(18 March 2025) Donald Trump has dismantled all U.S. foreign assistance and launched an ideological assault on sexual and reproductive health and rights (SRHR), threatening the lives and health of millions. This raises a critical question: will anyone step in when the U.S. steps out? The Swedish government has taken an important step by launching a new strategy for health and SRHR, backed by a budget of SEK 4.3 billion. While much greater efforts are needed to fill the urgent gaps, the Swedish strategy is symbolically significant. It demonstrates that European governments, including those leaning towards a more conservative agenda, are still interested in funding and taking a leadership role in promoting gender equality and SRHR globally. We urgently need other European countries and the EU to follow Sweden’s example.
Trump's bombshell proves he is keeping his campaign promises
On 20 January 2025 Trump entered the White House and immediately began implementing the policies he promised during his campaign. A growing list of Executive Orders is now drastically reshaping U.S. foreign and development policy, and Trump has gone further than initially promised. Despite previously claiming to have “known nothing” about Project 2025 — a 900-page ultra-conservative policy plan positioned as a roadmap for his administration — he has already enacted over 90% of the suggested actions for foreign policy. At the heart of his initiatives are intensified attacks on SRHR, gender equality, equity, inclusion, and LGBTIQ+ rights.
On Trump's first day in office, he signed an Executive Order halting all USAID for three months, during which time all programs will be reviewed against the President's ideological agenda. This order was soon followed by the reinstatement of the Mexico City Policy (the MCP), also known as the "Global Gag Rule", which prohibits U.S. foreign aid from going to organizations that provide information about or offer abortion services, even with their own funds, and even in countries where abortion is legal. Because of the way this policy is implemented, the MCP is notorious for restricting access to contraception, maternal healthcare, HIV prevention, and a range of other vital health services. On the same day, the Government re-joined the Geneva Consensus Declaration (GCD). The GCD has no official standing in the UN and calls on states to promote women’s health but excludes access to abortion. Most signatories of the GCD are authoritarian and illiberal governments, including those of Uganda, Egypt, Hungary, Saudi Arabia, and Belarus.
At the end of February, the administration signaled the premature end of the 90-day pause and promised a 90 % cut of USAID’s contracts. We can now expect a very different form of U.S. global health assistance. It will be highly conditional, and there will be a zeroing out of support for SRHR, except for some funding still being channeled to maternal health. Most likely, Governments that are offered U.S. assistance will be required to sign on to the anti-abortion Geneva Consensus Declaration and asked to implement its operational framework known as The Optimal Women's Health Framework.
Europe slashes its ODA — Sweden steps up on SRHR
Meanwhile, European countries previously known for their strong support of global health and SRHR (such as Germany, Sweden, Switzerland, France, Belgium, the Netherlands and the UK) have made substantial cuts to their Official Development Assistance (ODA). These cuts represent a shift towards national and European security, focusing on the situation in Ukraine and increased military spending. The Netherlands is also signaling disturbing ideological alignment with the U.S. administration, removing any support for inclusion and gender equality. The deep irony of these cuts is that the development cooperation contributes to stabilizing countries, enhancing global security, and reducing global health threats and is an important soft-power in diplomacy.
Although Sweden is part of the growing group of European nations that have reduced their ODA in favour of more protectionist agendas, it stands out positively for its strong support of SRHR globally — a field that traditionally attracts less attention from governments with conservative leanings. Recently, the Swedish government announced plans to invest SEK 4.3 billion over five years in global health and SRHR. SRHR has long been a priority issue in Swedish foreign and development policy, regardless of the political party in power. Although the term “feminist” has been dropped by the current Government, Sweden was the first country ever to pioneer a Feminist Foreign Policy in 2014. The Swedish government, alongside civil society, researchers, and other actors, has played a significant role in advancing gender equality and SRHR globally, particularly in the contentious areas of comprehensive sexuality education, contraception, safe abortion, and LGBTIQ+ rights.
Traditionally, Swedish ODA for SRHR has been channeled through various actors and complementary types of interventions. The new strategy enables Sweden to continue supporting crucial and contested areas of SRHR. The specific implementation details of this new strategy have yet to be communicated. Still, it is clear that, at least in theory, it allows Sweden to continue supporting interventions central to a rights-based approach to SRHR, including investing in:
- Quality health systems and the integration of all components of SRH services, and investments in comprehensive sexuality education.
- The dismantling of discriminatory legislation and changing harmful social norms around sexuality, reproduction, sex and gender.
- The involvement and funding of civil society organizations working for gender equality and SRHR. The most crucial change agents — who often take the most significant risks — are those working locally for human rights.
The devastating impact of Trump’s anti-human rights agenda
A global system where the U.S. previously accounted for a very high share of the health budget in some countries is neither sustainable nor desirable. There should be national ownership and leadership by Low and Middle Income Countries (LMICs) to achieve Universal Health Coverage inclusive of SRHR and the process needs to be supported by European donors and agreements. However, the speed and brutality with which Trump has enacted his stop-aid and anti-human rights agenda call for Europe to fill the most urgent gaps. Overnight, millions are now being left without access to safe delivery, contraceptives, HIV prevention, protections against sexual violence, safe abortion services, and a range of other essential health services needed for a healthy life and survival.
Europe is urged to promote SRHR
The EU and European nations must commit to additional funding to address the immediate gaps left by Trump’s policies. They should:
- Channel funding through and scale up existing platforms and mechanisms to reinforce funding for SRHR, gender equality, and global health. The Team Europe Initiative (TEI) for SRHR in Africa can serve as one such existing mechanism.
- Initiate dialogues with the Governments of countries hardest hit by Trump’s policies. Discuss the Geneva Consensus Declaration with them and work proactively to dismantle it and its program framework.
- Prioritize listening to and supporting local actors and partners as critical voices advocating for gender equality, SRHR, and human rights. They are best positioned to develop contextualized and sustainable solutions.
Europe needs to wake up. The health and lives of millions are at stake.