The Paradox of U.S. Global Reproductive Healthcare Policy
The Paradox of U.S. Global Reproductive Healthcare Policy
By Chris Foran, MD
The U.S. has historically been the single largest benefactor for global health initiatives worldwide. Despite this, the U.S. has long been an unreliable partner in providing comprehensive reproductive healthcare. A second Trump Administration will exacerbate the unreliability of the past and usher in a more direct and regressive hostility toward reproductive healthcare. This hostility animates a political movement that will seek to further limit reproductive healthcare worldwide and overturn the contemporary global health governance consensus that access to safe abortion is a human right.
The damaging U.S. policy toward global reproductive healthcare predates the Trump Administration. In 1973, the U.S. enacted the Helm’s Amendment, which stated that “no foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.” Subsequently, the Siljander Amendment barred the use of U.S. foreign aid to “lobby for or against abortion.” This amendment impaired the ability of healthcare workers to provide comprehensive counseling on reproductive healthcare options. In 1984, the Reagan Administration passed the “Mexico City Policy” (MCP), which reiterated the official U.S. position that abortion was not an acceptable component of family planning and further prevented any U.S. funding from being used by entities that practiced or counseled patients on abortion care. The original MCP applied only to family planning assistance and did not extend to other forms of U.S. global health aid.
In 2017, the first Trump Administration expanded the MCP, renaming it “Protecting Life in Global Health Assistance” (PLGHA). The prohibitions of the PLGHA went far beyond those of the MCP. Entities receiving U.S. global health assistance for any purpose—including family planning or other health projects—were required to agree that they “will not perform or actively promote abortions as a method of family planning or provide financial support to any other organization that conducts such activities.” The policy prohibited U.S.-based NGOs from providing subawards to foreign NGOs unless the foreign NGO also complied with the language of PLGHA. Importantly, to be compliant with PLGHA, awardees or sub-awardees could not use funding from any source, even non-U.S. sources, to “perform or actively promote abortions.” The MCP only threatened financing for family planning initiatives, approximately $600 million. The expanded PLGHA threatened a total loss of financing for awardees, roughly $12 billion, even if that funding was directed at non-abortion related issues such as HIV/AIDS, malaria, tuberculosis, nutrition, or maternal and child health. Estimates suggest that reinstating the MCP and expanding the PLGHA contributed to approximately 108,000 maternal and child deaths and 360,000 new HIV infections from 2017 to 2021.
The stakes of global access to reproductive healthcare are extremely high. Millions of unsafe abortion procedures occur each year, accounting for approximately 13% of maternal deaths worldwide. In abortion-restricted nations, as many as 75% of abortions are considered unsafe by the World Health Organization (WHO), compared to only 10% in countries with more permissive abortion laws. The WHO, the UN Human Rights Committee, the European Court of Human Rights, the Inter-American Court of Human Rights, and the African Commission on Human and Peoples’ Rights all recognize access to safe abortion care as a human right .
Supporters of abortion restrictions often cite concern for the lives of mothers and babies. However, their moral assertions are undercut by the fact that restrictive abortion laws do not reduce the number of abortions that occur worldwide. On the contrary, over the last 30 years, nations that expanded access to reproductive healthcare, including abortion services, experienced a decrease in the rates of abortion and improvements in maternal survival, while abortion rates have increased in countries with more restrictive laws.
On January 24, 2025, Secretary of State Marco Rubio suspended all U.S. foreign aid—including most global health funding—with few exceptions. This directly halts an estimated $600 million in family planning aid, which, in part, would provide nearly 48 million women worldwide with modern contraceptive care. For supporters of abortion restrictions, contraceptive care is a logical investment, as the rate of induced abortion for unintended pregnancy is double that of intended pregnancy. If this funding is not reinstated, this could result in millions of unintended pregnancies and thousands of preventable maternal deaths. The Guttmacher Institute estimates that for every $10 million in funding for family planning lost, 56,000 more unsafe abortions occur, and 300 additional women are at risk for maternal death.
As some funding is re-awarded, global health practitioners should anticipate that PLGHA mandates may soon extend to non-abortion-related global health programs. It is reasonable to predict that all recipients of future global health funding will need to agree to more extensive and binding language that sharply limits association with any project that promotes sexual or reproductive healthcare.
The Geneva Consensus Declaration is a harbinger of the Trump Administration’s intention to reverse the growing consensus that access to safe abortion care is a human right. This non-binding U.S.-led manifesto, signed by 34 nations in December 2020, states that “in no case should abortion be promoted as a method of family planning” and “there is no international right to abortion.” Such rhetoric is intended to shield the U.S. and its “like-minded partners” from accountability for rejecting contemporary medical and ethical standards. The Trump Administration will continue to pressure NGOs and global health governance organizations to expunge language declaring abortion care a human right. Global health practitioners should prepare for the possibility that future U.S. global health aid—reproductive or otherwise—may be contingent on signing the Geneva Consensus Declaration.
Comprehensive reproductive healthcare, including access to safe abortion care, is a human right. The political movement within the U.S. seeking to restrict foreign aid writ large and explicitly targeting reproductive healthcare will achieve outcomes directly contrary to its purported aims: more unintended pregnancies, higher rates of abortion, higher incidence of unsafe abortion, and more unnecessary maternal deaths.
The opinions expressed in this commentary are solely those of the author in his private capacity as a student at the Seton Hall University School of Diplomacy and do not in any way represent the views of the United States Navy or any other United States government entity.
Chris Foran, MD, is an M.S. Candidate in International Affairs specializing in Global Health at the Seton Hall School of Diplomacy and International Relations. He is also the former Senior Associate Editor of the Journal of Diplomacy and International Relations. He is a practicing physician and Fellow of the American College of Surgeons.
