Getting Back on Track: How to Advance the Biden-Harris Administration’s Early Actions on Women’s Health

Last week, the Biden-Harris administration took an important first step to restore US support for sexual and reproductive health and rights globally by repealing the Mexico City Policy. Historically, the rule has reduced access to contraception and counselling services which, counter to its intended goal, results in an increase in unplanned pregnancies and higher abortion rates. Rolling back the policy, which had been greatly expanded under the Trump administration, ensures people worldwide can exercise their right to bodily autonomy. And, as research from CGD and others shows, when women and girls can make informed decisions about whether and when to have children, it has a direct impact on boosting education outcomes, labor force participation, and wages.

The executive order has other pieces of good news too, including restoring US funding for the United Nations Population Fund (UNFPA). There’s no doubt that this action places the United States back on track to champion the protection and expansion of sexual and reproductive health and rights around the world. But there are several ways the administration should go even further to prioritize this issue and broader gender equality, especially given the devastating impacts of COVID-19 on women’s and girls’ health and well-being.

Here are four additional policy priorities for the Biden-Harris administration’s to-do list:

1.  Act fast to reverse the ripple effects of the Mexico City Policy

The Mexico City Policy prohibits foreign NGOs from performing, promoting, or advocating for abortions using funds from any source as a condition for receiving US funding for international family planning. Since it was first introduced by President Reagan, the rule has been rescinded and reinstated by successive presidents along party lines. In 2017, under the Trump administration, the policy was expanded with restrictions applying to all US global health assistance (an estimated $7.3 billion in FY2020), not just family planning funds. More than 1,300 global health awards, mainly at USAID and CDC, were subject to the policy by September 2018.

This broader scope has had negative impacts on service delivery across many US-supported global health programs, disrupting HIV/AIDS programming and cervical cancer screenings among other essential services for the most vulnerable populations. Evidence also points to a broader “chilling effect,” exacerbated by the expanded scope, where providers discontinued additional services or retreated from partnerships due to confusion, and even fear, about what was and was not permitted.

President Biden’s recent memo “immediately waive[s] such conditions in any current grants,” in addition to removing restrictions for future ones. In the short-term, US foreign assistance agencies, including USAID, must urgently and clearly notify implementing partners (prime partners and sub-award recipients) and work to formally revise provisions in grants and cooperative agreements. This is good news, but it will take time to undo the policy’s wide-reaching effects, considering many more grants and cooperative agreements were affected.

To avoid future whiplash, the Biden-Harris administration should work with lawmakers to pass the Global Health Empowerment and Rights (Global HER) Act, recently reintroduced in Congress, which would permanently repeal the Mexico City Policy. While we realize attention is focused on addressing the pandemic at home and abroad, permanently reversing the Mexico City Policy will not only contribute to inclusive recovery efforts, but also protect and accelerate US global health investments.

2. Double down on bilateral and multilateral investments to protect sexual and reproductive health services during COVID-19 and beyond

Encouragingly, the memo declares “it is the policy of [the] Administration to support women’s and girls’ sexual and reproductive health and rights in the United States, as well as globally.” Likewise, the National Strategy for the COVID-19 Response and Pandemic Preparedness signals the need to address the secondary impacts of the pandemic on health outcomes, especially for women and girls.

US bilateral and multilateral investments should prioritize sexual and reproductive health as an essential health service, with an emphasis on providing predictable and complementary support and a focus on greater effectiveness. Reinstating support for UNFPA is a welcome first step. And by including funding for UNFPA in its first budget request to Congress, the administration would demonstrate support for addressing the knock-on effects of the pandemic globally, including access to contraception and gender-based violence.

As the largest donor for family planning support, USAID is well placed to support continuation of voluntary contraceptive services as a cost-effective intervention in partner countries during the pandemic. To truly champion these priorities, USAID should also re-emphasize the importance of reproductive healthcare as central to meeting all people’s holistic health needs—in contrast to the previous administration’s approach which favored a pivot to the vague label “family health.” Further, the launch of USAID’s Next Generation Global Health Supply Chain Program offers an opportunity to leverage US investments in contraceptive supplies to strengthen in-country procurement and supply chain functions over the longer term.

3.  Replace USAID’s Gender Equality and Women’s Empowerment Policy

The Trump administration’s 2020 revision of USAID’s gender policy was met with harsh criticism from gender equality experts and civil society advocates—due both to its closed-door revision process and to the end product, which lacks an evidence-based conceptualization of gender inequality and data-driven policies and interventions to tackle it. The new policy takes a binary view of gender (excluding from discussion LGBTQI individuals and a recognition of how gender interacts with other demographic characteristics to compound discrimination); is framed around the promotion of “unalienable rights,” a term which lacks alignment with recognized international human rights conventions and declarations; and fails to include a discussion of persistent gender data gaps that limit data-driven policy efforts. The policy does not reference sexual and reproductive rights, but instead offers a more narrowly framed conception of family planning as occurring within marriage, lacking any discussion of women’s and girls’ broader agency, choice, and bodily autonomy. The Biden-Harris administration has the opportunity to replace this policy with one that is evidence-based, reflecting the full range of barriers to the achievement of gender equality—and should signal its plans to do so quickly. 

4. Break silos with other areas of gender equality

While the Trump administration emphasized the promotion of women’s economic empowerment, its overall approach to international development set the United States back in advancing gender equality more broadly—in part because women’s economic advancement is so reliant on investments in sexual and reproductive health and rights (SRHR) and other areas of gender equality. The Biden-Harris administration has the opportunity to take a more comprehensive, whole-of-government approach to the promotion of global gender equality. Notably, this should not entail rolling back the priority on advancing women’s economic opportunities—which is critical to overall gender equality and inclusive development—but instead be grounded in rigorous evidence that points to the full range of constraints preventing women and girls from equality in the workforce and wider society.

The announcement of a White House Gender Policy Council is a strong signal reflecting the Biden-Harris administration’s commitment to gender equality—particularly after the Trump administration eliminated the Obama-era White House Council on Women and Girls. The new Council will need to be well-resourced with a clear policy mandate so that commitment to a “whole-of-government approach” does not only live on paper. The Council should be charged with coordinating inter-agency efforts to ensure that all foreign (and domestic) policy considers gender and other forms of inequality—including international assistance, trade, and migration policy. In doing so, the Council should prioritize support for women’s organizations, continued emphasis on gender parity and broader diversity in future political appointments and personnel, and multilateral cooperation to advance gender equality, including through the United States’ participation in the upcoming Generation Equality Forum.