Who pays?

The Mexico City Policy is about “who pays” rather than reducing abortion numbers. Despite emotive protestations about the likely harmful effects of this policy, we find that the global abortion business at MSI-RC continues to grow. As President Trump reinstates this policy, we should follow suit and stop using our taxes to fund overseas abortion.

You might be interested in a quick skim of my November 2020 post which discusses the background to the Mexico City Policy.[i] And this one written in June 2021 which discusses the use of UK taxes to fund MSI-RC and others who provide abortions overseas.

In a study published April 2024, The Guttmacher Institute states that the implementation of the Mexico City Policy (MCP) (though they refer to this as the global gag rule) by President Trump in his first term, 2017 to 2020, “was the greatest expansion of the policy in its history.” It is a fact that the Trump administration applied the MCP restrictions to not just ~$600 million of contraception funding but much more widely to ~$12 billion of global health funding. Guttmacher claims that its research revealed significant harmful impact including,  “decreases in contraceptive services, clinic closures, discontinued mobile outreach services, loss of service integration, fractured partnerships and referral networks, and a weakened advocacy environment.” [ii]

In 2017, MSI-RC refused to sign the MCP. In a briefing, press release, and an opinion piece recently published in the BMJ, it claims, that as a result of not agreeing to the terms of the MCP, it lost $120 million of funding over the four years of Trump’s first administration. These funds, it says, would have enabled provision of services to eight million women, preventing unintended pregnancies, unsafe abortions, and maternal deaths. MSI-RC continues to use similar emotive claims about the likely impact from President Trump’s second implementation of MCP.[iii] [iv] [v]

However, a close review of the data published by MSI-RC in its Annual Report and Financial Statements shows a different picture. Like all large businesses, MSI-RC sets itself annual targets and measures its performance using a set of key performance indicators (KPIs), some of which are shown in the following table.[vi] [vii]

Before addressing these data, I want to note my acceptance and understanding that due to the MCP and subsequent reduction in funding from USAID, a few programmes will have been closed down earlier than previously planned. But, that said, I still do not agree with the wild claims of overall harmful impact.

Clearly Covid-19 had an impact on service delivery in 2020, and perhaps on into 2021. However, we can see from its own data, that MSI-RC provided one million more abortions in 2019 than it did in 2016, the year before President Trump’s inauguration and his signing of the Mexico City Policy. These data show that MSI-RC served seven million more women with contraception during President Trump’s first term, rather than a decline of eight million as it recently claimed in the BMJ. Its total services delivery, as measured using CYPs,[viii] was 13% higher in 2019 than it was in 2016.

There is no significant change in the annual value of grants received by MSI-RC in the years 2016 to 2019. Some movements are to be expected, as programmes move from start-up through steady-state to wind-down and finish; often payment is linked to service delivery. In his 2020 annual statement, Simon Cooke (CEO) says “grant income showed a decrease to £152.3 million from £160.4 million, in part due to average increased strength of the GBP throughout the year and in part due to reduced activity under COVID-19 affecting performance related grant income.” Overall, annual financial performance has been steady, with a small improvement in MSI-RC’s reserves.

The table includes a sample of the many donors supporting MSI-RC; it shows the annual decline in funds received from USAID, a direct impact of MSI-RC refusing to sign its agreement to the Mexico City Policy. However, it is interesting to note how other governments stepped in to make up this gap, see e.g., new funds from Canada and from the WISH programme funded by the UK Government, significant increases from Germany (KFW), Norway and Sweden, and new monies from Uganda.

We can see the significant increase in annual funding from Foundations set up by rich individuals; the large anonymous donor continues to grant more than £20 million per year, more or less the same as previously received from USAID.[ix] Using profits from his hedge fund, Sir Chris Hohn’s Children’s Investment Fund Foundation (CIFF) in the UK has become a valued donor, more than tripling its annual contribution since 2016.[x]

This an important trend, one that we need to pay careful attention to because it shows Cooke can operate MSI-RC without government, tax-payer funded grants. In his 2023 statement he says: “In 2023, over 50% of our donor income came from private giving and 50% from government donors, compared to 25% and 75% five years ago. We have also grown the income generated through our social business activities and are doing all we can to maximise the value of every £1 we spend on our programming.”

The loss of USAID funding in 2017 and the 2021 reduction in the UK’s overall commitment to foreign aid from 0.7% of national income to 0.5%, have been triggers for this change.[xi] I hope the reader can see that the cessation of tax-payer government funding does not have to impact on the services delivered. Regardless of any personal view about the rights or wrongs of abortion, we can see that even Cooke realises that he can get by without relying on government funding.

