a thousand hospitalizations, and thousands more adverse events, but that
number does not account for all complications. Of course, this does not count the hundreds of
thousands to millions of babies whose lives have been unjustly taken through chemical abortion.
FDA should therefore:
●
Reverse its approval of chemical abortion drugs because the politicized
approval process was illegal from the start. The FDA failed to abide by its legal
obligations to protect the health, safety, and welfare of girls and women. It never
studied the safety of the drugs under the labeled conditions of use, ignored the
potential impacts of the hormone-blocking regimen on the developing bodies of
adolescent girls, disregarded the substantial evidence that chemical abortion drugs
cause more complications than surgical abortions, and eliminated necessary
safeguards for pregnant girls and women who undergo this dangerous drug regimen.
Furthermore, at no point in the past two decades has the FDA ever acknowledged or
addressed federal laws that prohibit the distribution of abortion drugs by postal mail; to the
contrary, the FDA has permitted and actively encouraged such activity.

Now that the Supreme Court has acknowledged that the Constitution contains no right
to an abortion, the FDA is ethically and legally obliged to revisit and withdraw its initial
approval, which was premised on pregnancy being an “illness” and abortion being
“therapeutically” effective at treating this “illness.” The FDA is statutorily charged with
guaranteeing the
safety and efficacy of drugs and therefore should withdraw this drug that is proven to be
dangerous to women and by definition fatally unsafe for unborn children.

As an interim step, the FDA should immediately restore the REMS by removing the in-person
dispensing requirement to eliminate dangerous tele-abortion and abortion-by-mail
distribution.
Mail-Order Abortions. Allowing mail-order abortions is a gift to the abortion industry that
allows it to expand far beyond brick-and-mortar clinics and into
pro-life states that are trying to protect women, girls, and unborn children from abortion. The
FDA should therefore:
●
Reinstate earlier safety protocols for Mifeprex that were mostly eliminated in
2016 and apply these protocols to any generic version of mifepristone. A bare-
minimum policy of limiting abortion pills to the pre-2016 policy of 49 days gestation,
returning to the pre-2021 in-person dispensing requirement, and returning to requiring
prescribers to report all serious adverse events, not just deaths, to the drug sponsor
would increase women’s health and safety.

●
Address weaknesses in the current FAERS (FDA Adverse Events Reporting
System). The Administration and policymakers should ensure that health care workers,
particularly those in hospitals and emergency rooms, report abortion pill complications.
Women who experience complications from abortion pills typically go to an emergency
room, not to the abortion pill prescriber, so putting the onus of reporting on the prescriber
who typically has no idea that a complication has occurred means that the FAERS is
seriously undercounting adverse events. Submitting an adverse event to the database
should be a quick and efficient process for busy health care practitioners. Currently,
providers report that the process is difficult and convoluted.

●
Implement a policy of transparency about inspections of the abortion pill’s
sponsors, Danco and GenBioPro, as well as facilities that manufacture the pills. The
FDA should respond to congressional requests and Freedom of Information Act (FOIA)
requests about inspections, compliance, and post-marketing safety in a timely manner.

●
Stop promoting or approving mail-order abortions in violation of long-standing
federal laws that prohibit the mailing and interstate carriage of abortion drugs.16

(pg. 459)
(pg. 471)
LIFE, CONSCIENCE, AND BODILY INTEGRITY
●
Prohibit abortion travel funding. Providing funding for abortions increases the number
of abortions and violates the conscience and religious freedom rights of Americans who
object to subsidizing the taking of life. The Hyde Amendment44 has long prohibited the use
of HHS funds for elective abortions, but an August 2022 Biden executive order45 pressed
the HHS Secretary to use his authority under Section 1115 demonstrations to waive
certain provisions of the law in order to use taxpayer funds to achieve the
Administration’s goal of helping women to travel out of state to obtain abortions.
Moreover, the Department of Justice Office of Legal Counsel (DOJ OLC) issued a
politicized legal opinion declaring, for the first time in the history of Hyde, that this
action did not violate the Hyde Amendment and that Hyde applies only to the
performance of the abortion itself in violation of the plainly broad language that
Congress used.

