How the Trump admin's attacks on abortion could devastate health care access globally

When President Donald Trump first took office in 2017, one of the very first executive orders he signed sent shock waves through the international reproductive health space. By reinstating the Global Gag Rule, if global non-governmental organizations received funding from the United States, they were banned from providing or offering information about abortions. Later in his presidency, the Trump administration expanded the rule to apply to all U.S. global health assistance — the amount of money affected by the policy increased from $600 million to about $12 billion.

The ripple effects were greatly felt internationally. Health clinics in Ethiopia for teenagers, once supported by U.S. funding, shut down. An effort to include HIV testing in family planning in Kenya fell apart. In 2021, the Biden administration rescinded the rule, like the Clinton and Obama administrations did previously. But as the world gears up for a second Trump presidency, reproductive rights advocates around the world are preparing for even more severe impacts. Not only do they expect the Global Gag Rule to be reinstated, which has largely been the case under Republican presidents since 1984, but they also expect more expansions to occur. 

“The imposition of the U.S. policy is really driven by an anti-abortion ideology that is designed to both disrupt and coerce other countries' health systems and civil societies into restricting the health and rights of people around the world,” Beth Sully, a principal research scientist at Guttmacher Institute, said at a press conference. “We not only expect to see the incoming administration quickly reinstate the policy, but we're also expecting a potential expansion.”

Indeed, Project 2025 proposes a few expansions to the Global Gag Rule. A couple of notable ones mentioned include applying it to all foreign assistance, not just global health funding, and strengthening how it's enforced. Another suggestion is to block U.S. funding to the United Nations Population Fund (UNFPA), which would affect international efforts to improve access to family planning.

“It also proposes imposing the policy on U.S. organizations, which, if implemented, we would expect to see challenges in the courts as a limitation of their freedom of speech,” Sully said. “In addition, Project 2025 also suggests removing the exemption that has been in place for humanitarian aid thus far, applying the restrictive policy to humanitarian aid.” 

This would have “devastating consequences,” Sully said, as this funding is often being used in places where women experience high levels of gender-based and sexual violence. Previous research has shown that when the U.S. limits abortion care through the Global Gag Rule, it limits people's access to other essential health services around the world. Some studies have found that it can affect public health initiatives in other countries, such as HIV and AIDS programs. “The GGR’s development and implementation was consistently associated with poor impacts on health systems’ function and outcomes,” researchers concluded in 2019. 

As detailed by Guttmacher Institue, the first Trump administration’s Global Gag Rule expansions had “devastating” impacts. It decreased access to abortion and contraceptive care globally. It also created a “chilling” effect among clinicians who were scared to share family-planning resources due to a fear of it affecting funding— even in countries with progressive policies on abortion. 

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Dr. Carole Sekimpi, senior Africa director of MSI Reproductive Choices, said at the press conference that they are expecting one in three women of the 690 women of reproductive age living in countries that receive U.S. funding to be unable to access reproductive health and rights as a result of the next Trump administration’s anticipated Global Gag Rule. 

“We understand that the Gag Rule will not only affect abortion access, but it will strip women of contraception, and other methods of health care too,” Sekimpi said. “Like cervical cancer and HIV screening, which are usually provided in tandem with abortion and other forms of reproductive health care.”

Dr. Jean-Claude Mulunda, Ipas Democratic Republic of Congo director, said the influence of the Global Gag Rule is deeply felt on the ground in the DRC, weakening the entire health system.

“Support from the U.S. government is supposed to improve the resilience of the health system and prepare the system to provide to the community support that they need, especially the services that are most needed in a humanitarian setting,” Mulunda said. “Unfortunately, all the clinics and hospitals that are supported by the U.S. government funds are not allowed to provide information, they’re not allowed to provide abortion care.”

This especially harms young women who are victims of rape, incest and child marriage, he said. 

How soon this could happen after Inauguration Day remains unclear. There are reports that Trump plans to sign 100 executive orders on his first day in office. While there are other priorities for the incoming president, like immigration, reproductive rights advocates are anticipating the reinstatement of the Global Gag Rule as there are a number of anti-abortion events being organized in Washington D.C. in January.

“I think we anticipate at least the Gag Rule being signed before those events later in the week, so I think it will be early,” Sully said. “There is the executive order, and then there's the guidance that is issued and how that is being implemented.”

Meanwhile, the anticipation is already being felt on the ground today. 

“I just heard from our office in Nepal, that they have already lost a partner on a project because of their anticipation,” Dr. Anu Kumar, president and CEO of Ipas, said. “I think in Trump 2, the fear factor is much higher.”