Nurse Kephine Ojung’a said she has “seen a lot” after nearly three decades of working in reproductive health care in Kenya’s Kilifi County, on the east African country’s coast. But things got markedly worse for women there in the past year amid sweeping cuts to US aid programs.
Throughout developing parts of Africa, US funding once provided free birth control, maternity checkups and other reproductive health care via mobile medical clinics – services that abruptly vanished as the Trump administration dismantled the US Agency for International Development (USAID) and slashed funding for family planning.
“Each day in Kilifi, we count several unwanted pregnancies,” said Ojung’a, who works for the nonprofit Reproductive Health Network Kenya. The nonprofit has warned that clinics throughout the country have run out of birth control. “We’ve seen cases that lead to death… and we are still yet to see more, coming with sepsis, coming with hemorrhage, coming with shock.”
The frontline nurse described seeing firsthand the detrimental health impacts of women trying to terminate their own pregnancies by taking high dosages of painkillers, obtaining drugs for abortion without a prescription or medical supervision, or consuming toxic substances like detergent.
Over the past six months, CNN has spoken to multiple medical providers and nonprofits in six countries, who described layoffs of health workers, widespread shortages of birth control, and persistent supply chain challenges, particularly in remote areas where women have few options, as factors making the situation worse.
It’s a crisis in family planning medicine that is playing out across the African continent in the wake of aid cuts by the US and other donor nations .
The International Planned Parenthood Federation estimates that funding cuts have forced nearly 1,400 medical clinics to close around the world, resulting in 9 million people losing access to sexual and reproductive health services in 2025.
Now, the Trump administration’s budget request for fiscal year 2027 proposes even more cuts to global health programs, reducing funding by billions of dollars and specifically eliminating all reproductive health programs. The budget proposal says the White House aims to ensure no funding supports “unfettered access to birth control.” The president’s budget request is not binding, as Congress approves funding, but it is indicative of the administration’s spending priorities.
Nabeeha Kazi Hutchins, president of PAI, a reproductive rights NGO based in Washington, told CNN the proposal’s wording “makes it very clear that what they’re advancing is a political ideology and not public health evidence,” and that it shows an “incredible abandonment” of decades of bipartisan US commitment to international family planning.
In 2024, 43% of global family planning aid was funded by the US , according to health policy nonprofit KFF. That funding formerly gave 47.6 million women and couples access to modern contraceptives, according to an analysis of the 2024 budget by the Guttmacher Institute, a research organization focused on sexual and reproductive health that supports abortion rights. US policy bars international NGOs that provide abortions, give counseling about abortions or advocate for safe access to abortion from receiving US government funding.
But early last year, the Trump administration froze and then scrapped family planning grants once administered by USAID. Then, in July, Congress rescinded $500 million intended for family planning and reproductive health programs. The US administration also stopped all contributions to the United Nations Population Fund, the UN’s sexual and reproductive health agency, and withheld $9.7 million worth of US-purchased contraceptives in warehouses in Belgium rather than delivering them to women overseas.
Experts warn that the impact of further spending cuts on women’s lives will be significant in the 41 countries that once received USAID family planning support, many of them in Africa.
In Mozambique, aid workers reported a 7% increase in recorded teen pregnancies last year in areas where services were scaled back, after US funding cuts to UNFPA and the Global Fund hampered efforts to reach some of the most vulnerable communities.
“There is a direct correlation between the withdrawal of our assistance and the increased vulnerability of young girls,” Santos Simione, director of the Mozambican Association for Family Development (AMODEFA), told CNN by email. “Every percentage point of this increase represents girls dropping out of school, the perpetuation of the cycle of poverty, a rise in HIV infections, and an increase in child/early unions.”
In Malawi, one of the world’s least developed countries, the local NGO affiliated with the International Planned Parenthood Federation raised the alarm late last year about the impacts on women who had lost access to mobile clinic care and contraceptives in 2025.
“I waited for the clinic to come,” 24-year-old Ulemu Kapile told the Family Planning Association of Malawi at the time. “They used to come every month. But after the aid freeze, they never came back, and by the time I realized it, I was already pregnant.”
Medical providers and nonprofits working in Africa say US cuts to family planning services have led to deaths, unsafe abortions, hemorrhages and worsening maternity care.
Asked by CNN about the claims, a US State Department spokesperson said: “The American people expect their tax dollars to support programs that save lives, advance U.S. interests, and reflect American values, not fund abortion-related activities, left-wing social agendas, or wasteful overseas bureaucracies.”
