The politics and policies of the United States—the largest bilateral family planning donor—have outsized worldwide impacts.
The U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which ruled that there is no U.S. constitutional right to abortion, will have ripple effects around the world, according to the International Center for Research on Women’s (ICRW) policy brief, “U.S. Foreign Policy Implications of Overturning Roe v. Wade.” While Dobbs did not change existing U.S. foreign policy regarding abortion, the brief argues that it will embolden anti-abortion movements abroad, contribute to global stigmatization of abortion, cause confusion for policy implementation and open the door for new restrictions—all of which will negatively impact the health, economic resources and well-being of women throughout the world.
Dobbs is a reminder that current U.S. foreign aid restrictions “are not aligned with best health care practices nor consistent with human rights and bodily autonomy principles.”
The primary restriction, the Helms Amendment, prohibits the use of U.S. foreign assistance to pay for the performance of abortions “as a method of family planning,” but has been over-implemented, ignoring congressionally permitted exceptions.
The global gag rule (GGR), which blocked U.S. global health funding to any organization that provides, counsels, refers or advocates for abortion, was rescinded by the Biden administration in January 2021. But, the enabling legislation remains in the Foreign Assistance Act of 1961. Every Republican president since Reagan has imposed the GGR, making it almost certain to be reimposed, should Democrats lose the White House.
The politics and policies of the United States—the largest bilateral family planning donor—have outsized worldwide impacts. The General Accounting Office (GAO) found that confusion and fear resulting from the Trump administration’s 2017 reimposition and expansion of the GGR contributed to service reduction, including family planning services not prohibited by law. U.S. shifts in policy, including Dobbs, have a chilling effect and deter implementing partners from offering comprehensive services.
It has created global uncertainty over what this means for U.S. foreign policy, where and when abortion services can legally be provided, and what U.S. government partners are able to do.ICRW, “United States’ Foreign Policy Implications of Overturning Roe v. Wade” “
World Health Organization (WHO) guidelines designate abortion care as an essential service, necessary to save women’s lives. According to the WHO, 45 percent of abortions globally are unsafe and about 7 million women per year receive hospital care due to unsafe abortions. So, any reduction in services will harm health outcomes and increase maternal mortality.
The ICRW brief recommends the Biden administration take mitigating actions, including:
- confirming that Dobbs does not impact U.S. global programming on abortion,
- clarifying what is permissible under U.S. law,
- calling for repeal of the Helms Amendment in budget requests, and
- fulfilling all international human rights obligations regarding reproductive rights.
Congress should also act to support family planning expenditures, remove abortion restrictions from funding bills and pass two crucial pieces of legislation, the Abortion is Health Care Everywhere Act and the Global Health, Empowerment and Rights Act.
To launch its brief, ICRW convened women’s health experts to discuss the practical impact of Dobbs. Nelly Munyasia, executive director of Reproductive Health Network in Kenya, said Dobbs will embolden the well-organized anti-reproductive justice movement in Kenya that receives, unlike reproductive rights groups, unrestricted funding. These groups, which often present a religious narrative, instill fear and stigma surrounding abortion, especially at the community level, making healthcare providers fearful about providing care.
Dobbs could also spur backtracking on recent strides, such as the March 2022 Kenyan High Court decision that affirmed a constitutional right to abortion, and negatively impact related areas, such as contraceptive care and HIV prevention.
To counter these impacts, Munyasia encouraged giving women a platform to tell their stories to reduce stigma and educate policymakers, convening grassroots dialogues with political and religious leaders and organizing inter-generational activities to involve a younger demographic. She emphasized that imposing abortion restrictions will only deter safe abortions – unsafe abortions, health complications and suicides will increase.
Dr. Jean-Claude Mulunda, country director for the Democratic Republic of the Congo (DRC) at IPAS, said the DRC government has progressive standard guidelines for abortion care, in line with the Maputo Protocol, but providing comprehensive healthcare is hindered by confusion regarding U.S. aid. Service providers are unclear about permitted activities and need more guidance to help them comply with U.S. laws.
Mulunda further cautioned that Dobbs supports the narrative that abortion is not necessary or important. But abortion should not be linked to politics since it is a woman’s fundamental human right to exercise bodily autonomy. Women in the DRC, especially in areas without electricity and internet, rely on healthcare systems funded by USAID for information and counseling.
Jamille Bigio, senior coordinator for gender equality and women’s empowerment at the U.S. Agency for International Development, confirmed Dobbs would not reduce funding of sexual and reproductive health rights (SRHR) programs nor affect current restrictions, such as the Helms Amendment. She affirmed the Biden administration’s commitment to being a leader on protecting SRHR and investing in programs to improve women’s health outcomes, especially by scaling up local partnerships to ensure that policies are informed by local voices.
Sarah Craven, director of the United Nations Population Fund’s (UNFPA) Washington, D.C., office, pointed to a recent UNFPA report, “Seeing the Unseen,” which found that unintended pregnancies account for half of all pregnancies worldwide, with over 60 percent of unintended pregnancies ending in abortion.
Lack of SRHR access is deadly for women and inconsistency due to changes of political power in the United States causes reengagement difficulties and lost ground. UNFPA relies on strong CSO engagement to ensure the success of its programs and she encouraged lawmakers to listen to local stories, provide unrestricted funding and clarify guidelines.
Panelists echoed the brief’s conclusion that the U.S. government and international actors must do all that they can to stop any domino effects from Dobbs. Taking action now to alleviate any harms and provide clarity regarding U.S. policy will improve women’s health outcomes throughout the world.
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