Burning Birth Control: Trump’s Incendiary Act

Jacqueline H. Wolf

The Trump administration plans to bill U.S. taxpayers $167,000 to destroy a stockpile of contraceptive devices intended for women in sub-Saharan Africa (SSA)—a stockpile for which taxpayers have already paid $9.7 million. The cache, currently stored in a warehouse in Belgium, consists of 50,000 IUDs, 2 million doses of injectable contraceptives, 900,000 implantable birth control devices, and 2 million packets of birth control pills. Despite representing life-altering treatments for millions of women, as I explained in last week’s Urgent Care post (see “The Forgotten Lessons of Birth Control,” August 20), the stash will soon head to a medical waste company in France for destruction. The Belgian foreign ministry has condemned the move: “Sexual and reproductive health must not be subject to ideological constraints.”

Numerous governmental and non-governmental agencies around the world have offered to purchase the contraceptives and ship them to the countries they were intended for, to no avail. The Trump administration has rebuffed every offer, responding that they are complying with the Mexico City Policy, an anti-abortion pact that Trump recently rejoined. The Reagan administration implemented the Policy in 1985; it forbids using federal funds for “perform[ing] or actively promote[ing] abortion as a method of family planning.” Under the Policy, merely talking to women about abortion as an option is considered promoting abortion, leading critics to dub the Policy “the global gag rule.” According to the Trump administration, the Mexico City Policy speaks not only to abortion but also to the distribution of contraception because health workers might discuss abortion as an option if they distribute birth control devices to women who are unhappily pregnant. Trump’s interpretation of the Policy is particularly misguided because contraceptive use decreases the number of abortions and, in countries with a high incidence of unmet family planning needs, unsafe abortions and unintended pregnancies account for most maternal deaths. Since its initial implementation, every Republican presidential administration has adopted the global gag rule, and every Democratic presidential administration has rescinded it. And now the global gag rule is back in the news as Trump uses it to justify destroying almost $10 million worth of birth control intended for African women.

Forty-six of the 54 countries that form the African Union are in sub-Saharan Africa. The countries of the African Union are also assigned a region—Northern, Western, Middle, Eastern, or Southern—and fertility rates vary across regions. While fertility rates in the 1960s across Africa averaged about 6.5 births per woman of childbearing age, fertility rates today range from 2.4 in Southern Africa to 3.1 in Northern Africa, to 4.5 in Eastern Africa, to 5.3 in Western and Middle Africa.

International commitment to family planning began with a series of conferences on population and development sponsored by the United Nations. The first two emphasized family planning and economic policy to reduce population growth. At the third conference, in 1994, women’s health advocates called for reproductive health polices focusing on the status of women. That focus continued in the wake of the London Summit in 2012, co-sponsored by the Bill and Melinda Gates Foundation and the United Kingdom. More than a dozen ministers of health from both developed and developing countries attended the Summit, including representatives from the U.S. Agency for International Development (USAID) and the heads of several United Nations health agencies. Today, the ability to control one’s fertility is recognized as a human right. In dismantling USAID, Trump has withdrawn the United States from the commitment to that right.

Acceptance of contraception in African countries accelerated in response to two events: the HIV/AIDS epidemic in the 1990s and the 2006 adoption of the African Union’s Maputo Plan of Action. The Plan, signed by 48 African health ministers, confirms the earlier international calls to recognize family planning as a right and declares that contraceptive use makes births safer and mothers, babies, and children healthier.

That is why destroying millions of birth control devices is an act of enormous consequence. Widespread use of birth control lowers maternal mortality. In every locale where contraceptive use has risen, maternal deaths have declined. During the first decades of the 21^st century, as the fertility rate decreased across sub-Saharan Africa, maternal deaths fell from 857 per 100,000 births in 2000 to 531 deaths per 100,000 births in 2020. Currently, maternal mortality in SSA ranges from 23 deaths per 100,000 births in Seychelles (which is almost identical to the maternal death rate in the U.S. in 2022) to 1,150 maternal deaths per 100,000 births in war-torn South Sudan, a country with few health services.

