Our Vision

Healthcare is a human right. Abortion care and gender-affirming care are healthcare. Reproductive justice as defined by Sister Song (the largest national multi-ethnic reproductive justice collective) means bodily autonomy—the right to have children, not have children, and parent in safe communities.1 Gag rules strip those right away.

What Are Abortion Access Gag Rules?

Abortion access gag rules silence healthcare providers and block clinics from giving patients complete information about abortion at the risk of losing their funding. There are two major gag rules in U.S. policy: 

The Global Gag Rule (GGR)

The Global Gag Rule (GGR) bars organizations receiving U.S. foreign aid from providing abortion services, counseling patients about abortion, or advocating to change abortion laws—even with their own money.2 This has been supercharged to bar support for trans people and Diversity, Equity and Inclusion (DEI) – more on that below!

The Domestic Gag Rule (DGR)

The Domestic Gag Rule (DGR) targets Title X, the only federal family planning program. It forces clinics to choose: Stop offering abortion referrals and separate entirely from abortion providers, or lose funding for contraception, cancer screenings, STI testing, and HIV services.3

Where Are We Now?

  • The Trump administration reinstated the GGR in 2025.4  In January 2026, the administration massively expanded the GGR. For the first time, the rule covers all non-military U.S. foreign aid, including humanitarian, education, food, and HIV services.5 
  • It now applies to U.S.-based non-governmental organizations (NGOs), the United Nations, and international organizations—not just foreign groups.6
  • The expansion includes new ‘gender ideology’ rules which ban grantees from providing gender-affirming care, using correct names/pronouns, or including trans and nonbinary people in materials—even if the grantee is using non-U.S. money.7 It also prohibits grantees for support for DEI efforts.8

Impact on People Living with HIV: The expanded GGR restricts funding to HIV programs and organizations that serve transgender communities. Without access to medication, people living with HIV abroad will die. You can learn about this impact by viewing Bernard Mwololo, an HIV survivor activist’s story. 

  • Trump’s first-term DGR (2019) cut the Title X network in half. Patients served dropped from 3.9 million to 1.5 million. Six states lost all Title X providers.9 Although the DGR was rescinded in 2021, Trump is still devastating the Title X program in his second term.
  • Since its inception, Title X has been one of the few federal programs that people impacted most by HIV could receive access to comprehensive reproductive healthcare, like contraception. The Trump administration is proposing rules that would threaten access to contraception, erode standards of care, and remove guardrails that protect the program from ideologically driven organizations, such as crisis pregnancy centers.10
  • In March 2025, the administration froze Title X funding for 16 grantees (including all Planned Parenthood affiliates) across 23 states. Seven states now have zero Title X providers.11 51 Planned Parenthood health centers closed in 2025; 75% were in rural or medically underserved areas.12
  • Title X funding has been flat at $286.5 million/year since 2015—far below the $737 million needed. The House’s FY2027 budget proposes zero Title X funding.13


Impact on People Living with HIV: Title X clinics are a critical access point for HIV testing and linkage to HIV and reproductive care. The 2019 DGR caused nearly 70,000 fewer HIV tests at Title X clinics and a decrease in new diagnoses, meaning fewer people learned their status in time for treatment.14 The communities Title X serves most—Black and Latine people, LGBTQ+ people, and those in rural areas—are the same communities hit hardest by HIV.15 

What Can Be Done? 

  1. Pass Congressional Review Act resolutions that overturn the 2026 GGR expansion, including the anti-LGBTQ+ and anti-DEI restrictions.
  2. Pass the Global Health, Empowerment and Rights (HER) Act to permanently repeal the GGR by barring the U.S. from placing healthcare restrictions on foreign NGOs as a condition of receiving U.S. aid.16
  3. Fully fund the Title X program and reject any anti-abortion, anti-trans, and anti-DEI funding conditions that let ideologically driven programs replace qualified providers. 
  4. Pass the Expanding Access to Family Planning Act, which would guarantee annual funding for Title X for 10 years and ensure patients have factual information about their pregnancy-related options, including abortion care.17
  1. Fund state family planning programs to fill Title X gaps. 
  2. Pass shield laws protecting providers and patients, including telehealth medication abortion and gender-affirming care providers. These laws can, e.g., block cooperation with out-of-state investigations into legally protected healthcare, restrict out-of-state subpoenas for health data, and/or ban geofencing around health facilities for advertising or health-status inference. 
  3. Enact state right-to-contraception laws. Fifteen states, most recently Virginia18, plus D.C. already have them. 
  4. Protect reproductive health data collected by tech companies and tracking apps from law enforcement inquiries. For example, Washington’s My Health, My Data Act protects personal health data collected by non-HIPPA entities, like websites and mobile apps.19

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Resources

Special Thanks To Our Contributors!

  • Bee (Brandi) Velasquez
  • LaDawn Tate
  • Melanie A. Reese
  • Kneeshe Parkinson
  • Valerie Pinkston
  • Brooke Davidoff
  • Alyssa Crawford

And a huge shout out to our past intern Treasure Welle for writing our updated factsheets!

