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Carrying her infant daughter, 19-year-old Sithulisiwe Moyo waited for hours under the blistering sun at an outreach clinic in Epworth, a poor settlement outside Zimbabwe’s capital, Harare. For Moyo, the free birth control she receives there represents her best hope of returning to school and building a better life.
However, these critical services—funded by the US government, the world’s largest health donor—may soon disappear. Following his re-election, US President-elect Donald Trump is expected to reinstate the “global gag rule,” a policy that bars US foreign aid from being used to perform or promote abortions, even with non-US funds. A
Policy with Global Consequences
The gag rule, officially known as the Mexico City Policy, has been enforced by every Republican president since its inception in 1984 and rescinded by Democratic presidents. Trump expanded the rule during his first term, cutting off nearly $12 billion in US global health aid and family planning funds between 2017 and 2018, according to the US Government Accountability Office.
These cuts rippled across Africa, impacting efforts to prevent malaria, tuberculosis, and HIV, as well as providing contraception, water, and sanitation services. NGOs, including those in countries where abortion is illegal, were forced to shut down outreach clinics and reduce essential health services.
“Devastating Effects” Feared
Pester Siraha, director of Population Services Zimbabwe (PSZ), warned that the reinstatement of an expanded gag rule could have devastating consequences. PSZ, an affiliate of MSI Reproductive Choices, lost US funding during Trump’s first term due to its association with abortion rights.
During that time, PSZ was forced to close outreach clinics that served rural and impoverished communities. Siraha estimates that if the gag rule returns, 1.3 million women in Zimbabwe could lose access to care, resulting in an additional 461,000 unintended pregnancies and 1,400 maternal deaths.
“It’s not just about abortion—it’s about access to contraception, health education, and choices for women,” Siraha said. “This policy puts lives at risk.”
A Crisis Beyond Zimbabwe
The effects of the gag rule were felt across the continent. In Uganda, Kenya, South Africa, and other nations, NGOs shut down programs and clinics, reduced contraception access, and scaled back support for community health workers and vulnerable groups, including sex workers and LGBTQ+ communities.
In South Africa, where abortion is largely legal, some organizations altered their messaging or stopped providing abortion-related information to avoid losing US funding.
Lives on the Line
In Epworth, long lines of women at the outreach clinic illustrate the dire need for family planning in impoverished communities.
Engeline Mukanya, a 30-year-old mother of three, earns $100 a month as a hairdresser and cannot afford private providers who charge $20 to $60 for contraceptive implants. At the clinic, she received a free birth-control implant that will protect her for five years.
“It’s unfortunate that we are so far away from America, yet we’re caught in the crossfire of its politics,” Mukanya said. “All we want is the freedom to space our births and plan our futures.”
A Fragile Recovery
President Joe Biden rescinded the gag rule in 2021, enabling PSZ to regain $9 million in USAID funding—half of its donor revenue in 2023. However, the organization has not fully recovered from the losses incurred during Trump’s first term.
With other Western governments cutting overseas aid budgets, finding alternative funding is becoming increasingly difficult, Siraha said.
As Zimbabwe’s women face an uncertain future, advocates warn that the reinstatement of the gag rule could roll back decades of progress in global health, leaving millions without the care they desperately need.
