In Epworth, a settlement on the outskirts of Harare, Zimbabwe, 19-year-old Sithulisiwe Moyo embodies the struggle many young women face in accessing reproductive health services. Carrying her infant daughter, Moyo waited two hours for birth-control pills at an outreach clinic — her best chance at avoiding another unplanned pregnancy and achieving her dream of returning to school.
However, this vital service, funded by the U.S. government, is under threat due to the potential reinstatement of the global gag rule by president-elect Donald Trump. This policy, which prohibits U.S. foreign aid from being used to perform abortions or provide abortion-related information, has far-reaching implications for women’s health services worldwide.
Understanding the global gag rule
The global gag rule, also known as the Mexico City Policy, has a contentious history spanning over four decades. It has been consistently enacted by Republican presidents and rescinded by Democratic ones. Trump’s administration expanded the rule significantly, resulting in the loss of approximately $600 million in U.S. family planning funds and over $11 billion in global health aid from 2017 to 2018 alone. This funding was crucial for various health initiatives, including malaria and tuberculosis prevention, water and sanitation programs and contraception distribution.
Women’s health advocates, like Pester Siraha, director of Population Services Zimbabwe, express deep concern over the implications of Trump’s victory. The policy mandates that foreign NGOs receiving U.S. funding must cease any abortion-related activities, even if they are funded by other sources. This restriction has led organizations like MSI Reproductive Choices to forgo U.S. funding, resulting in the closure of outreach clinics that serve as the only healthcare option for many in rural areas.
The ripple effect on health services
The repercussions of the gag rule extend beyond Zimbabwe. NGOs in countries such as Uganda, Ghana, Ethiopia, Kenya and South Africa have had to scale back or eliminate services, including clinics, contraception and education programs for vulnerable populations. The Guttmacher Institute reports that these cuts have led to an increase in unplanned pregnancies, unsafe abortions and maternal deaths.
Chinogwenya, a global marketing manager at MSI Reproductive Choices, noted that the organization lost $120 million in donor income during Trump’s first term, which could have provided family planning assistance to 8 million women globally. The consequences of the gag rule are stark: it leads to more unintended pregnancies and ultimately increases the demand for abortions, contradicting the very intent of the policy.
Challenges in recovery
Following Biden’s rescission of the gag rule in 2021, organizations like Population Services Zimbabwe received a boost in funding, but the recovery process is slow. Siraha emphasizes that it takes a minimum of five years to rebuild the impact lost during the gag rule’s enforcement. If the policy is reinstated, an estimated 1.3 million women in Zimbabwe could lose access to essential care, leading to an additional 461,000 unintended pregnancies and 1,400 maternal deaths.
Forced choices and the fight for rights
In light of these challenges, MSI Reproductive Choices is actively lobbying for abortion rights and seeking alternative funding sources. Chinogwenya asserts that while Trump’s reelection may embolden anti-choice movements, the fight for women’s reproductive rights remains nonnegotiable. However, many NGOs face difficult decisions about whether to compromise their principles to secure funding, especially in countries where abortion is legal but stigmatized.
As women like Engeline Mukanya, a mother of three, navigate the complexities of family planning on limited incomes, the need for accessible reproductive health services becomes increasingly urgent. Mukanya, who earns $100 a month, relies on outreach clinics for affordable birth control options, as private providers charge exorbitant fees.
The need for change
The long lines at clinics in Epworth serve as a stark reminder of the dire need for family planning services in impoverished communities. Women like Mukanya and Moyo simply seek the freedom to space their births and make informed choices about their futures. As the political landscape shifts, the fight for reproductive rights and access to healthcare remains critical, not just in Zimbabwe but globally.
In a world where politics can dictate access to essential health services, it is imperative to advocate for policies that prioritize women’s health and autonomy. The future of countless women depends on it.
