BLOG POST

Trump’s Election Gives the UK a Clear Global Health Mission: Champion Family Planning and Reproductive Rights

The US role in global health appears increasingly uncertain as President-elect Trump prepares to enter the White House. While his previous term provides clues about future directions, evolving dynamics with Capitol Hill and the overall budget picture will also shape the US approach. Still, if past is prologue, the new administration will seek to significantly roll back support for sexual and reproductive health and rights (SRHR) globally.

A retreat by the United States—previously the largest funder of family planning and reproductive health (FP/RH; see Figure 1)—would have devastating impacts on women and girls around the world unless another donor steps in to fill the void. The UK could seize the opportunity to become a global leader in championing SRHR.

SRHR is a high-impact investment, representing good value for money for UK development spend. There is also a strong strategic case for the UK to step in: it has a uniquely robust record as a long-time supporter of SRHR; the topic spans Minister Dodds’s dual brief of women and equalities and development; and championing SRHR is well aligned with Labour’s “missions” of health and economic prosperity. With appropriate investments, the UK could play a pivotal role by leading a global coalition to monitor and strategically support SRHR, with a focus on family planning.

Potential US funding cuts to SRHR

Currently, the US is by far the largest provider of official development assistance (ODA) for SRHR, providing USD 9.4 billion in 2022—substantially more than the second largest country donor, the UK (USD 734 million). Indeed, the US contributes 66 percent of total ODA disbursements for SRHR and 44 percent of total ODA disbursements for family planning (Figure 1). These disbursements include significant support for contraception, control of sexually transmitted diseases, including HIV/AIDS, and cervical cancer screenings, but notably do not fund abortion as US law prohibits ODA from being used to this end.

Figure 1. Donor government funding for family planning, 2012–2023 (current USD, millions)

Donor government funding for family planning, 2012–2023 (current USD, millions)

Data source: KFF analysis, “Donor Government Funding for Family Planning in 2023

While we cannot predict the precise impact of a Trump presidency on SRHR funding, we can look to his first term for indications. In its first budget request to Congress, the Trump White House proposed cutting USD 2.2 billion from the annual global health budget (a 26 percent cut), including $607.5 million—the entirety of bilateral funding for FP/RH enacted in the previous year (see Figure 2). At the time, lawmakers rejected the depth of the proposed spending reductions, so they didn’t come to fruition. But should the incoming Trump administration pursue similar cuts, the 119th Congress may be less willing to push back.  

In addition, Trump, like all Republican presidents since Reagan, is expected to withhold funding to the United Nations Population Fund (UNFPA). In the past, European donors—led by the Nordics—responded by increasing their support by 20 percent. This year, however, these governments may not be in a position to step up to the same degree.

Figure 2: US Family Planning and Reproductive Health Bilateral Aid Funding, Requested vs Actual Amounts, FY2015–2024

US Family Planning and Reproductive Health Bilateral Aid Funding, Requested vs Actual Amounts, FY2015–2024

Data sources: “Requested” data from Department of State Congressional Budget Justifications Supplementary Tables, FY2015 - FY2024. “Actual” data from KFF analysis, “Historical Funding by Agency and Account for International Family Planning and Reproductive Health (FP/RH), in millions

If realised, major reductions in FP/RH spending will have direct negative impacts through restricting access to lifesaving healthcare. US funding to UNFPA in FY2016 helped prevent 947,000 unintended pregnancies, 295,000 unsafe abortions, and 2,340 maternal deaths. Guttmacher Institute’s Family Planning Investment Impact Calculator suggests that US ODA funding of family planning in 2022 saved the lives of 23,505 women and girls.

The Mexico City Policy—and the risk of UK complicity

Beyond funding cuts, the impact of US policy changes on global SRHR could be far-reaching. Since the 1980s, Republican presidents have reinstated the Mexico City Policy (MCP)—known to critics as the “global gag rule”—upon taking office. This rule prevents foreign non-governmental organisations (NGOs) who receive US funding for global family planning from providing or promoting abortion services, information, counselling, referrals or advocacy using funds from any source. In 2017, Trump reinstated the policy on day four of his term, and we should expect the same this January.

But Trump went even further, expanding the policy to apply to foreign NGOs receiving nearly any US global health assistance—the first time the policy was expanded beyond family planning funding. The broader policy increased the amount of US funding impacted by 20 times—from about USD 600 million to approximately USD 12 billion, spanning projects related to HIV/AIDS, nutrition, malaria, tuberculosis, neglected tropical diseases, and water, sanitation, and hygiene.

Research from CGD experts and others has shown that the MCP reduces access to contraception, leading to unplanned pregnancies and an increase in abortions, including unsafe abortions. The expanded MCP policy also negatively affected the delivery of essential health services supported by US global health programmes, including cervical cancer screenings and HIV services.

Some advocates of these restrictions (including allies of President Trump) have argued that his administration should expand this policy further, applying MCP to the entirety of the US foreign aid portfolio. Such a move would be unprecedented and have enormous implications, including for multilateral organisations and humanitarian assistance.

If the policy applies to UK implementing partners, including NGOs and multilaterals, the UK and other international funders will be faced with a terrible choice: be complicit in scaling back support to SRHR or move on without US funding and thus accept a significant weakening of key organisations such as the Global Fund, and of the concept of multilateralism.

