The United States is ending its financial support for family planning programs in developing countries, cutting nearly 50 million women off from access to contraception.
This policy change has attracted little attention amid the wholesale dismantling of US foreign aid, but it stands to have enormous implications, including more maternal deaths and an overall increase in poverty. It derails an effort that had brought long-acting contraceptives to women in some of the poorest and most isolated parts of the world in recent years.
The United States provided about 40 percent of the funding that governments contributed to family planning programs in 31 developing countries, some $600 million in 2023, the last year for which data is available, according to KFF, a health research organization.
That funding provided contraceptive devices, and the medical services to deliver them, to more than 47 million women and couples, which is estimated to have averted 17.1 million unintended pregnancies and 5.2 million unsafe abortions, according to an analysis by the Guttmacher Institute, a sexual health research organization. Without this annual contribution, 34,000 women could die from preventable maternal deaths each year, the Guttmacher calculation concluded.
“The magnitude of the impact is mind-boggling,” said Marie Ba, who leads the coordination team for the Ouagadougou Partnership, an initiative to accelerate investments and access to family planning in nine West African countries.
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The funding has been terminated as part of the Trump administration’s disassembling of the US Agency for International Development. The State Department, into which the skeletal remains of USAID was absorbed Friday, did not reply to a request for comment on the decision to stop funding family planning. Secretary of State Marco Rubio has described the terminated aid projects as wasteful and not aligned with US strategic interest.
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Support for family planning in the world’s poorest and most populous countries has been a consistent policy priority for both Democratic and Republican administrations for decades, seen as a bulwark against political instability. It also lowered the number of women seeking abortions.
Among the countries that will be significantly affected by the decision are Afghanistan, Ethiopia, Bangladesh, Yemen, and Congo.
The money to support international family planning programs is appropriated by Congress and was extended in the most recent spending bill that keeps the government operating through September. The move by the State Department to cut these and other aid programs is the subject of multiple lawsuits currently before federal courts.
The Trump administration has also terminated funding for the United Nations’ sexual and reproductive health agency, UNFPA, which is the world’s largest procurer of contraceptives. The United States was the organization’s largest donor.
Although the United States was not the sole supplier of contraception in any country, the abrupt termination of US funding has created chaos in the system and already caused clinics to run out of products.
An estimated $27 million worth of family planning products already procured by USAID are stuck at different points in the delivery system — on boats, in ports, in warehouses — with no programs or employees left to unload them or hand them over to governments, according to a former USAID employee who was not authorized to speak to a reporter. One plan, proposed by the new USAID leadership in Washington, is for remaining employees to destroy them.
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Supply chain management was a major focus for USAID across all areas of health, and the United States paid to move contraceptive supplies such as hormonal implants, for example, from manufacturers in Thailand to the port in Mombasa, Kenya, from where they were taken by trucks to warehouses across East Africa and then to local clinics.
“To put the pieces back together is going to be very difficult,” said Dr. Natalia Kanem, executive director of UNFPA. “Already this has had a catastrophic impact — it’s literally affecting millions of women and families. The poorest countries don’t have the resilient buffer.”
Even before the United States pulled out of family planning programs, surveys found that globally, about 250 million women of reproductive age wished to avoid pregnancy but did not have access to a modern contraceptive method.
At the same time, there had been great progress. Demand for contraception has been rising steadily — with long-acting methods that offer women greater privacy and secure protection — in Africa, the region of the world with the lowest coverage. Supply has improved with better infrastructure that helped get products to rural areas. And “demand creation” projects, of which the United States was a major funder, used advertisements and social media to inform people about the range of contraceptive choices available and the advantages of spacing or delaying pregnancies. Women’s rising levels of education boosted demand, too.
Thelma Sibanda 27, an engineering graduate who lives in a low-income community on the edge of the Zimbabwean capital, Harare, two weeks ago received a hormonal implant, that will prevent pregnancy for five years, at a free pop-up clinic run by Population Services Zimbabwe, which had a multiyear USAID grant to deliver free family planning services.
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Sibanda has a 2-year-old son and says she cannot afford more children. She cannot find a job in Zimbabwe’s fractured economy, and neither can her husband. They subsist on the $150 he earns each month from a vegetable stand. She had been relying on “hope and faith and natural methods” to prevent another pregnancy since her son was born, Sibanda said, and had wished for something more reliable, but it simply was not possible in her family’s budget — until the free clinic came to her neighborhood.
With its USAID funding, the Zimbabwean organization that provided her implant last year, was able to buy six sturdy Toyota vehicles and camping equipment so that an outreach team could travel to the most remote regions of the country, performing vasectomies and implanting IUDs in pop-up clinics. Since the Trump executive order, they have had to stop using all of that equipment.
The Zimbabwean organization is a branch of the international nonprofit MSI Reproductive Choices, which has stepped in with temporary funds so the teams can continue to provide free care for the women they can reach, such as Sibanda. MSI can cover the costs only until September.
Sibanda said her priority was providing the best possible education for her son, and because school fees are costly, that means no more children. But many African women have no way to make this kind of choice. In Uganda, while the national fertility rate is 4.5 children per woman, it is not unusual to meet women in rural areas with limited education who have eight or 10 children, said Dr. Justine Bukenya, a lecturer in community health and behavioral science at Makerere University in Kampala. These women become pregnant for the first time as teenagers and have little space between pregnancies.
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“By the time they are 30 they could have their 10th pregnancy — and these are the women who will be affected,” she said. “We are losing the opportunity to make progress with them. The United States was doing a very strong job here of creating demand for contraception with these women, and mobilizing young men and women to go for family planning.”
Some women who have relied on free or low-cost service through public health systems may now try to buy contraceptives in the private market. But prices of pills, IUDs, and other devices will most likely rise significantly without the guaranteed, large-volume purchases from the United States.
This article originally appeared in The New York Times.