Two weeks ago, President Trump’s executive order reinstating the Mexico City policy took effect. First established in 1984, this rule blocks US aid to organizations abroad that provide counseling or referrals on abortion. Previous iterations of this rule have applied to family planning funding only—during the George W. Bush administration, around $600 million in US foreign assistance. But the Trump administration’s version applies to all global health assistance, or $8.8 billion in foreign aid.

Essentially, clinics and organizations around the world that offer abortion-related services must now choose to either eliminate these services, or forgo any funding they receive from the US for any health services. Given that the United States has established itself as the world’s largest bilateral donor of global health assistance, and of family planning assistance, this choice is a consequential one—particularly in developing countries, where clinics may be few and far between, and where 99 percent of the global share of maternal deaths occur as a result of health service inequities.

So, where does nutrition fit into this picture? Many health clinics in low- and middle-income countries serve as general providers for entire regions, in some cases, and offer a variety of services—from reproductive care and abortion counseling, to HIV/AIDS intervention or nutrition assistance. Under the new policy, those general providers that continue to offer abortion counseling or care will lose funding they receive from the United States for any of their services—including programs that supplement pregnant women with iron, or growing babies with vitamin A, or interventions that support the whole variety health efforts essential to maternal and child nutrition, like proper sanitation and hygiene, comprehensive prenatal care, and infectious disease control.  

At its heart, though, this rule undercuts effective family planning worldwide, and that alone will have tremendous implications for maternal and child health, safety, and nutrition. Previous iterations of the Mexico City policy have led to widespread closures of family planning clinics and the termination of a variety of services throughout countries served by US assistance—not just abortion, but access to contraceptives and general reproductive healthcare and education as well. Today, 225 million women of reproductive age in low- and middle-income countries have an unmet need for family planning. In some countries, two-thirds of adolescent girls have inadequate access to these services. As a result, women and girls are often unable to control whether or not they become pregnant at times when it is healthy or prudent to do so—at great cost to their nutrition, and that of their children.

Birth spacing, for example, has a huge bearing on maternal and child nutrition. International guidelines recommend waiting at least two years after a birth before becoming pregnant again, so that a mother may fully heal, replenish vitamins and other nutrients, and engage in proper feeding practices with new infants. But for women without access to family planning education or services, it may be difficult to achieve optimal birth spacing—leading to unhealthy weight loss, anemia, and micronutrient deficiencies. For infants, inadequate birth spacing can contribute to low birth weight, preterm birth, poor nutritional status, physical and cognitive stunting, and heightened risk of mortality. A mother’s older children may also suffer developmentally as a result of shorter birth intervals—for example, if breastfeeding is interrupted or cut off due to a new pregnancy, or if there are not sufficient resources or time to feed and care for all children simultaneously.

Family planning can also assist in avoiding high-risk pregnancies—among these, having children too young or too old, or having too many. Each day, 20,000 girls under the age of 18 give birth in low- and middle-income countries, amounting to 7.3 million births each year, and even more pregnancies—largely due to unmet need for family planning. Underage pregnancies can be particularly dangerous for both mother and baby. Adolescents are themselves still growing—attaining 15-20 percent of their adult height and 50 percent of adult weight in their teenage years—and as such are vulnerable to undernutrition during pregnancy, especially in low resource environments where food security may already be tenuous. This risk, and others, make pregnancy and childbirth-related complications the leading cause of death among adolescent girls worldwide. It also contributes to heightened rates of low birthweight, malnutrition, and mortality in infants.

Family planning is critical to ensuring healthy pregnancies and optimal child development, especially in low- and middle-income countries. And, as women are increasingly empowered to control the timing and spacing of their pregnancies, they are able to attain greater educational outcomes, job opportunities, and household decision-making power—allowing them greater resources to maintain the health and nutrition of themselves and their families.

What this tells us is that health and development challenges are inextricably intertwined. Limiting resources in one area can stall, or reverse, progress in another. And for women and girls—whose health, nutrition, and empowerment affect that of generations—having a full suite of options might make all the difference.