KISUMU, Kenya — For decades, American anti-abortion organizations have pushed both at home and overseas to limit access to abortion services. Their greatest domestic victory came with the overturning of Roe v. Wade. Now, the Trump administration is giving fresh energy to the movement that seeks to export what it calls “family values” to countries around the world.
At the annual March for Life rally in Washington, Vice President JD Vance announced broad new limits on U.S. funding for nongovernmental organizations, foreign governments, and United Nations agencies that support abortion access, gender-affirming care, and diversity programs abroad.
“We’re going to start blocking every international NGO that performs or promotes abortion abroad from receiving a dollar of U.S. money,” Vance told the crowd in January.
These expanded restrictions build on the work already being done by conservative American nonprofits in Africa — a region where healthcare systems rely heavily on foreign aid. Africa also has the world’s highest estimated share of unsafe abortions and the highest maternal death rates, including the greatest number of pregnancy-related deaths per 100,000 abortions.
This report is part of an ongoing series examining maternal mortality in sub-Saharan Africa, which has the world’s fastest-growing population and accounts for 70% of all pregnancy-related deaths globally. Roughly 180,000 women die from pregnancy-related causes across the continent every year.
The new policy represents a dramatic expansion of a previous U.S. rule that cut off assistance to overseas organizations offering abortion-related services. Experts say at least $30 billion in U.S. aid could be affected, with far-reaching effects on health policy worldwide.
“We’re seeing opportunity here to have a consistently pro-life ethic,” said Nicole Hunt of Focus on the Family, a Colorado-based conservative Christian evangelical organization. “We’ve been influencing health policies for a long time with our foreign aid. This is just a new direction,” she told the Associated Press.
At the center of the controversy is an international agreement signed by African nations two decades ago that declared safe abortion a human right. Called the Maputo Protocol, it requires signatory countries to allow abortion in cases of rape, incest, fetal malformation, or risk to a woman’s health. However, enforcement has been inconsistent, pushing many women toward dangerous, illegal procedures. Sub-Saharan Africa sees more than 6 million unsafe abortions annually, according to the African Institute for Development Policy.
Energized by President Donald Trump’s policies, U.S. anti-abortion organizations are now working to eliminate even this limited access to safe abortion procedures.
In Nairobi, Nardos Hagos of the International Planned Parenthood Federation said she is gravely concerned about what lies ahead.
“We’ve now moved into a new era where we are the ones who are in opposition because the most powerful and influential supporters of reproductive health — the U.S. and a lot of Europe — are now more aligned with anti-rights groups,” she said. “We’re gonna see more women dying from unsafe abortions.”
Tracking the total amount of money U.S. anti-abortion charitable groups send to Africa is difficult. Publicly available tax filings from 17 such organizations show that money directed to Africa jumped 50% between 2019 and 2022, reaching more than $16 million, according to an analysis by the Institute for Journalism and Social Change. The organizations then spent nearly $9.4 million in Africa during 2023 and 2024, according to previously unreported data examined by the institute.
That figure is “just the tip of the iceberg,” said the institute’s Claire Provost. “What we’re seeing here is just a fraction of what the real investment on the continent is,” she said, noting that unlike many tax-exempt nonprofits, U.S.-based churches and certain religious organizations are not required to file annual financial disclosures detailing their revenue and spending.
Provost said it is not possible to see “even limited information” about how much money The Church of Jesus Christ of Latter-day Saints, among others, channels to Africa. The Salt Lake City-based church — widely known as the Mormon church — is “increasingly active on the continent, including opposing sexual and reproductive rights issues,” Provost said. With more than 1 million followers across Africa, the church has hosted “Strengthening Families” conferences on the continent over the past eight years.
Sean E.R. Donnelly, the church’s communications manager for Africa, said in an interview with the AP that about a quarter of the $1.5 billion the church spent overseas last year went to Africa, funding development projects “with the goal of helping people, especially families,” including work in healthcare, education, and emergency relief.
When asked about women’s reproductive rights and abortion, Donnelly said the church was “not really active” in those areas, though he acknowledged the topics may come up among African partners during church-sponsored events.
“We have the deputy prime minister, we have the ministries of gender, we have all the ministers who are relevant to family, and we’re helping them … as they craft policy and strategy to make sure that we protect the family,” Donnelly said of the conferences.
Asked specifically about the church’s stance on abortion, he provided a written statement saying the church generally opposes elective abortion in most cases but allows exceptions for rape, incest, or danger to a woman’s health when counseling its members. He also stated via email that the church carries out no activities related to abortion or reproductive rights.
One church-sponsored conference last year was held in Sierra Leone at a time when the country was close to decriminalizing abortion. Local rights groups say pressure from religious lobbies stalled that effort. Activists have raised concerns about the influence of local religious organizations whose strategies resemble those of some conservative American Christian groups. In response to AP questions about the conference and any influence on abortion-related issues, Donnelly said, “This is not how the church operates in Africa or globally.”
Determining how U.S. money is used once it arrives in Africa is complicated by weak financial disclosure requirements in many African countries. Focus on the Family spent $370,000 in Africa between 2019 and 2023, according to the Institute for Journalism and Social Change, which notes that figure likely understates the group’s actual reach and influence. Focus on the Family’s Hunt said the group’s mission is “to change hearts and minds on abortion” worldwide but declined to share specifics about its work in Africa.
