Abortion is a guaranteed right in Nepal’s constitution. However, doctors and healthcare providers often find themselves barred from offering abortion services—not by local authorities, but by laws made over 7,000 miles away in the United States. Like many nations in the Global South, Nepal receives significant US healthcare aid, but this support comes with hefty strings attached.
In 1973, the US Congress passed the Helms Amendment to the Foreign Assistance Act, prohibiting the use of foreign aid for “abortion as a method of family planning.” Since its enactment, the law has been enforced as a total ban on funding for abortion and related care, abandoning even exceptions US law commonly allows for federal funding of domestic abortions in cases of rape, incest, or danger to the mother’s life. The global gag rule, an executive order first introduced by former President Ronald Reagan and later expanded by former President Donald Trump, took this policy further, banning NGOs from so much as discussing abortions if they receive US global health assistance—even if they use non-US-provided funds for their abortion-related care.
In Nepal, where 74 percent of family planning aid comes from the United States, these policies have devastating and often deadly consequences. Providers are caught in a web of restrictions and fear, unsure whether offering abortion care—even when constitutionally protected—might jeopardize the critical funding on which their facilities depend. Nepal is far from alone. Across the Global South, US policies pressure healthcare providers to follow conservative American legislation—undermining local laws and resulting in countless preventable deaths. To truly support women and girls worldwide and restore the integrity of American foreign aid, the Helms Amendment and the global gag rule have to go.
Fifty-two years ago, the Supreme Court issued its ruling in Roe v. Wade, declaring that the Constitution protected the right to abortion. Although the decision was a triumph for reproductive rights, it also invigorated the anti-abortion movement that persists today, spurring opponents to mobilize against reproductive rights wherever they could. With the women’s rights movement gaining momentum and constitutional protections newly enshrined, openly targeting abortion rights at home was politically challenging. However, reproductive rights in the Global South presented an easier, less visible target for conservative activists and lawmakers.
Over a decade before Roe, Congress passed the Foreign Assistance Act of 1961, establishing the United States Agency for International Development (USAID). The act coincided with a period of mass decolonization in the Global South and, by emphasizing nonmilitary economic assistance as a humanitarian effort rather than a tool of imperialism, marked a major shift in US foreign aid policy. By the early 1970s, USAID supported health initiatives throughout the Global South—including abortion services—as part of its broader humanitarian mission. Anti-abortion groups saw these programs as prime targets for their cause and pressured lawmakers to act.
To appease the domestic pro-life movement, pro-choice legislators sacrificed the reproductive rights of women abroad. In December 1973—less than a year after Roe—Congress passed the Helms Amendment to the Foreign Assistance Act with bipartisan support. USAID swiftly protested the amendment, emphasizing that the Foreign Assistance Act “explicitly acknowledges that every nation is and should be free to determine its own policies and procedures with respect to population growth and family planning.” The Helms Amendment, however, stripped nations of this autonomy, restricting reproductive rights that were, at the time, constitutionally protected in the United States. By doing so, the Helms Amendment transformed the Foreign Assistance Act into a tool of colonial control—directly undermining its original decolonial intent.
Despite these concerns, many elected Democrats saw the amendment as a pragmatic strategy to ease tensions with conservative colleagues in a nation increasingly polarized by abortion. But in allowing the amendment to pass, they ultimately turned the reproductive rights of women in developing countries into bargaining chips in an American political struggle.
The Reagan administration doubled down on this approach with the 1984 Mexico City Policy, known as the global gag rule, which barred organizations receiving US family planning funds from providing abortions, even with non-US resources. In 2017, Trump dramatically expanded the policy to apply to NGOs receiving any US health-related funds, forcing many organizations to halt life-saving services. Rural Nepalese clinics were hit particularly hard, and many were forced to shut down, blocking the nation’s most vulnerable from accessing essential care. Due to confusion surrounding the executive order, the quality of Nepalese maternal and child health services decreased across the board, not just in abortion-related care. NGOs that continued to provide abortion services were excluded from consultations with the Nepalese government due to concerns about violating US laws. Even though abortion is legal in Nepal, its government was forced to distance itself from organizations providing abortion care. While President Joe Biden has repealed the gag rule, it returns with each Republican president, creating a damaging cycle of fear and funding uncertainty.
Even as the United States has returned abortion rights to state discretion with Dobbs v. Jackson Women’s Health Organization, the Global South has moved forward. In 1973, only one of the 56 nations receiving US health assistance permitted abortion on broad grounds; today, 48 of those 56 countries permit abortion in at least one instance, with 34 having more liberal abortion laws. In Cambodia, Mozambique, and Nepal, abortion is fully legalized.
Despite this legal progress, US funding restrictions are holding these nations back. Although the global gag rule is currently not in effect under the Biden administration, its cyclic return makes it well-nigh impossible for the low-resourced, stretched-thin NGOs working in the Global South to establish robust abortion services. And with Trump’s second term just beginning, the global gag rule is poised to be reinstated with even more severe consequences. Under Project 2025, a conservative agenda linked to Trump, organizations will be prohibited from offering abortion services if they receive any US foreign aid, not just health assistance. The Helms Amendment, which remains in place, further obstructs access—not only by barring aid-supported facilities from providing abortions but also through confusing enforcement that deters many facilities from offering services they are technically permitted to provide.
In a world where unsafe abortions claim the lives of millions of women, predominantly in the Global South, US laws are contributing to countless preventable deaths not only at home but also abroad. Experts estimate that repealing the Helms Amendment alone could save 17,000 lives each year. Women and girls are dying because of laws crafted thousands of miles away by lawmakers over whom they have no democratic influence.
American foreign aid claims to uplift and support lives throughout the world, yet restrictive policies like these treat women in developing nations as pawns in American political battles. Today, the Abortion Is Health Care Everywhere Act aims to repeal the Helms Amendment, while the Global Health, Empowerment, and Rights Act seeks to end the gag rule permanently. If Congress passes these measures, US aid can truly serve its mission: supporting health and dignity, not imposing moral diktats from Washington.