In the remote mountain villages of Nepal, the US election could be a matter of life and death.
The landlocked nation is heavily reliant on US aid for healthcare services in rural areas, but one of the most crucial services for young women – family planning – could soon disappear.
During Donald Trump's first presidency, he reinstated a "global gag rule" that withheld US aid funding from foreign NGOs if they provided abortion services, information or advocacy.
Even if other sources of funding were used to support these activities, NGOs were to be cut off.
Tens of thousands of women die from unsafe abortions every year across the world and advocates like Tushar Niroula fear that could increase if these laws return.
"The reinstatement and expansion of the global gag rule had a really profound impact on sexual and reproductive health programs in Nepal," Mr Niroula said.
"With limited access to safe abortion services, many Nepalese women turned to unsafe methods, increasing the risk of complications and maternal deaths."
Abortion policy a political football
The laws — formerly known as the Mexico City Policy and renamed the Protecting Life in Global Health Assistance policy under Mr Trump — have a long and tumultuous history.
They date back to 1984 when Republican President Ronald Regan made foreign NGOs agree to not perform or advocate for abortions as a condition of receiving family planning assistance under the USAID program.
These restrictions were rescinded a decade later by President Bill Clinton's Democratic administration, only to be reinstated by Republican President George W Bush in 2001 and revoked by Democrat President Barack Obama in 2009.
President Trump continued this tit-for-tat tradition in 2017 but he expanded the laws to cover all healthcare assistance provided by the US, not just voluntary family planning funds.
That meant the amount of funding impacted by the gag clause increased from $US575 million to $US8.8 billion ($747.5 million to $11.4 billion), according to an estimate from Human Right Watch in 2017.
While most foreign NGOs accepted these terms, some — including vocal reproductive rights advocate The International Planned Parenthood Federation — refused and were defunded.
When Democrat President Joe Biden was sworn in in 2021, he repealed the laws and said they undermined US efforts to "advance gender equality" and "all other areas of global health assistance" because they limited collaboration on other health issues such as HIV/AIDs, tuberculosis and malaria.
Whether the global gag laws will return and in what form remains to be seen given Mr Trump's mercurial approach to foreign policy and reluctance to introduce a federal abortion ban in the US.
Mr Trump's presidential campaign and the Republican National Commitee have been contacted for comment.
New services shut down in Nepal
While abortion has been legal in Nepal for more than two decades, the global gag rule left its mark the last time it was in force.
Mr Niroula, who runs the Nepal arm of abortion and contraceptive provider MSI Reproductive Choices, said a new service for women in rural areas was "shut down prematurely".
"It also brought financial strain on health organisations like ours, impacted other health programs and most importantly, increased unsafe abortions," Mr Niroula said.
"It's quite disheartening, but that's something which is happening globally."
The threat of lost aid funding has rippled across the healthcare system, with some organisations unwilling to partner with MSI because of their refusal to agree to the terms of the global gag rule.
Mr Niroula said that limited the reach of organisations like MSI with smaller budgets.
"And most importantly, it really disrupts the support that is rendered to the government and because of this, there's a fear the progress we have made will stagnate," Mr Niroula said.
A 'chilling effect' across healthcare
While the consequences of US policy will depend on local laws and healthcare systems, poorer countries that rely on US funding are likely to be most affected, such as Nepal, Cambodia and Myanmar.
It will also impact "the most marginalised and the poorest women" who cannot afford private healthcare, according to Sivananthi Thanenthiran, executive director of Asian-Pacific Resource and Research Centre for Women (ARROW).
"So the countries and the women that need the services the most are the ones who are not going to receive it."
Ms Thanenthiran said the laws had created a "chilling effect" across the healthcare system even in countries where abortion was legal.
"People are afraid that they may do something wrong and that doing something wrong is going to end funding for their services," she said.
"And the lack of availability [of abortion] puts it in the mind of the people that [there's] something wrong with it."
Global gag law won't stop 'risky' abortions
Bonney Corbin, advocacy director for MSI in the Asia Pacific, said women still have abortions even when they are "inaccessible in healthcare settings".
"They just do it in ways that are incredibly risky," she said.
"They might try and access medication online that's unsafe and unregulated, or they might try different methods, which [are] mostly based on much misinformation, whether it involves sticks or mud, violence or physical pain.
"So, funding abortion care doesn't mean that people have more abortions. It means that people have it in safe medical contexts."
Ms Corbin feared alongside the funding implications of the global gag laws, the anti-abortion rhetoric in the US could "have a domino effect of policy change at a global level".
"The conversations that happen in party rooms and around boardroom tables in the next six months will have broad implications on global policy, which within a year will have start having impacts on local level health policy," she said.
"The world will be looking to leadership from the Asia Pacific region around gender equality because we have been at the forefront of some of those discussions for quite a long time."
