This report focuses upon the impact of the gag rule on organisations that have accepted funding from the U.S. Agency for International Development (USAID) and are therefore ""gagged"" from advocating for abortion. The report also will consider the gag rule’s bar on providing or counseling on most abortion-related services. The paper demonstrates that each of the four countries selected for this study (Ethiopia, Kenya, Peru, and Uganda) have very restrictive abortion laws that contribute to high rates of maternal injury and death by forcing women to resort to illegal and unsafe abortions. In addition, NGOs and governments in each of the four countries receive substantial funding from USAID for family planning and reproductive health programs. The four countries were also chosen because they are at different stages of abortion law reform and at different stages in the development of their still nascent democracies. Interviews in each country reveal that the gag rule’s effects differ by country, the legal status of abortion and the extent to which USAID funds local NGOs. But in all instances, the global gag rule undermines fundamental cornerstones of U.S. foreign policy by restricting NGOs’ rights to free speech and association, and their ability to freely participate in civil society and democratic institutions for the purposes of improving safe and legal access to abortion. In contrast, the global gag rule imposes no restrictions on NGOs working to criminalize abortion or make the procedure less safe and accessible. This report documents the litany of harms caused by the global gag rule. These consequences range from censoring civil society organisations around the world to condemning women to unsafe abortion. The report then takes a closer look at the public health crisis of unsafe abortion on a global scale and follows with a comparative discussion of the epidemic in terms of the laws, policies and social contexts of the four countries under study. It also highlights international commitments to eradicate unsafe abortion and conclude with a call to repeal the gag rule.