Upon his return to the White House, President-elect Trump is expected to vastly cut funding for women’s health organizations around the world, and people on both the left and right are focused on what that means for abortion.
But the impact of Trump’s budget cuts would go far beyond abortions and would likely be devastating for millions of women and girls around the world. Trump’s approach would reduce the availability of contraception and likely increase maternal mortality and cervical cancer.
When he was president in 2017, Trump defined similar cuts as follows: “protect life in global health. But one study published by the National Academy of Sciences estimates that during Trump’s four years in office, this policy resulted in the deaths of 108,000 children and mothers in poor countries.
So I wish Trump could meet some of the women and girls who will be collateral damage. They are people like a 16-year-old girl sitting helplessly on a hospital bed that I met in Ambovombe, in the remote and impoverished south of Madagascar. The girl, Sambiasie (who only has one name), told me that she and her boyfriend were using an injectable contraceptive, which cost her 40 cents every three months – and then she ran out of it. ‘money.
“I had no money, so I missed an appointment,” she told me. For lack of 40 cents, she became pregnant. Her boyfriend then dumped her. She had to drop out of school. Then she had a miscarriage.
You might be thinking: It was irresponsible for her to have sex if she couldn’t afford birth control. That’s true, of course. But were you ever young? It is difficult to imagine how a reduction in the availability of contraceptives will not lead to more pregnancies, more girls dropping out of school, and probably also more abortions.
Republicans were once champions of family planning: President George HW Bush was so devoted to the cause that his colleagues nicknamed him the Rubbers. But the Republican Party is increasingly seeking to eviscerate the United Nations Population Fund, the largest provider of contraceptives to poor countries.
After taking office, Trump should end all U.S. funding for the United Nations Population Fundas he did in 2017. (President Biden reinstated it.) Trump is also likely to once again impose an expansive form of what critics call the “global gag rule,” ending any support for global health organizations that do not oppose abortion. (Biden rescinded the gag rule.)
All of this will be hotly debated among the men in suits in Washington, but it will play out in the lives of exhausted women in countries like Madagascar.
In a slum in the capital, Antananarivo, I visited a mobile clinic that offers free contraceptives, cervical cancer screenings and treatment for sexually transmitted infections. The clinic is a lifeline for women like Linah Ravaosoloarimalala, 25, who has three children and wants to call it a day. She is homeless, lives in a market and has neither the money to pay for contraception nor the ability to stop procreating.
“When my husband is drunk, he comes to me and forces me to have sex,” she says softly. “If I say I want family planning, he beats me. »
The advantage of contraceptive injections is that an abusive partner does not need to know about them, and she was able to get one at the mobile clinic. But that option may no longer be possible after Trump takes office.
The mobile clinic is one of four clinics run in the capital by MSI reproduction choicea global non-profit organization dedicated to women’s health. But Trump cut all funding for MSI in 2017 under the global gag rule, so two of the clinics were taken out of service. The United Nations Population Fund funded the two remaining clinics, including the one where Ravaosoloarimalala received her injectable contraceptive, but its existence will be in doubt if the Population Fund loses U.S. funding.
Conservative claims that their efforts are aimed at “protecting life” are a fallacy. Madagascar already prohibits all abortions, even to save a mother’s life, and in any case, American law has long prevented aid from being used to finance abortions.
That said, without access to contraception, women and girls will become pregnant – and some will find clandestine ways to terminate their pregnancies. Indian-made misoprostol, an ulcer drug that also causes abortions, is widely available in poor countries; I discovered that even in a rural pharmacy in Madagascar it is easy to buy without a prescription, no questions asked, for 50 cents a tablet.
A study by three Stanford researchers found that in the past, the global gag rule was associated with an increase in abortions. “Reductions in financial support for family planning may have led women to replace abortion with contraception,” the researchers conclude.
After Trump cut U.S. funding for the United Nations Population Fund in 2017, the result in Madagascar was that condoms, injectables, IUDs and implants became hard to find for a while, officials say health. There is no data, but I doubt people stopped having sex.
In the United States, we sometimes take family planning for granted. In much of the world, access is transformational.
“I’ve wanted family planning for a long time,” said Annick Harenasoa, 18, a high school student who visited a Population Fund-supported clinic for her first injectable contraceptive. “If this clinic didn’t exist, I think I would get pregnant. I wouldn’t make my dreams come true.
Five of her classmates had already become pregnant and dropped out, she said.
I participate in my annual Win a Trip, for which I choose a college student to travel with me to cover overlooked global issues. I wanted the winner, Trisha Mukherjee, to look at the gap between how Americans perceive issues and what’s actually happening in places like Madagascar.
The American right is worried that the Population Fund is complicit in abortions, but after decades of covering global health, I can state categorically that this is false. Indeed, by providing contraceptives, the fund has considerably reduced unplanned pregnancies, and therefore abortions.
And let’s be clear: “reproductive health” is not the same thing as abortion. Too many people equate the two, but the Population Fund saves women’s lives during childbirth. He fights taboos regarding menstruation which, as Mukherjee notes in an article of this trip, prevent millions of girls from going to school. He opposes child marriage and female genital mutilation. He is tackling AIDS. He repairs obstetric fistulas. She fights against violence against women. It offers cervical cancer screenings.
Is it sometimes a heavy bureaucracy? Of course! It’s the UN. But it also saves lives.
“If this clinic didn’t exist, I would have just waited to die,” cervical cancer survivor Lydia Vavitiana, 28, told me at the Population Fund-supported clinic in Ambovombe. . “It saved my life.”
Cervical cancer is not controversial like abortion, and therefore is rarely discussed – which means it is not discussed either. It kills some 350,000 women per year throughout the world, mainly in poor countries; in three dozen countries, it kills more women than any other cancer. It is a horrible and humiliating disease, sometimes diagnosed in part by the stench of rotting flesh.
Thank goodness there are groups like the United Nations Population Fund and MSI, which are tackling reproductive health in a way that is neither performative nor ideological, but actually saves lives.
Reproductive health is actually a hugely successful field globally. In Madagascar, women had an average of seven children each until the mid-1970s and today, partly because they can control when they become pregnant, they have an average of only three or four. Maternal mortality worldwide has halved over the past 35 years. AIDS is no longer a death sentence.
It is now less clear whether this progress can be sustained. MSI says the gag rule imposed by the Trump administration in 2017 cost it $120 million, enough to prevent six million unintended pregnancies and 20,000 maternal deaths. In Madagascar, MSI had to reduce its workforce from 539 health workers to 139.
I realize that Washington is getting caught up in its own political fevers and delusions. But I hope administration officials understand that if they cut funding to the United Nations Population Fund and women’s health organizations like MSI, it will not be an ideological triumph of an American political faction but will sound the death knell for women and girls just like their own mothers, sisters, wives and daughters.