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Despite the influential role of the US government as a global reproductive health aid donor since the late 1960s, little sociological attention has been paid to the race, gender, and class politics of evidence in global reproductive governance. This paper demonstrates how demographic and epidemiological evidence has been selectively interpreted in global policies and programs related to abortion and contraception. Although the global community has rejected the neo-Malthusian logics of population control, current reproductive health programming continues to focus narrowly on reducing fertility rather than achieving reproductive justice. Despite decades of evidence demonstrating the association between legal abortion and maternal mortality reduction, national abortion laws in many developing countries and “pro-life” US foreign aid policies continue to restrict abortion. Although post-abortion care (emergency treatment for complications of unsafe abortion) costs outweigh those of safe abortion, donors continue to promote the intervention as an effective maternal mortality reduction strategy. I draw on ethnographic data from Senegal, a country that has received family planning aid from the US since the 1980s, to demonstrate how post-abortion care frequently takes the form of obstetric violence. That low-income women and women of color in the global North and South face the greatest risks of poor reproductive health outcomes whether they terminate or carry to term a pregnancy demonstrates the race, gender, and class dimensions of a necropolitical regime of global reproductive governance. Scholars and advocates of reproductive justice must highlight these North/South entanglements in reproductive governance to demand evidence-based interventions and policies for all.