Two of the first actions of a pro-life Administration should be for HHS to withdraw
the Medicaid guidance (and any Section 1115 waivers issued
thereunder) and for DOJ OLC to withdraw and disavow its interpretation of the Hyde
Amendment.

●
Prohibit Planned Parenthood from receiving Medicaid funds. During the 2020–2021
reporting period, Planned Parenthood performed more than 383,000 abortions.46 The
national organization reported more than $133 million in excess revenue47 and more than
$2.1 billion in net assets.48 During this same year, Planned Parenthood reports that its
affiliates received more than $633 million in government funding and more than $579
million in private contributions.49 Planned Parenthood affiliates face accusations of
waste, abuse and potential fraud with taxpayer dollars, failure to report
the sexual abuse of minor girls, and allegations of profiting from the sale of organs from
aborted babies.

Policymakers should end taxpayer funding of Planned Parenthood and all other
abortion providers and redirect funding to health centers that
provide real health care for women. The bulk of federal funding for Planned

Parenthood comes through the Medicaid program. HHS should take two actions to limit this
funding:

1. Issue guidance reemphasizing that states are free to defund Planned Parenthood
in their state Medicaid plans.

2. Propose rulemaking to interpret the Medicaid statute to disqualify providers of

elective abortion from the Medicaid program.

Congress should pass the Protecting Life and Taxpayers Act,50 which would accomplish
the goal of defunding abortion providers such as Planned Parenthood.

CMS should resolve pending Section 1115 waivers from Idaho, South Carolina, and Tennessee,
which, like Texas in January 2022, are seeking both to prohibit abortion providers from
participating in state-run Medicaid programs and to work with other states to do the
 same. Abortion is not health care, and states should be free to devise and implement
programs that prioritize qualified providers that are not entangled with the abortion
industry.

●
Withdraw Medicaid funds for states that require abortion insurance or that
discriminate in violation of the Weldon Amendment. The Weldon Amendment51
declares that no HHS funding may go to a state
or local government that discriminates against pro-life health entities or insurers. In
blatant violation of this law, seven states require abortion coverage in private health
insurance plans, and HHS continues to fund those states. HHS under President
Trump disallowed $200 million in
Medicaid funding from California because of the state’s flouting of the law, but the Biden
Administration restored it.

HHS/CMS should withdraw appropriated funding, up to and including 10 percent of

Medicaid funds, from states that require abortion insurance coverage. DOJ should
commit to litigating the defense of those funding decisions promptly to the Supreme
Court in order to maximize HHS’s ability to withdraw funds from entities that violate the
Weldon Amendment.

Additionally, California has announced that it will discriminate against pharmacies that
do not carry chemical abortion drugs outside of California. California’s discrimination
takes the form of cutting state contracts with such pharmacies and clearly violates the
Weldon Amendment. The violation should likewise face the penalties discussed above.

●
Rewrite the ACA abortion separate payment regulation. Section 1303 of Obamacare
requires that insurers collect a separate payment for certain abortion coverage in
qualified health plans that are approved to be sold on exchanges and that they keep those
separate payments in separate accounts that are used only to pay for elective abortion
services. Neither the letter nor the spirit of the law was enforced under President Obama,
and a Trump- era regulation sought to correct this problem. The Biden HHS rescinded
this regulation to allow insurance companies once again—contrary to
the law—to collect combined payments for what are clearly required to be separate
payments for elective abortion coverage. “Separate” does not mean “together.”

HHS should reinstate a Trump Administration regulation and enforce what the plain text
of Section 1303 requires. That regulation should be further improved by requiring CMS
to ensure that consumers pay truly separate charges for abortion coverage.

●
Audit Hyde Amendment compliance. HHS should undertake a full audit to determine
compliance or noncompliance with the Hyde amendment and similar funding
restrictions in HHS programs. This audit should include a full review of the Biden
Administration’s post-Dobbs executive actions to promote abortion. It should also
encompass a review of Medicaid managed care plans in pro-abortion states.

