On February 26, 2026, three new rules from the U.S. State Department—collectively titled Promoting Human Flourishing in Foreign Assistance—will take effect, imposing sweeping new conditions on organizations receiving U.S. foreign aid.
The rules expand the Mexico City Policy, also known as the Global Gag Rule, which bars U.S. funding for organizations that provide or advocate for abortion services. They also prohibit speech and programming that promote “gender ideology” and restrict diversity, equity, and inclusion (DEI) activities.
A new report by the Williams Institute at the UCLA School of Law finds that the rules will have far-reaching consequences for U.S. and foreign organizations that support the health and human rights of transgender, nonbinary, and intersex people around the world.
The new rules apply to more than $40 billion in non-military foreign assistance. Among other things, they prohibit the provision or promotion of hormonal and surgical gender-affirming care, the use of pronouns that align with a person’s gender identity, public information campaigns encouraging acceptance of gender identity, and sex education materials that include gender identity.
Foreign NGOs and international organizations that receive any U.S. funding must certify that they will not engage in prohibited activities—even if those activities are financed entirely with non-government funds. U.S. organizations may engage in some prohibited activities, but only if they maintain complete physical and financial separation from their U.S. government-funded programs.
“The United States has chosen to withdraw support for LGBTQI+ populations and prohibit advocacy for their protection within the global context,” said lead author Ari Shaw, Senior Fellow and Director of International Programs at the Williams Institute. “These rules arrive precisely when LGBTQI+ people in many parts of the world most need external support and when U.S. engagement could help counter trends toward criminalization and exclusion.”
The new rules could disrupt key areas of LGBTQI+ health and well-being:
- Global health. According to the U.S. State Department, the President’s Emergency Plan for AIDS Relief (PEPFAR) provided preventive services to more than 2.4 million people in 2023, including nearly 800,000 gay and bisexual men and more than 85,000 transgender people. The new rule creates uncertainty about whether providing gender-affirming services or even acknowledging a patient’s gender identity could be deemed “promoting gender ideology.”
- Humanitarian and refugee assistance. The rules prohibit “lobbying or encouraging a foreign government to provide legal status or protections based on gender identity,” which limits advocacy for transgender refugees in countries that criminalize their identities and may increase LGBTQI+ people’s vulnerability to violence and exploitation.
- Reproductive health. Research shows that lesbians, bisexual women, transgender people, and nonbinary people already face significant barriers to reproductive health care, including discrimination from providers and clinical settings built around assumptions of cisgender, heterosexual patients. The new rules further limit the provision or referral of abortion services.
“The compliance burden and legal uncertainty imposed by these new rules may push organizations toward narrower service models that exclude transgender and gender-diverse people entirely,” said co-author Laurel Sprague, Research Director at the Williams Institute. “The risk of making a mistake can be existential for organizations led by and serving LGBTQI+ people, which may deter programming for cisgender LGB populations even where such programming is not clearly prohibited.”