Policy Implementation Versus Revocation: A Qualitative Exploration of Policy Change Communication between the U.S. Government and Global Health Implementing Partners in Malawi, Mozambique and Zimbabwe Public
Switzer, Margaret (Spring 2022)
Abstract
Context: The Global Gag Rule (GGR), also known as the Mexico City Policy (MCP), is a United States-based foreign policy that, when implemented, prohibits foreign nongovernmental organizations (NGOs) that receive certain categories of U.S. foreign assistance funds from providing or advocating for abortion, or counsel on or refer clients for abortion services as a method of family planning. Since 1984, this policy has been repeatedly enacted by Republican presidents and revoked by Democratic presidents. In 2017, former President Trump implemented an expanded version of the policy, renamed Protecting Life in Global Health Assistance (PLGHA). On January 28, 2021, President Biden revoked PLGHA via presidential memorandum.
Objective: To analyze the communication patterns of Trump’s PLGHA and Biden’s 2021 revocation from the perspectives of NGOs from three countries, and the associated implications for sustainable global health programming.
Methods: This study utilized 41 in-depth interviews with representatives from global health implementing partners in Malawi, Mozambique and Zimbabwe. Participants were recruited via purposive and snowball sampling. Interviews were conducted virtually via Zoom, recorded, and transcribed verbatim. Thematic analysis was conducted using MAXQDA.
Results: The implementation of PLGHA in 2017 was accompanied by more consistent communication from the U.S. government and prime partners, as compared to its revocation in 2021. This lack of comprehensive information and guidance on the proper implementation of the revocation of the GGR placed uncertainty on study participants. Due to uncertainties about what was permissible under current restrictions and fears of the policy being reinstituted by a future U.S. president, global health partners experienced unsteadiness moving forward with their programs and funding decisions in the wake of PLGHA’s revocation.
Discussion: The United States, through its reneging of the GGR every 4-8 years, has caused negative impacts on NGOs’ abilities to effectively implement global health programs, especially in sexual and reproductive health and rights (SRHR). If this policy remains as is, to be implemented and revoked by Republican and Democratic presidents, then U.S. implementing agencies and global health prime partners are responsible for providing more comprehensive guidance and communication about the policy to NGOs to ensure complete and accurate implementation.
Table of Contents
Table of Contents
Acronym List
Chapter 1: Introduction………………………………………………………………………...1
Introduction and Rationale
Problem Statement
Research Question
Purpose Statement
Significance Statement
Definition of Terms
Chapter 2: Literature Review…………………………………………………………………...8
Background Information on GGR/MCP/PLGHA
Explanation of International Global Health Partners
Implementation of PLGHA by former President Trump
Recent Revocation of PLGHA under President Biden
Chapter 3: Methods…………………………………………………………………………….29
Introduction
Research Partnership & Team Roles
Population and Sample
Interview Procedures
Data Collection Instruments
Data Analysis
Ethical Considerations
Chapter 4: Limitations and Delimitations…………………………………………………….36
Chapter 5: Results………………………………………………………………………………37
Communication of PLGHA
Communication of the Revocation of PLGHA
Communications from U.S. Government Agencies
Communications from INGO Headquarters
Communications from Prime Partners to Sub-Primes
Communications from Civil Society Organizations
Communications from Mass Media Channels
Comparison of Communications Between 2017 and 2021
PLGHA Monitoring, Compliance or Guidance Mechanisms
Monitoring & Compliance of 2021 Revocation
Impact of Frequent Policy Changes
Chapter 6: Discussion…………………………………………………………………………..60
Implications & Recommendations
Policymakers/Legislators
Advocates & Civil Society
International Non-Governmental Organizations (INGOs)
Recommendations for Future Action
Appendix………………………………………………………………………………………...67
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