Widespread use of birth control is also linked to lower infant and child mortality. In 1955, infant mortality (deaths of children under one year of age) in SSA was 183 deaths per 1,000 live births. As fertility rates declined, just as in every other birth-controlled population in the world, infant and child mortality fell. By 2000, the infant mortality rate in SSA was 88 deaths per 1,000 live births, still very high but less than half what it had been 50 years earlier; by 2015, infant mortality was 64 deaths per 1,000 live births. Deaths of children under age five likewise fell—from 142 deaths per 1,000 live births in 2000 to 99 in 2015. These declines increase birth control use even further—when their children survive childhood, women choose to give birth to fewer children and demand for contraception rises.

In addition to being lifesaving, family planning allows women to pursue educational and employment opportunities. Family incomes grow as more women work outside the home. That means children can stay in school rather than perform menial jobs to help their families financially. National economies expand with this healthier and better educated workforce. Yet much more can be done; modern contraceptive methods meet only 52% of the family-planning needs of women in SSA. Outreach to women seeking contraceptives should be expanding, not rapidly and cruelly contracting because of the wasteful decisions of the Trump administration.

A continuous supply of contraceptives to sub-Saharan Africa is essential to maintain the benefits of contraception. Before Trump, USAID was instrumental in maintaining family planning initiatives throughout Africa. Now, even the medical supply lines built by USAID, and used by other organizations, have been dismantled.

For decades, the UN and USAID, and most countries’ governments, have called for broad access to contraception as a basic human right. Trump’s policies are a full-scale attack on that right. He is taking women, children, families, and entire national economies backward with the order to destroy life-enhancing and life-saving birth control devices.

Jacqueline H. Wolf is professor emeritus of social medicine, Ohio University.

Sources:

Jeanna Smialke and Stephanie Nolen, “As Trump Administration Plans to Burn Contraceptives, Europeans Are Alarmed, The New York Times, August 7, 2025, available here.

Maham Javaid, Joyce Sohyun Lee, and Meg Kelly, “Trump administration to destroy birth control intended as aid,” The Washington Post, July 27, 2025, available here.

Charlotte Van Campenhout, “International Planned Parenthood condemns plan to burn US-funded contraceptives,” Reuters, July 25, 2025, available here.

Ammu Kannampilly, Jennifer Rigby and Jonathan Landay, “US-funded contraceptives for poor nations to be burned in France, sources say,” Reuters, July 24, 2025, available here.

M. Omar Rahman and Jane Menken, “Reproductive Health,” in Michael H. Merson, Robert E. Black, and Anne J. Mills, eds., Global Health: Diseases, Programs, Systems, and Policies, Third Edition (Jones & Barlett Learning, 2012): 115-176.

Amy O Tsui, Win Brown, Qingfeng Li, “Contraceptive Practice in sub-Saharan Africa,” Population and Development Review (March 31, 2017): 166-191, available here.

Francine Coeytaux, Debra Bingham, and Ana Langer, “Reducing maternal mortality: a global imperative,” Contraception: An International Reproductive Health Journal 83 (2), February 2011, P95-98.

John Stover and John Ross, “How Increased Contraceptive Use has Reduced Maternal Mortality,” Maternal and Child Health Journal 14, July 2009: 687-697.

“Family planning/contraception methods,” World Health Organization, July 3, 2025, available here.

Million Phiri, Clifford Odimegwu, Chester Kalinda, “Unmet need for family planning among married women in sub-Saharan Africa: a meta-analysis of DHS data (1995-202), Contraception and Reproductive Medicine (January 11, 2023).

“Sexual and Reproductive Health Fact Sheet,” World Health Organization, undated, circa 2022, available here.

“Maternal mortality: The urgency of a systemic and multisectoral approach in mitigating maternal deaths in Africa,” World Health Organization Analytical Fact Sheet March 2023, available here.