Bracing for global impact as Roe v. Wade abortion decision overturned

The U.S. Supreme Court effectively revoked the constitutional right to abortion Friday through its ruling on Dobbs v. Jackson Women’s Health Organization, putting the U.S. alongside Poland, El Salvador, and Nicaragua as the only nations to backtrack on or restrict abortion policy in decades — a decision that will reverberate around the world, experts tell Devex.

The ruling may fuel local anti-abortion movements, limit campaigns for abortion access, and complicate the politics around women’s rights, prompting abortion-rights advocates to brace for a wave of repercussions.

“The signal it sends abroad is a big concern,” Nabeeha Kazi Hutchins — the president and CEO at PAI, an organization that advocates for accessible, quality health care and works to advance reproductive rights — told Devex.

The move also counters global trends. Since the 1990s, about 60 countries have expanded laws or policies related to sexual and reproductive health and rights, while three — Poland, El Salvador, and Nicaragua — have gone back on earlier rules regarding abortion, she said. In the past two years, South Korea has decriminalized abortion and several Latin American countries — Argentina, Mexico, and Colombia — have increased abortion access, despite a long history of fierce religious opposition.

With the U.S. advocating for gender equality, human rights, and health care equity, the decision to strike down Roe v. Wade, the landmark 1973 decision granting a constitutional right to abortion, is “in contradiction to the values it is trying to advocate for abroad,” Kazi Hutchins said.

Potential impacts

Reproductive health advocates say the Supreme Court decision could have consequences globally, such as hurting local efforts around expanding sexual and reproductive health and rights, limiting funding, and exacerbating stigma.

This will be seen as a “first step” to “further erode access to abortion, using some of the same tactics,” Alexandra Johns, the executive director of the Asia Pacific Alliance for Sexual and Reproductive Health and Rights, told Devex.

Even in countries where there has been progress — such as Mexico, where its Supreme Court decriminalized abortion — there are concerns that the decision will fuel anti-abortion and anti-women’s rights sentiment and provide a “precedent to reevaluate the steps countries take on restricting or expanding SRHR,” Kazi Hutchins said, referring to sexual and reproductive health and rights.

The effects are already being seen. In Bangladesh, a local organization that works with PAI reported that within 24 hours of the leaked draft opinion last month on Dobbs v. Jackson Women’s Health Organization, groups opposed to the expansion of SRHR were “using this as additional fuel for why access to abortion and SRHR is not something Bangladesh should be moving forward with,” Kazi Hutchins said.

There is also significant concern about how the decision could ramp up stigma associated with abortion, even in countries where it is a right, Shama Karkal, the CEO at Swasti Health Catalyst in India, told Devex. The implementation and understanding of abortion laws is “heavily influenced by social norms,” she added.

The overturning of Roe v. Wade could affect broader legislation across the world as well, said Marcia Soumokil, the Indonesia country director at Ipas, an international NGO that works to increase access to safe abortions and contraception. In Indonesia, it could further galvanize proponents of a family resilience bill that would restrict women’s rights and access to contraceptives and criminalize homosexuality and extramarital affairs, she said at a recent media roundtable.

“When access to abortion is severely restricted in the U.S., it will send signals to the rest of the world governments, in Indonesia and other countries, that abortion rights are not part of human rights,” she added. “Conservative factions in society and government will interpret this change as a declaration that government does not oblige to protect abortion rights.”

While existing U.S. law under the so-called Helms amendment already prohibits the use of U.S. foreign aid funding for abortions, the Supreme Court decision could mean cuts to broader spending on SRHR, comprehensive sex education, and gender-related public health programs, said Johns from the Asia Pacific Alliance.

If there are secondary effects and access to safe abortions is further restricted, the result will not be fewer abortions globally, but just more unsafe and unregulated abortions, which can have serious mental and physical repercussions, several experts told Devex.

This can also be deadly. According to the United Nations Population Fund, 45% of all abortions around the world are unsafe, making them a leading cause of maternal death. “Almost all unsafe abortions currently occur in developing countries,” UNFPA said.

