Women and girls will suffer devastating consequences from the USAID funding freeze
Thousands of aid programmes that support women are being threatened by the funding freeze, limiting the ability of frontline workers to serve their communities. In 1961, the United States Agency for International Development (USAID) was established to provide food aid, humanitarian aid, and economic development to impoverished countries. In some countries, USAID’s family planning program was the main source of contraception and HIV treatment for decades.
However, on his first day in office, President Donald Trump implemented unprecedented cuts to U.S. foreign aid since taking office.
Trump and his billionaire ally Elon Musk took steps to shrink the federal government, which they claim misuses taxpayer funds. As a result of that action and stop-work orders halting many programs of the U.S. Agency for International Development worldwide, global humanitarian relief efforts have been thrown into chaos.
The suspension of foreign aid severely impacts reproductive healthcare for refugees, displaced persons, and those in conflict zones who rely on foreign-funded clinics for prenatal care, gender-based violence response, and emergency obstetric services. The abrupt loss of funding has forced clinics to close, halted medical supply deliveries, and furloughed staff, jeopardizing millions of lives.
In Uganda, malaria prevention efforts for pregnant women have stopped, while in Zambia, hemorrhage-preventing medications for pregnant women remain in storage. In South Africa, a clinical trial participant lost access to HIV and pregnancy prevention care, exposing an alarming breach of reproductive health protections and bodily autonomy.
Women will be the most intensely affected
Taken together, these actions constitute a serious attack on reproductive rights. It is expected that the freeze, which represents nearly 40% of global aid, will have a direct impact on programs promoting sexual and reproductive health and gender equality. In the absence of these services, maternal mortality, unintended pregnancies, and the spread of STDs are expected to increase.
What happens if USAID disappears?
In the absence of USAID funds, programs aimed at improving the sexual and reproductive health of women and girls will be particularly hard hit. The cuts will result in 4.2 million unintended pregnancies and 8,340 maternal deaths over three months for 11.7 million women and girls. USAID was the biggest bilateral funder of health and family planning in African countries.
Experts say the family planning work, which ranges from sexual education, access to contraceptives, and maternal and infant health, has all been implemented as a way to bolster the human rights of women and girls around the world.
In this interview, Lalaina Razafinirinasoa, the Deputy Africa Director of MSI Reproductive Choices, gives an overview of the impacts of the USAID stoppage on women and girls across the continent when it comes to defunding reproductive health care. Razafinirinasoa has over a decade of experience in program leadership, social marketing, and reproductive health. During her tenure as Country Director in Madagascar, contraceptive access doubled, and misoprostol was registered for use in gynecology to prevent pregnancy-related deaths.
Lalaina , you’ve dedicated your career to advancing reproductive health and rights for women and girls across Africa. How has witnessing the devastating impacts of the USAID funding withdrawal – on access to care, maternal health, and the lives of vulnerable communities – shaped your perspective on the urgency of this issue?
It’s devastating to see women and girls across Africa – and around the world – being deprived of lifesaving health care because of Trump and Musk’s ideological assault on US foreign aid. Working in Africa, it’s impossible to ignore the irony that a decision by the world’s richest man is damaging the lives of women living in some of our poorest communities. Denied the lifeline of family planning services, these women will no longer be able to safely space their pregnancies, leaving them open to multiple potential health risks and pushing them further into the cycle of poverty. Those in the most desperate circumstances will be left with no option but to risk their lives by resorting to unsafe abortion. Our colleagues are working around the clock to find solutions, including other sources of funding, but it’s a huge blow for everyone who cares about women everywhere being able to plan their families.
Please give us an overview of the immediate and long-term impacts of the USAID funding cuts on reproductive health services across Africa, particularly for women and girls.
The immediate impacts are disturbing and have been witnessed by our teams across Africa. USAID was the biggest bilateral funder of health and family planning work, and overnight, their funding was frozen. The trust we had slowly built up in communities over decades was left in tatters, and confidence in contraception was irrevocably damaged in a matter of days. Vulnerable women and girls have been let down in the worst possible way, and the impacts will be felt very quickly, especially in terms of unplanned pregnancies.
USAID provided 35% of the donated contraception stock within global family planning supply chains, supplying commodities through missions to 23 countries. In some countries, such as Zambia, we are already seeing stockouts of short-acting methods of contraception, such as injectables, and shortages of implants. The longer-term impacts will take time to come through, but over the coming months, we can expect many more unplanned pregnancies, complications, injuries, and fatalities caused by women and girls getting pregnant and giving birth. All because their ability to safely plan their families has been taken away.
11.7 million women and girls will be denied sexual and reproductive health services, leading to 4.2 million unintended pregnancies and 8,340 maternal deaths. Can you share how this is affecting the lives of girls in Uganda, Ethiopia, and Zimbabwe?
In Zimbabwe, MSI is one of the largest providers of sexual and reproductive health care in the country and lost 41% of its funding following the collapse of USAID. When the stop-work order came through, we had to tell our outreach teams in remote areas to turn back. They had no way of alerting the women they serve, so many still showed up, expecting to access family planning services. Many of the young women we serve have no other options and will likely become pregnant if their access to contraception is stopped.