●
Reverse distorted pro-abortion “interpretations” added to the Emergency Medical
Treatment and Active Labor Act. The Emergency Medical Treatment and Active
Labor Act (EMTALA)52 prohibits hospitals that receive Medicare funds from “dumping”
emergency patients who cannot pay by sending them to other hospitals. It also mandates
that hospitals stabilize pregnant women and explicitly protects unborn children.
 Hospitals or physicians found to be in violation of the statute could lose all of their
federal health funding—Medicare, Medicaid, CHIP, and other funds—and face civil
penalties of up to nearly $120,000.

In July 2022, HHS/CMS released guidance mandating that EMTALA- covered

hospitals and the physicians who work there must perform abortions, to include
completing chemical abortions even when the child might still be alive. The guidance also
declared that EMTALA would protect physicians and hospitals that perform abortions
in violation of state law if they deem those abortions necessary to stabilize the women’s
health. This novel interpretation of EMTALA is baseless. EMTALA requires

no abortions, preempts no pro-life state laws, and explicitly requires stabilization of the
unborn child.

HHS should rescind the guidance and end CMS and state agency investigations into cases
of alleged refusals to perform abortions. DOJ should agree to eliminate existing
injunctions against pro-life states, withdraw its enforcement lawsuits, and in lawsuits against
CMS on the guidance agree to injunctions against CMS and withdraw appeals of
injunctions.

●
Reissue a stronger transgender national coverage determination. CMS should
repromulgate its 2016 decision that CMS could not issue a National Coverage
Determination (NCD) regarding “gender reassignment surgery” for Medicare beneficiaries. In
doing so, CMS should acknowledge the growing body of evidence that such interventions
are dangerous and acknowledge that there is insufficient scientific evidence to support
such coverage in state plans.

●
Enforce EMTALA. The undeniable reality of abortion is that it does do not always
result in a dead baby, and these born-alive babies are left to
die. HHS should use EMTALA and Section 504 of the Rehabilitation Act,53 which prohibits
disability discrimination, to investigate instances of infants born alive and left untreated in
covered hospitals. CMS, OCR, and OIG should be required to follow through on these
investigations with specific enforcement actions.

HHS should revive a Trump Administration proposed regulation, “Special

Responsibilities of Medicare Hospitals in Emergency Cases and Discrimination on the
Basis of Disability in Critical Health and Human
Service Programs or Activities,”54 to achieve this end. In addition, Congress should pass the
Born-Alive Abortion Survivors Protection Act55 to require that proper medical care be given
to infants who survive an abortion
and to establish criminal consequences for practitioners who fail to provide such care.

●
Permanently codify both the Hyde family of amendments and the protections
provided by the Weldon Amendment. Congress can accomplish this through
legislation such as the No Taxpayer Funding for Abortion and Abortion Insurance Full
Disclosure Act56 (Hyde) and the Conscience Protection Act57 (Weldon).

(pg. 474)
 (pg. 455)
Respect for Life and Conscience. The CDC should eliminate programs and projects that do
` not respect human life and conscience rights and that undermine family formation. It should
ensure that it is not promoting abortion as health care. It should fund studies into the risks and
complications of abortion and ensure that it corrects and does not promote misinformation regarding
the comparative health and psychological benefits of childbirth versus the health and psychological
risks of intentionally taking a human life through abortion.
The CDC oversaw and funded the development and testing of the COVID-19 vaccines with
aborted fetal cell lines, insensitive to the consciences of tens of thousands to hundreds of
thousands of people who objected to taking a vac- cine with such a link to abortion. As
evidenced by litigation across the country, it is likely that thousands were fired unjustly
because of the exercise of their consciences or faith on this question, which could have been
avoided with a modicum of concern for this issue from CDC. There is never any justification for
ending a child’s life as part of research, and the research benefits from splicing or growing aborted
fetal cells and aborted baby body parts can easily be provided by alternative sources. All such
research should be prohibited as a matter of law and policy.
CDC should update its public messaging about the unsurpassed effectiveness of modern fertility
awareness–based methods (FABMs) of family planning and stop publishing communications that
conflate such methods with the long-eclipsed “rhythm” or “calendar” methods. CDC should
fund studies exploring the evi- dence-based methods used in cutting-edge fertility awareness.
Data Collection. The CDC’s abortion surveillance and maternity mortality reporting
systems are woefully inadequate. CDC abortion data are reported by states on a voluntary basis,
and California, Maryland, and New Hampshire do not submit abortion data at all. Accurate and
reliable statistical data about abortion, abortion survivors, and abortion-related maternal
deaths are essential to timely, reliable public health and policy analysis.
Because liberal states have now become sanctuaries for abortion tourism, HHS should use
every available tool, including the cutting of funds, to ensure that every state reports exactly how
many abortions take place within its borders, at what gestational age of the child, for what reason,
the mother’s state of residence, and by what method. It should also ensure that statistics are
separated by category: spontaneous miscarriage; treatments that incidentally result in the death of
a child (such as chemotherapy); stillbirths; and induced abortion. In addition, CDC should require
monitoring and reporting for complications due to abortion and every instance of children being
born alive after an abortion. Moreover, abortion should be clearly defined as only those
procedures that intentionally end an unborn child’s life. Miscarriage management or standard
ectopic pregnancy treatments should never be conflated with abortion.
Comparisons between live births and abortion should be tracked across vari- ous
demographic indicators to assess whether certain populations are targeted by abortion
providers and whether better prenatal physical, mental, and social care improves infant
outcomes and decreases abortion rates, especially among those who are most vulnerable.

