Why Trump’s next presidency poses a new threat to women’s health

Immediately after the news of Donald Trump’s second election win, postal orders of abortion pills spiked across the US. Planned Parenthood, the country’s biggest provider of reproductive health services, saw an eightfold increase in appointments for long-acting contraceptive devices known as IUDs.

The prospect of another Trump presidency appears to have prompted a fear among many Americans that their access to abortion and contraception may soon be drastically reduced. But the issue stretches beyond US borders. Around the world, hundreds of millions of women who had no say in Trump’s election could lose vital health services because of his decisions.

During his last term, Trump acted to restrict reproductive rights at home while making decisions that led to the closing of clinics abroad. In countries receiving US aid, progress stalled in efforts to increase uptake of contraception and reduce complications and deaths from unsafe abortion.

This time, he has already nominated an anti-abortion UN ambassador in Elise Stefanik and a health secretary, Robert F Kennedy Jr, whose views on a major issue – in his case vaccines – jar against the scientific evidence.

Another figure who could be in line for a new job is Valerie Huber, who spent two decades campaigning for ineffective abstinence education before being appointed to Trump’s last administration as a senior adviser. While there, she made sweeping changes that led to nearly a million fewer people gaining access to federal family planning programmes.

Last month, the Bureau of Investigative Journalism (TBIJ) revealed that she has been laying the groundwork to influence reproductive health services in several countries around the world. She has particularly focused on those which already have fragile reproductive and sexual rights.

Huber has spent the last couple of years meeting African officials and politicians in nine countries, from Burkina Faso to Uganda. She has also signed a secretive agreement with the Ugandan government to implement a women’s health project.

Huber told TBIJ that the project, called Protego, drew on “science-based concepts”. But given her stance on reproductive rights, it has caused concern for charities working in the area. She is already in talks with other countries with a view to rolling it out further.

After Trump’s election, Huber said that she was “[looking] forward to working alongside his administration” on women’s health around the world.

Global Gag Rule

Central to Trump’s global influence on women’s health is a policy called the Global Gag Rule, brought in by every Republican president and repealed by every Democrat since its introduction. It says that any organisation receiving US aid money must agree not to perform or promote abortion. Research has linked the rule to a fall in contraception use and, ironically, a rise in abortions.

The idea that “you can somehow treat abortions as if it is not part of a set of services” is not realistic, says Elizabeth Sully, a senior research scientist at the Guttmacher Institute, a reproductive rights charity that promotes access to safe abortion services. “It doesn’t meet people’s needs.

“What does that mean for women’s lives […] when they're being forced to carry a pregnancy that they wanted to avoid by using contraception?” she adds.

When her organisation looked at the effect of the Global Gag Rule in Uganda and Ethiopia, she said, it found reductions in family planning services and access to long-acting contraception, especially in mobile clinics serving more remote areas. She expects the pattern to be the same across all countries receiving US aid.

“[The gag rule] is stagnating progress and that is going to have implications in the longer run too on unwanted pregnancies … and unsafe abortions.”

Last time Trump was in office, he expanded the rule so it applied to aid used to fund any health service, not just family planning. It’s expected that a version of this will be repeated this time – and that it may be taken further still.

Indications can perhaps be found within Project 2025, a 900-page document drawn up by the ultra-conservative think tank the Heritage Foundation that sets out a vision for the next conservative administration. Though Trump distanced himself from it during the election campaign, he has already nominated several of its contributors – including Brendan Carr, for a role relating to the section he wrote.

Also named among the document’s contributors is Huber, whose long-held beliefs appear to be reflected in a chapter that states the next administration should remove all references to “gender equality”, “abortion” and “sexual and reproductive rights” from foreign aid policies, contracts and grants.

It also proposes expanding the gag rule to all foreign aid and removing certain exemptions, including one for humanitarian assistance.

This means organisations funded by US aid and offering vital help – for example around gender-based violence – might need to pledge not to provide or promote abortions, or face losing money.

“We're talking now about this policy being applied in some extremely fragile and vulnerable contexts where there is high levels of sexual violence and a need for access to abortion care really critically,” Sully says.

Project 2025 also recommends the next White House builds on a non-binding international agreement called the Geneva Consensus Declaration – also co-authored by Huber – which states there is “no international right” to abortion.

According to Gillian Kane, director of global policy at the reproductive rights charity Ipas, “Huber has basically written her new job description into the [Project 2025] document”.

“We can anticipate she will use her government influence to push an anti-abortion, anti-LGBTI, anti-gender agenda on a global scale.”

Buky Williams, a sexual and reproductive health and rights lead at Ugandan-based feminist organisation Akina Mama wa Afrika, said: “With Trump back in power, Protego and Huber’s influence will be legitimised by the US government and its resources.

“The reach and impact of their agenda will now be a US foreign policy agenda. And that gives us a lot of reasons to be worried.”