Restricting abortion rights can also be counterproductive. The abortion rate dropped by 43% in the decades between 1990-1995 and 2015-2019 in settings where abortion is broadly legal, excluding China and India, according to a study published in The Lancet. In contrast, the abortion rate increased by about 12% “in countries that highly restrict access to abortion,” the study found.

Forcing women and girls to keep pregnancies will also have negative impacts on poverty reduction and economic growth, experts said.

A challenge for Africa

The U.S. has an oversize influence worldwide, but particularly in Africa, where there is a saying that “if the U.S. sneezes, the whole world gets a cold,” said Pansi Katenga, the director of development at Ipas.

As a result, overturning Roe. v. Wade will cause “great harm,” she said. Ipas country directors from Nigeria, Ethiopia, and the Democratic Republic of Congo, along with Katenga, who is the former Malawi country director, expressed concerns about what the decision will mean for Africans.

In Malawi, advocates have pushed for legislation to expand access to safe abortions when a pregnancy is the result of rape or incest, or if a woman’s health is at risk. If enacted, the bill would save lives, Katenga said, but she added that it has been tabled and withdrawn from debate.

Efforts to pass that legislation could be further stalled due to the U.S. Supreme Court decision, “and women will continue to die,” she said. The groups that succeeded in delaying Malawi’s abortion-rights bill will also be energized by what’s happening in the U.S. and put more pressure on the Malawi government to bury the bill, she said.

Abortion-rights advocates have similar fears about conflict-torn areas in Ethiopia, said Demeke Desta, Ipas’ Ethiopia country director, during the media roundtable.

The Supreme Court decision will “embolden these anti-choice groups and have a strong impact on policymakers and on government itself,” Demeke said, adding that it could lead to a reversal of Ethiopia’s own abortion law.

Anti-abortion advocates in Nigeria were excited by the leaked decision, said Lucky Palmer, Ipas’ Nigeria country director, adding that expects they will use it “as an instrument for them to work to ensure every Nigerian woman is not able to make a choice for her body.”

The overturning of Roe v. Wade will “intensify the power of the anti-choice movement in Nigeria,” according to Palmer, who said that it will “further escalate the maternal mortality rate of women in Nigeria and put more women into poverty.”

Existing tensions

Some experts point to the ramifications that they’ve already seen from U.S. policies as a sign of what could happen going forward.

The impact of U.S. political shifts on other countries is often ignored — but it shouldn’t be, and often the “context is really different,” said Jean-Claude Mulunda, Ipas’ DRC country director.

For example, in DRC, where rape is used as a weapon of war, government efforts to implement laws allowing safe abortions have been hindered by U.S. policy, Mulunda said.

The Helms amendment, passed in 1973 in the wake of the Roe v. Wade decision, prohibits U.S. foreign assistance for abortions as a method of family planning, while the Mexico City Policy goes further and bans foreign NGOs that receive U.S. global health funding from engaging in abortion-related activities, including counseling or education.

The result is that even when the Mexico City Policy — implemented when Republicans are in power and lifted when Democrats take over — is not in place, it has a chilling effect on the adoption of abortion-related policies.

The DRC government recently updated policies related to medical management of rape cases and wanted to include safe abortion, Mulunda said. The U.S. Agency for International Development, which helps fund DRC’s health system, said it would pull support for the Health Ministry if abortion was included in guidelines, he added.

“It’s not allowing women to exercise their right, and choice is legal in DRC,” he said. 

The challenges are acute in humanitarian settings because the U.S. funds most of DRC’s humanitarian response, including health care and medical clinics, Mulunda said. A 14-year-old girl from Goma was denied an abortion after being raped because of U.S. regulations, he added, and she died from an unsafe abortion attempt after failing to find a safe service option.

“The U.S. does fund a lot of our development budgets” in Malawi, Katenga said. “They have influence, have power. Sometimes they don’t even have to say anything.”

When Malawi crafted recent guidelines about pandemic response, several groups wanted to include abortion care, but a second draft didn’t even include SRHR, she said.

“People are scared to annoy USA … because it's not just the health sector, but they are also funding livelihoods and the energy sector,” Katenga said, adding that in a country like Malawi, development assistance makes up a significant chunk of the Treasury’s budget.

Jenny Lei Ravelo contributed reporting.