The end of Roe v. Wade

The end of Roe v. Wade: Why it matters for family planning in Africa

On June 25 it became official: the United States (U.S.) Supreme Court overturned the 1973 decision in Roe v. Wade, the landmark case that had established a constitutional right to abortion in the U.S. To make matters worse, this could very well just be the beginning of a broader erosion of sexual and reproductive health and rights (SRHR) in the U.S. One conservative Supreme Court justice already called for reconsidering other previous Supreme Court rulings, such as those establishing the right to use contraception and the right to have a same-sex relationship.

The consequences of the end of Roe v. Wade have been felt across the U.S. immediately. With laws regulating abortion now the purview of individual states, the procedure has already been banned entirely or become heavily restricted in over a dozen states and new restrictions continue to be enacted. Meanwhile, efforts by Democratic lawmakers to enshrine the right to contraception into federal law are blocked by Republican members of Congress.

While the impact of the Supreme Court decision outside of the U.S. has been limited so far, given that the U.S. government is a major funder of international family planning and global health programmes, funding cuts or restrictions are a possibility in the future. What is certain is that the decision has energized the Christian anti-abortion movement in the U.S. – which has close ties with the anti-abortion movement in Africa – and beyond. And in the U.S. as well as in Africa, many in the anti-abortion movement also oppose contraception.

As the activists and movements that oppose abortion and contraception in Africa seek to increase their influence in the wake of the end of Roe v. Wade, it becomes increasingly important to work closely with and support stakeholders across Africa who support family planning and SRHR more broadly – including religious actors and leaders. Ensuring that all Africans can make decisions about the timing and number of their children, access modern contraception, and lead self-determined lives is fundamental to a healthy future for the entire continent.

A major influencer: U.S. contributions to international family planning and global health

The U.S. government is the largest donor to global health overall as well as the single largest bilateral donor for family planning worldwide. The end of Roe v. Wade combined with a possible return of a conservative majority in Congress later this year – and possibly a Republican president in two years – could lead to a significant reduction in overall funding, or a tightening of restrictions for how U.S. multilateral and bilateral funding can be used when it comes to SRHR.

The impact of who holds political power in Washington on family planning and SRHR has already been demonstrated repeatedly with the Mexico City Policy (MCP), which opponents call the Global Gag Rule . Since Ronald Reagan first introduced the MCP in 1984, it has been implemented under every Republican president and lifted under every Democratic president. The rule restricts foreign non-governmental organisations (NGOs) that receive funding from the United States Agency for International Development (USAID) from providing comprehensive reproductive health counselling and services. When the MCP is in effect, foreign NGOs cannot provide information, counselling, or referrals for abortion, offer abortion care, or advocate for safe and legal abortion. Historically, these restrictions applied primarily to recipients of USAID’s family planning funding, but President Trump oversaw a vast expansion (and renaming) of the MCP to apply to all U.S. global health funding. While the declared aim of the MCP is to restrict abortion, it has also had a demonstrated negative impact on family planning services and access to contraceptive care – as we have previously documented in our 2019 study on the international opposition to SRHR.

Given this precedent, it is far from inconceivable that an erosion of SRHR in the U.S. could lead to a parallel erosion of support for SRHR in its foreign policy, particularly in terms of family planning and global health funding. Currently, the U.S. is a critical funder of family planning services in more than 30 countries, the majority of which are in Sub-Saharan Africa. In 2020-2021, the U.S. Congress approved US$607.5 million for international family planning assistance, including $32.5 million for the United Nations Population Fund (UNFPA). An analysis by Guttmacher Institute shows the impact of these funds: in one year alone, this level of funding helped avert 12 million unintended pregnancies and 19,000 maternal deaths.

As a multilateral funder, the U.S. is also a significant contributor to the World Health Organization (US$700 million in 2020-2021), which strongly supports access to safe abortion as a matter of essential health care and human rights.

In all, the U.S. government plays a critical role in funding global health and global development. On the face of it, abortion may appear to be just one minor aspect of these efforts, but the history of the MCP and the current erosion of abortion rights within the U.S. paints a different picture. Both in U.S. domestic and foreign policy, experts expect comprehensive SRHR – including access to modern contraceptive methods, some of which are already under attack by conservative U.S. politicians – as an essential component of global health and development, to increasingly come under fire. Government and institutional donors that support SRHR should prepare to close any future funding gaps that may emerge as the U.S. political landscape changes.

