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What Trump and Harris mean for global reproductive health and rights

A woman gestures as she speaks to a group of women seated on the ground
Female community health worker Jharana Kumari Tharu counsels a group of women, including expectant mothers and those who have recently delivered, on good health practices in Binauna village, in Nepalís Banke District. Flickr/USAID CC BY-NC 2.0

As the 2024 U.S. presidential election approaches, debates around reproductive rights have taken center stage in American politics, driven by landmark events like the Supreme Court’s overturning of Roe v. Wade. This decision has sparked a wave of community activism, legal battles, and electoral mobilization focused on issues such as abortion access, assisted reproductive technologies (ARTs), and maternal health disparities. However, the implications of the upcoming election on reproductive rights extend far beyond U.S. borders. Donald Trump and Kamala Harris present contrasting visions for reproductive health and rights, and their policy platforms have the potential to significantly reshape U.S. foreign assistance, multilateral engagement, and global priorities in this field.

Given these stakes, what impact will the 2024 U.S. election have on reproductive health and rights worldwide, and how will this shape forms of U.S. global engagement?

The politics of US reproductive health assistance abroad

The United States has a complicated history of engagement with global reproductive health and rights. U.S. foreign assistance for family planning first began under the Foreign Assistance Act of 1961, a move motivated by concerns over population growth, especially in Asia and Africa. Early programs were criticized for promoting coercive practices and focusing on population control rather than rights-based approaches to reproductive health. However, U.S. policies gradually evolved over the decades to emphasize health, education, and gender equality, aligning with shifts in global conversations around reproductive politics, population, and development.

At the same time, U.S. foreign assistance has always been deeply intertwined with domestic politics, especially around abortion. The passage of the 1973 Helms Amendment—shortly after the Roe v. Wade ruling—set a precedent by prohibiting the use of U.S. foreign assistance funds for abortion as a method of family planning. Additional restrictions came under Ronald Reagan’s 1984 Mexico City Policy (also known as the Global Gag Rule), which barred U.S. foreign aid to any NGO that provided or promoted abortion as part of its health services, even if these were funded through non-U.S. sources. Since its introduction, the Mexico City Policy has been a political battleground, with subsequent Republican administrations reinstating it and Democratic administrations rescinding it.

Despite these challenges, the U.S. remains the largest bilateral donor in global family planning and reproductive health. For fiscal year 2023, the U.S. provided approximately $608 million in foreign assistance—most of which is managed through USAID programs in over 40 countries, primarily focusing on 29 priority countries across Asia and Africa. This funding supports efforts to expand contraceptive access and address issues such as maternal mortality, child marriage, gender-based violence, and the integration of reproductive health services with HIV/AIDS prevention.

‘Protecting life’ under Trump

During his presidency, the Trump administration implemented some of the most restrictive policies on global reproductive health and rights in recent history. On January 23, 2017—just days into his administration—Trump reinstated the Mexico City Policy, following the precedent set by his Republican predecessors. However, the administration went a step further by introducing a more expansive policy—Protecting Life in Global Health Assistance (PLGHA)—which extended the restrictions not only to family planning funds but to all U.S. global health assistance. As a result, the amount of funding subject to these restrictions jumped from around $600 million to over $7.3 billion. While research on the impacts of PLGHA is ongoing, early findings suggest the policy has negatively affected health service delivery, particularly access to emergency contraception, while also constraining the ability of health care providers and women to make autonomous decisions regarding reproductive health.

Trump’s presidency also marked a significant shift in the United States’ approach to multilateral engagement and a return to great power rivalry, especially with China and Russia. This retreat from multilateralism affected U.S. support for the World Health Organization (WHO) and the United Nations Population Fund (UNFPA), two key U.N. agencies focusing on reproductive health and rights. Soon after taking office, the Trump administration withdrew U.S. government funding from UNFPA, alleging that it supported coercive sterilizations and abortions in China. The UNFPA quickly denied these allegations, asserting that its work “promotes the human rights of individuals and couples to make their own decisions, free of coercion or discrimination.”

While Trump’s claim against the UNFPA reflected intersections between geopolitics and global reproductive health, it was not new. In blocking UNFPA funding, Trump invoked the Kemp-Kasten Amendment, which has been used periodically since the mid-1980s by Republican administrations to restrict funding to the UNFPA, despite the U.S. being one of the organization’s founding supporters in 1969. The U.S. stoppage of funding to the UNFPA is estimated to have impacted roughly 8% of its budget. While other donors stepped in to cover some of the shortfall, the decision had a significant impact on global reproductive health, particularly in countries where USAID did not extend family planning and reproductive health coverage and in humanitarian settings, especially in the Middle East.