1: SisterSong, “Reproductive Justice,” accessed August 11, 2026, https://www.sistersong.net/reproductive-justice. (sistersong.net)
2: Amy Friedrich-Karnik and Samira Damavandi, “Weaponizing US Foreign Aid: Trump’s New 2026 Global Gag Rule,” Guttmacher Institute, March 16, 2026, https://www.guttmacher.org/2026/03/weaponizing-us-foreign-aid-trumps-new-2026-global-gag-rule
3: Ruth Dawson, “Trump Administration’s Domestic Gag Rule Has Slashed the Title X Network’s Capacity by Half,” Guttmacher Institute, February 5, 2020, https://www.guttmacher.org/article/2020/02/trump-administrations-domestic-gag-rule-has-slashed-title-x-networks-capacity-half.
4: Ibis Reproductive Health, “Four Days into Second Trump Administration, the Global Gag Rule Is Back,” Ibis Reproductive Health, January 2025, https://www.ibisreproductivehealth.org/news/four-days-second-trump-administration-global-gag-rule-is-back
5: Ibis Reproductive Health, “Four Days into Second Trump Administration, the Global Gag Rule Is Back,” Ibis Reproductive Health, January 2025, https://www.ibisreproductivehealth.org/news/four-days-second-trump-administration-global-gag-rule-is-back
6: Ibid
7: Williams Institute at UCLA School of Law, “New, Expanded Foreign Aid Restrictions Target Transgender, Nonbinary, and Intersex People Globally,” press release, February 25, 2026, https://williamsinstitute.law.ucla.edu/press/global-gag-rule-press-release/.
8: Amy Friedrich-Karnik and Samira Damavandi, Weaponizing US Foreign Aid: Trump’s New 2026 Global Gag Rule, March 2026, https://www.guttmacher.org/2026/03/weaponizing-us-foreign-aid-trumps-new-2026-global-gag-rule.
9: Ruth Dawson, “Trump Administration’s Domestic Gag Rule Has Slashed the Title X Network’s Capacity by Half,” Guttmacher Institute, February 5, 2020, https://www.guttmacher.org/article/2020/02/trump-administrations-domestic-gag-rule-has-slashed-title-x-networks-capacity-half.
10: Amy Friedrich-Karnik and Megan L. Kavanaugh, The Dangerous Unraveling Of The United States’ Family Planning Safety Net, July 14, 2026, https://www.healthaffairs.org/content/forefront/dangerous-unraveling-united-states-family-planning-safety-net.
11: Megan L. Kavanaugh, Nakeisha Blades, Amy Friedrich-Karnik, and Jennifer J. Frost, “Trump Administration’s Withholding of Funds Could Impact 30% of Title X Patients,” Guttmacher Institute, April 8, 2025, https://www.guttmacher.org/2025/04/trump-administrations-withholding-funds-could-impact-30-percent-title-x-patients.
12: Planned Parenthood Federation of America and Planned Parenthood Action Fund, “Planned Parenthood Federation of America and the Action Fund Release New Report, Fact Sheet Detailing Harm of President Trump’s Attacks on Sexual and Reproductive Health Care in Year One,” press release, January 21, 2026, https://www.plannedparenthoodaction.org/pressroom/planned-parenthood-federation-of-america-and-the-action-fund-release-new-report-fact-sheet-detailing-harm-of-president-trumps-attacks-on-sexual-and-reproductive-health-care-in-year-one.
13: Ibid
14: Jennifer Sherwood, Nathan Roberson, Deborah Stenoien, Elise Lankiewicz, Brian Honermann, and Greg Millett, “Declines in HIV Testing and Diagnoses: A Policy Analysis of the 2019 Title X Federal Regulations on Family Planning Clinics,” Sexual and Reproductive Health Matters 33, no. 1 (2026): Article 2670146, https://doi.org/10.1080/26410397.2026.2670146. 
15: Jeremiah Johnson, Asa Radix, Raniyah Copeland, and Guillermo Chacón, “Building Racial and Gender Equity into a National PrEP Access Program,” Journal of Law, Medicine & Ethics 50, no. S1 (2022): 55–59, https://doi.org/10.1017/jme.2022.37.
16: H.R. 764, Global Health, Empowerment and Rights Act, 119th Cong. (2025), introduced January 28, 2025, https://www.congress.gov/bill/119th-congress/house-bill/764.
17: H.R. 2762, Expanding Access to Family Planning Act, 119th Cong. (2025), introduced April 9, 2025, https://www.congress.gov/bill/119th-congress/house-bill/2762/all-actions.
18: Reproductive Freedom for All, “Reproductive Freedom for All Applauds Governor Spanberger for Signing the Right to Contraception Act,” accessed September 9, 2026, https://reproductivefreedomforall.org/news/reproductive-freedom-for-all-applauds-governor-spanberger-for-signing-the-right-to-contraception-act/. 
19: Washington State Office of the Attorney General, “Protecting Washingtonians’ Personal Health Data and Privacy,” accessed July 30, 2026, https://www.atg.wa.gov/protecting-washingtonians-personal-health-data-and-privacy.