Why Africa has already become a proxy war in the US assault on reproductive rights

Whether the US overturns the federal right to abortion or not, the writing may be on the wall for the future of US foreign policy

Protestors demonstrate against increasing abortion restrictions in the US
Protesters demonstrate against increasing state restrictions on abortion ahead of Roe v Wade’s Supreme Court challenge. US states have enacted 37 new abortion restrictions in 2022 alone, according to the Guttmacher Institute. Photo credit: Lorie Shaull

Laura López González, for The Continent magazine

The US Supreme Court looks poised to overturn the Constitutional right to abortion in the country. If it does, it will be the climax of a carefully orchestrated, decades-long campaign by US conservatives against reproductive rights at home. It may also be a harbinger of things to come in Africa.

If a draft US Supreme Court judgment leaked earlier this month becomes law in June or July, as many fear, it will overturn a 1973 court ruling establishing the Constitutional right to abortion in the United States. 

Striking down the decision known as Roe v Wade won’t make abortion illegal in the United States. Instead, it will devolve the power to regulate the procedure away from the federal government and back to the states. Just more than half of all US states will likely ban abortion. States like California and New York have increased funding for services in the expectation that they will become sanctuary states for those with the means to travel for care

The rise of Christian nationalism

Overturning Roe would be the culmination of decades of legislative and legal manoeuvring by conservatives, who have taken advantage of rightward shifts in the courts. In the last two decades, this has coincided with a rise in the Christian nationalism that helped elect former President Donald Trump. Christian nationalists believe that the US is a fundamentally Christian nation and that the government should keep it that way despite Constitutional separations of church and state. 

If Roe falls, US President Joe Biden has said he believes conservatives will target same-sex marriage protections on similar legal grounds. 

“[African] countries have the ability in their own domestic laws to shore up and protect the rights of their citizens by taking appropriate legislative action to uphold sexual reproductive rights…. The time is now for countries to be working in that direction.”

Brian Honermann
Deputy director, The Foundation for AIDS Research (amfAR)

Measuring abortion opinions is tricky, not least because how questions are framed can skew answers and make results difficult to compare. Still, a March nationally-representative poll by the Pew Research Center found that nearly one-in-five Americans believe abortion should be legal in all cases. Conversely, 8% said there should be blanket bans on the procedure. 

A national abortion ban, however unlikely, would increase maternal mortality by 21% without factoring in deaths from unsafe abortion, found a recent Duke University study. Among Black women — who face systemic barriers to safe pregnancies and already high death rates — fatalities would rise by a third.

The United States has one of the worst maternal mortality ratios among high-income countries globally. 

Roe and the future of aid in Africa

“We are all too familiar with the pernicious impact US policies can have on reproductive rights beyond its borders,” says Kylie Harrison, MSI Reproductive Choices global communications manager. The organisation provides contraceptives and safe abortion in at least two dozen countries.

Harrison joins others who fear that dismantling the right to abortion in the US will embolden anti-choice groups globally. US coalitions already spend millions in “dark money” to support opponents of abortion and gay rights around the world, including Africa, a 2020 openDemocracy investigation found.

It’s hard to imagine abortion opponents are not already bolstered as US states like Texas enact or propose bans on abortions after six weeks, effectively banning the procedure in many cases. 

Overturning Roe v Wade by itself does not change official US foreign policy. However, it does unravel the only draft legislation before Congress to permanently restrict the United States from placing related and dangerous conditionalities on aid to countries when more African countries are moving to expand access to abortion. African countries could find it hard to turn down assistance after Trump strategically defunded a traditional provider of contraception on the continent, the United Nations Population Fund (UNFPA).

Public policy deputy director at the Foundation for AIDS Research (amfAR) Brian Honermann believes stripping UNFPA’s funding was a deliberate move by Republicans who would prefer to dispense aid in ways that allow them to attach conditions to bilateral or even multilateral assistance.

Roe’s possible reversal likely signals harsher conditions on a greater range of aid under future Republican administrations.

“Countries have the ability in their own domestic laws to shore up and protect the rights of their citizens by taking appropriate legislative action to uphold sexual reproductive rights, including good laws on informed consent and protecting abortion,” Honermann says. “The time is now for countries to be working in that direction.”

He continues: “It’s very hard for the US government to order people to provide services in a way that violates the law.”

Almost a dozen African countries are moving to increase abortion access

African countries have steadily increased the grounds for abortions over the last two decades. Six countries still ban the procedure, but most nations permit terminations to safeguard pregnant people’s health. Many include provisions for survivors of rape or incest, shows 2021 data from the Center for Reproductive Rights. 

Fewer countries provide terminations in the case of congenital problems. Only a handful — Ethiopia, Rwanda, Zambia and South Africa — allow for abortions if the pregnancy threatens a person’s socioeconomic status.

Boniface Ushie is a research scientist at Kenya’s African Population and Health Research Center and has tracks abortion laws on the continent. 

“We have always known it: Wherever the law prohibits abortion, it doesn’t reduce abortion. What it does is that it increases the incidence of unsafe abortion,” Ushie explains. “But we are beginning to see that shift towards broader access in some countries.”

At least 10 countries, including Benin, the Democratic Republic of Congo, Sierra Leone, and the East African Community members, have recently taken steps toward increasing access to safe abortion. Still, Ushie admits progress is slow, and he fears the message Roe sends to many African countries that remain fundamentally conservative. 

US civil society, Ushie says, can still fight to uphold Roe — it may be too late by the time sentiment reaches Africa.

“The US is a country where people can still fight for what they believe in the civil society is strong,” he says. “That’s not the case for African countries …given the kind of oppression and repressive laws and regimes that we have.”

Gagged and gone

A 1973 law passed in reaction to Roe prohibits US federal funding for domestic or international abortions. Still, Republican presidents have made what’s commonly known as the global gag rule a hallmark of their administrations since 1984. The gag rule blocks US funding to foreign organisations that perform or promote abortions abroad, even if this is funded with other donors’ money. 

Gag rules are incredibly destructive, research shows but not always created equal. Instead, they tend to reflect a particular president’s agenda. Former US President George W Bush created the largest bilateral HIV programme in the world. His version of the gag rule exempted that programme from restrictions.

But Trump’s expanded version of the gag rule went farther and deeper than the gag policy had gone in nearly two decades, gaging all US global health assistance as well as smaller organisations that did not take US money but that were linked to bigger groups that did. 

AmfAR found that in this way, Trump’s expanded global gag rule attached US conditions to 12% of the money disbursed to countries by the Global Fund to Fight AIDS, TB and Malaria, which is funded by countries around the world. Nigeria, Tanzania and South Africa were among the top five countries most affected by the gagging of Global Fund money, amfAR found. South Africa has one of most liberal abortion laws in the world although access remains difficult.

Multiple studies have shown that organisations over-interpreted the gag rule, shutting down services that would have been allowed for fear of falling foul of powerful US funders. Biden repealed the gag rule in January 2021, but — without proper communication from the US government — some nonprofits believed the policy was still in effect as late as August 2021, a recent report by reproductive rights coalition Fòs Feminista shows. 

“The form that the gag rule comes back in may morph to be more restrictive or less restrictive, depending on how the Republican party moves,” Honermann explains. “The attacks on gender equality that are going on at the moment and the direction of the Republican Party suggests that it will be substantially worse.”

An edited version of this story was originally published in The Continent magazine on May 13, 2022.