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.