Kefin Ojunga, a nurse, has worked in reproductive health care for nearly 30 years in Kenya’s Kilifi County on the East African country’s coast and said she has “seen a lot.” But the situation for women there has worsened significantly over the past year as U.S. aid programs have been slashed.
Previously, U.S. funds provided free contraception, prenatal care, and other reproductive health care through mobile clinics throughout developing parts of Africa. That service suddenly disappeared when the Trump administration dismantled the U.S. Agency for International Development (USAID) and cut funding for family planning.
“Every day in Kilifi, we count several unintended pregnancies,” said Ojunga, who works for the nonprofit Reproductive Health Network Kenya. The nonprofit group warned that clinics across the country are running out of contraceptives. “We have seen cases that lead to death…and we are yet to see many more cases, including cases with sepsis, hemorrhage, and shock.”
Frontline nurses said they have witnessed the negative health effects of women attempting to terminate their own pregnancies by taking high doses of painkillers, obtaining abortion pills without a prescription or medical supervision, and ingesting toxic substances such as detergents.
Over the past six months, CNN spoke with multiple health care providers and nonprofit organizations in six countries who explained that layoffs of health care workers, widespread shortages of contraceptives, and persistent supply chain challenges, especially in remote areas where women have few options, are contributing factors to the situation.
It’s a crisis in family planning health care that’s spreading across the continent, following cuts in aid from the United States and other donor countries.
The International Planned Parenthood Federation estimates that funding cuts will force around 1,400 clinics to close around the world, resulting in 9 million people losing access to sexual and reproductive health services by 2025.
The Trump administration’s current fiscal year 2027 budget request proposes further cuts to global health programs, cutting funding by billions of dollars and specifically eliminating all reproductive health programs. The budget proposal says the White House aims to set aside no funding to support “free access to contraception.” The president’s budget requests are not binding because Congress approves funding, but they do represent the administration’s spending priorities.
Nabiha Kazi Hutchins, president of PAI, a Washington-based reproductive rights NGO, told CNN that the proposal’s language “makes very clear that what they are advancing is political ideology, not public health evidence” and represents an “incredible abandonment” of the United States’ decades-long bipartisan commitment to international family planning.
In 2024, 43% of the world’s family planning aid will come from the United States, according to the health policy nonprofit KFF. The funding previously provided 47.6 million women and couples with access to modern contraceptives, according to an analysis of the 2024 budget by the Guttmacher Institute, a sexual and reproductive health-focused research organization that supports abortion rights. U.S. policy prohibits international NGOs that provide abortions, provide abortion counseling, or advocate for safe access to abortion from receiving U.S. government funding.
But early last year, the Trump administration froze and eliminated family planning subsidies once administered by USAID. And in July, Congress canceled $500 million earmarked for family planning and reproductive health programs. The US government also suspended all contributions to the UN Population Fund, the UN’s sexual and reproductive health agency, and stored $9.7 million worth of contraceptives purchased by the US in a Belgian warehouse instead of shipping them to women overseas.
Experts warn that further spending cuts will have a significant impact on women’s lives in the 41 countries that previously received USAID family planning assistance, many of them in Africa.
In Mozambique, aid workers reported a 7% increase in recorded teenage pregnancies in areas where services were cut last year, after U.S. funding cuts to the United Nations Population Fund and the Global Fund hampered efforts to reach some of the most vulnerable communities.
“There is a direct correlation between the withdrawal of our support and the increased vulnerability of girls,” Santos Simione, director of the Mozambican Family Development Association (AMODEFA), told CNN in an email. “Every percentage point of this increase represents girls dropping out of school, perpetuating cycles of poverty, increasing HIV infections, and increasing child/early unions.”
In Malawi, one of the world’s least developed countries, local NGOs affiliated with the International Planned Parenthood Federation warned late last year about the impact on women who would lose access to mobile clinics and contraceptives by 2025.
“I was waiting for the clinic to come,” Ulem Kapire, then 24, told Family Planning Association Malawi. “She used to come every month, but after the aid was frozen, she stopped coming, and by the time I found out, I was already pregnant.”
Health workers and nonprofit organizations working in Africa say U.S. cuts to family planning services are leading to deaths, unsafe abortions, hemorrhages and poor obstetric care.
