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The U.S. continues to attack the reproductive rights of women globally, resulting in unintended pregnancies and unsafe abortions
Dr Banchiamlack Dessalegn is Marie Stopes International’s Regional Director for East and Southern Africa, based in Addis Ababa, Ethiopia.
With the U.S. presidential elections just days away, it is hard to miss the growing efforts of the Trump administration to roll back reproductive rights. From the expanded Global Gag Rule, to Amy Coney Barrett’s supreme court confirmation and last week’s Geneva Consensus Declaration, with the U.S. administration asking countries to sign “that there is no international right to abortion”, the fight for reproductive rights and gender equality is far from over.
At MSI, as a global provider of contraception, safe abortion and post-abortion care, we have seen the consequences of these efforts first-hand, with women’s lives, health and futures put at risk.
Trump not only reinstated but expanded the Global Gag Rule to restrict all recipients and sub-recipients of U.S. global health funding from delivering, providing information on, signposting to, or advocating for abortion care. This has left many organisations with a choice between providing lifesaving services and the organisation’s survival. For MSI, it meant losing $30 million in support from the US government.
American citizens are told that the Global Gag Rule prevents their taxes from being spent on abortion. However, this is already prohibited under the 1973 Helms Amendment. Research from 26 African countries under the George W. Bush administration found that the Global Gag Rule led to a 14% reduction in contraceptive use and a 40% rise in abortions - many of which were likely to be unsafe. As we know, restricting abortion access doesn’t stop women having them, it only makes them less safe.
MSI’s data tells a similar story. Prior to the reinstatement of the Global Gag Rule, U.S. funding supported MSI to deliver information and voluntary family planning services to roughly 2 million women every year. Over Trump’s term, this would have enabled providers to reach an estimated 8 million women, preventing an estimated 6 million unintended pregnancies, 1.8 million unsafe abortions and 20,000 maternal deaths.
Countries in East and Southern Africa, the region I work in, have been particularly hard hit. In Madagascar for example, research from Columbia University found that cuts caused by the Global Gag Rule led to facility closures, stock outs and a drop in contraceptive use, with women unable to access their chosen contraceptive method, and a subsequent rise in unintended pregnancies and unsafe abortions. One woman shared:
“I got pregnant since the [contraceptive] method wasn’t there. Food is already difficult to find, and we weren’t able to buy medicines because there are none in this health centre. The truth is that I didn’t choose to get pregnant; it’s because of the stockout.”
In Nepal, Columbia University found that organisations that had signed the Global Gag Rule were failing to refer women for safe abortion care, even when the life of the woman was at risk, due to fears of losing funding. In Uganda and Senegal, organisations reported having to drop out of policy work addressing unsafe abortion and maternal mortality for the same reason.
U.S. policy is not only restricting access but bolstering those attempting to roll back the international consensus on reproductive rights. Last week, the Trump administration encouraged governments to undermine human rights commitments, asking signatories to sign a document called the Geneva Consensus Declaration. The declaration was signed by 32 countries including Poland, which just moved to ban abortion in almost all cases. Meanwhile, in the U.S. Supreme Court, the current administration has rushed to replace the late justice Ruth Bader Ginsburg, a champion of women's rights, with anti-choice appointee, Amy Coney Barrett.
Over the last four years, women have faced continuous attacks on their reproductive freedom, and while the future of the Global Gag Rule remains uncertain, U.S. policy on abortion continues to impact women around the world.
Despite these attempts, every day in the countries where we work, we see defiance, solidarity and resilience, with advocates, healthcare providers and women themselves refusing to let U.S. policy dictate abortion access. In my region, we have seen huge strides to increase access, through the political commitment and partnership between African Ministries of Health and other governmental and non-governmental partners globally.
Women will always need access to safe abortion care, and now more than ever we need continued support and new partnerships to repair the damage done. At the end of the day, US policy does not just harm access to contraception and safe abortion, but blocks women and girls’ full participation in educational, economic, and political opportunities too.
Whoever wins next week, we cannot abandon long-held commitments to uphold reproductive choice, and all eyes will be on the next president to support women to access the care they need, safely and with dignity.