The Ensuring Accurate and Complete Abortion Data Reporting Act of 2023 9 would amend title XIX
of the Social Security Act and Public Health Service Act to improve the CDC’s abortion
reporting mechanisms by requiring states, as a condition of federal Medicaid payments for
family planning services, to report streamlined variables in a timely manner.

(pg. 456)
(pg 483)

Restore Trump religious and moral exemptions to the contraceptive mandate

(also a CMS rule). HHS should rescind, if finalized, the regulation titled “Coverage
of Certain Preventive Services Under the Affordable Care Act,” proposed jointly by
HHS, Treasury, and Labor.70 This rule proposes to amend Trump-era final rules
regarding religious and moral exemptions and accommodations for coverage of certain
preventive services under the ACA. Preventive services include contraception, and it
appears the proposed rule would change the existing regulations for religious and moral
exemptions to the ACA’s contraception mandate. There is no need for further rulemaking
that curtails existing exemptions and accommodations.

●
Require HRSA to use rulemaking to update the women’s preventive services
mandate. The contraceptive mandate issued under Obamacare has been the source of
years of egregious attacks on many Americans’ religious and moral beliefs. The mandate
was issued as part of the women’s preventive services guidelines, which were issued
without any rulemaking that involved public notice and an opportunity to comment. Instead,
HRSA issued and changed the mandate by simply posting changes to its website. HRSA
also started off not requiring coverage of fertility awareness–based methods of family
planning, then requiring them, and then removing the requirement without notifying the
public. A federal judge recently ruled that this failure to undergo notice and comment in
issuing the mandate
is unlawful. HRSA should be required to repromulgate any women’s preventive services
mandates through the notice and comment process that is compliant with the
Administrative Procedures Act.

Moreover, since the Obama Administration HRSA entered into long- term contracts
with the pro-abortion American College of Obstetricians and Gynecologists (ACOG)
and related entities to serve as an exclusive adviser with respect to the content of this
mandate, HRSA has used
this arrangement to ignore comments that members of the public were sometimes
able to submit in the process, and ACOG has abused its position to attack HHS’s
allowance of religious and moral exemptions to the contraceptive mandate. HHS
should rescind these contracts and
establish an advisory committee that is compliant with the Federal Advisory Committee Act and
has members that are committed to women’s preventive services and are not pro-abortion
ideologues.

●
Expand inclusion of fertility awareness–based methods and supplies to family
planning in the women’s preventive services mandate. The ACA requires coverage
of and prevents insurance plans from imposing
 any cost-sharing requirements on women who obtain preventive care and screenings as
defined by HRSA. In 2016, HHS included “instruction in fertility awareness-based
methods” as part of this requirement. However, in December 2021, HHS removed that
language from its list without using the notice-and-comment process or giving any
rationale, both of which are mandated by the Administrative Procedures Act. In August
2022, a federal court blocked this attempt to eliminate health insurance coverage for
fertility awareness–based methods of family planning from requirements that cover at
least 58 million women, and the judge made his ruling permanent in December 2022. HRSA
should promulgate regulations consistent with this order.

