In the ever-evolving landscape of reproductive healthcare across the globe, sharp debates, shifting alliances, and new strategies are emerging on all sides. Recent developments in both the United States and Liberia have brought the contentious issue of abortion—and the broader question of women's health—back into the spotlight, with politicians, advocacy groups, and healthcare providers all jostling to shape the future of care.
On October 27, 2025, U.S. Congressman Chris Smith (R-NJ), Chairman of the U.S. House Foreign Affairs Subcommittee on Africa, sounded a stark warning from Washington, D.C. about what he calls the growing global promotion of abortion pills. Citing a recent study by the Ethics and Public Policy Center (EPPC), Smith argued that the risks associated with mifepristone, a widely used abortion pill, are much higher than previously reported by U.S. regulatory agencies. According to Smith, the April 2025 EPPC report claims that serious complications from mifepristone are "22 times higher than what the U.S. Food and Drug Administration (FDA) currently recognizes."
“The abortion pill is not safe, and the cover-up must end,” Smith declared, referencing the study’s finding that "following a mifepristone abortion, 11 percent of women experience sepsis, infection, hemorrhaging, or another serious or life-threatening adverse event. That’s shocking." He did not mince words about what he sees as a dangerous trend, especially as it relates to developing countries.
Smith's concerns are particularly focused on Liberia, where lawmakers are considering a Public Health Act amendment that would broaden access to abortion services. The campaign for this amendment, he claims, is being supported by international donors including Ireland, the United Nations Population Fund (UNFPA), UNICEF, and Sweden. In Smith’s view, this is nothing short of “a new form of neo-colonialism.” He accused these international actors of "using development funds to impose abortion on African nations under the false banner of women’s rights."
To counter this trend, Smith announced plans for new U.S. legislation—the Safe Passages Act—which he says will expand maternal healthcare by increasing access to trained birth attendants, emergency obstetric care, and rural health infrastructure. "True compassion demands that we invest in life-saving maternal care, not life-ending drugs," Smith said. "Liberia’s children—and their mothers—deserve far better." As of late October, Liberia’s Ministry of Health had not issued an official statement on either the proposed amendment or Smith’s pointed remarks.
Yet, the global health community’s perspective on abortion pills is markedly different. The World Health Organization (WHO) and other leading health agencies maintain that mifepristone and misoprostol—when administered under approved medical supervision—are among the safest and most effective methods for terminating early pregnancies. They argue that the complication rates associated with these drugs are significantly lower than those resulting from unsafe abortions, which remain a leading cause of maternal death in many low-resource settings.
While the international debate heats up, the United States itself is undergoing a seismic shift in the way reproductive health services are delivered. In the wake of the Supreme Court’s decision to overturn Roe v. Wade three years ago, anti-abortion pregnancy centers have been quietly expanding their medical offerings. According to a recent Associated Press report, these centers, which were once best known for providing ultrasounds and diapers, now offer an array of services from testing and treating sexually transmitted infections to even primary care. The expansion has accelerated as states have enacted abortion bans, and as Planned Parenthood—the nation’s largest provider of both abortions and broader reproductive health services—has been forced to close or consider closing clinics due to changes in Medicaid funding.
Heather Lawless, founder and director of Reliance Center in Lewiston, Idaho, put it bluntly: “We ultimately want to replace Planned Parenthood with the services we offer.” Lawless noted that about 40% of patients at her center now seek care for reasons unrelated to pregnancy, with some even using the center’s nurse practitioner as their primary caregiver. This is a dramatic shift from the centers’ original mission, and one that has not gone unnoticed by both supporters and critics.
Abortion-rights advocates have voiced serious concerns about this trend. They argue that many of these centers lack accountability, refuse to provide birth control, and offer only limited ultrasounds that cannot be used to diagnose fetal anomalies. There’s also the issue of so-called "abortion-pill reversal" treatments, which a growing number of centers offer despite a lack of scientific evidence supporting their efficacy. Jennifer McKenna, a senior adviser for Reproductive Health and Freedom Watch, questioned whether these centers "have the clinical infrastructure to provide the medical services it’s currently advertising."
Most anti-abortion pregnancy centers in the U.S. do not accept insurance, meaning they are not subject to the same federal privacy laws or insurance standards as traditional clinics. While some states require medical directors to comply with licensing requirements, critics argue that the lack of oversight leaves patients vulnerable. Kaitlyn Joshua, founder of the abortion-rights group Abortion in America, expressed concern that, with Planned Parenthood clinics closing, women may be left with few options. “Those centers should be regulated. They should be providing information which is accurate,” she said, “rather than just getting a sermon that they didn’t ask for.”
Supporters of the pregnancy centers, however, push back against these criticisms. Thomas Glessner, founder and president of the National Institute of Family and Life Advocates—a network of 1,800 centers—insisted that "their criticism comes from a political agenda," and noted that centers do have government oversight through their medical directors. Moira Gaul, a scholar at the Charlotte Lozier Institute, said the centers "are prepared to serve their communities for the long-term."
The numbers tell a story of rapid change. By 2024, more than 2,600 anti-abortion pregnancy centers were operating in the U.S.—an increase of 87 from the previous year, according to the Crisis Pregnancy Center Map project led by University of Georgia researchers. Meanwhile, the number of clinics offering abortions fell by more than 40, with just 765 remaining. Nearly 20 states, mostly Republican-led, now funnel millions of taxpayer dollars into pregnancy centers—Texas alone allocated $70 million this fiscal year, while Florida dedicated over $29 million to its “Pregnancy Support Services Program.”
For some women, these centers are filling gaps left by other providers. Jessica Rose, a patient at Alternatives Pregnancy Center in Sacramento, California, described her experience after detransitioning from living as a man: “APC provided me a space that aligned with my beliefs as well as seeing me as a woman.” For others, like Hayley Kelly in Missouri, the centers provided STI testing and support during difficult times. Yet, as the centers expand, the debate over the quality and scope of care—and the ideological underpinnings of their mission—shows no signs of abating.
As the battle over reproductive health continues on both sides of the Atlantic, the future remains uncertain. What is clear is that the stakes—for women, families, and communities—could not be higher.
