Decades of advocacy by U.S.-based anti-abortion groups have reshaped reproductive health policy both at home and abroad, with the reversal of Roe v. Wade marking their biggest domestic victory. Now, the second Trump administration is injecting dramatic new momentum into their cross-border campaign to export conservative “family values” to nations across the globe.
Speaking at the annual March for Life anti-abortion demonstration in Washington D.C. in January, Vice President JD Vance unveiled sweeping new restrictions on U.S. funding for international nongovernmental organizations, foreign governments, and United Nations agencies that work to expand access to abortion, gender-affirming care, and diversity programming overseas. “We’re going to start blocking every international NGO that performs or promotes abortion abroad from receiving a dollar of U.S. money,” Vance told the gathered crowd.
These expanded restrictions build on decades of on-the-ground anti-abortion advocacy led by U.S. conservative nonprofits, particularly in sub-Saharan Africa, a region where local health systems rely heavily on foreign assistance. Already home to the world’s highest rate of unsafe abortions and the highest maternal mortality linked to pregnancy termination, sub-Saharan Africa bears 70% of the world’s global maternal deaths, recording roughly 180,000 preventable pregnancy-related fatalities each year.
Analysts estimate the new policy could impact at least $30 billion in U.S. foreign aid, upending global reproductive health frameworks that have been in place for decades. For conservative advocates, the shift represents a long-sought alignment of U.S. foreign aid with their ideological goals. “We’re seeing opportunity here to have a consistently pro-life ethic,” explained Nicole Hunt, a representative of Colorado-based conservative evangelical group Focus on the Family. “We’ve been influencing health policies for a long time with our foreign aid. This is just a new direction.”
A key target of the movement is the Maputo Protocol, a 20-year-old international agreement signed by most African nations that enshrines safe abortion as a human right. The protocol requires signatory countries to legalize abortion in cases of rape, incest, fatal fetal abnormality, and when a pregnancy threatens a woman’s life or health, but implementation across the continent has been uneven, forcing millions of women to seek unregulated, unsafe procedures each year. The African Institute for Development Policy records more than 6 million unsafe abortions annually across sub-Saharan Africa, and emboldened by the new U.S. policy, anti-abortion activists are now working to roll back even the limited access guaranteed by the protocol.
Reproductive health advocates say the policy shift has already created a new, hostile landscape for reproductive rights work across the continent. “We’ve now moved into a new era where we are the ones who are in opposition because the most powerful and influential supporters of reproductive health — the U.S. and a lot of Europe — are now more aligned with anti-rights groups,” said Nardos Hagos, regional representative for the International Planned Parenthood Federation in Nairobi. “We’re gonna see more women dying from unsafe abortions.”
Tracking the full scope of U.S. anti-abortion funding flowing into Africa is complicated by loose disclosure rules for religious and charitable groups. An analysis by the Institute for Journalism and Social Change, a research organization, of public tax filings from 17 major U.S. anti-abortion groups found funding to Africa jumped 50% between 2019 and 2022, reaching more than $16 million. Previously unreported data from the institute shows the same groups spent nearly $9.4 million across the continent in 2023 and 2024 alone.
Claire Provost, a researcher with the institute, notes that these numbers are just “the tip of the iceberg,” because U.S.-based churches and many religious organizations are exempt from mandatory annual financial disclosure requirements that would reveal how much funding they direct to anti-abortion work in Africa. One major group increasingly active on the continent is The Church of Jesus Christ of Latter-day Saints, commonly known as the Mormon church, which has more than 1 million followers across Africa and has hosted “Strengthening Families” conferences across the continent over the past eight years.
Sean E.R. Donnelly, the church’s Africa communications manager, told the AP roughly a quarter of the $1.5 billion the church spent on international programs last year went to African development projects focused on healthcare, education, and emergency relief “with the goal of helping people, especially families.” When asked about reproductive rights, Donnelly said the church is “not really active” on abortion issues, though it does invite government officials to its conferences to help craft “policy and strategy to make sure that we protect the family.” The church’s official position opposes elective abortion in most cases, but allows exceptions for rape, incest, and threats to a pregnant woman’s life or health.
Local rights groups have noted that the church held a major conference in Sierra Leone last year, just as the country was moving forward with plans to decriminalize abortion. Pressure from local religious lobbies ultimately stalled the reform, a change that advocates link to the ideological and financial support from U.S. conservative groups. Donnelly denies the church interfered in the process, saying “This is not how the church operates in Africa or globally.”
