The sudden stop work order on USAID in January 2025 sent shock waves around the world. Many health clinics were immediately shut down, leaving millions without access to vital medicines and facilities, with potentially deadly consequences, especially for HIV patients, children, and women and adolescent girls.
To many, the subsequent axing of 83% of USAID programmes seemed like pure nihilism, engineered by ideologues who wanted to kill off the agency. But there was a long-term vision behind the destruction. The gutting of USAID has cleared a path for the next phase of a plan to reshape the global health landscape, say reproductive justice campaigners.
“Consider the first nine months [of the Trump administration] as round one,” Beth Schlachter, senior director of US external relations at MSI Reproductive Choices, told delegates at the recent International Conference on Family Planning (ICFP) in Bogotá, Colombia. “Now they’ve taken down the system of US foreign assistance, the [government] is rebuilding it.”
Key to that rebuilding are the new bilateral aid agreements the US is negotiating with governments. These deals, said Schlachter, will almost certainly come with conditions to make it harder for organisations to provide family planning services.
Schlachter is not the only expert to warn governments and NGOs to be on high alert for attempts by the US and ultra-conservative Christian organisations to undermine progress in sexual and reproductive health.
The Guardian spoke to leaders of reproductive justice organisations about what is coming next, and what effect these plans could have on women and girls around the world.
The Protego project
In October, the Institute for Women’s Health (IWH) in Washington DC celebrated the fifth anniversary of the Geneva Consensus Declaration (GCD), a 2020 manifesto from the first Trump administration that states that “there is no international right to abortion, nor any international obligation on the part of states to finance or facilitate abortion”. It was immediately condemned by more liberal governments and rights groups: Amnesty International said it believes the GCD endangers lives and flies in the face of human rights and decades of health research.
During the Washington event, Hungary, one of the original sponsors of the GCD, welcomed Guinea as the latest signatory, bringing the total number of supporting states to 40, half of them in Africa. Valerie Huber, president of the Institute for Women’s Health and architect of the GCD, said the goal is to reach 80 countries in the next three years, creating “an invincible force for women’s health, strong families, and national sovereignty that no international pressure can break”.
Huber is leading efforts to turn GCD principles into active policies in partner countries through her Protego project, a development that has alarmed many experts and activists. “Any policy based on GCD is catastrophic for bodily autonomy and reproductive rights. We should all be concerned and watchful for what’s coming out of the US,” says Jamie Vernaelde, a senior researcher at reproductive justice NGO Ipas.
In a statement to the Guardian, Huber rejected the idea that the GCD represents a threat to women’s health. “The GCD’s actual stated goals include reducing maternal mortality, improving health outcomes across the life course, and promoting health coverage for all. Claims that it ‘endangers lives’ contradict the document itself.”
The goals of the Protego project are outlined in a 62-page guide called the Women’s Optimal Health Framework. Vernaelde described the document as being “dressed up in language that asserts the value of women and girls”, but with “few specific recommendations”. She added that it goes against science-based health policies and “barely mentions any form of modern contraceptive methods, and excludes marginalised communities, such as people living with HIV, people who use drugs, sex workers, and sexual and gender minorities. No mention is made of adolescent access to comprehensive sexuality education; it prioritises parental rights over children’s rights.
“It is trying to supplant [human rights] frameworks that already exist.”
Huber denied there was a lack of detail and that the project attempts to replace existing human rights consensus. “The framework contains over 1,000 citations and provides comprehensive, evidence-based information … and provides countries with research-based alternatives that align with their cultural values and sovereignty.”
The framework does not mention abortion, other than to say it is not a form of contraception, but it states that it is “consistent with the foundational pillars of the GCD”, and Huber has spoken publicly about the potential of the project to support countries in their defence against donors that, she argues, seek to impose progressive “ideology”, such as access to safe, legal abortion, on to nations.
Huber said the IWH’s approach “focuses on reducing circumstances that lead women to consider abortion through robust support systems, quality healthcare, and education. This pro-woman approach addresses root causes”.
Huber advocates for abstinence-based education instead of comprehensive sexuality education (CSE) – the UN and World Health Organization-backed process of teaching age-appropriate information about sexuality and sexual and reproductive health. Research on the impact of CSE shows that it equips young people with the knowledge and skills to stay safe, maintain healthy relationships, take fewer risks and understand gender equity and rights.
In October 2023, a pilot Protego project was launched in Guatemala, which has one of the highest rates of teen pregnancy in Latin America, and was designated the “pro-life capital of Latin America” by former president Alejandro Giammattei.
One of the first Protego initiatives was a “parent-child communication guide” launched by Huber and the then education minister, giving tips on how to discuss sensitive issues, including advice on sexual relationships. It emphasises parental rights, seemingly playing to the rightwing moral panic that parents are losing control over their children. Efforts to introduce CSE to schools in Guatemala already faced numerous barriers. Protego’s parent guide will further undermine those efforts, placing parental control above children’s rights.
Now, the focus is on Protego in Africa. Uganda, an initial sponsor of the GCD, was an early adopter of Protego, with the first lady and minister for education Janet Museveni signing up in February 2024. As in Guatemala, one of the first initiatives was a school curriculum that will serve as an alternative to CSE, and has allegedly been handed to Huber for review. Burundi gave its support in October 2025.