If broadened extensively, the policy would further weaken on-the-ground provision of essential services and have the potential to erode political support for reproductive health in low- and middle-income countries. This is critical because it is domestic funding and policies that are key to populations’ long-term, sustainable sexual and reproductive health.

The financial case: SRHR is great value for money for the UK

There is a strong value-for-money case for the UK to step into the gap left by the US.

First, SRHR funding includes highly cost-effective health interventions, such as contraception provision: a CGD review found that “covering contraception is likely to generate significant cost-savings” in terms of reduced healthcare costs, while the Copenhagen Consensus think tank puts the benefit-cost ratio for family planning interventions at 22:1.

Second, advancing SRHR drives economic empowerment of women, with positive knock-on effects for the global economy. For example, in the US, the availability of oral contraceptives has been estimated to be responsible for one-third of women’s wage growth in the 1990s. And in other countries like Colombia and Malaysia, access to contraception has helped girls to stay in school and increased women’s participation in the formal labour force.

And, of course, maintaining SRHR funding is critical from a rights point-of-view—crucial to realising the universal rights to health, bodily autonomy, and gender equality.

The strategic case: why SRHR is the right global health mission for the UK

From a policy perspective, the UK is uniquely positioned to step in due to its historical track record, alignment with Labour Party policy, and the leadership of Minister Dodds.

The UK has a strong (cross-party) track record of leadership and commitment in this area. For example, in 2014, the UK (with UNICEF) hosted the first Girl Summit to mobilise international efforts to end female genital mutilation. The UK is a founding member of the Global HIV Prevention Coalition, and has long been “instrumental in providing strategic leadership” to UNAIDS, placing a particular emphasis on adolescent girls who are disproportionately impacted by AIDS. The UK was the second largest country provider of SRHR disbursements in 2022. And the UK’s 2023 International Development White paper committed to “strongly defend and progress sexual and reproductive health and rights, including safe abortion, through policy, investment and diplomacy.”

The Labour Party’s 2024 manifesto stated that “empowering women and girls” is a priority area for development. Minister Dodds, who holds a dual brief of women and equalities, and development, has shown strong interest in this area. For example, on International Safe Abortion Day in September 2024, she signed the She Decides commitment to safe abortion on behalf of the UK Government.

Labour proclaims it is a “Mission-led government”, but it lacks a clear global health vision. SRHR, by promoting health and economic growth, could become a key pillar of its global health and economic missions.

The way forward

The UK alone does not have sufficient resources or influence to replace the US’s involvement; however, it can generate transformative impact in the following ways:

1. Strengthen the global coalition of SRHR champions

The UK should lead a global coalition of countries who believe in the importance of SRHR or value the wider principles of upholding multilateralism and country autonomy. Private philanthropies will also have an important role to play. Especially in recent years, they have been substantial providers of family planning disbursements: the Bill and Melinda Gates Foundation and Susan T. Buffett Foundation gave a combined USD 850 million in 2022. Melinda French Gates, who last year announced that she would be giving USD 1 billion to women’s causes and gender equity over the next two years (including USD 250 million to improve women’s health globally), could be an especially powerful voice.

2. Collate and track global data on SRHR funding and policies to enable a joint data-driven strategy to respond to the MCP

The breadth of the incoming US administration’s restrictions on foreign aid funding in this area are yet unknown. And the severity of such limitations could depend on how vigorously US agencies and appointees pursue implementation. Collecting and mapping existing fragmented data on SRHR funding and policies could help inform a joint strategy to prepare for different scenarios of breadth, severity, and implementation of potential changes imposed by the new US administration.

3. Shift to catalytic bilateral support for countries, including advocacy

Since it will be infeasible to fill the whole gap left by the US, UK financial assistance should be strategically targeted. Because family planning is a core health system function, and highly cost-effective, the UK and allies should support countries to use domestic financing where possible, in line with the New Compact and Lusaka Agenda. This could include technical assistance and providing a small amount of funding to civil society groups, as the UK does through the Robert Carr Network Fund, which uses the funding to advocate for SRHR services, changes in domestic resource allocation, produce evidence of rights-abuses, and seek legislative and policy changes. 

4. Use its voice in multilateral spaces to stand firm against rights encroachments

The UK must be a champion for UNFPA and use its role on UN boards, and as a key donor to multilaterals, to reject policy changes which would further the anti-rights agenda. While the UK may be reluctant to oppose the US, it will be crucial to stand firm since neutrality would risk complicity. The UK should also use its positions on the Boards of global health initiatives to prepare for substantial falls in funding (particularly HIV funding) and to push these institutions to update their transition and co-financing processes to achieve more sustainable financing.  

Fundamentally, a second Trump administration could bring cuts to US funding for family planning and reproductive health, alongside policies that could constrain access to family planning care and information. This context provides the UK with a clear global health mission: monitor changes in family planning and reproductive health funding and policies; shift to catalytic bilateral programming, especially for family planning to help fill the gap; strengthen the global coalition for SRHR; and use its multilateral voice to resist the rollback of rights.

 

The authors are grateful to Erin Collinson for insightful comments and suggestions, and to Justin Hurley for data support.

Disclaimer

CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.


Image credit for social media/web: Towfiqu Barbhuiya/ Adobe Stock