Millions lose access to contraceptive care

What you probably already know: Humanitarian aid groups across the world have been in a monthslong state of whiplash. Since issuing a 90-day freeze on all foreign assistance in January, the Trump administration has worked to dismantle the agency tasked with delivering humanitarian assistance overseas — the United States Agency for International Development (USAID) — through layoffs and contract terminations. Though the clock technically runs out this week, the administration completed a review of all foreign aid by late February, terminating 5,200 USAID awards (about 83% of the agency’s work). The remaining initiatives could be absorbed by the State Department, which provides overall foreign policy guidance to USAID.

Why? President Trump wants overseas assistance to be closely aligned with his "America First" approach, posting on social media that USAID’s spending "IS TOTALLY UNEXPLAINABLE... CLOSE IT DOWN!" Elon Musk, the tech billionaire head of the so-called Department of Government Efficiency, has called USAID "a criminal organization" and boasted about “feeding USAID into the wood chipper.” After the spending freeze was announced, Secretary of State Marco Rubio said "every dollar" must be "justified" by evidence that it makes the US safer, stronger, and more prosperous. Polling data suggests Americans support foreign aid spending cuts. About 60% of adults said the government was spending “too much” overall on foreign aid, according to a March 2023 AP-NORC poll — but surveys also show the average American drastically overestimates the amount being spent.

What it means: USAID distributed nearly $43.8 billion during the 2023 fiscal year, about 0.7% of the US budget. Most of the funding goes to Asia, sub-Saharan Africa, and Europe (mainly to support humanitarian efforts in Ukraine). Funding cuts will be felt most acutely in sub-Saharan Africa, which received $12 billion in aid last year to support life-saving HIV/AIDS treatment and prevention, Ebola management, and family planning programs. As of 2023, 67% of contraceptives supplied through USAID went to African countries, where sexually transmitted infections and maternal and perinatal conditions are among the leading causes of death for girls and women. In the 90 days since Trump announced the foreign aid freeze, an estimated 11.7 million women and girls worldwide were denied access to contraceptive care, according to the Guttmacher Institute. Statistically, this could result in 4.2 million unintended pregnancies and 8,340 deaths from complications during pregnancy and childbirth in 2025 alone, with Africa seeing particularly high rates. Sub-Saharan African countries have the highest fertility rates in the world, with Niger leading at 6.7 births per woman — nearly four times higher than the US (1.84).

What happens now? These statistics are just a clinical representation of the risks women and girls in Africa now face without US foreign aid. Understanding the true human impact requires meaningful dialogue with the USAID workers who lost their jobs, the people running life-saving programs that now face financial destabilization, and the women and girls whose futures are uncertain. Formidable wants to tell their stories in an upcoming series focused on the impacts of foreign aid cuts in Africa. Stay with us.