HHS should more thoroughly ensure that fertility awareness–based methods of family
planning are part of women’s preventive services under the ACA. FABMs often involve
costs for materials and supplies, and HHS should make clear that coverage of those items
is also required. FABMs are highly effective and allow women to make family planning
choices in a manner that meets their needs and reflects their values.

●
Eliminate men’s preventive services from the women’s preventive services
mandate. In December 2021, HRSA updated its women’s preventive services guidelines
to include male condoms after claiming for years that it had no authority to do so
because Congress explicitly limited the mandate to “women’s” preventive care and
screenings. HRSA should not incorporate exclusively male contraceptive methods into
guidelines that specify they encompass only women’s services.

●
Eliminate the week-after-pill from the contraceptive mandate as a potential
abortifacient. One of the emergency contraceptives covered under the HRSA
preventive services guidelines is Ella (ulipristal acetate). Like its close cousin, the abortion
pill mifepristone, Ella is a progesterone blocker and can prevent a recently fertilized
embryo from implanting in a woman’s uterus. HRSA should eliminate this potential
abortifacient from the contraceptive mandate.

●
Withdraw Ryan White guidance allowing funds to pay for cross-sex transition
support. HRSA should withdraw all guidance encouraging Ryan White HIV/AIDS
Program service providers to provide controversial “gender transition” procedures or
“gender-affirming care,” which cause irreversible physical and mental harm to those
who receive them.

●
Ensure that training for medical professionals (doctors, nurses, etc.) and doulas is
not being used for abortion training. HHS should ensure that training programs for
medical professionals—including doctors, nurses, and doulas—are in full compliance with
restrictions on abortion funding and conscience-protection laws. In addition, HHS
should:

1. Investigate state medical school compliance with the Coats–Snowe

Amendment,71 which prohibits discrimination against health care entities
that do not provide or undergo training for abortion.

2. Ensure that the Accreditation Council for Graduate Medical Education

(ACGME) complies with all relevant conscience statutes and regulations and
that states have taken the affirmative steps (for example, by issuing
 regulations) to assure compliance with Coats–Snowe.

3. Communicate to medical schools that any abortion-related training must be

on an opt-in rather than opt-out basis.

4. Require states that receive HHS funds to issue regulations or enter into
arrangements with accrediting bodies to comply with the Coats–Snowe
Amendment’s prohibition of mandatory abortion training by individuals or
institutions. The Coats–Snowe Amendment specifically requires such state
regulations or arrangements.
(pg. 486)
(pg. 460)
NATIONAL INSTITUTES OF HEALTH (NIH)
The National Institutes of Health (NIH) is the world’s largest biomedical research agency
and is made up of 27 different components called Institutes and Centers. Despite its popular
image as a benign science agency, NIH was respon- sible for paying for research in aborted
baby body parts, human animal chimera experiments, and gain-of-function viral research that
may have been responsible for COVID-19.
Bioethics Reform. Research using fetal tissue obtained from elective abortions is immoral and
obsolete. Research using human embryonic stem cells also involves the destruction of human life and
should not be subsidized with taxpayer dollars. Good science and life-affirming, ethical research
are not mutually exclusive. In fact, ethically derived sources such as discarded surgical tissue and
adult stem cells (made pluripotent), not tissue obtained from elective abortions, have contributed
the most successful treatments for a variety of ailments.
Congress authorized HHS to choose not to fund extramural abortion-de-rived fetal tissue
research that fails ethics advisory board review, and in 2019, the Trump Administration’s HHS
chose that course. Subsequently, however, the Biden Administration restored unrestricted funding
of abortion-derived fetal tissue research. HHS should:

●
Promptly restore the ethics advisory committee to oversee abortion- derived fetal
tissue research, and Congress should prohibit such research altogether.

●
End intramural research projects using tissue from aborted children within the
NIH, which should end its human embryonic stem
cell registry.

●
Aggressively implement a plan to pursue and fund ethical alternative methods of
research in order to ensure that abortion and embryo- destructive related
research, cell lines, and other testing methods become both fully obsolete and
ethically unthinkable.

