The president’s aid budget cut and restoring the ‘global gag rule’ will see millions more pregnancies and abortions, and thousands more women dying in childbirth

Why Donald Trump is bad for the health of the world – in five charts

When Donald Trump said “America first” back in January, it wasn’t long before he put his money where his mouth was.

America has long been the world’s most generous bilateral funder of healthcare programmes in the developing world. However, the Trump presidency has delivered a triple whammy: cutting aid budgets, defunding the UN Population Fund and reinstating a policy cherished by every Republican president since Reagan aimed at restricting abortion around the world – the so-called global gag rule.

The cumulative consequences over four years look ominous: millions of unintended pregnancies, thousands of unsafe abortions, tens of thousands of lives lost, and hard-won progress against diseases such as HIV and tuberculosis jeopardised.



The following charts display some of the facts in play.

Chart 1

The global gag rule, signed by executive order on 23 January, penalises any aid group that refuses to sever all links anywhere in the world with anyone connected to abortion services, counselling and advice.

More than 60 countries in the developing world benefit from US bilateral healthcare funding.

Some already have stringent abortion laws, allowing for terminations only in cases where the mother’s life is at risk. Others are far more liberal, permitting abortion in cases of rape, incest, foetal abnormality and on request. These countries, represented by blue circles, collectively received more than $3bn from the US in 2016.

But the global gag rule impact is far more messy than simply jeopardising funding to those 30-odd countries. It targets any NGO with a connection, however loose or remote, to abortion. Thus a group providing primary care in any country, whatever its abortion laws, might be forced to forgo US cash if it receives funding from another source to do any work related to abortion.

Chart 2

So how much money is in play? US bilateral healthcare assistance has edged upwards in recent years to more than $10bn.

But according to the Kaiser Family foundation, Trump’s 2018 budget provides for the deepest cuts to global healthcare funding ever. The foundation conducted modelling to assess what impact the cuts might have if Congress approves them. It estimated there would be at least 50,000 additional new HIV cases, at least 7,600 additional new tuberculosis cases, and a decrease in the number of women receiving contraception ranging from 6.5 million to 25 million.

“These estimates are based on one-year budget cuts only; if funding levels remain at the new, reduced level in the subsequent year, the cumulative impact would be doubled,” the foundation said.

Chart 3

So what is the impact of the global gag rule on abortion around the world?

The last time it was in effect, during the eight years of George W Bush’s presidency, from 2001-2008, academics found paradoxical outcomes.

“Our study found robust empirical patterns suggesting that the Mexico City policy is associated with increases in abortion rates in sub-Saharan African countries,” wrote Standford University researchers, led by Eran Bendavid, in 2011.



While they did not speculate why the US policy had this effect, aid groups say defunding family planning programmes will inevitably lead to more unwanted pregnancies – and more unsafe abortions.

Chart 4

Take a country like Uganda. Its population has roughly doubled in the last 20 years, to almost 40 million. Women on average have five children. It is in essence a bellwether for the surge in population in Africa that many consider unsustainable. If Uganda continues growing at this rate, it will rise into the top 20 most populous countries in the world by 2050.

Marie Stopes International (MSI) provides more than half of Uganda’s family planning services. In 2016, the organisation provided an estimated 1.2 million Ugandans with contraceptives, while its work prevented 342,800 unplanned pregnancies and 170,700 unsafe abortions in the country.

But at the end of this month, MSI will lose $20m in US funding because of the global gag rule. There will be more pregnancies, more unsafe abortions, more maternal deaths – and more people.

Chart 5

Last year, Marie Stopes estimated that it prevented more than 240,000 unsafe abortions in Nigeria by helping women control when they get pregnant.

Extrapolate that out through the Trump presidency – and add the other countries where MSI operates – and you start to get a feel for what’s at stake.

MSI says 6.5m unintended pregnancies will now occur that could have been averted had it continued to receive the funding it got under the Obama presidency. Even more strikingly, more than 2m additional abortions – the very thing the Trump White House is seeking to avoid – will take place, many of them unsafe.

Some 22,000 women will die in childbirth as a result, according to MSI. And for those more interested in the bottom line, the overall cost in sickness, death and lost potential is calculated at £265m.