Under Trump, campaigners say, $600m in aid could be ‘cut drastically’, costing maternal lives, as they predict return to anti-abortion stance on health funding

Hundreds of millions of dollars in US aid that helps prevent child and maternal deaths and reduces unintended pregnancies worldwide could be at risk under a Donald Trump administration, campaigners and thinktanks have warned.



Citing “worrisome” indicators, such as Trump’s U-turn against abortion, his pledge to appoint pro-life justices to the Supreme Court and his choice of Mike Pence, an anti-abortion activist, as vice-presidential running mate, they fear a reversal in aid commitments that have seen gains in reproductive health and gender equality.

Suzanne Ehlers, president and CEO of PAI, a global advocacy group for reproductive health, said: “What we know from Trump as a candidate is that international development is not high on his agenda.”

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As the president-elect looks inwards, Ehlers said she is most fearful of the loss of the US’s position as the world’s most generous bilateral donor supporting reproductive health rights – with current funding at $600m (£474m).

“We have a long history of funding, even before President Reagan,” said Ehlers. “Reagan wanted to bring it down to zero. In Trump, we have the kind of president who wouldn’t be afraid of that kind of budget request and Republicans in Congress who would support him in that. Every year Congress has to approve these levels, and that funding can be cut drastically.

“This is not just about opposition to birth control, but about young girls being forced into marriage, about maternal deaths and about child health.”

The $600m includes money to fight against child marriage and gender-based violence. It is unlikely that it would be lost immediately, but over a period of months.

Trump’s views on US foreign aid have been relatively vague; for instance, he said in June that the US should “stop sending aid to countries that hate us and use that money to rebuild our tunnels, roads, bridges and schools”. It is unclear whether, with support in Congress to maintain it, he would make cuts in the foreign aid budget overall. However, where the money would go and what it would fund could shift, to support US trade or the anti-abortion lobby.

If, as campaigners fear, Trump’s vice-president is given leeway on this issue, he could “go for broke”, putting in place stringent anti-reproductive health measures domestically and abroad.

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Pence, who describes himself as an evangelical Catholic, made his name as one of the most anti-abortion members of Congress, and, as Indiana governor, signed every anti-abortion bill on his desk, in addition to an anti-LGBT bill his critics said would allow widescale discrimination. He has argued against condoms and for abstinence as the only way to stay safe from premature pregnancy and STDs.

Serra Sippel, President of the Centre for Health and Gender Equality (Change), which aims to ensure US international policies promote reproductive and sexual health globally, is deeply worried a potential policy shift under the Trump-Pence administration that could have implications far beyond reproductive heath.

“We know that, while Mr Trump has not so much of a track record on this, his vice-president, Mike Pence, is on record as being against abortion, of supporting abstinence and of putting ideology over evidence and science and that’s very scary,” said Sippel.

“We can expect to see US aid [funds] supporting religious groups that promote abstinence and that have an anti-LGBT agenda. That’s frightening, in the context of places like Uganda, which passed an anti-LGBT law. It’s very dangerous for the US to support groups that fuel the fire of anti-LGBT rights – there are lives at risk in those countries.

“We saw this happen during the Bush administration. Because of Mr Pence’s record, we are all worried.”

Sippel also expects what is known as the “global gag rule”, a US health policy that has a chilling effect on reproductive rights, to be re-invoked and to see a withdrawal of US funding – some $32m – from the United Nations Population Fund, as it did under Bush and other anti-family planning administrations.

The policy denies foreign organisations US family planning funding if they provide abortion information, referrals or services, or if they engage in any abortion rights advocacy with their own funds. Projects on the ground are faced with a stark choice – to refuse US funding or to take the funding and to end abortion advice. First introduced by the Reagan administration, it was repealed by President Clinton, reinstated by George Bush and repealed again by President Obama.

“We expect the global gag rule to come back under a Trump president,” said Sippel. “That could happen as early as January. Our colleagues are fearful and worried about what this means for women and girls.”

In 2015 the US gave 27m women ​access to contraceptives and prevented 2m unsafe abortions and 6m unintended pregnancies

The loss of US funding to the UNFPA, if it happens, Sippel said, would also represent a loss of US leadership.



“Having the US government support the UNFPA is a message to the rest of the world that reproductive rights for women and girls matter,” she said.

Analysis by the Guttmacher Institute (GI) found that last year’s US aid budget for family planning gave 27 million women and couples access to contraceptives, prevented more than 2 million unsafe abortions, 6 million unintended pregnancies and helped prevent 11,000 maternal deaths worldwide.

Sneha Barot, a senior policy manager at the GI, said when Congress or the administration has been dominated by social conservatives, they have slashed funds for reproductive health and family planning.

“There is a real fear of this funding being cut,” she said. “Women are the ones who are hurt by these sorts of policies.”

But, among some quarters, there is hope that Trump, who has in the past expressed a pro-choice stance on abortion, may have a change of heart once he is in the White House.

Katja Iversen, president of Women Deliver, a global advocacy group for women and girl’s rights, said: “We hope when Donald Trump goes into the White House he will see things differently than he has in the last while. He will be pressured from within to scale back progress on women’s rights in the US and worldwide but … he has had strong support for family planning and abortion before.”