As the world speculates on the implications of a possible Donald Trump return to the White House, much of the focus has been on how this could affect abortion rights in the United States. However, beyond domestic borders, Trump’s policies could significantly impact women’s healthcare and reproductive rights across the globe.

The United States is the largest contributor to global health aid, disbursing $15.8 billion in 2022. This dwarfs the contributions of other major donors like Germany ($4.4 billion) and the UK ($2 billion). For many countries dependent on this funding, any cuts or restrictions could have life-altering consequences, especially in terms of sexual and reproductive health services.

The Return of the Global Gag Rule?

In Trump’s first term, his administration reinstated and expanded the Mexico City Policy, also known as the Global Gag Rule. This policy was instituted by President Reagan in 1984, prohibiting any US funding to organizations that perform, promote, or counsel for abortion services regardless of whether American funds are directly used for such services.

Policies such as these have been abandoned in the past by Democratic presidents and re-established by Republicans. Trump transcended all his predecessors, however. His rule even extended non-family planning programs such as HIV/AIDS programs, sanitation, and other health related services and was more ambitious. This further increases the scope of funding from all affected programs, which was about $600 million under Bush to about 12 billion dollars under trump.

A Devastating Impact on Women’s Health

Research consistently shows that the global gag rule harms women’s health, particularly in low-income countries. When Trump reinstated the policy, organizations worldwide faced funding cuts that forced them to shut down essential services.

For example, in Kenya, clinics providing sexual and reproductive healthcare, including services for pregnant women and children, had to close their doors. Stocks of contraceptives dwindled, and access to family planning advice became scarce. In Uganda, organizations that worked to prevent deaths from unsafe abortions stopped their programs out of fear that they might inadvertently violate the vague definitions of "abortion services."

MSI Reproductive Choices, a global reproductive health charity, reported a 17% funding cut in 2017 because it refused to comply with the gag rule. As a result, abortion rates in some regions surged by up to 40%. Tragically, many of these abortions were unsafe, contributing to an increase in maternal mortality. According to data, the death rate for unsafe abortions is 200 per 100,000 procedures, compared to just 1 per 100,000 for safe abortions.

The Ripple Effects on Public Health

The global gag rule also disrupts other critical health services. Clinics that integrate family planning with HIV testing, cancer screening, and maternal care often find themselves unable to operate effectively when their funding is restricted. The consequences of such disruptions can be severe:

• Higher Unintended Pregnancy Rates: With reduced access to contraceptives, more women face unplanned pregnancies, increasing their vulnerability to unsafe abortions.

• HIV Prevention Setbacks: A 2022 study found that in countries heavily reliant on U.S. aid, the reinstatement of the global gag rule led to an additional 90,000 new HIV infections annually.

• Maternal and Child Health Decline: A lack of funding often forces clinics to scale back services for pregnant women, infants, and children, leading to higher maternal and infant mortality rates.

The Case of Nepal

Nepal, where abortion is legal and enshrined in the 2018 Safe Motherhood and Reproductive Health Rights Act, illustrates how the global gag rule affects even countries with progressive reproductive health policies. The U.S. is the largest donor to Nepal’s health sector, contributing over 60% of its aid for family planning and reproductive health under President Biden.

During Trump’s presidency, Nepal saw a sharp decline in contraceptive availability, leading to increased unintended pregnancies. Organizations involved in abortion services were sidelined from government health discussions, as officials feared jeopardizing U.S. aid. Despite Nepal’s legal framework, the restrictions undermined access to essential healthcare.

A Policy That Backfires

Ironically, the global gag rule often produces the opposite of its intended effects. By cutting funding for safe abortion services, it pushes more women toward unregulated and dangerous procedures. A review of global data estimated that an additional 30,000 maternal and child deaths occur annually when the policy is in place.

“When these kinds of restrictions are in place, the number of abortions increases, and much of that increase happens in unregulated, dangerous settings,” one analysis found. Moreover, the gag rule compromises efforts to integrate sexual and reproductive health with broader public health initiatives, weakening healthcare systems overall.

What Needs to Happen Now?

If Trump reintroduces the global gag rule, it will likely dismantle decades of progress in global health and women’s rights. Other donors, especially in Europe, must step in to fill the funding gap. During Trump’s first term, countries like the UK and Germany increased their aid contributions to counteract the effects of U.S. policy. This time, a more coordinated and sustained effort is needed.

Safeguarding women’s healthcare requires more than temporary measures. Long-term commitments from global donors are crucial to prevent the closure of vital services and protect women from the dangerous consequences of unsafe abortions.

The Bigger Picture

The global gag rule is more than just a political decision—it’s a life-or-death issue for millions of women worldwide. As the possibility of Trump’s return looms, the international community must act swiftly to ensure that access to safe abortions, modern contraceptives, and comprehensive health services remains available to those who need them most.

If nothing is done, the repercussions will be devastating. For many women, these policies represent not just a loss of healthcare but also a loss of autonomy and safety. The stakes could not be higher.