We must fight even harder to protect women’s health in the era of Trump and the global right

US president Donald Trump has begun his attack on women’s health. In his first two weeks as president, he began taking action as detailed in Project 2025, the blueprint for his second presidency developed by right wing think tank The Heritage Foundation.1 He signed an executive order to withdraw the US from the World Health Organization; reinstated the global gag rule2; condemned and abolished equality, diversity, and inclusion initiatives; instructed the censorship of scientific publications that include reference to LGBTQ+ or gender “forbidden terms”3; attempted to end the US President’s Emergency Plan for AIDS Relief (PEPFAR); and began his assault on US foreign aid, public health, and disease control abroad and in the US.4 Sexual and reproductive health organisations are predicting and experiencing the harm of these measures. According to Guttmacher, the 90 day freeze in United States Agency for International Development (USAID) funding will lead to 11.7 million women and girls being denied healthcare, 4.2 million unintended pregnancies, and 8340 maternal deaths.5 We must not be distracted by the Trump show. We must respond by focusing on what his administration is creating as they are destroying.

Trump’s attacks on women’s health are embedded in a global right wing agenda. Experts on the global far right propose that they will gain power, legitimacy, influence, and momentum by focusing on the global, particularly in organising against a globalist bourgeoisie and managerial elite.6 The global nature of the agenda is crucial to understanding the movement that threatens women’s health locally and worldwide. Confronting these threats requires attention to local action: strengthening domestic laws on comprehensive sex education and sexual and reproductive health rights at every level of government, and—in places where abortion is illegal—advocating for social decriminalisation of abortion, where abortion becomes so normalised that the public support its decriminalisation even if the state does not.7

The aim of Trump and the global right, as stated in Project 2025, is to deconstruct existing global health governance and its commitment to women’s health and build a new multilateral order based on religion and conservative values around the family and gender roles.16 A major risk is that global health institutions fail to see this, instead acquiescing to the demands of the global right. Concerned with a potential domino effect, global health leaders may decide which health priorities they can ignore or water down in a bid to keep states within institutions such as WHO. This has happened before, most notably the “Cairo compromise” in 1994 that ushered in the prioritisation of maternal health over comprehensive sexual and reproductive health.7 Now is the time to double down on commitments to sexual and reproductive health to stop women dying from preventable causes such as unsafe abortion. We must not sell them out to a regressive political ideology. Any compromise to the tools we have to protect women’s health will be damaging and is a politically naive move. The global right is already establishing a new world order.

While Trump was signing executive orders, US Secretary of State Marco Rubio was recommitting to an alternative model of global health multilateralism—the Geneva Consensus Declaration on Promoting Women’s Health and Strengthening the Family.8 The Geneva consensus and the associated Protego health: the optimal women’s health framework (WOHF) is the women’s health wing of Project 2025.9 The Geneva consensus and WOHF are core parts of the global right’s new multilateralism: one that is built on women’s health. Established in 2020 by right wing thinkers linked to Project 2025 such as Valerie Huber, the Geneva consensus reads like a standard commitment to women’s health. Where it diverges is its unequivocal stance: “In no case should abortion be promoted as a method of family planning.” The Geneva consensus has 37 signatories, with Brazil, Egypt, Indonesia, Uganda, and the US all co-sponsoring a letter to the UN General Assembly calling for wider support for a ban on the international right to abortion and reaffirmation of traditional family roles.

The challenge of the Geneva consensus to women’s health is immediate. Evidence shows that abortion bans do not stop abortions—they just increase the risk of unsafe abortion and denial of essential care, and result in women dying around the world.10 The challenge, however, is to prove how dangerous the consensus will be. The Bureau of Investigative Journalism noted how WOHF had “entered into a secretive agreement with the Ugandan government to find public money to spend” and that “key documents relating to the project are being kept away from the public eye.”11 This is not isolated, the Institute of Women’s Health, the US based advocacy organisation that wrote and seeks to implement WOHF, does not publish on their website where they work, who their donors are, or how much, what, or where their money is spent.12 While this is not a mandatory requirement of non-profit organisations, it is best practice for organisations with an international reach.13 We must adopt a new way of working to track, measure, and expose the damage to women’s health of this new global right’s multilateralism. This requires transnational partnerships and alliances between groups working at all levels of women’s rights, following leadership from global south activists, and adopting methods that specialise in exposing government secrecy by working with investigative journalists, experts in forensic accounting and intelligence, and supporting organisations monitoring government transparency and freedom of information requests.

Trump and the global right’s politics are focused on performance and distraction with deadly consequences for women. Resistance to attacks on women’s health requires as much attention to what they are trying to build as to what they are trying to destroy. There is a mirror world14 of global health multilateralism—where things look familiar, including language, concerns, and priorities, but the ideology and intent is completely different—and we must not ignore it. Advocates of women’s health and gender equality need new tools of research, to strengthen global alliances and partnerships, and to keep the focus on our own communities as much as the shocking news from Washington.