In addition, the Administration should reconvene a new National Council on Bioethics

(NCB) to discuss new and emerging areas of ethical concern, to assess whether the ends justify
the means when it comes to the promise of therapies and cures, and to establish what limiting
principles should guide research and health policy. Because the male–female dyad is essential
to human nature and because every child has a right to a mother and father, three-parent
embryo cre- ation and human cloning research should be banned. A new NCB should convene
leading experts to examine these issues and provide policy recommendations for the new
frontier of bioethical questions that our country will have to address in the coming years.
Finally, HHS should create and promote a research agenda that supports pro- life policies
and explores the harms, both mental and physical, that abortion has wrought on women and
 girls.

(pg.461)

(pg. 585)
PRO-LIFE MEASURES
●
Promote pro-life workplace accommodations for mothers. Federal law should
protect life and promote pro-family policies. Current law, the Pregnancy
Discrimination Act,3 provides nondiscrimination protections in the workplace for
pregnancy, childbirth, or related medical conditions. The Pregnant Workers Fairness
Act (PWFA)4 requires employers to make reasonable accommodations for women “to the
known limitations related to the pregnancy, childbirth, or related medical conditions,”
unless “the accommodation would impose an undue hardship on the operation of
the [employer’s] business.” The Americans with Disabilities Act (ADA) also provides
nondiscrimination and accommodation protections in the workplace for certain
pregnancy-related disability.5 None of these laws
requires an employer provide health insurance benefits for elective abortion.

●
Pass a law requiring equal (or greater) benefits for pro-life support for mothers
and clarifying abortion exclusions. Congress should pass a law requiring that to the
extent an employer provides employee benefits for abortion, it must provide equal or
greater benefits for pregnancy, childbirth, maternity, and adoption. That law should also
clarify that no employer is required to provide any accommodations or benefits for
abortion.

●
Keep anti-life “benefits” out of benefit plans. Some benefits attorneys and pro-
choice advocates have argued since the Supreme Court’s Dobbs
v. Jackson Women’s Health Organization decision6 that the longstanding doctrine of
Employee Retirement Income Security Act of 1974 (ERISA)7 preemption should block
individual states’ efforts to prohibit employers from helping employees procure
abortions via offering various kinds of coverage under employee-sponsored benefit
plans. ERISA should not be allowed to trump states’ ability to protect innocent human
life in the womb. Congress and DOL should clarify that ERISA does not preempt states’
power to restrict abortion, surrogacy, or other anti-life “benefits.”

