On 3 May, the leak of the US Supreme Court draft document planning to overturn of Roe v. Wade made it clear just how close women in the United States are to losing their most fundamental reproductive rights. Undoing the federal right to abortion guaranteed by 1973’s Roe decision would leave it up to individual states to decide whether women can terminate pregnancies, and under what conditions, and many have already made it clear they plan to ban abortion entirely or almost entirely as soon as the new judgement comes in. As a result, Planned Parenthood has estimated that thirty-six million people in the US could lose access to safe, legal abortion, with women and people of colour from minoritised communities and those living in rural areas further from abortion providers the worst impacted.

In the ensuing days, those at risk in the US have rightly been the centre of global attention and concern. But the end of Roe is also likely to have consequences much further afield. Anti-abortion ideology already influences US foreign policy, and has been disrupting access to sexual and reproductive health services beyond US borders since well before this latest news.

It may come as a surprise to hear that the US is currently the largest global donor to sexual and reproductive healthcare (SRH) schemes worldwide. Through global health programmes it contributes almost ninety percent of financial assistance to those countries who rely on foreign aid to maintain their health systems. Under the Global Gag Rule first instituted in 1984 by Ronald Reagan, however, NGOs outside the US have effectively been required to endorse an anti-abortion stance, guaranteeing that they will not use funding to provide abortion services, referrals, or information to citizens, or to advocate for decriminalisation or the liberalisation of a state’s abortion law, if they want to receive US family planning funds. These funds might instead go to sex education, management of sexually transmitted infections, testing and screening, and preventative contraceptive use, much of which is done to dissuade abortion in the long run. The restrictions apply to the use of these NGOs’ own money, from any source, not just the SRH funding received from the States.

Since Reagan, every US president has had the option to enact or revoke the policy, making sexual healthcare information and services in countries globally ranging from Colombia, Belize and Kenya, Sri Lanka, and Zambia dependent on the oscillations of American politics. Things have usually followed party lines. In 2017, after reinstating the law repealed by Obama, Donald Trump expanded it to apply to all US foreign healthcare funding, for everything from malaria to nutrition to tuberculosis. Biden rescinded the Gag Rule in January 2021, but between then and 3 May this year abortion activists had called on the Democratic president to go further end the law altogether, permanently, along with its counterpart, the Helms Amendment, which since 1973 has directly prevented US aid money from going toward abortion provision or information services.

Terminations, of course, take place in all countries regardless. Combined, the Guttmacher Institute estimates that the Gag Rule and the Helms Amendment contribute to more than thirty-five million unsafe abortions each year—abortions self-induced or delivered by an unqualified or unskilled practitioner, often in unsterile environments, and which are in their entirety cited as the cause of thirteen percent of annual maternal deaths worldwide. Evidence from across the world, from El Salvador to South Africa to Romania, indicates that the more restrictive abortion legislation is, the more women die or contract diseases during and after giving birth, a correlation reported in a September 2021 brief submitted to the US Supreme Court. Measures that restrict women’s reproductive autonomy reliably translate into broader failings in the sphere of women’s health as a whole—a situation anti-abortion activists are more than happy to defend both inside and outside the US.

Of course, the Gag Rule and the Helms Amendment existed alongside Roe for decades, so there’s no reason the latter’s overturning automatically has to translate into harsher restrictions worldwide. But American cultural hegemony locks this situation down. The anti-choice movement in the US has long positioned itself as the leader of a global cause. International groups without direct links to the US have regularly hosted prominent American anti-abortion activists, recognising the success of their movement and seeking to learn from it. And while NGOs funded by American aid have been prevented from offering or talking about abortion, American anti-abortion groups with wealthy backers have funnelled millions of dollars to global parallels with similar intentions. One American conservative Christian legal advocacy group, the Alliance Defending Freedom, spent $23.3 million in Europe between 2008 and 2019, and allied with parallel organisations in Poland, where abortion was effectively outlawed in 2020. Assuming the global movement won’t be galvanised in terms of both morale and money by this huge domestic victory would be fundamentally naïve.

That the growing strength of the anti-abortion movement can also influence things in more subtle ways is clear closer to home. England, Scotland, and Wales are contested territories in this respect, given that the failure to repeal the 1861 Offences Against the Person Act means that having an abortion here is still technically criminal. Two doctors must verify that the requirements of the 1967 Abortion Act, which amended, rather than ended, the 1861 Act, are met for an abortion to be legal. The 1967 law also did not extend to Northern Ireland, where abortion was only decriminalised in 2019 and where practical access remains extremely limited. Cuts to the UK’s foreign aid have also been blamed for undermining access to sexual healthcare worldwide.

While none of this can be traced back to the rise of the US anti-abortion movement, it relies rhetorically on what’s happening on the other side of the Atlantic to justify its own failures, and to characterise abortion as something controversial that should therefore be more difficult and distressing than other medical procedures. The hurdles, the funding cuts, the technicalities that make abortion practically, if not legally, more challenging can be waved away on the basis of ‘at least we’re not as bad as them’.

In light of the regression taking place in the US, this argument is no longer acceptable. The global question of legal abortion has to be removed from the region of contentious morality and understood as what it is: a vital form of healthcare, and a vital aspect of equal rights, whose absence can and will result in deaths, predominantly those of working-class women and women of colour. Like all healthcare and all equal rights, we have to fight for the imperfect access that exists both at home and around the world to be not only defended, but improved. If we don’t, we risk losing everything we’ve got.