If it had not been for the disruption of Donald Trump’s appearances in the United Nations the last week of September, more attention might have been devoted to an international day of advocacy for safe abortion, on Sept. 28, arranged by more than 1,200 organizations. A woman’s right to choose has few more powerful political enemies than the Trump administration, which has collected American aid programs of greatest interest to women everywhere under the title Protecting Life in Global Health Assistance.

Just days before Sept. 28, Usaid circulated a 17-page question-and-answer memorandum to try to explain how the imposition of Trump’s anti-abortion policies, promoted by his most conservative political supporters, will play out on the world stage.

Unlike past actions by previous Republican presidents, these strictures apply across the board not only to American nongovernmental organizations but also to all US departments and agencies with foreign programs.

A few weeks after the safe-abortion day events, the UN Population Fund (Unfpa) joined the discussion on women’s health and reproductive rights by focusing on fertility in its 2018 State of World Population report. The findings are not unrelated to the abortion debate. US nongovernmental organizations have found in fieldwork abroad that when harsh limits are placed on health services for girls and women, abortions actually multiply. So do unwanted pregnancies, with various, sometimes surprising results. The report surveyed 15 countries over five regions.

“High fertility can indicate a number of shortfalls in human rights,” the Population Fund said in “The Power of Choice,” the report’s title. “Typically, these countries are poorer, with limited access to health care and education. Entrenched gender discrimination discourages women’s autonomy. Practices such as early marriage, which correlates with an early start to childbearing, can be widespread.

“Fertility matters for societies because it can impede or accelerate progress towards greater prosperity, equitable and sustainable development, and well-being for all,” the Fund wrote. It matters in migration: “Where couples and individuals are fully empowered, fertility tends to hover around two births per woman, the level considered sufficient to keep population sizes stable in the absence of migration.”

And then there is the instability, displacement, environmental strain and human suffering of conflict, much of it occurring recently in Africa, a region of high fertility.

“Of 43 parts of the world with fertility of four or more births per woman today, 38 are in Africa,” according to the report. “Outside Africa, Afghanistan, Iraq, Palestine, Timor-Leste and Yemen have fertility of four or higher, and are exceptional in that they have experienced conflict or crisis in the past few decades.”

The shortfall in accessible contraception is a big factor in fertility rates. This leads back to the consequences of limiting reproductive health and rights for women and girls.

The Trump anti-abortion campaign and other shifts away from supporting women’s reproductive rights — and what is now interpreted as a general lack of respect in the White House for women — have been a growing concern among advocates for women in the US ever since the Trump administration took office. Non-American nongovernmental organizations have become a particular target of the policies.

The Trump administration makes it clear that it is pressuring foreign NGOs by requiring them to sign on to broad anti-abortion clauses that reach, unintended or not, beyond women’s health and choices. American NGOs that provide assistance to foreign NGOS are expected to enforce the rules. The guidelines state:

“Under this policy, ‘global health assistance’ includes funding for international health programs, such as those for HIV/AIDS; maternal and child health; nutrition, infectious diseases, including malaria and tuberculosis; global health security; and voluntary family planning and reproductive health.”

Oddly, but in keeping with a Trumpian America First perspective, Usaid’s work, according to its website, “advances U.S. national security and economic prosperity, demonstrates American generosity, and promotes a path to recipient self-reliance and resilience.” Not a word is said about the human condition that makes aid imperative.

One statistic stands out: early pregnancy and unsafe abortion are among the leading causes of death among teenage girls worldwide.

From the early days of the Trump administration, major international women’s health  organizations, including the International Planned Parenthood Federation and Marie Stopes International, have refused to agree to US policy, forfeiting American aid. The anti-abortion requirements, known as the Mexico City policy (where it was introduced in 1984), more commonly, the global gag rule — have also been criticized by Human Right Watch.

