Major international women’s health networks, advocacy groups and donors are readying for a battle against the incoming administration of President-elect Donald Trump, which they fear will seek to block support for women’s reproductive rights worldwide.
The exact funding and policy risks for girls and women’s health in developing countries and conflict zones is not yet clear, as Trump’s transition team has not rolled out any specific announcements on how it plans to tackle health abroad, or international development.
But the history of previous Republican administrations offers one of the clearest indications of what might happen when Trump takes office: cuts to the United Nations Population Fund, and restrictions on funding groups internationally that offer or provide information on abortions.
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“It is probably an advantage to have been through it with the [President George W.] Bush administration. We think it will be worse this time, with more attacks on women's rights, on gender equality, on sexual and reproductive rights, because they have done it before and they know what they want,” said Françoise Girard, the president of the International Women’s Health Coalition, which funds women and girls’ health and rights organizations worldwide.
“We are going to be in opposition, obviously, so it is going to be oppose, organize, mobilize … the U.S. has been so core to the U.N., development, all these things.”
The United States is the largest funder for international family planning — contributing more than $607 million in 2016 — and also for global health development assistance overall. Its contributions to global health have remained relatively flat since 2010. U.S. foreign assistance for family planning programs has helped 27 million women and couples receive contraceptives and prevent 6 million unintended pregnancies, according to Guttmacher Institute.
This support, however, has been tenuous under two recent Republican presidencies in the U.S. After initially reducing support to UNFPA, George W. Bush’s administration withdrew all funding for UNFPA one year after taking office in 2001. Bush also reinstated a “Global Gag Rule,” which prohibits assistance to foreign organizations that provides information about abortions or provide the service. Ronald Reagan first instituted the policy in the 1980s.
Trump has wavered on the issue of women’s health and the right to seek a safe abortion. He most recently said that he wants to see Roe v. Wade — the landmark abortion U.S. Supreme Court decision — overturned, and to make abortion a state issue. In the past, he has flip-flopped on defunding Planned Parenthood, and even if he considers himself “pro-choice”.
Vice President-elect Mike Pence, meanwhile, has been consistent in his attacks on reproductive rights and Planned Parenthood.
“We have not heard about their plans on this and as always, we remain optimistic but if we see what has happened with Republican leaders when they take over the Global Gag Rule was instituted within a couple of days and we are very worried about that happening,” said Katja Iversen, president and CEO of the global advocacy group and network Women Deliver.
Beth Schlachter, executive director of the global partnership Family Planning 2020, or FP2020, voiced concern about Pence’s political record.
“There’s an unknown of what Trump is going to do with reproductive health, internationally, but we do know the vice president-elect’s feelings, which are very clear, about shutting down Planned Parenthood and conflating family planning with abortion,” she said. “They could do all sorts of things that make U.S. assistance highly prescriptive and start to limit activities within a certain framework.”
FP2020 was among the groups represented at a recent meeting in Washington, D.C., focused on ways forward for reproductive health in an uncertain, yet threatening, political environment post-election. More smaller meetings are planned going forward, as some women health’s experts expressed in interviews a need to shift gears after Trump’s surprise election and coordinate with other partners.
Already, more than 225 million women and girls in developing countries lack basic health services, though progress has been made in recent years to increase access to contraception and health care. Revitalizing the Global Gag Rule may put U.S. aid recipients working to remedy this problem in a difficult position.
“Many providers will choose not to take the U.S.’ money and retain the integrity of their services,” said Suzanna Dennis, director of research at PAI, the reproductive health care group that has advocated for the permanent elimination of this funding restriction any U.S. president can enact or repeal.
Under the Bush administration, the Global Gag Rule prevented health organizations from expanding services, and pushed some to shut down their services and clinics, according to research PAI conducted in Kenya, Zambia, Ethiopia and Romania.
The U.S. is also one of the largest funders to the UNFPA, contributing an annual $35 million to its standard “core” budget, but also giving additional funding to other donation streams that bring its contributions closer to $80 million, according to FP2020. That makes the U.S. the second largest contributor to the U.N. agency dedicated to women and girls’ health. UNFPA trains midwives and health workers and provides reproductive supplies to women and girls in crisis zones, for example. They do not, however, offer abortions.
“We are looking forward to continuing our partnership with the U.S. government and continuing to hopefully meet the needs of women and girls as we always have,” said Sarah Craven, the director of the UNFPA’s office in Washington, D.C. “If you look at our history we have had times when the U.S. has pulled back because of these issues, but these are not partisan topics.”
“My plan is to continue to talk about the good work we have and to tell them about what we do. There is misinformation out there. That is what we are fighting against.”
Upcoming annual women’s rights and women’s health conferences at the U.N. in early 2017 will offer early signs of U.S. leadership on global health and foreign aid. The Trump administration could also show its potential to undo a U.N. health agenda that has broadened from a focus on just pregnant women and mothers to all women and girls’ health.
All eyes will be on the U.S. to see if it opposes language around family planning and reproductive health services in the agreement emanating from the April U.N. Commission on Population and Development meeting.
And Dennis, of PAI, says she expects “huge attacks on women and women’s rights at the Commission on the Status of Women this year” in March.
“This year will be a testing ground for what a Trump administration will look like at the U.N.,” she said. “The U.S. has been such an important voice and the U.S. administration in the last eight years has been such a huge voice for good at the U.N.
Now, the stakes are high if the U.S. moves away from its strong human rights platform at the U.N.