Beyond shifting funding, the growing influence of U.S. anti-abortion groups has emboldened a wave of harassment and intimidation targeting reproductive health workers and providers across Africa. Hannah Ruguru, who works at a reproductive health clinic in Kisumu, western Kenya, entered the field after her own sister died from an unsafe backstreet abortion. Today, her work has become increasingly dangerous: she has been screamed at by anti-abortion protesters, and deleted her Facebook account after years of relentless online abuse. “Sometimes you can get scared,” she said. “But at the end of the day, I’m helping women.”
A 2024 report from Marie Stopes International, which operates the clinic Ruguru works at, documents widespread coordinated attacks across multiple African countries led by U.S.-based groups and U.S.-funded local organizations. In the Democratic Republic of Congo, health workers have been detained for days for providing legally allowed abortion services before being released without charge. In Ethiopia, the head of the local office of U.S.-based anti-abortion group Family Watch International has targeted senior reproductive health leaders with online harassment and spread anti-abortion misinformation via YouTube. In Kenya, staff contact information has been published online with false accusations of murder, and private clinic owners report repeated police harassment, detention, and extortion.
Musoba Kitui, regional director of the Ipas Africa Alliance, which advocates for safe abortion access, called the combination of new U.S. aid restrictions and growing ideological incursion deeply concerning. “The changes in U.S. foreign aid policy combined with this advancing American interest in ideology in Africa is really concerning,” Kitui said. “We think the consequences are going to be dire,” especially for women and marginalized LGBTQ+ communities who already face barriers to care.
Anti-abortion leaders frame the campaign as a necessary defense of traditional cultural values against what they describe as an imposed global progressive agenda. At a 2023 conference in Nairobi bringing together U.S., European, and African anti-abortion Christian leaders alongside senior Kenyan government officials, attendees framed the fight over reproductive rights as an global cultural conflict. “It’s a culture war, really,” said Charles Kanjama, vice chairman of the African Christian Professionals Forum, the conference organizer. He noted that international aid previously flowed overwhelmingly to reproductive rights groups, but “we are hoping that … we can start attracting money from people who think like us.”
That momentum is already translating to institutional change across the continent. In June 2024, representatives from 20 African nations finalized a draft charter in Ghana that calls for rejecting international sexual and reproductive health rights frameworks; the charter will go to a vote before the African Union in 2025. Anti-abortion activists from the U.S. have already begun international fundraising to support the charter’s passage.
In Kenya, one of Africa’s largest economies, the impact of shifting policy is already visible on the ground. The African Population and Health Research Center records an average of seven preventable deaths from unsafe abortion complications every single day. While the 2010 Kenyan constitution allows abortion when a woman’s life or health is at risk, and courts have expanded access to cases of rape, incest, and threats to mental health, a colonial-era penal code still criminalizes abortion providers and patients, who face up to 14 years in prison. Most public hospitals refuse to perform even legal abortions, leaving women to choose between costly private care or unregulated dangerous procedures. In May 2023, a Kenyan appeals court overturned a lower court ruling that affirmed abortion access as a fundamental right — a case led by Kanjama, who called the ruling a restoration of “constitutional balance.”
The Kenyan government did not respond to repeated requests for comment on the issue. In a statement responding to questions about the new U.S. aid rules, the U.S. State Department defended the policy: “The American people expect their tax dollars to support programs that save lives … and reflect American values, not fund abortion-related activities, left-wing social agendas, or wasteful overseas bureaucracies. U.S. assistance continues to support a wide range of maternal and child health services as part of the America First Global Health Strategy.”
On the ground in Kenyan public hospitals, doctors and public health workers say the reality of the policy is a growing tide of preventable death. “By the time the women come, we are often dealing with a life-threatening situation,” said Dominic Omollo, reproductive health coordinator in Bondo, western Kenya, where public hospitals only treat life-threatening complications from unsafe abortions, not the procedures themselves.
For 25-year-old Mary Olouch, that reality proved fatal. A fish seller in rural Karabok village, Olouch discovered she was pregnant while already raising a young child, and hid her pregnancy from her husband. She did not qualify for a legal abortion at a public hospital, and could not afford the cost of private care. She bled to death after an illicit abortion, leaving her young child motherless. Today, two trees mark her grave just meters from her home.
After Olouch’s death, Loice Ochieng, a local community health volunteer, said women in the village began speaking openly about abortion for the first time — a topic that had long been taboo. “Because they have seen that this thing can cause death,” Ochieng said.