As the 2024 US presidential election approaches, the debate over reproductive rights has taken center stage in US politics, spurred by landmark events such as the Supreme Court’s reversal of Roe v. Wade. The decision sparked a wave of community action, legal battles, and electoral mobilization focused on issues such as abortion access, assisted reproductive technology (ART), and maternal health disparities. But the impact of the upcoming election on reproductive rights extends far beyond the borders of the United States. Donald Trump and Kamala Harris offer contrasting visions on reproductive health and rights, and their policy platforms significantly shift U.S. foreign aid, multilateral engagement, and global priorities in this area. It has the potential to change.
Given these stakes, what impact will the 2024 US election have on reproductive health and rights around the world? And how will this shape America’s global engagement?
The politics of U.S. reproductive health support abroad
The United States has a checkered history of involvement in global reproductive health and rights. U.S. foreign aid for family planning, a move motivated by concerns about population growth, particularly in Asia and Africa, first began under the Foreign Assistance Act of 1961. Early programs were criticized for promoting coercive practices and focusing on population control rather than a rights-based approach to reproductive health. However, over the decades, U.S. policy has gradually evolved to emphasize health, education, and gender equality, in line with changing global debates over reproductive politics, population, and development.
At the same time, U.S. foreign aid has always been deeply intertwined with domestic politics, particularly regarding abortion. The Helms Amendment of 1973, passed shortly after Roe v. Wade, set a precedent prohibiting the use of U.S. foreign aid funds for abortion as a means of family planning. President Ronald Reagan’s 1984 Mexico City Policy (also known as the Global Gag Rule) placed additional restrictions on U.S. foreign aid to NGOs that provide or promote abortion as part of their health services. It was prohibited even if it was funded by sources other than the United States. . The Mexico City policy has been a political battleground since its introduction, with subsequent Republican administrations reinstating the policy and Democratic administrations reversing it.
Despite these challenges, the United States remains the world’s largest bilateral donor of family planning and reproductive health. In fiscal year 2023, the United States provided approximately $608 million in foreign assistance, most of which was administered through USAID programs in more than 40 countries, primarily focused on 29 priority countries in Asia and Africa. This funding will support efforts to expand access to contraceptives and address issues such as maternal mortality, child marriage, gender-based violence, and the integration of reproductive health services and HIV/AIDS prevention.
“Protecting lives” under the Trump administration
During his presidency, the Trump administration implemented some of the most restrictive global reproductive health and rights policies in recent history. On January 23, 2017, just days into the Trump administration, President Trump reinstated the Mexico City policy, following the precedent set by his Republican predecessor. But the administration went a step further and introduced the Protection of Life in Global Health Assistance (PLGHA), a broader policy that extends limits to all U.S. global health assistance, not just family planning funds. As a result, the amount of funding subject to these restrictions jumped from about $600 million to more than $7.3 billion. Research into the impact of PLGHA is ongoing, but early findings suggest that the policy is having a negative impact on health care delivery, particularly access to emergency contraception, and that health care providers and women are struggling to maintain reproductive health. It has been suggested that this constrains the ability to make decisions autonomously.
President Trump’s inauguration also marked a major shift in the United States’ approach to multilateral engagement, marking a return to great power conflict, particularly with China and Russia. This withdrawal from multilateralism affected U.S. support for the World Health Organization (WHO) and the United Nations Population Fund (UNFPA), two major UN agencies focused on reproductive health and rights. . Shortly after taking office, the Trump administration withdrew U.S. government funding from UNFPA, accusing it of supporting forced sterilizations and abortions in China. UNFPA quickly denied these claims, insisting that its work “promotes the human right of individuals and couples to make their own decisions without coercion or discrimination.”
Trump’s advocacy for UNFPA reflected the intersection of geopolitics and global reproductive health, but that is not new. In blocking UNFPA funding, President Trump invoked the Kemp-Kasten Amendment. This amendment has been regularly used by Republican administrations since the mid-1980s to restrict funding to UNFPA, even though the United States was one of the countries that supported the establishment of UNFPA in 1969. be. Funding to UNFPA is estimated to have influenced approximately 8% of its budget. Although other donors have stepped in to fill some of the gaps, this decision has affected global reproductive health, particularly in countries where USAID has not expanded family planning and reproductive health coverage, and particularly in the Middle East. had a significant impact on the global environment.