Asked by CNN about this claim, a US State Department spokesperson said: “Americans expect their tax dollars to support programs that save lives, advance American interests, and reflect American values, rather than funding abortion-related causes, left-wing social agendas, or wasteful foreign bureaucracies.”
The spokesperson added that the administration’s focus is “to deliver life-saving care in global health priority areas, including HIV/AIDS, tuberculosis, malaria, and maternal and child health.”
However, research shows that the availability of modern contraceptives and the prevention or spacing of pregnancies improves maternal mortality rates, household incomes, and infant health outcomes. Additionally, health care providers in several countries told CNN that contraceptive services are often integrated with other health services, such as HIV-AIDS prevention and gynecological care, which are also affected by the cuts.
“If we do nothing, there will be dire consequences,” said Patrick Kinemo, Tanzania country director for MSI Reproductive Choices, an organization that works to provide reproductive health care in dozens of countries.
MSI says Tanzania alone faces a funding shortfall of about $18.3 million this year for contraceptives, including oral contraceptives, implants and intrauterine devices (IUDs). MSI said that while these contraceptives will impact women’s lives for years after 2026, its own analysis suggests they would have prevented 1,600 maternal deaths this year alone.
He noted that improvements in family planning have contributed to the significant reduction in maternal mortality in the country. “Without these products, the situation could be reversed.”
Adequate spacing between pregnancies also reduces infant mortality. According to previous research from USAID, the main reason for this is that mothers can breastfeed for longer periods of time, which improves the child’s health and nutritional indicators and reduces stunting. It also allows women to work, and increases household income, which improves the health of families, Kinemo said.
More women may be forced to take steps that risk their health as aid cuts limit their options. Dr. Bakari O’Malley, project coordinator for UMATI, a reproductive health nonprofit in Tanzania, told CNN last year, “We are afraid of unsafe abortions, and the number is increasing.” In some countries, including Malawi, Nigeria and Tanzania, where health workers spoke to CNN, abortion is severely restricted by law.
In Zambia, aid workers say they are concerned that significant cuts are having a negative impact on the care young women and soon-to-be mothers receive.
“Quality is clearly compromised. You can’t have the same quality if you have two people working when you used to have six,” said Amos Mwale, executive director of Zambia’s Center for Reproductive Health and Education. She said the number of midwives currently in clinics was significantly reduced, meaning women were having to wait until they were further into labor to receive care.
Pregnant women “will have to walk long distances and also have to wait longer than usual if they need to receive antenatal services,” Mwale said.
Aid officials said countries were struggling to fill the hole created by deep funding cuts, among other budgetary pressures.
A Malawi Family Planning Association spokesperson said the country’s Ministry of Health supports its work but cannot afford to expand services to the most rural areas. The organization received one-time funding from IPPF to continue its operations. But in some areas left without adequate funding, U.S.-backed partners have “completely shut down services… leaving women in complete despair,” the spokesperson said.
In fiscal year 2024, before Trump returns to office, U.S. investments in global family planning are estimated to have prevented 17.1 million unintended pregnancies and 34,000 maternal deaths, according to the Guttmacher Institute. U.S. funding also averted an estimated 5.2 million unsafe abortions, the report said.
Congress recently passed additional funding for global health assistance in fiscal year 2026, including money for family planning and reproductive health, but budget experts told CNN there is a one-year lag before that money is spent.
Meanwhile, reproductive health advocates warn that funding could still be diverted or canceled as in 2025.
The U.S. State Department is still reviewing family planning programs and funding for fiscal year 2026, a department spokesperson told CNN in March.
As the family planning sector tightens around the world, women fear they will lose control over their reproductive choices.
“Everyone is afraid of getting pregnant,” said Peace Adizwe, a student in Abuja, Nigeria, who relied on subsidized contraception. She said women were concerned that the lack of access to certain contraceptives would force them to switch to less reliable methods.
Contraceptive costs are also rising due to aid cuts and shortages of contraceptive pills. “I’m shocked by the difference in prices,” Adizue said.
For service providers, the situation is difficult to see. Kenyan nurse Ojuna said, “What’s happening now… sometimes brings me to tears.”
Over the past few months, her clinic has repeatedly had to turn away women who have walked miles in hopes of getting the latest medical care and birth control.
“My shelves are empty today,” she had to tell them. “Most of the time, in Swahili, we say hakuna. Hakuna doesn’t mean anything.”
