Trump 2.0 sends “a ripple of fear” through the reproductive health community fighting for safe abortions worldwide

Last year a 17 year old, Patient X, was admitted to Kamuzu Central Hospital, a tertiary referral centre in Malawi, with generalised peritonitis. An examination found that a stick had perforated and remained in the patient’s uterus and that the organ was pus filled and necrotic: the result of a botched backstreet abortion. Patient X underwent a total abdominal hysterectomy and in the following weeks developed a fever and fascial dehiscence, a serious complication that occurs when the abdominal wall separates after surgery. Throughout, the patient and her mother denied that she had visited one of Malawi’s thousands of clandestine abortion providers.1

Malawi criminalises abortion except when the pregnant individual’s life is in danger. As in aid dependent nations throughout the global south, Malawi’s slow progress in liberalising abortion is under attack by anti-abortion actors who, buoyed by a second Donald Trump presidency in the US, are growing in legislative and governmental influence. “The mood among sexual and reproductive health advocates across Africa is shock and fear around what ‘Trump 2’ will bring in terms of lost lives and lost legislative gains,” says Kenneth Juma, a senior sexual and reproductive health researcher at the United Nations’ Human Rights Council.

MSI Choices, an international non-governmental organisation (NGO) that provides contraception and safe abortion services in 36 countries, has estimated that cuts made to USAid funding under Trump’s first presidency led to 1.8 million unsafe abortions that would have been prevented by MSI’s work, as well as 20 000 additional maternal deaths.2

In 2025 these risks have mounted, says Sarah Shaw, MSI’s head of advocacy. “There is a ripple of fear in the prochoice …