Beyond funding: Symbolic fuel for the anti-abortion movement in the U.S. and Africa

A more immediate impact of overturning Roe v. Wade is what the decision signals to anti-abortion activists and movements around the globe: the U.S. does not support reproductive rights. Already, the decision has emboldened anti-abortion movements – which often also oppose contraception – in the U.S. and globally, including in Africa. In Kenya, for example, anti-abortion advocates are celebrating the decision to overturn Roe v. Wade.

There is also a notable connection between anti-abortion movements in the U.S. and Africa. An investigation by openDemocracy found that from 2008–2018, U.S. Christian groups spent over US$54 million in Africa to fight against access to abortion, contraception and comprehensive sexuality education, as well as lesbian, gay, bisexual and transgender (LGBT) rights. In South Africa, where abortion is legal, a conservative Christian group from the U.S. operates 50 so-called “crisis-pregnancy centres,” which spread dangerous misinformation about abortion and contraception. Centres run by the same group in Uganda have been criticised by the country’s top health officials for opposing contraception.

These activities notwithstanding, the trend in Africa – as elsewhere in the world – over the past two decades has been towards making abortion more accessible. Support for family planning and expanding access to modern contraception is also strong among African governments, and is anchored in the African Union’s Roadmap on Harnessing the Demographic Dividend Through Investments in Youth as well as the Extended Maputo Plan of Action on Sexual and Reproductive Health and Rights (2016-2030). Our own recent study on how religious organisations can advance the demographic transition in West Africa found many examples of religious leaders and faith-based organisations that support and promote family planning and gender equality – evidence that many religious actors on the continent support various components of SRHR.

SRHR and Demographic Change in Africa

According to United Nations estimates, the population of Africa will nearly double in the next thirty years. How governments across the continent can provide sufficient hospitals, schools, food, safe drinking water and jobs is one of the most pressing questions of our time (and a question at the heart of our recent studies on social protection systems and leapfrogging in Africa). Yet the reality persists that women in many African countries have more children than they desire. One of the reasons for this is a high level of unmet need for modern contraception. Currently, about 58 million African women of reproductive age have an unmet need for modern contraception because they want to avoid a pregnancy and either use no contraceptive method, or use traditional methods, which are less effective than modern methods. As a result, over 40 percent of pregnancies in Africa each year are unintended. In turn, 40 percent of these unintended pregnancies end in abortion. In total, over 11 million abortions occur in Africa per year, about three quarters of which are unsafe.

Investments to improve SRHR in Africa – from comprehensive sexuality education and high-quality contraceptive care to safe abortion care – don’t just improve individual lives, they are also essential to countries’ sustainable development and demographic transition. Every country around the globe undergoes a process of demographic transition, albeit at different times and speeds. At the beginning of the demographic transition, countries experience a combination of high fertility rates (the average number of children per woman) and mortality rates. When living conditions improve, mortality rates begin to decline. Fertility rates in this phase usually remain unchanged, which temporarily results in high population growth. However, once it becomes clear that more children survive, when education levels and gender equality improve, and people have greater ability to make self-determined decisions about their life, fertility rates decline as well. As a rule, when girls’ and women’s education and socio-economic empowerment increases, they delay marriage and childbearing, and choose to have smaller families.

Africa’s 54 countries are at various stages of the demographic transition. Fertility rates have already fallen significantly in some countries, such as Tunisia and South Africa, where women on average have around two children. Other countries, particularly in West and Central Africa, are still in an earlier stage of demographic transition with high fertility rates and high population growth. In Mali and the Democratic Republic of Congo, for example, women have an average of six children. To ensure that every country in Africa can undergo the demographic transition (and have a shot at achieving a demographic dividend) women across the continent must be able to make self-determined decisions about the timing and number of their children. Many policies can help make this a reality, but expanding SRHR, including comprehensive sexuality education, family planning and a wide range of contraceptive methods, is essential.

The end of Roe v. Wade