The New-York based International Women’s Health Coalition, a member of the International Campaign for Women’s Right to Safe Abortion, calls the right to abortion when “legal, accessible and safe” an integral part of general reproductive health care. Instead, it is “stigmatized by culture and myths, restricted through regressive legislation and economic barriers, and politicized by conservative policymakers and advocates.” Thousands of preventable and avoidable deaths ensue, the coalition and others argue.

The statement of support for Safe Abortion Day said:

“Abortion is more common than generally expected — globally, 25 percent of pregnancies end in abortion. The procedure is common all over the world, but the rate of abortion varies by region. It is highest in Latin America and the Caribbean (44 abortions per 1,000 women), followed by Asia (36), Africa (34), Europe (29), Oceania (19), and finally, North America (17).”

The statement continued: “Despite the global normalcy of abortion, far too many women lack legal and/or financial access to this critical health service. This lack of accessibility does not reduce the number of abortions. Instead, it forces women to make the chilling decision between carrying an unwanted or unviable pregnancy to term or resorting to a clandestine, and often unsafe, procedure. The rates of abortion are highest where the restrictions are the tightest. As a result, 25 million unsafe abortions are estimated to occur each year. This is a public health crisis entirely of our own making.”

The Trump international anti-abortion policies, supported not only by the conservative evangelical Christian right but also the Roman Catholic Church hierarchy in the US and the Vatican, were reviewed by the US government early this year and will be reviewed again in December.

At the same time, damage to women’s health projects in the poorest countries are being calculated by numerous nongovernmental organizations. While some exceptions are allowed by the policy — foreign NGOs may repair injuries caused by botched abortions and perform or refer procedures in cases of rape, incest or a threat to life — the effect has been chilling in many places.

In Washington, the research and advocacy organization PAI (formerly Population Action International) reports: “Evidence shows that restrictions imposed by the Global Gag Rule on family planning assistance can increase the number of abortions in developing countries by reducing access to contraception. . . . The Planned Parenthood Association of Ghana saw 50 percent more women come to their clinics for post-abortion care the year after the Global Gag Rule was reinstated by the Bush administration.” (The rule had been lifted during the Clinton presidency.)

On a reporting trip to Ghana during those years, I was asked by a youth leader trying to teach safe sex to his age group, Why would Christians in America do this to them?

Separately from the Mexico City policy, Trump also ruled out, by presidential order for the second time, all US funds to the UN Population Fund, the world’s largest network of family planning and reproductive health. (Obama had restored and increased funds during his years in office.)

“It’s hard to know exactly what justification the Administration has advanced for this decision — the notification the Trump administration sent to Congress is classified ‘sensitive’ and thus the public has not seen it,” Amanda Klasing, senior researcher in the women’s rights division of Human Rights Watch wrote in March of this year.

“However, the UN Population Fund has been told that, like last year, the Trump administration is claiming it violates the Kemp-Kasten Amendment, which blocks US aid to any organization the US determines is involved in coercive abortion or involuntary sterilization.” There was “zero evidence” of that, Klasing added.

“UN Population Fund is an agency that goes where few others do — into war zones and countries wracked by natural disasters — to try to make sure that pregnant women and girls get health care, can deliver babies safely, and are protected from gender-based violence, even as the world falls apart around them,” she wrote. “There is more need than they can address, and without US funding even more women will fall through the cracks.”

Barbara Crossette

Barbara Crossette is the senior consulting editor and writer for PassBlue and the United Nations correspondent for The Nation. She is also a member of the Council on Foreign Relations. She has also contributed to the Oxford Handbook on the United Nations.

Previously, Crossette was the UN bureau chief for The New York Times from 1994 to 2001 and previously its chief correspondent in Southeast Asia and South Asia. She is the author of “So Close to Heaven: The Vanishing Buddhist Kingdoms of the Himalayas,” “The Great Hill Stations of Asia” and a Foreign Policy Association study, “India Changes Course,” in the Foreign Policy Association’s “Great Decisions 2015.”

Crossette won the George Polk award for her coverage in India of the assassination of Rajiv Gandhi in 1991 and the 2010 Shorenstein Prize for her writing on Asia.