Why The USAID Freeze Is A Catastrophic Blow to Global Sexual Health 

None of them saw it coming. One day, they were running clinics, sending mobile health teams to rural villages, delivering contraception and carrying out abortions for women who needed it most. Then, their funding was gone. Millions of dollars frozen overnight. Stop-work orders issued without warning.

The United States Agency for International Development (USAID), the US government’s foreign aid arm, has effectively shut down after the Trump administration abruptly froze its operations for 90 days on 8 February this year. Citing inefficiency and misalignment with his ‘America First’ strategy, President Donald Trump’s decision has sent shockwaves through the global aid sector. Employees were told to stay away from headquarters, international staff were ordered home and the website was shut down.

While the overall impact on global poverty reduction is immense, one of the most overlooked crises is the obliteration of sexual health services – a disaster that will leave millions of women and girls without care.

The numbers are staggering. In Afghanistan alone, nine million people will lose access to services and 1,700 health workers will be unemployed. In Gaza, 50,000 pregnant women will lose care. The Guttmacher Institute estimates that after the first week of the freeze, nearly one million women and girls will have lost access to contraception funded by USAID. Every week, that number grows by another million. If the freeze lasts all year, more than four million unintended pregnancies will occur and at least 8,000 women will die in childbirth. Cervical cancer screenings and STI treatments are also collapsing before the eyes of thousands of frontline workers.

“It has unleashed chaos,” says Anna Mackay of MSI Reproductive Choices. “And it feels deliberate.” For Afghanistan, the crisis is layered on top of another: the Taliban’s misogynistic rule. They have already banned women from education, employment and public life. Health NGOs were among the few places where they could work, supporting their families in a collapsing economy.

Speaking anonymously from rural Afghanistan, one midwife told Service95: “I am the only source of income for my family. Now, I sit at home. My patients keep calling me, anxiously asking questions.” She was sitting in the clinic when she heard the news. “I felt very sad. To be honest, it was one of the worst days of my life.”

Elon Musk’s Department of Government Efficiency (DOGE) was partially responsible for taking the axe to USAID, triggering outrage that the world’s richest man is slashing funds meant for the world’s poorest. Since Donald Trump’s election, Musk’s personal fortune has ballooned by more than the agency’s entire annual budget, accounting for less than 1 per cent of federal spending.

The cuts are also hammering rural communities reliant on outreach programmes. “We are very worried about the people living in remote areas,” says Donald Makwakwa, Executive Director of the Family Planning Association in Malawi. “They don’t read the news. They don’t know what’s happened. They will travel to meet us and will wait, confused, and no one will come. This will destroy trust and damage our reputation.”

His concern echoes in Afghanistan, where Najibullah Samim, CEO of the Afghan Family Guidance Association, shared that the security guard hired to protect the clinic’s assets after it closed called him and said, “So many women keep turning up and crying when I tell them it’s closed.”

For Idlib and Aleppo, Syrian provinces battered by years of bloodshed, the collapse of medical aid is pushing an already broken system to the brink. According to the Idlib Health Directorate, 23 hospitals and health centres have shut their doors, among them, two maternity hospitals and three clinics in refugee camps. One of these camps, the largest in Syria, was never meant to hold 800,000 people, but it does. It’s a city of the displaced, people who fled as Bashar al-Assad’s bombs rained down on their homes, only to find themselves trapped in a place where even the most basic healthcare is now vanishing. The Directorate estimates that more than a million people have now been cut off from medical services.

USAID has long been a punching bag for critics who claim that foreign aid is a waste of American taxpayer dollars. Yet it has delivered some of the most successful global health initiatives out there, including making major strides to eradicate malaria and averting an Ebola pandemic. Plus, the President’s Emergency Plan for AIDS Relief (PEPFAR) has saved over 25 million lives.

The agency insists that PEPFAR is still operational, but on the ground, chaos reigns. The so-called waivers allowing some programmes to continue have been riddled with delays and confusion – Médecins Sans Frontières reports that across its vast network, not a single organisation was able to resume work under the initial guidance.

In South Africa, where 7.7 million people live with HIV, prevention services are collapsing, and emergency funds exclude crucial programmes such as gender-based violence support. “We see over 100 survivors of gender-based violence daily, nearly half of them children,” says the NGO NACOSA, which relies on USAID for up to 40% of its funding. “Without funds, rape survivors can’t access PEP [a medicine that can be taken to help prevent people at high risk of contracting HIV from getting infected], leaving them vulnerable to HIV.”  

There are fears the funding freeze, initially framed as a 90-day pause, could be permanent. “We are not treating this as a pause but as a seismic withdrawal of a major source of development aid,” says Anna.

The consequences will be deadly – rising unplanned pregnancies, soaring unsafe abortions, more deaths in childbirth, plus fewer women in school or work. “People aren’t going to stop having sex. Without contraception, what happens? Women will seek abortions. And many will die,” adds Donald.

Najibullah recalls memories of August 2021, when the Taliban took over and NGOs scrambled to adapt: “It felt like the same panic as when the regime changed.” His clinics have since secured emergency funding from the United Nations Population Fund (UNFPA) and the Australian government, but the reprieve is temporary and he is keen to stress their fears for the future.

In Malawi, Donald worries he and his team won’t be paid this month. “It feels like the ecosystem is crashing around us,” he says. Anna also shares that MSI has lost $14 million in USAID funding across five countries – money that would have reached more than two million women and girls.

As the full impact of the USAID funding freeze becomes clearer, it demands our collective resolve now more than ever. The first signs of resistance are emerging, as last Thursday, a federal judge issued a temporary order to lift the funding freeze, citing the irreparable damage it has caused to nonprofits and organisations working tirelessly to support global health.

However, as the legal victory unfolds, the reality on the ground remains grim and there is no clear evidence yet that programmes are back in action. In every conversation we’ve had with those on the front lines, there’s one common thread: the funds are not flowing.

But this is a moment for solidarity. “Feminist networks won’t be cowed by this,” says Anna. “We’ve dealt with shocks before – climate, conflict. This is going to be hard, it’s going to be tough. Fires are burning all over the place; there are acute needs and gaps left all over the landscape by USAID. But we will keep working together.”

Charities and networks will continue to advocate for sexual and reproductive health and rights, demanding that other governments step in and fill the void. Meanwhile, Anna says people can do their part, too – whether it’s sharing an Instagram post, subscribing to a charity newsletter or writing to your local politician to urge them to advocate for redirecting funds to fill the gap left by USAID’s cuts. “We will keep working together and we are asking those who can, to use their voices. Speak out.”