Leading international charities have issued a stark warning that a series of new "coercive" health agreements spearheaded by Donald Trump's administration could cause global access to legal abortion to collapse.
The 'America First' Deals Replacing Traditional Aid
Following an initial freeze on foreign aid spending when Trump returned to the White House, the United States is now negotiating a raft of new funding compacts with governments across Africa. These deals, which have already been signed with 14 sub-Saharan nations, promise financial assistance in exchange for conditions ranging from mining rights and access to valuable national health data to agreements that align national health spending with American priorities.
These agreements replace the previous patchwork of health programmes under the United States Agency for International Development (USAID), which was dismantled during Trump's first year back in power. Campaigners argue this new approach makes the "America First" doctrine explicit, transforming aid from an act of altruism into a blunt bargaining chip.
"When a donor ties the continuation of HIV treatment, maternal and child health programmes, and outbreak response to unrelated political or economic concessions, that’s coercion," said Liza Barrie, a campaign director for US advocacy group Public Citizen. "And it erodes sovereignty, trust, and lives."
Vague Language and the Shadow of the Global Gag Rule
A major concern for NGOs is the deliberately vague wording of the compacts. Sarah Shaw, advocacy director at reproductive health charity MSI, stated, "What's really manipulative about the compacts is not really what they're saying, it's what they're not saying. And there's just lots of loopholes in the language that favour the US government."
This ambiguity is feared to leave the door open for the US to impose new rules after countries are locked into the deals. A prime concern is the potential expansion of the "global gag rule," or Mexico City policy. Every Republican president since the mid-1980s has enacted this policy, which prevents NGOs receiving US aid from providing or even discussing abortion services, even with their own funds. Trump reinstated it in his first week as president in 2025.
An expanded version, expected to be announced, could apply to national governments as well as NGOs. "It will essentially prohibit any abortion provision in the public sector because they won't be able to use any money regardless of where it's come from," Shaw explained. "It means that public sector abortion provision will just disappear."
Kenya's Precedent: Data, Dollars, and Desperation
The agreement with Kenya, seen by The Independent, serves as a potent case study. Dr. JE Musoba Kitui, Africa regional director for Ipas, described how Trump's initial aid freeze saw Kenya lose around half its health funding and over 40,000 health workers overnight. "The system was now very ready to sign any funding that they [could] get for whatever conditions," he said, leading the government to "sign away the rights of women and girls" in exchange for US support.
The Kenyan compact commits the government to providing the US with information to monitor compliance with laws that prohibit US funding for abortion. It also prioritises faith-based health providers, which, while important, often refuse services like specialist HIV care for LGBT+ communities.
Critically, the deal aims to "promote US interests abroad" by granting access to valuable health data and biological samples. Mitchell Warren of HIV advocacy group Avac said this could allow the US to develop "the next great vaccines," but offers no guarantee Kenya would benefit from technologies derived from its own data. Concerns also exist that accessed medical records could be used to discriminate against visa applicants.
Dr. Kitui warned that women, fearing their pregnancy data could be accessed, might avoid public health facilities altogether. The data-sharing plan is currently paused pending a court case on privacy grounds, with a verdict expected in mid-February 2026.
A Wider Pattern of Conditionality
The pattern extends beyond Kenya. In Zambia, while a deal is pending, the US embassy has explicitly linked a "substantial grant package" to "collaboration in the mining sector." A US State Department spokesperson, commenting on the Kenyan pact, said the US plans to provide up to $1.6 billion over five years, while Kenya pledged to increase domestic health spending by $850 million. The spokesperson confirmed the agreements include provisions to ensure compliance with US laws prohibiting funding for abortion.
With many agreements not fully public, transparency remains a significant issue. As these coercive deals proliferate, charities warn the consequences could be catastrophic, leveraging desperate need to roll back reproductive rights and national sovereignty on an unprecedented scale.
