Dr Anu Kumar, CEO of the global reproductive justice organisation Ipas, outlines the impact of a global clampdown on abortion

“Unsafe abortion remains a leading cause of maternal mortality, and it is entirely preventable,” says Dr Anu Kumar, CEO of Ipas, an international reproductive justice organisation. “So there is something we can do about it. We know what to do and we know how to do it. We just need to do it.”

But Kumar concedes that the election of Donald Trump as United States (US) President has ushered in a “pretty grave and serious moment” for reproductive rights.

Trump draws significant support from vehemently anti-abortion Christian conservatives and is widely expected to entrench more anti-abortion measures when he assumes office in late January, both in the US and globally – and this is likely to impact on millions of women and girls, and organisations like Ipas and its partners.

Ipas focusses solely on expanding access to abortion and contraception services and works in 23  countries, mainly in sub-Saharan Africa, Asia and Latin America, as well in the US.

Last year, the organisation helped over 640,000 people to get abortions and over 1.5 million to get contraceptives.

 

US domestic impacts

Abortion access in the US has already been curtailed since the national right to abortion was abolished by the Supreme Court in 2022, thanks to conservative Trump appointees to the court.

Since then, 14 US states including Texas have almost totally banned abortion and four others have severely restricted access. Texas has focused its laws on health professionals who perform abortions, introducing lengthy jail terms for them.

This has instilled fear in health professionals to the detriment of patients. Recently, a Texan woman died in childbirth because doctors were too scared to give her a standard procedure after her miscarriage – presumably in case it was misconstrued as an abortion. 

Porsha Ngumezi bled to death because doctors did not give her get a dilation and curettage (D&C) that would have removed pregnancy tissue from her uterus and stopped her haemorrhaging, reports ProPublica. 

In July, a Texan woman was charged with murder for taking abortion pills to end her pregnancy.

“Right after the election, there was a huge increase in sales of medical abortion pills, which is an indicator in the US that women are expecting there to be a crackdown,” notes Kumar, who is based in North Carolina in the US. 

Restrictions on abortion pill mifeprisone

There are a number of different avenues that the future Trump administration can take to limit domestic access to abortion, through the executive, via administrative powers, Congress and the courts.

“One of the most significant paths will be restrictions on the use of mifepristone, one of two drugs that are that is used to provide medical abortions,” says Kumar, adding that 63% of all US abortions are medication abortions. 

Ipas anticipates that the Trump administration will restrict telehealth abortions, while the  Federal Drug Administration (FDA) may remove or restrict access to mifepristone or rescind the licencing of the drug altogether. 

“We could also see the Justice Department enforcing the Comstock Act that has been on the books since 1873, although it hasn’t been enforced in recent decades,” notes Kumar.

This prohibits the mailing and receiving of “obscene materials”, and abortion-related material, devices and pills could be categorised as obscene. 

“That kind of broad interpretation of the Comstock Act could criminalise people for administering surgical or medication abortion pills. And then, of course, there’s the judiciary, which could rule against access to medical abortion pills.”

Global scenarios

But the US also exports its anti-abortion agenda, particularly to countries that receive US aid. Fifty one years ago, the US introduced the Helms Amendment, which prohibits the use of US foreign assistance money for abortion. This is adhered to by Republicans and Democrats.

In 1984, Republican President Ronald Reagan introduced what has become known as the Global Gag Rule, preventing NGOs that receive US funding from using their own funds to provide abortions or referrals, or lobby for abortion law reform. Every Republican administration has implemented this since it was introduced, while Democrats have rescinded it.

“The last time the Trump administration was in power, they expanded the Gag Rule to apply to all global health funding, which impacted about $12 billion,” said Kumar. “Now the threat is that it will be expanded even further, and it could impact programmes from HIV to water and sanitation to research.”

It could also be expanded to apply to US-based NGOs and foreign governments. 

“We don’t know if that will be the case, but if we do see such a drastic expansion, it will have a dramatic impact on not only Ipas’s work, but the work of all of our partners in this sector and beyond.”

Antiretrovials or abortion?

For example, in South Africa, abortion is legal and provided in the public health system. But  the country also receives US funding for HIV through the US President’s Emergency Plan for AIDS Relief (PEPFAR).

So would South Africa need to choose between providing abortion or antiretrovirals?

“It’s hard to walk through what that would look like,” says Kumar. “It’s quite complex. Very likely, the announcement will be made about the Gag Rule on Day One of the Trump administration and we’ll see whether they’re expanding it and, if so, by how much.

“Then the contract language will come out several months later, and in that contract language, we will actually see how they’re intending on enforcing it.”

But the Gag Rule is also likely to also have a chilling effect on countries that may have been considering liberalising abortion access but decide it’s too high a price to pay given the centrality of the issue for the US, she adds.

Global aid is drying up

There aren’t many countries that can step into the breach left by the US withdrawal of funds for sexual and reproductive health (SRH). The Swedish and the Dutch – historically significant SRH funders, are also under more right-wing governments and are pulling back.

Canada remains supportive, but faces its own election in 2025 and conservatives are strengthening in that country too.

“Potentially other governments could step in, although I have to say I don’t have a long list in mind,” says Kumar.

“The world is in some ways, a much worse place than we were during the first Trump administration. We have at least two active wars going in Ukraine and the Middle East that Europe and the rest of the world are extremely worried about. That is taking not just human lives and resources.”

Alternative to Universal Declaration of Human Rights?

The prospect of the US defunding the UN Population Fund (UNFPA) is “almost a given”, says Kumar.

Its withdrawal from the World Health Organization (WHO) is “pretty likely” because of Republicans’ anger about how the WHO handled the COVID-19 pandemic and the pandemic agreement currently being negotiated.

“But the US withdrawal from these UN technical agencies is really about a broader issue,” says Kumar.

The Trump administration and its conservative allies are proposing the anti-abortion Geneva Consensus Declaration as “an alternative view of the Universal Declaration of Human Rights”, says Kumar. 

“This is a framework that undermines the Universal Declaration of Human Rights and imposes a different worldview, and that is actually what they’re after.”

Glimmers of hope?

“One major area of hope is that the sexual, reproductive health and rights movement has actually been extremely successful over the last 30 years,” says Kumar.

“Sixty countries have liberalised their abortion laws. Only four countries have gone backwards, and the United States is one of them.”

The election of a more liberal government in Poland that is making progress to relax its abortion ban “gave me a fair amount of hope that that the right wing fever may be breaking a little bit”, she added. 

The loss of support of Narendra Modi in the Indian election was also promising, says Kumar, as he has had to “form a coalition government and temper some of his anti-democratic tendencies.” 

Money talks and the US has long used it to force through its ambitions, but Kumar also hopes that countries will “make their values clear and resist some of the the bullying that typically takes place with the US government, especially when it comes to pooled funding mechanisms and working in partnership with the US government”. 

“A withdrawal of of some countries from US partnerships in development systems could send a very strong signal that countries don’t share the same values as the US government does,” she adds.

Image Credits: Ipas, Council on Foreign Relations.