Although President Trump’s stance on domestic reproductive rights, particularly abortion, has been inconsistent, global reproductive health policy is likely to mirror that of previous Republican administrations. If elected in 2024, he will likely reinstate both the Mexico City policy and the Kemp-Kasten Amendment, building on his administration’s previous “Protecting Life in Global Health Assistance” agenda. However, the inauguration of President Trump could mean further setbacks for global reproductive health and rights. For example, the blueprint laid out by Project 2025, which President Trump has distanced himself from, lists the protection of life as one of the “core objectives” of U.S. foreign aid and extends PLGHA to all U.S. foreign aid. By doing so, we are trying to close the perceived “loophole”. Despite strong evidence that women and children in emergencies are often at greater risk of sexual and gender-based violence, unwanted pregnancies, unsafe abortions, and increased maternal risks, humanitarian assistance and gender equality and economic empowerment programs. Reproductive health support is often required in these situations.
Beyond “life-saving” expansions in bilateral aid, President Trump’s second term also included renewed efforts to block funding for UNFPA, consistent with the policies of previous Republican administrations. is likely to escalate the reduction in multilateral engagement. The geopolitics of global reproductive health is already being reflected in Congress, with the recent bill to combat communist China proposing funding limits for U.S. aid to the United Nations Population Fund, a potential It is likely to gain further momentum under President Trump. This strategy reflects a broader conservative agenda that seeks to shape reproductive rights globally by redefining U.S. involvement in global reproductive health and building on multilateral partnerships. prefers more controlled bilateral aid.
Harris and the world’s “reproductive freedom”
Kamala Harris established reproductive freedom as one of the cornerstones of her campaign platform. Harris’ vision of reproductive freedom, which is primarily based on the domestic context in the United States, focuses on abortion rights, and she describes laws that restrict access to abortion as “esoteric” and “immoral.” ” is labeled. However, it also includes conversations about reproductive health, maternal mortality, access to IVF, and affordable child care, framing these issues as interconnected rights under threat. As part of this, she built on her previous work as a senator and co-sponsored a 13-piece bill to reduce rising maternal mortality rates, especially among Black women, through the Black Maternal Health Monnibus Act. I did.
Harris’ exact position on global reproductive health is not yet clear, but her approach will likely reflect key Democratic priorities. If elected, she would likely continue funding UNFPA and rescind the Mexico City policy, as well as the “Protecting Women’s Health at Home and Abroad” memorandum introduced at the start of the Biden-Harris administration. . The memorandum asserts that Trump-era regulations will negatively impact women’s reproductive health, create barriers to bilateral development assistance, and undermine U.S. partnerships in global health efforts against malaria, tuberculosis, and HIV/AIDS. did. As she continues these Biden-era policies, Harris is also likely to increase multilateral engagement. Harris’ first international call as vice president was with WHO Director-General Tedros Adhanom Ghebreyesus, reaffirming the administration’s decision to rejoin the organization. This is consistent with current Democratic legislative efforts in Congress to authorize annual spending on UNFPA’s core functions and programs and ensure consistent support for multilateral reproductive health efforts.
Harris’s focus on domestic reproductive freedom, centered on bodily autonomy, lived experience, and rights-based approaches, has the potential to contribute to the global debate on reproductive health and rights. This is especially true at a time when these issues are facing increasing resistance. However, her position on global reproductive health and rights is not well articulated, especially for people and communities most affected by militarism, climate change, and sexual violence. It is difficult to predict how the administration will address these concerns through foreign aid and multilateral engagement. . Although major changes in U.S. foreign aid policy are unlikely, USAID’s continued focus on “indigenization” aligns with the Harris administration’s broader goals of health equity, care, and reproductive freedom. Community-led reproductive health initiatives could be encouraged.
Looking to the future: What’s at stake?
The 2024 US election will have far-reaching implications for global reproductive health and rights. In particular, three key areas stand out:
Global reproductive policy. This election will focus on how the United States’ domestic reproductive policy shapes its global engagement. Whether you think of it as “protection of life” or “reproductive freedom,” the results will affect how the United States approaches reproductive health and rights globally and, ultimately, communities around the world. It will have a significant impact on whether it affects health equity and justice in society. US foreign aid. The potential return of the Mexico City policy could disrupt USAID’s localization efforts, which seek to build equitable partnerships with local communities. USAID fully supports community-led development, as this policy restriction, if reimposed, could limit the organizations USAID can partner with and challenge its emphasis on community-defined issues. The ability to do so may be shaped. Multilateral engagement. This election will determine whether the United States adopts a more bilateral approach, calls for greater oversight and control over multilateral engagement, or pursues a more traditional approach to the Global Partnership for Reproductive Health and Rights Worldwide. They will decide whether to support a rules-based international order.
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