Because Editar Ochieng knew the three young men, she didn’t think twice when they beckoned her into a house in an isolated area near the Nairobi River. One was like a brother; the other two were her neighbors in the sprawling Kenyan slum of Kibera.

Ochieng did not know the woman who performed her abortion. She and a friend scoured Nairobi until they found her, an untrained practitioner who worked in the secrecy of her home and charged a fraction of what a medical professional would. Mostly, what Ochieng remembers is the agony when this stranger inserted something into her vagina and “pierced” her womb. “It was really very painful. Really, really, really painful,” she told me. Afterward, Ochieng said, she cut up her mattress to use in place of sanitary pads, which she could not afford. She was 16 years old.

As traumatic as her experience was, Ochieng was more fortunate than many women in Kenya, which bans most abortions. She, at least, survived.

Like Ochieng, most Kenyan women facing unwanted pregnancies have no good choices. They live in a culture that gives women little agency over their bodies; they experience high levels of poverty—two-thirds of residents live on less than $3.20 a day—and they must contend with conflicts between abortion laws codified in the country’s 2010 constitution and an older, harsher penal code that remains on the books. Because the penal code criminalizes abortion, relatively few women are able to obtain the procedure legally, and then only if a health professional determines that their life or health is in danger or, technically, if their pregnancy was the result of rape. That final exception dates only to 2019—13 years after Ochieng’s three acquaintances raped her—and is rarely applied.

Despite the prohibitions, more than half a million Kenyan women have abortions every year. The small percentage with means might find a trained professional willing to perform a clandestine, but safe, abortion. All too often, women gamble on risky methods reminiscent of the coat-hanger days of pre–Roe v. Wade America. They insert knitting needles into their vaginas and ingest dangerous chemicals, abortion rights advocates in the country say. They turn to unskilled providers, who scrape their uteruses with wires, give them concoctions intended for animals, or tell them to ingest concentrated soap, said Nelly Munyasia, executive director of Reproductive Health Network Kenya, which represents nearly 600 private health care providers. The national hospital in Nairobi, Kenya’s capital and largest city, has an entire ward dedicated primarily to women suffering from the complications of botched abortions, the advocates said. (Post-abortion care is legal.)

If they can’t access abortion, some women resort to killing healthy newborns, tossing them in rivers or poisoning them with Coca-Cola. Ochieng told me that the dead infants and aborted fetuses pulled from Kibera’s drainage systems and pit latrines were an indication of women’s desperation. “They know when you do a safe abortion, you don’t come with the fetus. You only carry your fetus because you’re doing it at the backstreet,” she said. “And it is happening because of … the condition of the women who are living in poverty, and they don’t have an option.”

Nearly half—45 percent—of the 73 million abortions performed worldwide each year are unsafe. One big reason: U.S. anti-abortion policies.

When performed properly, abortion is considered extremely safe. But nearly half—45 percent—of the 73 million abortions performed worldwide each year are unsafe, the World Health Organization reported. Others suggest the proportion is even higher; in sub-Saharan Africa, three-fourths of abortions are considered unsafe. Globally, unsafe abortions cause 39,000 maternal deaths and millions of complications a year, a preventable scourge that almost entirely afflicts women in developing countries, WHO confirmed. “There are a huge number of lives being lost,” said Elizabeth Sully, principal research scientist at the Guttmacher Institute, a research organization that supports sexual and reproductive health and rights.

One big reason: American anti-abortion policies.

For half a century, the United States has used the power of the purse to force poorer nations to abide by the anti-abortion values of American conservatives or forgo aid for family planning and, more recently, other health care. Of the several policies adopted over the years, two have been particularly onerous, according to several studies and more than 20 interviews with researchers and reproductive rights advocates in the United States and abroad. Touted to reduce abortions, the policies actually have driven up their numbers sharply and led to tens of thousands of unnecessary maternal deaths. “Anything that happens in the U.S. has a huge impact on the rest of the world,” said Giselle Carino, director of Fòs Feminista, an international alliance that promotes sexual and reproductive health and justice. When Washington places restrictions on abortion, “we have a lot of evidence how it hurts, particularly the women who need the most care and services.”

That anti-abortion policies would lead to more abortions seems counterintuitive, except when you consider that the organizations that perform, counsel, and educate people about abortion are often those that provide condoms, pills, IUDs, and other forms of birth control. If health care providers so much as mention abortion, they can lose money for broader health care services, including contraceptives. Fewer contraceptives equal more unwanted pregnancies. More unwanted pregnancies equal more abortions. More abortions in countries that greatly restrict them equal more unsafe abortions. And more unsafe abortions equal more maternal deaths.

The United States is not to blame for all the internal political and cultural strife in other countries. But as the largest funder of health care in the world, what it does matters. Essentially, this nation has given women around the globe no alternative but to seek backstreet abortions that send some to emergency rooms and others to their graves.

This November, Americans will vote in the biggest election since the Supreme Court, in 2022, overturned the constitutional right to abortion, giving states the authority to decide whether and when people could terminate pregnancies. Millions of women now live in states that severely restrict access or ban abortion altogether, spawning great hardships as they are compelled to travel to get abortions, forced to carry nonviable pregnancies to term, or turned away from hospitals for fear their miscarriages will be construed to be abortions. Such suffering, relatively new to young women in the United States, is commonplace in countries that must abide by the abortion restrictions Washington places on them. Commonplace there, and commonly ignored here. Candidates rarely mention how U.S. foreign policies harm women or campaign on the torment caused by Congress and presidents.

This year, one candidate is singularly responsible for imposing the tightest restrictions affecting overseas abortion access to date. His name: Donald Trump.

The women who bear the brunt of U.S. abortion-related restrictions are predominantly Black and brown. They live, most of them, in Africa, Latin America, and parts of Asia. They are also the people who, in the middle of the last century, U.S. policymakers were uncommonly worried about—worried not about their well-being, but about their birth rates. Indeed, the government’s current involvement in funding family planning worldwide can be traced back to midcentury consternation about how a population explosion could deplete dwindling natural resources, said Yana Rodgers, faculty director of the Center for Women and Work at Rutgers University. “Family planning was seen as a method by which to limit the growth of biologically and socially inferior races,” Rodgers wrote in her 2018 book, The Global Gag Rule and Women’s Reproductive Health.

For reasons both racist and environmental, Democrats and Republicans alike supported population control programs internationally and domestically, Rodgers wrote. In 1965, President Lyndon B. Johnson, a Democrat, issued a call to action. Three years later, the U.S. Agency for International Development, or USAID, started distributing birth control in developing countries. President Richard Nixon, a Republican, and his ambassador to the United Nations, George H.W. Bush, successfully pushed to establish the U.N. Fund for Population Activities, or UNFPA, which grew to be the world’s largest provider of donated contraceptives. As a Congress member in the 1960s, Bush was such a strong advocate for birth control that his colleagues called him “Rubbers.”

Soon, however, the politics of abortion overtook the politics of population growth in the power centers of Washington. Once the Supreme Court legalized abortion in 1973, religious conservatives pressed politicians........

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