In his first week in office, President Biden issued an executive order repealing a contentious ban on U.S. funding for organizations abroad that perform abortions or offer information about them — aid restrictions that President Donald Trump had reimposed and expanded.

But the executive order was just a first step toward deeper changes to U.S. foreign assistance that abortion rights advocates have long sought, and now see a path to achieving, with both houses of Congress and the presidency under Democratic control.

On Tuesday, Rep. Jan Schakowsky (D-Ill.) introduced the Abortion is Health Care Everywhere Act to repeal the 1973 Helms Amendment, which restricts U.S. foreign assistance for health-care providers offering certain abortion services and, its critics say, has come to be applied broadly, as a total ban on abortion funding.

Schakowsky’s proposed change to the U.S. Foreign Assistance Act would replace the Helms Amendment with language explicitly stating that U.S. funding can be used to provide comprehensive abortion services. The United States is the largest single donor to health-care programs worldwide.

“This is a moment when people are really concerned about women’s rights, women’s autonomy and controlling their own bodies,” Schakowsky said.

“The United States is back as a diplomatic force throughout the world,” she added, and repealing the Helms Amendment is “a way to show solidarity with women around the world.”

The Helms Amendment

The Helms Amendment — named for its antiabortion sponsor, the late senator Jesse Helms (R-N.C.), and enacted in 1976 — bars U.S. assistance from going to foreign organizations that provide abortions as part of family planning services.

It is distinct but related to the “global gag rule,” often called the Mexico City policy after the place where it was drafted in 1985, which Democratic presidents have repeatedly repealed, as Biden did, and Republican presidents have reenacted.

Although the gag rule is more restrictive on paper, the Helms Amendment has had its own “chilling effect” by deterring aid recipients from providing any abortion services for fear of violating U.S. requirements, said Anu Kumar, the president of Ipas, an international organization focused on safe abortion and access to contraception.

U.S. funding for abortions in the case of rape, incest or a threat to a mother’s life would, in theory, still be allowed, according to the legislation. In practice, however, the United States has not offered clarity for providers around these gray areas, leading recipients to stop offering safe abortion services across the board, Kumar said.

Other major health-care donors, including Britain, Canada, Denmark, Norway and Sweden, “don’t isolate abortion and stigmatize abortion in their foreign policy or their foreign aid,” she said. But because Washington is the world’s biggest such donor, it has “essentially bullied those other donors into complying with the Helms Amendment” when countries pool together aid funding, Kumar said.

A recent study by the Washington, D.C.-based Guttmacher Institute, which supports abortion and reproductive rights, found that repeal of the Helms Amendment could lead to 19 million fewer unsafe abortions and 17,000 fewer maternal deaths annually. The study was limited to countries where abortion is legal on some grounds and where the United States backs family planning programs, which means the actual rates probably would be higher, Kumar said.

The Guttmacher Institute calculated that maternal deaths related to abortion would be reduced by 98 percent in those countries, and 12 million fewer women a year would require medical care for abortion-related complications.

The United States, Kumar said, is “indirectly contributing” to maternal deaths “that are occurring needlessly.” These restrictions have had a racialized effect, she said, as “the people that are most impacted by the Helms amendment are Black and Brown communities living thousands of miles away.”

Reproductive rights as foreign policy

Supporters of the Helms Amendment say U.S. taxpayer money should not go to abortion providers in other countries. The Trump administration courted like-minded thinkers both in the United States and abroad, aligning Washington with an increasingly shrinking group of countries opposed to liberalizing abortion rights.

Under Biden, abortion rights advocates are hoping not only to roll back Trump-era restrictions, but to put in place legal changes to prevent their return, ending the whiplash cycle of oscillating policies as Republicans and Democrats trade power.

Before Biden issued the executive order repealing the global gag rule, Ipas and other organizations lobbied the administration to issue a similar order for the Helms Amendment, which it did not. On Monday, International Women’s Day, Biden issued an executive order creating a Gender Policy Council, intended in part to advance gender equality in domestic and foreign policy.

The administration, however, has yet to endorse Schakowsky’s bill and the Global Health, Empowerment and Rights Act, which would prevent future presidents from unilaterally reinstating the Mexico City policy, introduced the day of Biden’s executive order. Vice President Harris, in her former role as a senator from California, was a co-sponsor of the Global HER Act when it was previously introduced in 2019.

The White House did not respond to a request for comment on the proposed legislation. A source familiar with the administration’s thinking said it is reviewing policy options on an ongoing basis.

Schakowsky and others have called on Biden to issue a “clean presidential budget” that “removes any harmful abortion provisions” as a way to sidestep aspects of the Helms Amendment, she said. Advocates have also asked the administration to issue guidance around the Helms Amendment to ensure that abortion services outside of family planning are still funded in the meantime.

Brian Dixon, vice president for media and government relations at the Population Connection Action Fund, said he was “optimistic” that the Global HER Act, which had previously made it to the Senate, was likely to pass. “New leadership in the Senate offers a chance” for pushing forward the repeal of the Helms Amendment as well, he said, if votes were to fall along party lines, which a filibuster could still disrupt.

In recent decades, nearly 50 countries have liberalized abortion rights, while only a handful have rolled them back. “From a global point of view, it is very clear that we are moving toward a world where everyone who wants safe abortion services can find them,” Kumar said.