Sexual and reproductive health under the Trump presidency: policy change threatens women in the USA and worldwide.

Even before President Trump's inauguration, it was clear that women's sexual and reproductive health (SRH) was going to be a focus of his policy initiatives. Now that he is in office, the impact of these policy changes is beginning to come into focus – and these initiatives affecting abortion, contraception, maternity care and more – are concerning from a medical and public health perspective. The past decade has seen improvements in the use of more effective contraception and a reduction in unintended pregnancy in the USA,1 and it is worrisome that Trump's policies could roll back progress on women's health. One of President Trump's first executive orders after his inauguration was to re-impose the Mexico City Policy, which regulates US funding to foreign non-governmental organisations. Also known as the Global Gag Rule, this policy prevents organisations that receive United States (US) funding from using any of their financial resources, regardless of source, to provide, inform about or advocate for access to abortion care in their countries. The Trump order appears to have expanded the scope of the Gag Rule, which has been imposed by every Republican president since Ronald Reagan: it now extends beyond funding from the United States Agency for International Development (USAID) to include programmes such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health (NIH). If reducing abortion were the aim of this policy, it is not at all clear that it is effective. Data from over a quarter of a million women across 20 nations …