Hannah Ruguru made a personal vow to help women access safe abortions after her own sister died following an illegal procedure. But her work at a reproductive health clinic in Kisumu, in rural western Kenya, has become increasingly dangerous.
She has been screamed at by protesters and faced so much online harassment on Facebook that she deleted her account. “Sometimes you can get scared,” Ruguru said. But “at the end of the day, I’m helping women.”
Marie Stopes International, which operates the clinic where Ruguru works, reported in 2024 that staff in several African countries described online harassment and legal attacks from U.S.-based groups and U.S.-funded local organizations. In Congo, the report said, health workers were detained for days for providing legally permitted services before being released without charges.
“The extent of the opposition has made abortion providers fearful of coming into work,” the report stated.
In Ethiopia, the group said the head of the local office of U.S.-based Family Watch International has “targeted and trolled members of our senior leadership team on social media” and posted YouTube videos spreading anti-abortion misinformation. In Kenya, the names and home addresses of staff at reproductive rights organizations have been posted online, with accusations of murder.
The owner of a private abortion clinic in Nairobi said staff have been harassed and detained by police, with officials demanding bribes and threatening criminal charges if they are not paid. The owner spoke on condition of anonymity due to fear of retaliation.
Musoba Kitui, regional director of Ipas Africa Alliance, which advocates for reproductive rights and safe abortion care, said the shifts in U.S. foreign aid policy combined with “this advancing American interest in ideology in Africa is really concerning.” “We think the consequences are going to be dire,” Kitui said, particularly for women and marginalized communities including LGBTQ+ individuals.
Last year, anti-abortion Christian groups from the U.S., Europe, and Africa, along with senior Kenyan officials, gathered in Nairobi for a conference titled “Promoting and Protecting Family Values in Challenging Times.” A Poland-based anti-abortion organization called Ordo Iuris distributed a guide in four languages — including Swahili — with advice on lobbying international bodies such as the United Nations, the European Union, and the African Union.
Travis Weber, vice president of the Family Research Council, a Washington-based evangelical group involved in anti-abortion advocacy, said he attended the Nairobi conference to “defend the family as God designed it.”
Charles Kanjama, vice chairman of the African Christian Professionals Forum, which organized the conference, said that in the past, international aid frequently supported reproductive rights — but the landscape has shifted. “We are hoping that … we can start attracting money from people who think like us,” said Kanjama, considered one of Africa’s most prominent anti-abortion figures. “It’s a culture war, really.”
The anti-abortion movement does appear to be gaining ground. In June, representatives from 20 African countries finalized a draft charter at a conference in Ghana calling for the rejection of sexual and reproductive health rights. That charter is set to be voted on by the African Union next year. Family Watch International’s co-founder, Sharon Slater, was among those raising money for the charter’s passage at the European Parliament in Brussels this year.
In Kenya — one of Africa’s wealthier nations — an average of seven women die every day from complications related to unsafe abortions, according to the African Population and Health Research Center. Kenya’s 2010 constitution allows abortion when a woman’s life or health is at risk, and subsequent court rulings have extended that to cases of rape, incest, or serious threat to a woman’s mental health.
However, a significant legal gray area remains. Kenya’s penal code, which dates back to the colonial era, still criminalizes abortion providers and women who seek the procedure, with penalties of up to 14 years in prison. Most public hospitals do not perform abortions, leaving women to choose between expensive private clinic services or dangerous illegal methods, according to healthcare officials.
In May, a Kenyan appeals court overturned a ruling that had affirmed abortion access as a fundamental right — a case led by Kanjama, who called the decision a restoration of “constitutional balance.”
The Kenyan Health Ministry, Justice Ministry, and the government spokesperson’s office did not respond to repeated requests for comment from the AP.
The U.S. State Department, responding to AP questions about the Trump administration’s new overseas aid rules, said: “The American people expect their tax dollars to support programs that save lives … and reflect American values, not fund abortion-related activities, left-wing social agendas, or wasteful overseas bureaucracies.” The department added: “U.S. assistance continues to support a wide range of maternal and child health services as part of the America First Global Health Strategy.”
In Kenya, doctors are required to treat women who arrive at hospitals suffering from complications following illegal abortions, including severe bleeding, infections, and loss of their uteruses — and these are the cases that most often reach public hospitals.
“By the time the women come, we are often dealing with a life-threatening situation,” said Dominic Omollo, the reproductive health coordinator in Bondo, western Kenya.
Even as U.S., international, and Africa-based anti-abortion groups say their goal is to protect life, healthcare providers and activists on the ground say the practical outcome is more unsafe abortions and more women dying.
In Karabok, a rural Kenyan village, two trees mark the burial site of Mary Olouch, just steps from where the 25-year-old bled to death after an illegal abortion. “She did not open up to anyone,” said Loice Ochieng, a community health volunteer responsible for family planning in the village.
Olouch already had a young child when she discovered she was pregnant again. She kept it from her husband. When he returned home one evening to find her bleeding, he rushed her to the hospital — but she did not survive.
Olouch did not qualify for an abortion at a public hospital and could not afford a private clinic on her modest income from selling fish. Abortion carries deep stigma in rural communities, and husbands often forbid their wives from using contraception, Ochieng said.
Following Olouch’s death, women in Karabok began speaking more openly about abortion — a subject that had previously been nearly unspeakable in the community. Now, Ochieng said, if women “have a problem, they come to me, they ask. Because they have seen that this thing can cause death.”
