“The irony and hypocrisy of it is that this is a bone to the self-described ‘pro-life’ movement, but it will result in deaths to women who just want to space their births,” said Dana Hovig, the chief executive of Marie Stopes International. The organization estimates that the result will be at least 157,000 additional unwanted pregnancies per year, leading to 62,000 additional abortions and 660 women dying in childbirth.

That may overstate the impact. Kent Hill, an official of the U.S. aid agency, insists that there will be no increase in pregnancies because the American contraceptives will simply be routed to other aid groups in Africa.

That will work to some degree in big cities. But it’s a fantasy in rural Africa. Over the years, I’ve dropped in on a half-dozen Marie Stopes clinics, and in rural areas there’s typically nothing else for many miles around. Women in the villages simply have no other source of family planning.

“This nearsighted maneuver will have direct and dire consequences,” a group of prominent public health experts in America declared in an open letter, adding that the action “will translate almost immediately into increased maternal death and disability.”

Proponents of the cut-off are not misogynists. They are honestly outraged by forced abortions in China. But why take it out on the most impoverished and voiceless people on earth? Mr. McCain seems to have supported Mr. Bush, mostly out of instinct, and when a reporter asked him this spring whether American aid should finance contraceptives to fight AIDS in Africa, he initially said, “I haven’t thought about it,” and later added, “You’ve stumped me.”

Retrograde decisions on reproductive health are reached in conference rooms in Washington, but I’ve seen how they play out in African villages. A young woman lies in a hut, bleeding to death or swollen by infection, as untrained midwives offer her water or herbs. Her husband and children wait anxiously outside the hut, their faces frozen and perspiring as her groans weaken.

When she dies, her body is bundled in an old blanket and buried in a shallow hole, with brush piled on top to keep wild animals away. Her children sob and shriek and in the ensuing months they often endure neglect and are far more likely to die of hunger or disease.

In some parts of Africa, a woman now has a 1-in-10 risk of dying in childbirth. The idea that U.S. policy may increase that toll is infuriating.