EPWORTH, Zimbabwe (AP) — Carrying her youthful daughter, 19-year-old Sithulisiwe Moyo waited two hours to collect birth control pills from a tent set up in a impoverished settlement on the outskirts of Harare, Zimbabwe’s capital.
The outreach clinic in Epworth offers Moyo the best chance of achieving her dream of going back to school. “I’m too young to be a baby machine,” she said. “At least this clinic will help me avoid another pregnancy.”
But the free service, funded by the U.S. government, the world’s largest health donor, may soon no longer be available.
As he did in his first term, US President-elect Donald Trump is likely to invoke the so-called Global Gag Rule in January, a policy that prohibits US foreign aid from being used to perform abortions or provide abortion information. The policy cuts American government funding for services that women around the world rely on to avoid pregnancy or provide relief for their children, as well as for health care that has nothing to do with abortion.
Four decades of constant restrictions
The gag rule has been used by Republican presidents and repealed by Democratic presidents for 40 years. Every Republican president since the mid-1980s has invoked the rule, known as the Mexico City Policy for the city where it was first promulgated.
As one of his first acts as president in 2017, Trump expanded the rule to allow foreign NGOs to benefit from approximately $600 million in U.S. family planning funds and more than $11 billion in U.S. global health assistance between 2017 and 2018 alone were cut off to the US Government Accountability Office, the investigative arm of Congress.
The money – much of it destined for Africa – covered measures such as preventing malaria and tuberculosis, providing water and sanitation, and disseminating health information and contraception, which could also have an impact on HIV prevention.
Women’s health advocates are “uneasy” after Trump’s victory, said Pester Siraha, director of Population Services Zimbabwe, an affiliate of MSI Reproductive Choices, an NGO that supports abortion rights in 36 countries.
The policy requires foreign NGOs that receive U.S. government funding to agree to stop abortion-related activities and also discuss it as a family planning option — even if they employ funds outside the U.S. government for such activities. During Trump’s first term, MSI did not agree to these terms, effectively making the company ineligible for funding from the U.S. government.
Siraha said a blueprint offered to Trump by the conservative-leaning Heritage Foundation in its plan known as Project 2025 suggests the modern administration could enact “a broader global gag rule.”
Even NGOs in countries like Zimbabwe that ban abortions are affected. Population Services Zimbabwe, for example, closed its outreach clinics during Trump’s first term after losing funding due to its association with MSI Reproductive Choices. Such outreach clinics are often the only healthcare option for rural populations who have constrained access to hospitals due to poverty or distance.
“This leaves women with nowhere to turn for help, not even information,” said Whitney Chinogwenya, global marketing manager at MSI Reproductive Choices.
Some NGOs in other African countries such as Uganda, Ghana, Ethiopia, Kenya and South Africa have scaled back services, including clinics, contraception, training and support for state and community health workers, as well as programs for youthful people, sex workers and LGBTIQ+ communities.
Other services have stopped completely. The risk of unplanned pregnancies, unsafe abortions and related deaths has increased in many of the affected countries, according to the US-based Guttmacher Institute, which advocates for abortion rights.
Chinogwenya, the marketing manager for MSI Reproductive Choices, said her organization’s fundraising revenue fell by $120 million during Trump’s first term. The money would have helped 8 million women worldwide with family planning and prevented 6 million unintended pregnancies, 1.8 million unsafe abortions and 20,000 pregnancy-related deaths, she said.
The gag rule policy “leads to more unwanted, unwanted and intolerable pregnancies and therefore an increase in abortions,” said Catriona Macleod, a professor of psychology at Rhodes University in South Africa.
“This legislation does not protect life…it has been called America’s deadly export,” said Macleod, who directs the university’s sexuality and reproduction programs.
Trump’s transition team did not respond to a request for comment from The Associated Press.
Damage is not always basic to repair
President Joe Biden lifted the gag rule in 2021, resulting in Population Services Zimbabwe receiving $9 million, about 50% of its donor funding, from USAID in 2023. “But we have not recovered all the loss we suffered,” said Siraha, the organization’s director.
“It takes at least five years to make a difference. If we then have another five-year gap, that means we wipe out all the gains,” she said.
Her organization estimates that 1.3 million women in Zimbabwe could lose the care they need, leading to an additional 461,000 unintended pregnancies and 1,400 maternal deaths if the gag rule were reinstated.
Cuts in foreign aid budgets by other Western governments would make it harder to find alternative financing, Siraha said.
Forced to make complex decisions
MSI Reproductive Choices advocates with global leaders and alternative funders to fight for abortion rights.
“Trump’s re-election may embolden the anti-choice movement, but the fight for women’s reproductive rights is non-negotiable,” Chinogwenya said.
However, agencies that rely heavily or entirely on U.S. funding may have little choice but to “roll back their abortion access policies” to qualify for funding, said Denise Horn, an international relations and civil society expert at Bryant University in Rhode Island.
In South Africa, where abortion is largely legal, some NGOs, particularly those without alternative funding, have stopped openly discussing abortion as an option or have changed their policies and the information they share publicly, according to an assessment by South Africa’s Rhodes University and the International Women’s Health Coalition, a New York-based NGO.
“Organizations must therefore evaluate what matters most: the non-abortion work they can continue to do or the principle of pro-choice,” reads part of the 2019 assessment report. “Ultimately, these organizations will have to make this difficult decision .”
The long lines of women outside the outreach clinic in the Epworth settlement in Zimbabwe underscore the urgent need for family planning services in destitute communities.
Engeline Mukanya, 30, said she is already struggling to support her three children on the $100 she earns a month braiding women’s hair. Nurses inserted a contraceptive implant into her left arm to protect her from pregnancy for the next five years.
Like many here, she can’t afford private providers who charge $20 to $60.
“It is unfortunate that we are so far from America and yet find ourselves caught in the crossfire of its policies,” she said. “All we want is the freedom to time our births.”
