Carrying her infant daughter, 19-year-old Sithulisiwe Moyo spent two hours waiting in line at a makeshift clinic in Epworth, a disadvantaged area near Zimbabwe's capital, Harare. The tent-based outreach service provides Moyo with crucial access to birth control, aiding her in her goal to return to school. "I am too young to be a baby-making machine," she stated. "At least this clinic helps me avoid another pregnancy."

This vital service, funded by the U.S. government—the largest health aid donor globally—faces uncertainty. With U.S. President-elect Donald Trump expected to reinstate the global gag rule, funding for such clinics may soon disappear. The policy, which restricts U.S. foreign aid from being used for abortion services or information, has been enacted by Republican presidents and revoked by Democratic presidents for the past 40 years.

In one of his initial acts as president in 2017, Trump expanded this policy significantly. The changes caused foreign NGOs to lose approximately $600 million in U.S. family planning funds and over $11 billion in global health aid between 2017 and 2018, as reported by the U.S. Government Accountability Office. These funds were intended for a variety of critical areas such as malaria and tuberculosis prevention, improving water and sanitation, and disseminating health information and contraception.

Women's health advocates, like Pester Siraha, director of Population Services Zimbabwe, express deep concern over Trump’s re-election and the potential reinstatement of the global gag rule. Population Services Zimbabwe, aligned with MSI Reproductive Choices—an NGO supporting abortion rights in 36 countries—experienced significant cutbacks during Trump’s first term due to funding losses linked to the rule.

According to Siraha, a proposal from the conservative Heritage Foundation under the Project 2025 initiative suggests that a new Trump administration could enforce an even stricter version of the policy. This would pose severe consequences for NGOs globally, including in countries where abortion is illegal, such as Zimbabwe.

The impact on local communities could be dire. During Trump's previous term, clinics operated by Population Services Zimbabwe in rural areas had to shut down due to the funding shortfall. With limited hospital access because of poverty and distance, these clinics are often the only healthcare resource available to rural populations. "It leaves women with no place to turn for help, even for information," said Whitney Chinogwenya, global marketing manager at MSI Reproductive Choices.

The potential policy change has already led to reductions in services in other African countries like Uganda, Ghana, Ethiopia, Kenya, and South Africa. Programs affected include clinics, contraception distribution, training and support for health workers, and vital services for young people, sex workers, and LGBTIQ+ communities.