A few weeks ago, in what has become an arms race to limit reproductive freedom in the United States, North Dakota approved the country's most restrictive abortion ban. Days earlier, that repugnant title was held by Arkansas, and who knows what absurd restriction tomorrow will bring.

What US elected officials are doing to reproductive rights in the US is outrageous, but at least we have some recourse as voters and advocates. What US elected officials are doing to the reproductive rights of women in developing countries – through foreign policy that exports our own abortion hang-ups – is reproductive colonialism.

The Helms Amendment was enacted in 1973 and bars US aid recipients from using funds for abortion services, even in countries where it is legal. However, funding can support abortion referrals and even the procedure itself in cases of rape and incest. But it rarely or never does.

The language of the policy is vague and confusing, prohibiting "abortion as a method of family planning" and the "motivation or coercion" of anyone to perform the procedure. The US Agency for International Development (USAID) (and one presidential administration after the next) has continually neglected to provide sufficient guidance on how to implement the policy.

This has left ample room for misinterpretation by aid recipients and USAID staff, which is further fostered by the US' long history of politicising and stigmatising abortion combined with the undue power of a wealthy donor country. The result is that Helms is being implemented as if it were a total abortion ban.

Maternal mortality

Seeds of stigma and censorship have been sewn into already-struggling health systems of poor countries, hampering meagre efforts to address unwieldy maternal mortality rates. It is poor women who suffer, unable to access the safe, legal abortion services they deserve.

It may seem incredible that a hazy global policy would have such stark real-life effects. But US-based reproductive rights groups have been diligently documenting its troubling impact in both Africa and Asia for years. This evidence has helped blow the cover off one of the most pernicious and most neglected US foreign policies.

Reproductive rights groups have raised the alarm, continuing to push the Obama administration to issue clarifying guidelines. Last year, 12 members of US Congress publicly called on President Obama to even reviewthe policy – the first time it would have received such close attention in decades.

Most recently, the European Parliament issued an open letter to President Obama on the negligence of Helms. Through its careless implementation (as effectively a total abortion ban), they rightly point out, the US is in direct violation of international humanitarian and rights agreements.

This includes the Geneva Conventions, which ensure the right to safe abortion for women and girls raped during times of conflict, and the Paris Declaration on Aid Effectiveness, which obligates donor countries to support the priorities and strategies articulated by developing country aid recipients.

For most such countries, reducing the number of women dying from pregnancy- and childbirth-related causes is a priority. Unsafe abortion persists in epidemic proportions as a leading, yet preventable, cause of maternal death. Ensuring safe access to this procedure is a critical strategy for reducing deaths – it is basically that simple.

Ideally, the Helms Amendment should be repealed. It is archaic and over-reaching, a relic of paternalistic aid that we should have long moved beyond. It was authored by the late Republican Senator Jess Helms, a well-known racist and homophobe, and is shameful as global reproductive health legacy.

But barring repeal, at the very least the policy should be implemented properly. This is not about personal opinion on the morality of abortion, but rather the principles of good, fair and effective foreign policy. Abortion counselling and referral as well as services in cases of rape and incest should be fully funded, and USAID should take active steps to ensure everyone – grantees, employees and government officials – knows this is so.

Reproductive rights

For many developing country governments, abortion is not a political bugaboo so much as a public health issue requiring urgent attention. Who are we as donors to stand in their way? As human beings, women deserve the right to access health services and control their bodies and fertility. Who is anybody to stand in their way?

As the Obama administration espouses such values as "reproductive rights are human rights", strives toput women at the centre of our foreign policy agenda and unveils global health initiatives aimed at funding harmonisation and developing country ownership, shouldn't they also be honest about the skeleton in our closet?

If the Helms Amendment directly affected the lives of male US policymakers, we would have seen immediate action to address missteps years ago. Instead, Helms disproportionately affects the lives of impoverished women thousands of miles away. The onus has been on global reproductive rights advocates to help bring these distant realities to bear in up-close ways, and they have delivered on that.

Yet there has been no official or definitive action by the Obama administration on Helms yet, nor any public indication that such action is imminent. Perhaps the wheels are in motion, but they are moving far too slowly. Each day that this policy persists misapplied is one more day that the US tacitly contributes to maternal deaths and injuries around the world.

The notion of funding abortion services, whether domestically or globally, is an inordinately sticky issue in the US. Advocates appreciate that. But at a certain point, the value of the lives and rights of women around the world must trump US policymakers' squeamishness about difficult abortion discussions.

In his last term, President Obama can make a crucial mark on US foreign policy history by rectifying four decades of recklessness, and acknowledging the value of women's rights worldwide.