“This project is gaining traction,” says Vernaelde.
“The fact that some organisations oppose our approach reflects ideological differences and perhaps discomfort with our rejection of ideological colonialism, not deficiencies in our frameworks or approach,” said Huber.
For Rahom Maria Bukirwa, programme manager at the Women’s Probono Initiative (WPI), a Ugandan legal aid organisation focused on women’s rights, Protego is just the latest development in a multipronged attack from religious conservative groups. “As a woman I have experienced the patriarchy – being first born and having a younger brother – it has been there constantly. But being in this [rights] space I see how it plays out on a larger scale.”
She said narratives around same-sex marriage and relations – strictly outlawed in the country – family values, national sovereignty, and the sexualisation of children through CSE, are shaping the country’s laws, policies and social attitudes. This is in part because they have direct access to lawmakers while NGOs such as WPI are often shut out of discussions. “In government, allyship is money oriented. The advantage that anti-rights groups have is a flexible network of funding. For us [rights-focused NGOs] we have a strict funding environment, so it’s hard to get into those rooms,” says Bukirwa.
’It will mean more women dying’
After causing chaos by abruptly stopping USAID in January, the US government is negotiating new aid packages with governments around the world. The plan, outlined in the America first global health strategy, is to sign bilateral agreements with 71 countries that will become self-reliant after a number of years.
The main focus is on fighting HIV, and the prevention and treatment of malaria, TB and polio. A draft memorandum of understanding makes virtually no mention of sexual and reproductive health.
“We know family planning will not be a priority; abortion will not be a part of the conversation; abstinence will be a focus,” says Nelly Munyasia, executive director of Reproductive Health Network Kenya.
Kenya was heavily reliant on USAID for family planning products. Losing that funding has led to a severe shortage of contraceptives. Shelves are empty and women looking for renewal of drugs or devices are being turned away. Without new money, the shortages will continue.
But concern is not just that sexual and reproductive health is being defunded; the fear is that the bilateral agreements will come with conditions to force governments to comply with the US administration’s values. “Many governments are excited that the US is coming in with funding,” says Schlachter. “[But] the US is highly transactional, [and] we don’t know the full extent of what the Trump administration will ask as payback for the investment. It’s a complete Trojan horse moment.”
These conditions are likely to align with the expanded “global gag rule” which, when it comes into force early next year, will include governments for the first time in its stipulation that any recipient of US health funding must certify that neither it, nor any other NGO with which it works, promotes or provides abortion.
Munyasia’s concern is that if US health aid becomes conditional on the global gag rule, groups such as hers, the largest provider of family planning services in the country, are at risk. The US has said it will only funnel money through faith-based groups, not NGOs, which it has accused of wasting money. “We will see surveillance on organisations that work around abortion and contraceptives for adolescents,” says Munyaisa. “It’s going to be terrible; it’s already terrible.
“If the Kenyan government complies we will see a lot of organisations deregistered and an increase in women dying of backstreet abortion. We fear this as civil society and we fear for women and girls.”
Schlachter echoes Munyasia’s fears. “[Bilateral agreements are] the next stage that will limit access to [family planning] services even further. If programmes shrink it will mean more pregnancy, more unsafe abortions, more women dying – it’s a continuation of that destruction phase, with more destruction,” she says.
Some countries, most recently Zambia, Zimbabwe and the Democratic Republic of the Congo, are boosting their own family planning budgets. Kenya is not among them. Munyasia believes this puts Kenya in a particularly vulnerable position. “For countries that have already found ways of mitigating, they can negotiate [with the US], they have the upper hand. They will look at the memorandum of understanding and say this yes, this no. But countries like Kenya, my dear country, is at zero [domestic funding for family planning].”
The ‘creation’ phase
“Destruction, consolidation and creation,” is how Neil Datta, executive director at the European Parliamentary Forum for Sexual and Reproductive Rights, characterises the Trump administration’s modus operandi.
If the shutdown of USAID is the destruction, and new bilateral agreements are consolidation, the “creation” phase will see a new system of services that offer alternatives to established sexual and reproductive health facilities.
Examples that already exist include crisis pregnancy centres that try to dissuade women from accessing abortion care; abstinence-based education programmes instead of comprehensive sexuality education; and natural family planning clinics as a substitute for modern contraception.
Most of these services are funded by governments or church-organised NGOs (ChONGOs), but not always. The EU recently withdrew funding from three World Youth Alliance (WYA) projects after a review showed they did not align with EU values and were one-sided or biased when it came to “sexual and reproductive health rights”. WYA denies the accusations. One of its core services is Femm, a health and fertility app funded by anti-abortion Catholic campaigners.
Another programme is Teen Star, a curriculum that teaches children about natural fertility and is already active in 30 countries.
“These anti-gender services do not just offer an alternative, they are genuine health risks,” says Datta.
Where once anti-gender services were seen as a nuisance or peculiarity, today they are gaining political support.
In Europe this “alternative framework” received $131.7m (£99m) in funding across 80 organisations between 2019 and 2023, according to a report authored by Datta.
Renewed US aid, the expanded global gag rule, and support for projects such as Protego means there is a “potential funding and legal framework ready to jump start anti-gender services around the world. [This is] what we need to be prepared for in the months ahead,” says Datta.
