President Trump signs an executive order in the Oval Office on Jan. 23. Behind him is Chief of Staff Reince Priebus. (Saul Loeb/AFP/Getty Images)

One of President Trump’s first foreign policy decisions is set to affect some of the world’s poorest people: women seeking health services in places such as sub-Saharan Africa and South Asia, where government hospitals are sometimes scarce.

On Monday, the Trump administration announced that it would revive a Reagan-era policy that bans American assistance to organizations that offer abortion services, including counseling and referrals. In practice, experts say, that policy will freeze millions of dollars in funding that has gone to critical health treatment, including HIV testing and neonatal care.

The United States does not fund any abortion services overseas, but many health groups receive American assistance to provide other women’s services, while using different funding sources to provide abortion counseling and procedures. Now, those organizations will have to stop providing abortion services if they want to continue to receive U.S. aid for their other programs. The policy is known as the “global gag rule” because it even restricts references to abortion in counseling sessions.

Organizations such as Planned Parenthood, which receives about $100 million per year from the U.S. Agency for International Development (USAID), have said that they will continue to provide abortion services, foregoing the U.S. funding and closing other programs. But other groups will probably stop providing the services.

“There will definitely be an increase in unmet need, and some women might lose lives because of exposure to unsafe abortions,” said Yilma Melkamu, director for programs at the International Planned Parenthood Federation.


In Kenya, public health experts raised immediate concerns about the new policy. Women here often resort to dangerous methods to end their pregnancies, including drinking battery acid and using wire coat hangers. In parts of rural Kenya, young women have hired local healers to stomp on their stomachs until the pregnancy is deemed over.

“Trump’s policy means even fewer services will be offered,” said Chimaraoke Izugbara, a researcher at the African Population and Health Research Center (APHRC) in Nairobi. “Some women will not be reached, and providers may not be available to offer services. I think we are headed to a major disaster.”

Nearly 8,000 women in Kenya die every year from complications caused by pregnancy and childbirth. At least a fifth of those deaths are caused by self-induced abortions, according to Izugbara.

Groups that oppose abortion celebrated the new U.S. policy. Carol Tobias, president of the National Right to Life Committee, said it would “put an end to taxpayer funding of groups that promote the killing of unborn children in developing nations.”

Most sub-Saharan African countries have restrictive abortion laws. In Kenya, for example, abortion is legal only if a doctor decides there is a “need for emergency treatment.” Private organizations are often the only option for women in search of safe access to abortion.

In some cases, those women were the victims of sexual violence, according to Planned Parenthood, including refugees who were raped. Each year, about 1.6 million women on the continent are treated for complications from unsafe abortions, according to the Guttmacher Institute, a research organization based in New York.

The International Planned Parenthood Federation uses its USAID funding to provide contraceptives in Ethiopia, counseling for HIV/AIDS patients in Kenya and family planning services in Nepal, among other things. Some of those programs will probably be shuttered when the group loses U.S. aid.

In a statement, the group said it “will not support policies which actively restrict or take away an individual’s right to choose.”

A similar policy was implemented under President George W. Bush. Researchers discovered that the policy seemed to lead to “increases in abortion rates in sub-Saharan African countries,” according to a report published in the Bulletin of the World Health Organization in 2011.

“The results were exactly the opposite as the intended effect of the policy,” said Eran Bendavid, one of the researchers and an assistant professor of medicine at Stanford University.

One possible reason for the increase was that the U.S. policy, while aimed at abortion, curtailed the activities of organizations that provided condoms and other birth-control methods, resulting in more unwanted pregnancies, the study said.

Kim Soffen in Washington contributed to this report.