In Uganda, following the stop-work order, misinformation started circulating that contraception was going to be banned and women would be fined for using it. This led to women racing to get contraceptive implants removed early, even using unscrupulous providers. Our team has been working with local authorities in the affected area to share correct information, including through radio phone-in shows.
Ethiopia has laid off some 5,000 staff from public health facilities following the cuts. MSI team members were arriving to train health workers in sexual and reproductive health care but finding no one there to train.
How has the withdrawal of USAID funding disproportionately affected marginalized groups, such as adolescent girls, rural communities, and women living in poverty?
The majority of the women we serve around Africa are from the poorest and most marginalized communities, often in remote rural regions. Many don’t have health facilities nearby and have to walk 10km or more to meet our outreach teams to access contraception and cervical cancer screening. The withdrawal of this care will leave them with no family planning options. In Zimbabwe, for example, more than a third of MSI’s clients are under 24. They are adolescent girls and young women who want to avoid pregnancy for now so they can focus on getting an education or earning a living. Getting pregnant before they are ready means they are much more likely to get trapped in a cycle of poverty and ill health.
How has the freeze affected other health services indirectly supported by USAID, such as HIV/AIDS prevention or maternal care?
The withdrawal of USAID is causing major disruptions across all the building blocks of health systems in African countries. Women and girls are disproportionately impacted. There have been huge cuts in funding for maternal health care, including funding for the nurses and midwives who are so vital for healthy pregnancies and safe childbirth.
In Ethiopia, MSI was being funded by USAID to improve the quality of reproductive, maternal, child, and adolescent health services by strengthening supportive supervision, establishing private-public technical working groups, and supporting private facilities to become centers of excellence. But without alternative funding, this is all at risk.
When it comes to HIV/AIDS, the USAID stoppages are already having serious impacts, as successful U.S. initiatives such as PEPFAR (the President’s Emergency Plan for AIDS Relief) are being included. This is leading to drug shortages, clinic closures, and job losses for health workers. In a letter to Secretary of State Marco Rubio, 500 AIDS physicians and researchers warned that a sudden end to PEPFAR could kill six million people in the next four years, reverse decades of progress, and lead to growing HIV epidemics across the world.
How has MSI Reproductive Choices adapted to these challenges, and what support do you need to continue providing essential services?
With unprecedented cuts to international aid and with many other organisations facing closure, our frontline teams are facing a dual challenge: keeping services formerly funded by USAID open while navigating the broader impacts on partners and health systems. In this challenging context, MSI’s teams are pivoting and adapting to keep services running wherever possible.
With roughly half of MSI’s funding coming from our own income generating services, including our private sector clinics and pharmaceutical channels, we are in a strong position to protect services. But we will require partnership with donors who believe in the power of reproductive healthcare and can support us to reach underserved clients with no alternative access to this life-changing care.
As partner and public sector services face closure, MSI will fiercely hold the line and defend reproductive health and rights so that even in settings impacted by aid cuts, women and girls can continue to make choices about their bodies, their families, and their futures.
What steps can the international community take to fill the gap left by USAID’s withdrawal, and what message would you like to send to global leaders about the urgency of restoring funding?
It has never been more important to protect and support resources for sexual and reproductive health care. This is not just about supplying family planning products – it’s also about how we fill the gaps USAID has left when it comes to in-country health leadership support, planning, coordination, and data sharing across many countries. In the weeks and months ahead, providers, governments, and donors will need to be flexible and willing to rapidly adjust their strategies and programs to mitigate the damage, proactively share intel and gaps, work together to find creative solutions, and share costs and resources.
In this time of crisis, we are asking donors to:
• Take a more intentional convening and coordination role, given their broader perspective and knowledge of who is funding what and where and what the immediate gaps are likely to be.
• Ensure that political leadership is underpinned by financial support – particularly in funding last-mile programs for the hardest to reach.
• Support multilateral institutions such as the UNFPA (United Nations Population Fund) and the Global Financing Facility (GFF) to work with ministries of health to maintain support for sexual and reproductive health care.
What lessons can be learned from this crisis to prevent similar situations in the future, and what is your vision for a sustainable and resilient reproductive health system in Africa?
As a social business, MSI generates a significant portion of its revenue from its own private sector operations, alongside funds from institutional donors, foundations, and private individuals.
In these uncertain times, it will be more important than ever to hone our social business model and make sure services are self-sustaining, as well as to use our voice to bring more people into the cause and diversify our funding. Proven, cost-effective strategies such as community-based services, task shifting, and integration will become even more crucial. As governments in low- and middle-income countries are forced to transition quickly from donor dependency, domestic and alternative financing models will need to be fast-tracked, learning from countries that are further along in this transition.
Increased advocacy and a resilient civil society will also become even more essential to ensure domestic resources are being channelled back to meet the health needs of everyone and that investments in preventative healthcare such as contraception are seen as a smart investment that reduces the overall costs of direct health care delivery.
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