In Zimbabwe, 19-year-old Sithulisiwe Moyo, carrying her infant daughter, waits for hours in line at an outreach clinic on the outskirts of Harare. For Moyo, the clinic is a lifeline, offering the only affordable access to birth control in her impoverished community. “I am too young to be a baby-making machine,” she says, expressing her hope of returning to school. However, this vital service, funded by US government aid, could soon be under threat as President-elect Donald Trump is expected to reinstate the controversial “global gag rule” when he takes office in January.
The global gag rule, also known as the Mexico City Policy, prohibits US foreign aid from being used to perform abortions or provide abortion-related information. This policy not only restricts abortion services but also affects a broad range of healthcare services, including family planning, maternal care, and HIV prevention, which many women in developing countries rely on.
For the past 40 years, Republican presidents have invoked the gag rule, while Democratic presidents have sought to reverse it. Trump, in his first term, expanded the policy to the extent that foreign non-governmental organisations (NGOs) lost approximately $600 million in US family planning funds, with more than $11 billion in global health aid being withheld between 2017 and 2018 alone. This funding primarily supported healthcare services in countries across Africa, including efforts to combat malaria, tuberculosis, and HIV, as well as providing clean water and sanitation.
The policy’s effects are particularly felt in African nations, where access to reproductive healthcare services is already limited. NGOs like Population Services Zimbabwe, an affiliate of MSI Reproductive Choices, which supports abortion rights in 36 countries, were forced to close outreach clinics during Trump’s first term after losing US funding. These clinics were often the only healthcare option for rural communities facing long distances and poverty.
Pester Siraha, director of Population Services Zimbabwe, expressed concerns that a more comprehensive version of the gag rule may be implemented under Trump’s second term, following a blueprint outlined by the conservative Heritage Foundation in its “Project 2025.” This could further limit access to critical healthcare, including family planning services, across the African continent.
Even countries with strict anti-abortion laws, like Zimbabwe, were affected by the gag rule. These regulations not only shut down vital outreach services but also led to a significant reduction in the availability of contraception, training, and support for healthcare workers, as well as programs targeting vulnerable groups like young people, sex workers, and LGBTIQ+ communities. The result was a spike in unintended pregnancies, unsafe abortions, and related deaths, according to the Guttmacher Institute, which advocates for reproductive rights.
Whitney Chinogwenya, the global marketing manager for MSI Reproductive Choices, highlighted the devastating impact of the gag rule on the organisation’s ability to provide family planning assistance. During Trump’s first term, MSI lost $120 million in donor income, which would have been used to prevent millions of unintended pregnancies, unsafe abortions, and pregnancy-related deaths globally.
The gag rule has been described as “America’s deadly export” by Catriona Macleod, a professor at Rhodes University in South Africa, who argued that the policy does not protect life but instead contributes to more unsafe abortions and preventable maternal deaths.
When President Joe Biden assumed office in 2021, he rescinded the gag rule, allowing organisations like Population Services Zimbabwe to access crucial funding once more. However, Siraha pointed out that the damage caused by the policy is not easily repaired. “You need a minimum of five years to have an impact. If we then have another gap of five years, it means we are reversing all the gains,” she said. If the gag rule is reinstated, an estimated 1.3 million women in Zimbabwe could lose access to vital healthcare, resulting in 461,000 unintended pregnancies and 1,400 maternal deaths.
More Read
The potential reimposition of the gag rule comes at a time when many Western governments are also cutting back on overseas aid, making it even more difficult for NGOs to secure alternative funding.
In response, MSI Reproductive Choices is lobbying global leaders to protect women’s reproductive rights, with Chinogwenya asserting that the fight for abortion rights is non-negotiable. However, some organisations, especially those relying heavily on US funding, may be forced to adjust their guidelines on abortion in order to qualify for aid.
In South Africa, where abortion is legal, some NGOs have been forced to stop openly discussing abortion as an option or alter the information they share due to the gag rule. This has led to difficult decisions for organisations, as they must balance their pro-choice stance with the need to continue providing essential health services.
For women like Engeline Mukanya, a mother of three in Zimbabwe who earns just $100 a month plaiting hair, the stakes are high. She recently received a birth-control implant to protect her from pregnancy, as she cannot afford the $20 to $60 charged by private providers. Mukanya’s story reflects the deep need for family planning services in impoverished communities, and the looming reimposition of the gag rule threatens to reverse hard-won progress in women’s health.
“It’s unfortunate that we are so far away from America, yet we are being caught in the crossfire of its politics,” Mukanya said. “All we want is the freedom to space our births.”
