One area of global health policy that is most talked about and yet least understood is reproductive healthcare. Most people know it is important, but only a few understand why it matters, who influences it, or how decisions made at the international level can determine what services Africans receive in their communities.
Reproductive healthcare is the backbone of women’s health systems. It includes services like contraception and family planning, pregnancy and maternal care, safe childbirth services, prevention and treatment of HIV and other sexually transmitted diseases, sexual health education, and menstrual health management. For many people, especially those in rural areas, reproductive health clinics are the closest thing they have to primary healthcare. That means the same clinic that provides contraception may also offer HIV testing, Malaria treatment, children’s vaccinations, and prenatal care. This is why when these systems are tampered with, the reproductive healthcare services affect everyone.
According to the World Health Organization (WHO), public financing for health in the African region is low relative to needs. Many African health systems depend on external funding because, in most cases, their public budgets are often used for urgent priorities like infectious disease management, workforce shortages and other necessary services.
What is currently concerning is how these services are not only determined by medical need alone but also by global politics.
The Global Gag Rule
One of the most influential policies affecting reproductive healthcare in the world is the Global Gag Rule, which is formally known as the Mexico City Policy.
It was first introduced by the administration of Ronald Reagan in 1984. The policy prohibits foreign non-governmental organisations from receiving United States funding for providing abortion services, referring patients for counselling, or advocating for abortion services as a method of family planning. The restriction applies even if those organisations use separate, non-American funds for abortion-related work. The organisations are left with little to no choice, because they have to either comply with the restrictions and keep getting their funding or reject the conditions and lose financial support that sustains other health services like contraception, HIV treatment and maternal care.
Since the Global Gag Rule has been introduced, it has been turned on and off by different U.S. presidents. Republican administrations have consistently reinstated it, while the democratic administration has revoked it. This back and forth creates instability for health programmes around the world. Clinics that rely on foreign funding struggle to plan long-term programmes when the rules governing that funding can change with every election.
In January 2025, the policy was reinstated by Donald Trump. A year later, the administration expanded it by applying similar restrictions to more foreign aid programmes under the Promoting Human Flourishing in Foreign Assistance (PHFFA) policy.
In fact, analysts at the Kaiser Family Foundation (KFF) estimate that this expansion could affect billions of dollars in global health and development.
Geneva Consensus Declaration
While the Global Gag Rule operates through financial conditions, the Geneva Consensus Declaration works through political alliances.
It was launched in 2020 by a coalition of governments which include the United States, Brazil, Egypt, Hungary, Indonesia, and Uganda. The declaration states that there is no international right to abortion and emphasises the role of the family as the fundamental unit of society.
What this means is that countries can now use the declaration to justify their positions against abortion rights and support restrictive reproductive health policies without the need to pass new international laws to back their decisions.
Despite its name, it is not a treaty and was not negotiated through the United Nations system. Human rights groups such as Amnesty International argue that it functions as a political statement that is intended to influence global debates around reproductive rights.
Several African countries have signed the declaration and aligned themselves with its approach to reproductive health policy. Some of these countries are Uganda, Kenya, Egypt, Benin, Burkina Faso, Cameroon, the Democratic Republic of Congo, Djibouti, Eswatini, The Gambia, Niger, Senegal, South Sudan, Sudan, and Zambia.
Together, the Global Gag Rule and the Geneva Declaration Consensus are put in place to control funding and narratives around reproductive rights.
The Reality in Africa Health System
Kenya is an example of how global health policies can impact national health systems. For years, many of the reproductive health programmes in Kenya have depended on international funding from organisations like USAID and PEPFAR. These programmes support family planning initiatives, HIV treatment services, maternal healthcare facilities, and community health outreach programmes in the country.
Kenya’s maternal mortality ratio is approximately 355 deaths per 100,000 live births, and for them to reduce the figures, they need sustained investment in precisely the services that international policies influence, such as family planning, skilled birth attendances and emergency obstetric care.
Civil society groups and health advocates have raised concerns about bilateral agreements that could change how reproductive health programmes are funded and managed. Legal issues and public scrutiny have shown the extent to which international partnerships can affect domestic health policy.