In his above statement, Cooke points to an improvement in operational efficiency. In 2016, 12,357 staff delivered 32.7 million CYPs and in 2023, 8,830 staff delivered 44.5 million; that’s almost a doubling in staff efficiency, so doing more with less, cutting out slack and reducing waste. I’m sure that such improvements are well received by private sector donors.

In a recent press release, MSI’s “unequivocal” message to Donald Trump is: “we will never sign the global gag rule.” [xii]

Fine. The loss of USAID will have no lasting impact on MSI-RC’s business, and indeed the Executive team there needs to stop running after U.S. government funding, should stop building programmes around this and stick to Foundation funding. Many of us here in the UK are hoping that our government might follow where Trump leads but that seems unlikely, as recently confirmed by Lord Collins of Highbury, “The UK government is proud to defend and promote universal and comprehensive sexual and reproductive health and rights (SRHR), including safe abortion. In the face of increasing anti-SRHR activism we will harness UK political leadership and strategic funding to elevate the voices of those most marginalised in the global south, convene and coordinate likeminded and non-traditional partners and protect SRHR from rollback at both global and national levels.” [xiii]

I don’t agree with the use of my taxes and our government’s foreign aid being used to support MSI-RC’s abortion services overseas. I think that if we want to support women’s reproductive health, then surely we can find other NGOs and programmes that do so e.g., those advocating for and delivering maternity care improvements.

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[i] Duffy, K. (2025, January 26). Your taxes are funding abortion on-demand overseas. Percuity. https://percuity.blog/2020/11/30/your-taxes-are-funding-abortion-on-demand-overseas/

[ii] Skuster, P., Sully, E. A., & Friedrich-Karnik, A. (2024). Evidence for ending the global gag rule: a multiyear study in two countries. https://doi.org/10.1363/2024.300502

[iii] Migration, C. (2023, December 5). Briefing: Impact of the Global GAG Rule on frontline Reproductive Healthcare. MSI Reproductive Choices. https://www.msichoices.org/latest/the-impact-of-the-global-gag-rule-on-frontline-reproductive-healthcare/

[iv] Jardine, O. (2025, January 28). Standing strong in the face of US anti-abortion policies. MSI Reproductive Choices. https://www.msichoices.org/latest/standing-strong-in-the-face-of-us-anti-abortion-policies/

[v] Sekimpi, C. (2025). Trump’s global gag rule on abortion care will damage women’s health, rights, and futures. BMJ, r173. https://doi.org/10.1136/bmj.r173

[vi] Riach, E. (2024, July 15). Annual Report & Financial Statements 2023. MSI Reproductive Choices. https://www.msichoices.org/latest/annual-report-financial-statements-2023/

The above is the latest published annual report, others can be found online including e.g., the 2021 report: https://www.msichoices.org/wp-content/uploads/2023/10/msi-annual-report-2021.pdf and that from 2016: https://www.msichoices.org/wp-content/uploads/2023/10/17_pd9781_ms_ar_revised_spread_lr.pdf

[vii] MSI REPRODUCTIVE CHOICES – Charity 265543. (n.d.). prd-ds-register-of-charities.charitycommission.gov.uk. https://register-of-charities.charitycommission.gov.uk/en/charity-search/-/charity-details/265543/accounts-and-annual-returns

[viii] Jardine, O. (2024, December 3). What is a CYP? MSI Reproductive Choices. https://www.msichoices.org/latest/what-is-a-cyp/

[ix] Duffy, K. (2024, March 25). MSI-RC anonymous donor funds. Percuity. https://percuity.blog/2024/03/20/msi-rc-anonymous-donor-funds/

[x] Ciff. (2024, July 25). CIFF: Children’s Investment Fund Foundation. https://ciff.org/

[xi] Duffy, K. (2025, January 30). Do not use my taxes to pay for abortion overseas. Percuity. https://percuity.blog/2021/06/09/do-not-use-my-taxes-to-pay-for-abortion-overseas/

[xii] Riach, E. (2025, January 27). MSI’s ‘unequivocal’ message to Donald Trump: we will never sign the global gag rule. MSI Reproductive Choices. https://www.msichoices.org/latest/press-release-msis-unequivocal-message-to-donald-trump-we-will-never-sign-the-global-gag-rule/

[xiii] Genito-urinary medicine: Human rights. (2025, January 7). TheyWorkForYou. https://www.theyworkforyou.com/wrans/?id=2025-01-07.HL3785.h&s