Mexico City policy may be associated with higher rates of maternal and child mortality and HIV incidence


Restricting U.S. foreign assistance to nongovernmental organizations (NGOs) that provide information or access to abortion-related services in developing countries can have adverse effects on maternal and infant mortality and incidence rates of HIV on the same scale as an ongoing civil conflict.

In an article published on PNAS, Kerim Can Kavakli (Bocconi University, Milan) and Valentina Rotondi (SUPSI and University of Oxford) study the effects of the so-called Mexico City Policy (MCP). Since its inception in 1985, the MCP has withdrawn US federal funding from NGOs that provide abortion information or access around the world. “The MCP is applied and rescinded along partisan lines. It is one of the first policies implemented or pursued by every Republican president and lifted by every Democratic president, usually within the first week of a new administration” , Kavakli and Rotondi said.

Previous studies have analyzed abortion rates under MCP and found that when MCP is in place, the number of pregnancies and abortions increases. Kavakli and Rotondi study the link between MCP and a wide range of health outcomes.

Using national-level data from 134 countries between 1990 and 2015, Kavakli and Rotondi find that MCP is associated with higher rates of maternal mortality, infant mortality and HIV incidence. Furthermore, the effects are amplified by reliance on US aid and mitigated by aid from non-US donors, whose support is unaffected by the MCP.

For a subsample of 38 countries (population over 900 million) heavily dependent on US aid, the effects imply between 1 and 4% increase in maternal and infant mortality rates and incidence of HIV. “Such numbers are comparable to the effect of an ongoing civil conflict in a country,” Rotondi said.

In absolute numbers, the estimates imply that restoring the MCP between 2017 and 2021 increased the number of maternal and child deaths in these 38 countries by around 27,000 per year and a total of 108,000 over the four-year period, and the number of new HIV infections of about 90,000 per year and 360,000 over the four years.

The authors supplement these findings by using individual data from 30 low- and middle-income countries to better understand the mechanisms that lead to these adverse effects.

They find that MCP disrupts the provision of family planning services in affected countries and is therefore associated with much less direct access by women to in-person family planning programs and in-person AIDS information.

Additionally, when the MCP is in place, women are less likely to report using modern contraceptive methods, and pregnant women are more likely to report that their pregnancy is unwanted. Newborns are less likely to be tested for HIV as part of antenatal care, and their mothers are less likely to receive medical support from professional health personnel after delivery.

We conclude that by restricting access to family planning programs, MCP makes it more difficult for people to obtain sexual and reproductive health information and support, leading to increased maternal and infant mortality as well as than the incidence of HIV worldwide.“, said the authors.


Journal reference:

Kavakli, KC, et al. (2022) US Foreign Aid Restrictions, Maternal and Child Health: Evidence from “Mexico City Politics”. PNAS.


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