(pg. 585)
(pg. 260)
The next Administration should ensure that USAID’s goal in service of its mission is to
help protect and propel all members of society—women, children, and men—from conception
to natural death. To do so, USAID’s Office of Women, Children, and Families should strive to
ensure that communities have their basic human needs, without which they will be unable to
thrive, met first and foremost. Basic human needs include equal and safe access to potable water,
sanitation, food, education, health care, houses of worship, justice, pregnancy and family resource
centers, working capital, electricity, technology, and business opportunities. The Office of
Women, Children, and Families should implement the Geneva Consen- sus Declaration on
Women’s Health and Protection of the Family and prioritize partnerships with local
organizations, including faith-based organizations (FBOs).
Protecting Life in Foreign Assistance. Protecting life should be among the core objectives
of United States foreign assistance. Shortly after taking office, how- ever, President Biden issued a
memorandum that reversed a myriad of pro-life policies and revoked the Protecting Life in
Global Health Assistance (PLGHA) policy, widely known as the Mexico City Policy. Biden
also restored funding to the United Nations Population Fund (UNFPA), which supports and
implements China’s coercive abortion and sterilization regimen.
PLGHA requires foreign NGOs, as a condition of receiving assistance, to agree not to perform or
actively promote abortions as a method of family planning in foreign countries. Previous pro-
life Presidents beginning with Ronald Reagan applied these conditions to family planning
assistance, but President Trump for the first time expanded the Mexico City Policy to protect
“global health assistance furnished by all departments or agencies” (estimated to be $8.8 billion
annually). The Biden Administration restored abortion subsidies to pro-abortion NGOs
including Planned Parenthood International and MSI Reproductive Choices. In reversing
PLGHA, Biden declared a radical assault on the policy of protecting life, choosing instead to
promote abortion on demand around the world under the guise of “sexual and reproductive health
and rights.” USAID’s priority of funding the global abortion industry negates programs that
promote life, women’s health,
and the family.
Even under PLGHA, several loopholes allowed support for the global abortion industry to continue.
International NGOs that perform and promote abortions overseas like Population Services
International, Pathfinder, PATH, the Population Council, EngenderHealth, and WomanCare Global
International continued to receive funding from USAID under PLGHA and now, under Biden,
receive tens of millions more in U.S. taxpayer dollars in foreign assistance annually without any
oversight. When the United Nations Secretariat promoted abortion and abor- tion-inducing drugs
under the umbrella of “sexual and reproductive health” as an element of its COVID-19 Global
Humanitarian Response Plan in May 2020, the exemptions in PLGHA for humanitarian aid
and multilateral organizations illuminated another loophole in the policy’s effectiveness in
safeguarding U.S. tax- payer dollars from being used to promote abortion.
Pro-abortion groups also have received funds under other categories of foreign aid that fall
outside the scope of global health assistance, including women-related and economic assistance
programs. Members of Congress have advocated closing these loopholes by extending PLGHA to all
foreign assistance through the Protect- ing Life in Foreign Assistance Act, sponsored by Senator
Mike Lee (R–UT) and Representative Virginia Foxx (R–NC).11 Current law in the Foreign
Assistance Act gives the President broad authority to set “such terms and conditions as he may
determine” on foreign assistance, which legally empowers the next conservative President to
expand this pro-life policy.
To stop U.S. foreign aid from supporting the global abortion industry, the next conservative
Administration should issue an executive order that, at a minimum, reinstates PLGHA and
summarily blocks funding to UNFPA but also closes loop- holes by applying the policy to all
foreign assistance, including humanitarian aid, and improving its enforcement. The executive
order to reinstate PLGHA should be drafted broadly to apply to all foreign assistance. It
should simultaneously rescind President Biden’s memorandum entitled “Protecting Women’s
Health at Home and Abroad,” issued on January 28, 2021.12 The new pro-life executive order should
apply to foreign NGOs, including subgrantees and subcontractors, and remove exemptions for
U.S.-based NGOs, public international organizations, and bilateral government-to-government
agreements. All entities funded by USAID, both directly and indirectly, should report their
compliance with the PLGHA, and USAID should institute penalties, including debarment from
future federal funding, for violations of it. The new executive order also should instruct the
Administrator of USAID to publish reports on implementation of the PLGHA by both prime and
sub-prime recipients.
In addition, the Helms Amendment should continue to be applied, as it has been by both
Republican and Democratic Administrations for more than 50 years, as a complete ban on the use
of taxpayer dollars to pay for abortions abroad.
International Religious Freedom. Conservatives believe international religious freedom
is central to USAID’s development efforts. President Trump’s Executive Order 13926 on
“Advancing International Religious Freedom”13 instructed the Secretary of State, in
consultation with the USAID Administrator, to budget at least $50 million a year for programs
that advance international reli- gious freedom and “ensure that faith-based and religious entities,
including eligible entities in foreign countries, are not discriminated against on the basis of
religious identity or religious belief when competing for Federal funding.”
Under the Trump Administration, the agency set up a senior-level Chief Adviser for International
Religious Freedom who reported directly to the Administra- tor with the task of coordinating a
“whole-of-USAID” approach to achieving this priority. It created a robust genocide-response
capability. USAID affirmed the agency’s partnerships with faith-based organizations through
its rule on “Partic- ipation by Religious Organizations in USAID Programs;”14 “Partnership Guidance
and Answers to Frequently Asked Questions (FAQs) for Faith Based Organizations;” and “Legal
Guidance and Answers to FAQs for USAID Staff.”
Today, USAID officials and their progressive partners have resisted efforts to promote
religious freedom, especially as it relates to abortion and gender ideology, which are anathema to
the traditional societies where USAID funds programs (in addition to many U.S. taxpayers). U.S.
Secretary of State Antony Blinken repudiated his predecessor’s focus on religious freedom.

(pg. 262)