From “Mexico City” to PLGHA+: A New Compliance Era for Foreign Assistance

November 20, 2025

If you are still receiving U.S. foreign assistance, either as a prime awardee or a sub-awardee, you should be aware of the broad new policy restrictions expected to apply to all non-military foreign assistance by the end of this calendar year.

The Mexico City Policy, first introduced by President Reagan in 1984 at a UN conference in Mexico City, bars foreign NGOs receiving certain U.S. global health funds from performing or promoting abortion. Specifically, this policy prohibited those NGOs “to pay for the performance of abortions as a method of family planning, or to motivate or coerce any person to practice abortions.”

In 2017, the first Trump Administration significantly expanded and rebranded it as the Protecting Life in Global Health Assistance (PLGHA) policy, extending the “global gag rule” beyond family planning to all overseas health funding. Although the Biden Administration rescinded PLGHA—as every Democratic administration has done—the current Trump Administration reinstated it this past January.

Under the PLGHA policy, non-U.S. organizations are prohibited from performing, advocating for, or failing to pledge to oppose abortion with any source of funding if they receive any U.S. government funds. Crucially, the restriction applies not only to NGOs but to any non-U.S. entity accepting any U.S. assistance. This includes universities, civil society groups, for-profit companies, cooperatives, and faith-based organizations. In other words, the policy governs an organization’s conduct with its own independent resources, not just its use of U.S. funds.

A new, expanded iteration of this policy is expected soon and will likely go much further in both scope and substance – i.e., PLGHA+. It is expected to broaden the list of prohibited activities and extend its reach to more types of awards, entities, and sectors.

Emerging Signals and Likely Changes

Recent public reports from POLITICO, The Guardian, Devex, and Reuters indicate that the Trump Administration is working on significantly expanding restrictions on U.S. taxpayer assistance far beyond the abortion-specific limits in the PLGHA policy. Based on multiple credible sources familiar with the process, we understand that several elements reported publicly are likely to appear in the final policy revision.

It is likely that the new policy will be released before the end of 2025. It is also highly likely to apply PLGHA-type restrictions (i.e., restricting certain actions with any source of funding if an organization accepts any U.S. government funding) to all foreign assistance other than military assistance. This would encompass any non-military support, including health, education, economic growth, governance, and humanitarian assistance. It is also very likely that the policy will restrict a wide range of activities beyond those related to abortion, such as activities involving the promotion of diversity, equity, and inclusion (DEI) or so-called “gender ideology.”

Known Unknowns

What remains unclear until the policy is promulgated is the precise scope of applicability in terms of:

• Which types of entities/recipients will be covered;

  
  

• Which types of funding instruments will be affected; and

  
  

• Which specific activities will be prohibited.

It appears likely that the expanded policy will continue to fall most heavily on non-U.S. entities. Historically, PLGHA did not directly apply to U.S.-based organizations due to First Amendment concerns, but U.S. organizations were restricted from providing any of their U.S. government health funding to non-U.S. entities that did not comply with the policy. This administration has certainly not shied away from constitutional challenges, including in defending federal employee removals. As the types of funding and prohibited activities expand, the number of affected organizations will grow, but it is virtually certain that U.S. organizations will at least continue to be required to “flow down” these restrictions to subrecipients and, in effect, police their non-U.S. partners’ compliance.

A major unknown is whether the revised and expanded “gag rule” will apply to U.S. government contracts and subcontracts. In the past, the policy applied only to assistance instruments (grants and cooperative agreements), in part because revising the Federal Acquisition Regulation (FAR) to cover contracts and subcontracts was considered too onerous. However, the current FAR overhaul and the increased use of FAR and agency-level deviations could create a pathway to extend the policy to contracts and subcontracts as yet another expansion.

It seems clear from this administration’s efforts over the past 10 months that the expansion of PLGHA will go beyond abortion, but the final boundaries remain uncertain. An expansive term such as “human flourishing” has reportedly been floated as a shorthand for prohibitions related to DEI, “gender ideology,” and potentially other disfavored policies. The vagueness of such terms makes it difficult to predict the policy’s final scope.

Key questions include:

• Will prohibited DEI policies be limited to those that are actually discriminatory in effect, or will the much broader definitions used in recent Executive Orders and Presidential Memoranda apply?

  
  

• Will any use of terms like “inclusion,” “acceptance,” and “belonging” be implicated, or only those policies that appear to advantage one characteristic or identity over another?

  
  

• How might the “A” in DEIA (accessibility) be treated, if included at all? Will accessibility be confined to certain characteristics (e.g., physical disability), or will it also encompass non-visible, non-physical conditions that might be interpreted as affecting “human flourishing”?

Another key unknown is the scope and language of any required pledges or certifications. It is easy to anticipate some form of anti-DEI/“gender ideology” pledge being layered onto the anti-abortion pledge that has historically accompanied Mexico City/PLGHA health funding. How objectionable or burdensome U.S. government funding recipients find such a pledge will depend entirely on the exact wording.

For example, requiring organizations to certify that they have no internal DEI policies at all (not just with respect to U.S.-funded activities) would depend on how DEI is defined (and whether “A” is included) and could directly conflict with the laws of the countries in which those organizations are registered. If definitions are vague or overly broad, the level of risk accepted—knowingly or not—by organizations signing such a pledge could be significant. Over time, there may be more clarity from implementation, enforcement, and potential litigation, but that clarity may be delayed and uneven.

Finally, there are indications that the administration may attempt to impose the expanded policy on public non-U.S. recipients of assistance, such as other pro-life governments and multilateral institutions (e.g., the United Nations and various international financial institutions). It is also unclear whether the policy will apply to regular assessed dues owed to such bodies. Some like-minded (e.g., more socially conservative) governments may be willing to sign on, but others are likely to resent the diplomatic heavy-handedness of tethering domestic policy and self-governance to U.S. funding conditions. To the extent this administration still seeks to work with multilateral organizations, which remains an open question, applying PLGHA+ to them could become a major stumbling block, or even the final proverbial nail in the coffin of certain relationships, with foreign policy implications for years to come.

Unknown Unknowns

There may also be additional components or variations that emerge between now and the policy’s announcement, and again at the implementation stage. Some elements may be impossible to predict or may evolve in response to political, legal, or diplomatic pressures. What is clear is that organizations working in international development and humanitarian assistance will be left to navigate a complex mix of legal uncertainty, policy ambiguity, and operational risk.

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For a free consultation about how these potential changes may affect your organization, please reach out to Mission Driven Counsel LLP at engage@missiondrivencounsel.com.