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International health organizations have warned that Donald Trump’s push to dismantle US foreign aid and orders barring diversity, equity and inclusion are destroying programs that once provided healthcare to millions of women and girls worldwide.
Providers said a 90-day stop work order imposed by the Department of State to “review” contracts for compliance with the new administration’s orders means many clinics, which operate on shoestring budgets, will never reopen – pausing services for everything from cervical cancer screenings to HIV treatment to the removal of intrauterine contraceptive devices.
“The whole ecosystem is crumbling,” said Dr Carole Sekimpi, a doctor in Uganda and senior director for Africa with MSI Reproductive Choices, a UK-based non-profit that provides family planning services around the world, and which expects to lose $14m in US funding.
“Ninety days later – we’re going to be rebuilding from the ground … Because of the extensive damage done to the ecosystem for reproductive health and rights.”
The pause has also sown distrust, she said, as women had scheduled healthcare only to find clinics closed: “Women and girls walked up one morning and there was no care.”
The US provides $8.2bn each year for foreign humanitarian aid, around 1% of total US spending. That money supports programs that touch the lives of tens of millions of people globally, particularly in countries with weak health systems or which are strategically important, such as Sudan, Uganda and Ukraine.
For nearly a decade, Congress has appropriated $607.5m in foreign aid for family planning, funding that experts estimate would have provided modern contraceptives to 47 million women and girls.
However, when Trump entered office, he ordered all US foreign aid frozen for 90 days as contracts are “reviewed” and ordered a work stoppage on diversity, equity and inclusion programs, often called DEI.
Although the state department later issued waivers and said “life-saving” humanitarian aid was not subject to the pause, staffing reductions and confusion caused by the president’s orders mean that there have been significant delays even for such basic programs as food assistance. The USAid Inspector General’s office identified more than $489m in food aid at risk of spoiling as it sat at ports and warehouses around the world.
The inspector general responsible for the report was fired the day after its release by the Trump administration. Trump fired 17 other inspector generals after he took office. Inspectors general are legally required to be given 30 days advance notice and a detailed list of reasons for their firing.
“Can you imagine if you are a woman seeking help, and the clinic is shut?” said Elisha Dunn-Georgiou, president and CEO of the Global Health Council. “You can’t get treatment, you can’t get care, because America has decided on a whim that you’re not worthy. That’s unfathomable.”
The pause in foreign aid funding and many of Trump’s executive orders are now part of court cases seeking to stop the actions – part of what legal scholars are calling a “constitutional crisis” in the US, as the president dismantles programs established and funded by Congress – the branch of government with the “power of the purse”.
As those issues move through courts, funding orders are sowing “chaos” for programs around the world, including for international sexual and reproductive health workers whose work is necessarily tailored to women, girls and sexual minorities.
“We are really in a fight for our lives – for everybody’s life,” said Dunn-Georgiou. “We have got to do everything we can to get this foreign aid freeze declared unconstitutional, to get everything we can salvage from USAid re-employed, to get a major campaign to counteract the misinformation coming from the administration, because people are not getting services. People are getting sick and people are dying.”
Waivers have failed to effectively restart programs because of the long and, at times, impossible process of translating a waiver into money that can be used to support a program, Dunn-Georgiou added.
“If you hear from the US government, ‘Well, there is a waiver, we don’t understand what the problem is,’ that is a lie,” said Dunn-Georgiou.
Due to the Trump administration’s stop-work order on foreign aid, the Guttmacher Institute estimates 130,390 women each day will be denied access to such contraception, with 11.7 million women denied after the 90-day pause. That could result in as many as 4.2 million unintended pregnancies and more than 8,340 maternal deaths.
That number is based on the assumption that after the 90-day pause, programs will resume. In a press call on Wednesday, leaders of international programs said the long pause means the program might return in a form wholly unrecognizable.
“If it returns it will probably be abstinence and natural methods which we know will not address the issues,” said Sekimpi.
“Since the suspension of USAid and USAid programs, we have witnessed unprecedented chaos … The impact is on a scale not anticipated.”
