The US has ended financial support for family planning programs in developing countries, separating nearly 50 million women from access to birth control.

This policy change has attracted little attention in the wholesale demolition of US foreign aid, but it has great significance, including mother deaths and an overall increase in poverty. It derails the efforts that have in recent years brought long-acting birth control pills to some of the world’s poorest and most isolated regions.

The US contributed to family planning programs in 31 developing countries last year, providing about $600 million in 2023, according to the health research institute KFF.

According to an analysis by the sexual health research institute, the US funding provides birth control pills and medical services to deliver them to more than 47 million women and couples, reaching over 47 million women and couples. Without this annual contribution, 34,000 women could die from preventable mother deaths each year, Guttmacher’s calculation concluded.

“The magnitude of the impact is daunting,” said Mariva, who leads the coordination team for the Ouagadougou Partnership, an initiative to accelerate access to investment and family planning in nine West African countries.

The funding ended as part of the Trump administration’s breakdown of the US International Development Agency. The State Department, whose USAID skeletal remains were absorbed on Friday, did not reply to a request for comment on its decision to cease funding for family planning. Secretary of State Marco Rubio explains that he wasted the fired aid project and is not in line with America’s strategic interests.

Supporting family planning in the world’s poorest and most populous countries has been a consistent policy priority for both Democrats and Republican administrations for decades, considered a breakwater against political instability. It also reduced the number of women seeking abortions.

Among the countries that will be heavily affected by the decision are Afghanistan, Ethiopia, Bangladesh, Yemen and the Democratic Republic of the Congo.

Funds to support the International Family Planning Program have been allocated by Congress and have been extended to the latest expenditure bill, which the government is operating until September. Moves by the State Department to cut these and other aid programs are now the subject of multiple lawsuits before federal courts.

The Trump administration has also fired US funding for UNFPA, the UN’s sexual reproductive health organization, the world’s largest procurement of birth control pills. The United States was the organization’s largest donor.

The US was not the sole supplier of birth control in any country, but the sudden termination of US fundraising has created disruption to the system and has already run out of products in clinics.

The estimated $27 million worth of family planning products already raised by USAID are stuck at various points in boats, ports and warehouses. Programs and employees have no programs or employees left to take them down or hand them over to the government. One plan proposed by Washington’s new USAID leadership is for the rest of the employees to destroy them.

Supply chain management is a major focus for USAID in all areas of health, with the US paying for transporting contraceptive products such as hormone implants, for example, from Thai manufacturers to ports in Mombasa, Kenya.

“It will be extremely difficult to put your work back on,” said Dr. Natalia Kanem, executive director of UNFPA.

The US has also paid for data and information systems that help the government track what is in stock and what needs to be ordered. None of these systems have been working since the Trump administration sent halt work orders to all programs that received the USAID grant.

Bellington Wwalika, a professor of obstetrics and gynecology at the University of Zambia, said contraceptives have already begun running in some parts of the country, with the US supplying a quarter of the national family planning budget.

“Wealthy people can buy the products they want. It is the poor who have to think, ‘What should I get between food and birth control?'” he said.

Even before the US retracted its family planning program, the survey found that globally, 1 billion women of reproductive age wanted to avoid pregnancy, but modern methods of birth control were inaccessible.

At the same time, there have been great progress. Demand for contraception is steadily increasing in Africa, a region of the world with lowest coverage, in long-acting ways that provide women with greater privacy and safe protection. Supply has been improved with better infrastructure and helped deliver products to rural areas. And the “Demand Creation” project, which is the main funder in the US, used ads and social media to inform people of the various options available and the benefits of pregnancy intervals or delays. The rise in education levels among women has also increased demand.

Two weeks ago, Thermasibanda, a 27-year-old engineering graduate who lives in a low-income community on the edge of Zimbabwe’s capital, Harare, received a hormone implant that prevents pregnancy for five years.

Shibanda has a two-year-old son and says he can’t afford more children. She can’t find a job in Zimbabwe’s broken economy and her husband can’t. They follow the $150 presence he earns from the vegetable stand every month. She relied on “hope, faith and natural methods” to prevent another pregnancy from happening after her son was born, Shibanda said, hoping for something more reliable, but that was simply impossible on her family’s budget – until a free clinic came to her neighborhood.

With USAID funding, the Zimbabwean organization that provided implants last year has been able to purchase six robust Toyota vehicles and camping equipment so that outreach teams can travel to the country’s most remote parts and provide vascular removal and IUD at pop-up clinics. Since Trump’s executive order, they have had to stop using all of that equipment.

International nonprofit MSI reproductive options intervened with temporary funds to ensure that they could continue to provide free care to women they could reach, such as Shibanda.

Shibanda said her priorities are to provide her son with the best possible education and that there are no more children as tuition costs. However, many African women have no way of making this choice. In Uganda, the national fertility rate is 4.5 children per woman, but it is not uncommon to meet women in rural areas with limited education with eight or 10 children, said Dr Justin Bukenya, lecturer in community health and behavioral sciences at Makerele University in Kampala. These women become pregnant for the first time as teenagers, with little space between pregnancy.

“By the time they were 30, they were able to get their 10th pregnancy. These are the women affected,” she said. “We’re missing the opportunity to make progress with them. The United States was doing a very strong job of creating the demands of birth control with these women here and mobilizing young men and women to go to family planning.”

Some women who rely on free or low-cost services through the public health system may now seek to buy birth control pills in the private market. However, the prices of tablets, IUDs and other devices are likely to rise significantly without guaranteed to buy large quantities from the US.

“As a result, women who relied on free or affordable options through the public health system could now be forced to rely on private sector sources.

The next biggest donor to post-US family planning is the Netherlands, which provided about 17% of donor government funding in 2023, and the UK provided 13%. The two countries recently announced plans to cut their aid budget by more than a third.

BA said the focus of the West African countries she works for is to mobilize domestic resources and come up with ways for governments to try and relocate money to cover what the US supplies. Charities such as the Gates Foundation and financial institutions, including the World Bank, which are already important contributors to family planning, could provide additional funding to try to move products into the country.

“We were very optimistic. Even with all the political instability in our area, we’ve been using modern methods to add millions of women over the last few years,” BA said. “And now, it’s all, US support, policy, it’s all gone completely. The gap is too big to fill.”