A cas­cade of re­cent pol­i­cy changes in the Unit­ed States has pushed women’s re­pro­duc­tive health in­to cri­sis—both do­mes­ti­cal­ly and glob­al­ly. From the dis­man­tling of con­tra­cep­tion re­search units at the Cen­tres for Dis­ease Con­trol and Pre­ven­tion (CDC) to the de­lib­er­ate de­struc­tion of US-pro­cured birth con­trol sup­plies abroad, these ac­tions are now thought to be jeop­ar­dis­ing ac­cess to ba­sic re­pro­duc­tive care.

Re­cent cuts at the CDC in­clud­ed the elim­i­na­tion of a team ded­i­cat­ed to up­dat­ing con­tra­cep­tive guid­ance for health­care providers. This team’s work was cru­cial for in­form­ing doc­tors about the safest and most ef­fec­tive birth con­trol op­tions.

The elim­i­na­tion of this team, as part of broad­er job cuts at the CDC, has raised con­cerns about the avail­abil­i­ty of up-to-date, ev­i­dence-based in­for­ma­tion on con­tra­cep­tion. Doc­tors re­ly on these guide­lines to make in­formed de­ci­sions about which birth con­trol meth­ods are ap­pro­pri­ate for in­di­vid­ual pa­tients, in­clud­ing those with com­plex med­ical con­di­tions or those who are breast­feed­ing.

Ob­ste­tri­cians and fam­i­ly physi­cians in the US have called this a dev­as­tat­ing loss to women’s health in­fra­struc­ture. Lack of cen­tralised CDC guid­ance threat­ens con­ti­nu­ity in con­tra­cep­tion coun­selling and could dri­ve in­con­sis­tent prac­tices among clin­i­cians. With­out up­dat­ed rec­om­men­da­tions, clin­i­cians may be forced to re­ly on out­dat­ed or frag­ment­ed re­sources.

Mean­while, US pol­i­cy de­ci­sions are al­so im­pact­ing glob­al re­pro­duc­tive health. In a con­tro­ver­sial move, the US gov­ern­ment or­dered near­ly $9–10 mil­lion worth of con­tra­cep­tives des­tined for low-in­come coun­tries to be in­cin­er­at­ed rather than dis­trib­uted.

The in­cin­er­at­ed con­tra­cep­tives in­clud­ed 900,000 birth con­trol im­plants, 2 mil­lion dos­es of in­jectable long-act­ing birth con­trol, 2 mil­lion packs of con­tra­cep­tive pills and 50,000 IUDs. Many crit­ics have now de­nounced it as a po­lit­i­cal state­ment over women’s au­ton­o­my and pub­lic health.

This oc­curred at a med­ical waste dis­pos­al fa­cil­i­ty out­side Paris mere days ago: rather than dis­trib­ute $10 mil­lion worth of birth con­trol, which had been pur­chased by US­AID and was des­tined to be giv­en to women in low-in­come coun­tries, pri­mar­i­ly in Africa, the ad­min­is­tra­tion de­cid­ed to burn it. Of­fers to do­nate or re­dis­trib­ute the sup­plies were re­fused.

Un­for­tu­nate­ly, this is the lat­est in the far-reach­ing fall­out from gov­ern­ment cuts which have slashed fund­ing to many pro­grammes. The cuts have been dev­as­tat­ing for non-prof­it or­gan­i­sa­tions that work to im­prove women’s health and safe­ty world­wide. Sarah Shaw, an as­so­ciate di­rec­tor at the glob­al fam­i­ly plan­ning group MSI Re­pro­duc­tive Choic­es, says that the cuts will put women at risk as they strain their health with un­planned preg­nan­cies and seek out il­le­gal abor­tions; oth­er women who are de­nied ac­cess to birth con­trol will lose out on the op­por­tu­ni­ties for ed­u­ca­tion, pro­fes­sion­al de­vel­op­ment or re­mu­ner­a­tive work that can help them es­cape abuse, rise out of pover­ty, pur­sue their tal­ents and am­bi­tions and bet­ter pro­vide for the chil­dren they al­ready have.

Glob­al­ly, these de­ci­sions re­move crit­i­cal re­sources for women in cri­sis con­texts, refugee sit­u­a­tions, and re­gions with lim­it­ed con­tra­cep­tive op­tions.

Ul­ti­mate­ly, this re­pro­duc­tive health cri­sis re­veals how pol­i­cy de­ci­sions—both do­mes­tic and for­eign—can rip­ple out­ward to af­fect mil­lions. From un­der­min­ing na­tion­al con­tra­cep­tion guid­ance sys­tems to de­stroy­ing life-sav­ing sup­plies abroad, the con­se­quences are re­al for women’s au­ton­o­my and well-be­ing.