While Trump’s stance on domestic reproductive rights, particularly abortion, has been inconsistent, his global reproductive health policies are likely to mirror those of previous Republican administrations. If elected in 2024, he would likely reinstate both the Mexico City Policy the Kemp-Kasten Amendment under his administration’s previous “Protecting Life in Global Health Assistance” agenda. However, a new Trump presidency could mean even greater rollbacks in global reproductive health and rights. For example, the blueprint laid out by Project 2025, which Trump has distanced himself from, seeks to enshrine protecting life as one of the “core objectives” of U.S. foreign assistance and close perceived “loopholes” by extending PLGHA to all U.S. foreign assistance—including gender equality and economic empowerment programs, along with humanitarian aid, in spite of a solid body of evidence that shows that women and children in emergencies are often at increased risk of sexual and gender-based violence, unintended pregnancies, unsafe abortions, and maternal mortality, frequently needing more—not less—reproductive health support in such contexts.

Beyond expanding “protecting life” in bilateral aid, a second Trump term would likely escalate the rollback of U.S. multilateral engagement, including renewed efforts to block funding for UNFPA, consistent with the policies of previous Republican administrations. Such a geopolitics of global reproductive health is already being reflected in Congress, where a recent Countering Communist China Bill has advocated for funding restrictions on U.S. aid to the UNFPA, and this could gain more traction under a potential Trump presidency. This strategy reflects a broader conservative agenda seeking to shape reproductive rights on a global scale by redefining U.S. engagement in global reproductive health—favoring more controlled bilateral assistance over multilateral partnerships.

Harris and global ‘reproductive freedom’

Kamala Harris has established reproductive freedom as one of the cornerstones of her electoral platform. Harris’ vision for reproductive freedom, while largely based on the U.S. domestic context, focuses on abortion rights—with Harris labeling laws restricting abortion access as “arcane” and “immoral.” However, it also includes conversations around reproductive health, maternal mortality, IVF access, and affordable child care, framing these issues as interconnected rights under threat. Part of this draws on her previous work as a senator, where she co-sponsored a package of 13 bills to reduce rising maternal mortality rates—particularly among Black women—through the Black Maternal Health Momnibus Act.

While Harris’ precise stance on global reproductive health remains undefined, her approach will likely mirror key Democratic priorities. If elected, she would likely continue funding for the UNFPA and rescind the Mexico City Policy, much like the “Protecting Women’s Health at Home and Abroad” memorandum introduced at the start of the Biden-Harris administration. The memorandum argued that Trump-era restrictions negatively impacted women’s reproductive health, created barriers to bilateral development assistance, and undermined U.S. partnerships in global health efforts against malaria, tuberculosis, and HIV/AIDS. In continuing such Biden-era policies, Harris would also likely strengthen multilateral engagement. As vice president, Harris’ first international call was with WHO Director-General Tedros Adhanom Ghebreyesus, reaffirming the administration’s decision to rejoin the WHO. This also aligns with the Democrats’ current legislative efforts in Congress to authorize annual appropriations for the UNFPA’s core functions and programs, ensuring consistent support for multilateral reproductive health initiatives.

Harris’ focus on domestic reproductive freedom—centered around bodily autonomy, lived experiences, and a rights-based approach—could then contribute to global debates on reproductive health and rights, especially at a time when these issues face increasing resistance. However, her position on global reproductive health and rights is not fully articulated, making it difficult to predict how her administration would address these concerns through foreign assistance and multilateral engagement, especially for people and communities most impacted by militarism, climate disaster, and sexual violence. Although significant shifts in U.S. foreign assistance policy are unlikely, USAID’s ongoing emphasis on “localization” could facilitate more community-driven reproductive health initiatives that align with the Harris administration’s broader goals of health equity, care, and reproductive freedom.

Looking forward: What’s at stake

The 2024 U.S. election will have far-reaching implications for global reproductive health and rights. In particular, three key areas stand out:

  • Global reproductive politics. The election will highlight how U.S. domestic reproductive politics shape its global engagement. Whether framed as “protecting life” or “reproductive freedom,” the outcome will have significant implications for how the U.S. approaches reproductive health and rights globally and ultimately impact health equity and justice for communities worldwide.
  • U.S. foreign assistance. The potential reinstatement of the Mexico City Policy could disrupt USAID’s localization efforts, which aim to build equitable partnerships with local communities. If reimposed, the policy’s restrictions may shape USAID’s ability to fully support locally led development by placing constraints on which organizations it can partner with, and potentially challenging its emphasis on community-defined agendas.
  • Multilateral engagement. The election will determine whether the U.S. adopts a more bilateral approach—demanding greater oversight and control over multilateral engagement—or supports global partnerships and a more traditional rules-based international order for reproductive health and rights globally.

Photo source: USAID U.S. Agency for International Development via Flickr, CC BY-NC-2.0