Another country worth looking at is Nigeria because it shows the scale of the problem. Although the country didn’t sign the Geneva Consensus Declaration, it has a population of over 220 million people and currently has one of the highest maternal mortality rates in the world.
Sub-Saharan Africa accounts for 70% of global maternal deaths, and Nigeria alone makes up nearly 28.5% of those deaths. The country’s health system has for a long time depended on international funding for HIV treatment programmes, maternal healthcare services, and reproductive health initiatives.
When major foreign-funded programmes faced disruptions in 2025, Nigeria’s government introduced a supplementary health budget to support immunisation and epidemic response. Even with that intervention, officials confirmed that there is still a considerable gap after the reductions in international assistance. This setback has mainly affected HIV services. Programmes supported by PEPFAR provide antiretroviral treatment to millions on the continent, and interruptions to these services risk treatment failure and the emergence of drug-resistant strains of the virus.
Uganda also shows how international policies inform national reproductive health debates. The country has also for years relied on external funding for HIV treatment and has left a funding gap when support was suspended. At the same time, Uganda has been involved in global politics discussions around reproductive rights, like how it is also participating in the Geneva Consensus Declaration.
In 2023, Uganda passed one of the most severe anti-homosexuality laws to make consensual same?sex relations punishable by life imprisonment and “aggravated homosexuality” punishable by death. Human rights organisations, like Human Rights Watch, have documented worsened discrimination and violence against LGBTQI+ people since the law was enacted. The International AIDS Society has warned that this hostile environment undermines efforts to deliver HIV services and keeps vulnerable populations away from care.
Uganda’s health system continues to bank on donor-supported programmes for HIV treatment, maternal care, and reproductive health services. As international policies shape reproductive health funding, organisations in Uganda face the same dilemmas as those seen in other African countries. These directly affect whether programmes continue and whether patients continue to receive care.
Kenya, Nigeria, and Uganda are just a few examples among many other African countries touched by these policies. Patients who once relied on free or subsidised services must now travel long distances or go without care. According to the International Planned Parenthood Federation, interruptions to this global funding have started affecting millions of women and girls worldwide. Clinics have reduced their services, and organisations that once provided contraceptives, counselling, and maternal care have been forced to limit their operations.
Health systems in these countries are already fragile, and sudden changes in the global health funding can destabilise them completely, especially in countries where donor-supported programmes make up a major part of public health infrastructure.
Although one can clearly see the impact in African countries, it also extends to other continents and countries. For instance, some parts of Asia, Latin America, and Eastern Europe also face these pressures. In many regions, clinics that are supported by international health programmes help deliver contraception, maternal healthcare, and HIV services. So when there is a change in the funding policies, they also encounter the same issue as those in Africa and the people affected do not influence those decisions.
One thing we need to understand in all this is how reproductive healthcare is not only a women’s issue; its effects are felt everywhere and by everyone. Maternal deaths leave families without caregivers and children without mothers. Communities lose workers, leaders and sources of stability. The Guttmacher Institute estimates that during a freeze or loss of U.S. contraceptive funding, more than 8,000 women could die from pregnancy and childbirth complications that might have been prevented. HIV treatment programmes serve both men and women and when they are unable to get services to help them, it affects the entire population, increasing the risk of transmission and sabotaging decades of progress in controlling the epidemic.
The ongoing debate around reproductive healthcare is all about power. While national governments pass laws and set health policies, the international funding systems and political collaborations dictate how these policies will play out in real life. This affects access to important services, the resources available, and the health outcomes for women, men and communities in general.
Policymakers, donors, and international organisations must ensure that whatever decision they make about reproductive healthcare prioritises people’s needs over political ideology.
We, as individuals, can also help protect our healthcare by staying informed about international and national health policies. Follow and support local organisations working on reproductive health in your country. Share reliable information with people around you. Ask your elected representatives where they stand on international health funding agreements and bilateral deals signed in your country’s name.
If you are in Nigeria, Kenya, Uganda, or any of the other affected countries, find out whether your government has signed health agreements and what conditions those agreements carry. Small actions like this can contribute to a greater push for equitable access. The decisions made today will eventually determine healthcare access for the next generation.