The administration’s focus, the spokesperson added, is “on implementing life-saving care in global health priority areas, including HIV/AIDS, tuberculosis, malaria, and maternal and child health.”
Research shows , however, that access to modern contraceptives, and the ability to prevent or space out pregnancies, improves maternal mortality rates, family incomes and babies’ health. What’s more, health providers in several countries told CNN that birth control services are often integrated with other medical work, like HIV-AIDS prevention and obstetrician-gynecologist care, which have also been impacted because of the cuts.
“If nothing is done, then there are going to be some dire consequences,” said Patrick Kinemo, the Tanzania country director for an organization called MSI Reproductive Choices, which works in dozens of nations to provide reproductive health care.
Tanzania alone is facing a funding gap of around $18.3 million for contraceptives like birth control pills, implants and intrauterine devices (IUDs) this year, according to MSI. Those contraceptives would impact women’s lives for many years beyond 2026, MSI said, but this year alone it would have prevented 1,600 maternal deaths, according to its own analysis.
He noted that improved family planning is responsible for a significant reduction in the country’s maternal mortality rate. “Without these commodities, that could reverse.”
Barred from burning $9.7 million in birth control, the Trump administration may now be running down the clock
Adequate space between pregnancies also lowers infant mortality rates. That is largely because mothers can breastfeed for longer periods of time, which improves child health and nutrition indicators and reduces growth stunting, according to previous research from USAID . It also allows women to work, with increased household income helping to improve family health, Kinemo said.
As aid cuts limit their options, more women may be forced into taking health-endangering measures. Dr. Bakari Omary, the project coordinator at the Tanzanian reproductive health nonprofit UMATI, told CNN last year: “We are fearing unsafe abortion, and there has been an increasing number.” In several of the countries in which health workers spoke to CNN – including Malawi, Nigeria and Tanzania – abortion is severely restricted by law.
One year on from dismantling of USAID, study projects that global aid cuts could lead to 9.4 million deaths by 2030
In Zambia, aid workers said they feared that heavy staffing cuts were negatively impacting the care that young women and soon-to-be-mothers were receiving.
“The quality is definitely compromised. You can’t have the same quality with two people working when you had six,” said Amos Mwale, executive director of the Centre for Reproductive Health and Education in Zambia. There are now far fewer midwives in clinics, he said, which means women must wait until they are further on in labor to get care.
Pregnant women are “walking long distances, and then they have to also wait for longer hours than normal if they have to access antenatal services,” Mwale said.
Aid workers said countries were struggling to fill the gaps left by the steep funding cuts amid other budget pressures .
A spokeswoman for the Family Planning Association of Malawi said the country’s national Ministry of Health was supporting its work, but that it could not afford to extend services to the most rural areas. The organization has received some stopgap funding from IPPF to continue its work. But in some areas left without adequate funding, US-backed partners “completely shut down the services… so the women are absolutely desperate,” the spokeswoman said.
In fiscal year 2024 – before Trump came back to office – US investment in global family planning is estimated to have prevented 17.1 million unintended pregnancies and 34,000 maternal deaths , according to the Guttmacher Institute. The US funding also averted an estimated 5.2 million unsafe abortions, it said.
Although Congress recently passed more funding for global health aid in fiscal year 2026, which includes money for family planning and reproductive health, budget experts told CNN that there will be a yearlong lag time for that money to be spent.
Meanwhile, reproductive health advocates warn that the funding could still be redirected or rescinded, as it was in 2025.
The US State Department is still evaluating family planning programs and funding for the 2026 financial year, the spokesperson for the department told CNN in March.
As the global family planning sector is squeezed, women say they fear losing control of their own reproductive choices.
“Everybody is scared of getting pregnant,” said Peace Adizue, a student in Abuja, Nigeria, who used to rely on subsidized birth control. She said that women were worried the unavailability of certain contraceptives meant they would have to change to less reliable methods.
Birth control costs have also soared amid aid cuts and contraceptives being out of stock. “I am shocked at the difference in the price,” Adizue said.
For service providers, the situation is hard to see. “What is currently happening… sometimes makes me shed tears,” said nurse Ojung’a, in Kenya.
Over and over in recent months, her clinic has been forced to turn away women who’ve walked miles hoping for modern medical care or contraception.
“Today, my shelves are empty,” she has had to tell them. “In most cases we have, in Swahili, hakuna . Hakuna means nothing.”
