Global health organizations warn of ‘enormous and terrible’ threat to abortion rights if Trump returns

Women’s health providers around the world are bracing for potentially disastrous consequences if Donald Trump wins the US presidential election in November.

Policies implemented during Trump’s last presidency caused “devastating” damage in a number of countries, said Beth Schlachter, a senior director at MSI Reproductive Choices in the US. It meant “clinics closing, health teams closing, women dying … but a second Trump term will be on a different scale”.

Global health organizations lost U.S. funding if they refused to agree not to perform or actively promote abortion under the “global gag rule.” This often meant the closure of facilities that offered broader health services, such as family planning.

Joe Biden lifted the ban in 2021, a week after he was inaugurated as US president, a move celebrated by health organizations around the world. However, right-wing US strategists have laid out detailed plans in their Project 2025 roadmap for a Republican administration to transform the way the US government operates immediately after a Trump victory.

They are pushing for even tighter restrictions on the activities of organizations that receive US funding, the withdrawal of US support for international organizations, and the use of the country’s influence to further restrict access to abortions worldwide.

Schlachter said the industry “needed to understand the implications of Trump’s retaking of the White House.” Trump’s attempts to distance himself from Project 2025 were disingenuous, she suggested. “These are his people, and they’re telling us loud and clear what damage they’re planning to do.”

The global gag rule, which requires organizations that receive U.S. funding for family planning services to agree not to perform or actively promote abortions, has been in place under Republican presidents since Ronald Reagan. The Trump administration went further, however, making that agreement a condition for organizations to receive U.S. funding for global health care in general.

The Project 2025 documents suggest that the next Republican president should go even further and apply the gag rule “to all foreign aid, including humanitarian assistance”. This would affect about $51 billion (£40 billion) of foreign aid at current levels, health policy analysts suggest.

Such an expansion would be “huge and terrible”, said Dr Marleen Temmerman, professor of obstetrics and gynaecology at the Aga Khan University East Africa and former director of reproductive health at the World Health Organization (WHO).

Under Trump’s previous administration, U.S. funding for research into topics such as heart disease and diabetes was jeopardized because abortions for fetal malformations were performed at the university hospital, she said.

Dr Carole Sekimpi, senior Africa director at MSI Reproductive Choices, said the 2017 gag rule was “disastrous for women”.

“It actually increases the number of abortions because there are more and more women with limited access to contraception, limited access to information and therefore a greater chance of unwanted pregnancies, and therefore the need for an abortion,” she said.

The gag rule had a broader deterrent effect, Sekimpi added. “It really makes the opposition stronger. Those who are against rights, against freedom of choice – the hate movement.”

According to Temmerman, organizations should collaborate and possibly outsource reproductive health care work to separate organizations to safeguard their other projects.

According to a United States report, the US is responsible for nearly two-thirds of global funding for the promotion of sexual and reproductive health and rights. report by the German Foundation for World Population (DSW), a family planning charity.

During Trump’s last presidency, MSI saw its annual donor income fall by $30 million – or 17% – after refusing to sign the global gag rule. The charity said this meant 8 million women were left without access to family planning services – resulting in an estimated 6 million unintended pregnancies, 1.8 million unsafe abortions and 20,000 maternal deaths.

The Guttmacher Institute published a study looking at the impact in Uganda and Ethiopia, where global gag regulations were found to have “stalled and even reversed progress toward expanded access to modern contraception.”

In Nepal, MSI worked with the government to expand family planning services, train health workers and set up clinics.

“Everything changed after the election of Donald Trump,” said Tushar Niroula, operations director at MSI Nepal. “The operation had to be gradually shut down.”

The percentage of women of childbearing age in Nepal using modern contraceptives has stagnated, he said. “Disadvantaged populations in hard-to-reach areas are not able to access services. That is the effect of the global gag rule.”

Partner organisations were afraid to refer women to MSI for abortion care, even in cases of rape, incest or when the mother’s life was at risk. These are all exceptions to the global gag rule, the charity said, adding that desperate women often opt for unsafe methods.

“It’s devastating,” Niroula said. “We’ve seen many cases where women have chosen traditional methods of abortion and have had complications, and almost died.”

Documents published by Project 2025 suggest that membership in international organizations such as the UN and WHO should only be seen as “a means to achieving defined goals” and emphasize that withdrawal is an option “when such institutions act against US interests.”

The US should work with a coalition of “like-minded countries” to shape the work of international agencies, building on the anti-abortion Geneva Consensus Declaration signed by the last Trump administration and 33 largely illiberal or authoritarian governments, they suggest. The US withdrew its signature a few months after Trump left office.

Individuals with ties to the last Trump administration and Project 2025 are already working in countries like Guatemala and Uganda to embed policy based on that statement, according to analysis by reproductive rights group Ipas.