Women in Malawi are dying in silence from unsafe abortions, says Darlington Hararwa of Malawi. As the founding director of Passion for Women in Children, Hararwa is an outspoken champion of reforming Malawi’s restrictive abortion law. But his advocacy work is about to get more difficult. President Donald Trump reinstated the global gag rule in the first days of his presidency and expanded the restriction to all recipients of U.S. global health funds. Under the global gag rule, recipients of U.S. funds cannot provide abortion services, information, or referrals and are not allowed to advocate for abortion law reform. The impact of Trump’s uniquely restrictive global gag rule on women’s health and rights will be greater than the gag rule in the past. Since President Barack Obama reversed the global gag rule at the beginning of his presidency, health workers, advocates, and governments have made significant progress toward a future where all women can realize the right to safe abortions. The reinstatement of the global gag rule will stall this progress.
The global gag rule—or the Mexico City Policy—was first enacted by President Ronald Reagan in 1984. Ever since, the gag rule has undergone a tug-of-war, with Democratic presidents rescinding the policy and Republicans reinstating it upon taking office. The 1973 Helms Amendment banned the use of U.S. foreign assistance funds for abortion, while the global gag rule dictates what an organization does with its own, non-U.S. funds. Groups that provide abortion services, information, or referrals, or that advocate for abortion law reform, cannot receive funds that are subjected to the global gag rule. The past global gag rules applied to foreign organizations that receive family planning funds provided by the U.S. Agency for International Development (USAID). Trump’s global gag rule expands this restriction to recipients of all American global health assistance—a sixteen-fold increase in the amount of funding covered by the rule.
The United States directs its global health assistance to the poorest regions of the world and where maternal mortality is highest—countries such as Malawi, Rwanda, and Tanzania—where women who cannot safely end their pregnancies lose their lives from unsafe abortions. These health risks are a major cause of maternal death in developing countries, with nearly 22 million women experiencing unsafe abortion per year worldwide. Barriers to safe abortions in these nations include not only restrictive laws and policies, but also a lack of access to information, equipment, drugs, and skilled providers. Women who cannot access safer methods of abortion put their lives and health in danger to end unwanted pregnancies.
Governments in the global south have reformed their abortion laws over the past several decades to reduce unsafe abortions and promote the human rights of women. While nearly every country in the global north liberalized their abortion laws between 1950 and 1985, many southern countries retained the old abortion laws of their former colonizers until recent decades. Champions of women’s health and rights pushed for abortion law reform following the 1994 International Conference on Population and Development, during which 179 countries agreed to address unsafe abortion as a public health concern. Forty nations have since liberalized their abortion laws, including African and Asian countries where the U.S. government invests heavily in global health—most notably in countries like Ethiopia, Kenya, Mozambique, Nepal, Rwanda, and South Africa.
Progress was curtailed by President George W. Bush’s gag rule. For example, health workers in Uganda who treated women suffering complications from unsafe abortions could not talk about the need for abortion law reform. Kenyan and Ethiopian women’s rights advocates could not speak freely in support of women’s rights to abortion. Reproductive health experts in Nepal could not increase access to safe abortion care.
But the harm from Trump’s global gag rule will be more widespread as the landscape for abortion rights and access has shifted since 2001. Because of the recent liberalization in national abortion laws, a much larger number of grantees must forgo their work on abortion. After Bush reinstated the global gag rule, governments in over 30 countries in the global south changed laws and policies meant to make abortion more accessible. Others nations are still undergoing reforms.
Because abortion is legal, an unprecedented number of health workers, community groups, and civil society organizations are providing abortion services, information, and referrals—while others advocate for legal and policy change. For example, abortion access in Nepal has grown quickly since the government amended its abortion law in 2002, in part because of partnerships between diverse actors including the Nepali government, advocacy groups, private partners, and international and local non-governmental organizations (NGOs). The Coalition for the Prevention of Unsafe Abortion—a group of community-based organizations, youth-focused NGOs, traditional leaders, and others—is advocating for reform of Malawi’s restrictive abortion law. In Kenya, reproductive health advocates have pushed for the Ministry of Health to implement safe abortion services following the enactment of a new constitution that expanded women’s right to safe abortion.
Trump’s global gag rule will limit their efforts as some of these groups receive U.S. global health assistance. Health care providers will be forced to stop providing abortion services and information and will stop referring women to other safe providers. Experts and women’s health rights advocates will stop speaking out on the need to reform abortion law and policy. These champions of abortion rights know what happens when a woman with an unwanted pregnancy cannot get a safe abortion; they are fighting for the lives of women in their own countries. As a major funder of global health, the U.S. government is powerful enough to practically silence many of them.
The global community of abortion rights advocates must fight back. Through the She Decides Initiative and similar efforts, funders will support some organizations that lose U.S. funding so they can continue their work on abortion. U.S. grantees and governments in the global south must not go beyond the policy requirements to censor themselves. And those who can speak out against the Trump global gag rule and in favor of abortion rights must do so, more forcefully than ever before.