Maternal mortality rates have declined significantly across the world since the turn of the century, but global health experts fear that progress could be rolled back as a result of the Trump administration’s cuts to U.S. foreign aid.
Maternal deaths per 100,000 live births dropped by about 40 percent worldwide between 2000 and 2023, according to a recent report from the World Health Organization (WHO).
The WHO said women today are more likely to survive childbirth than ever but warned that cuts to foreign aid pose a “threat of major backsliding” in that progress.
“The report comes as humanitarian funding cuts are having severe impacts on essential health care in many parts of the world, forcing countries to roll back vital services for maternal, newborn and child health,” the United Nations health agency said in a release accompanying the report.
“These cuts have led to facility closures and loss of health workers, while also disrupting supply chains for lifesaving supplies and medicines such as treatments for hemorrhage, pre-eclampsia and malaria – all leading causes of maternal deaths.”
President Trump and his administration have taken a series of actions to slash foreign aid since his return to the White House in January.
On his first day back in office, Trump issued an executive order freezing all foreign aid for 90 days. Shortly thereafter, the Trump administration issued a stop-work order on foreign assistance awards and then announced the United States Agency for International Development (USAID) would be placed under review and reorganized. Senior agency officials were placed on leave and hundreds of staffers were fired.
Secretary of State Marco Rubio said last month that 83 percent of USAID contracts have been canceled. And the administration terminated almost all of the remaining 900 employees of the agency in late March.
USAID managed almost all of the child health and family planning work the United States government executes abroad, according to Jennifer Kates, senior vice president and director of global health and HIV policy at health policy nonprofit KFF.
The U.S. spent $500,697,000 on maternal and child health programs abroad in fiscal 2023, according to an analysis from KFF. Some countries, like Nigeria, Ethiopia and the Democratic Republic of Congo, received upward of $30,000,000 worth of aid for these efforts from the U.S.
The dismantling of the agency has as a result “dramatically disrupted services and the ability to implement and manage those programs,” Kates said, which will inevitably have a “significant” impact, even if that impact has yet to be seen by the global community.
Care from health professionals before, during and after childbirth can save the lives of women and newborns, according to the WHO, as can reducing the number of unplanned pregnancies through birth control.
Family planning services abroad were dealt a heavy blow by the administration’s foreign aid freeze, with a number of health clinics shutting down and the supply chain for contraception suffering disruptions in the weeks after it went into effect.
A January analysis from the Guttmacher Institute, an abortion-rights research group, found that the pause caused 912,000 women and girls to be denied family planning care throughout the dozens of countries that receive U.S. aid in the first week alone.
Since the funds and personnel that can provide those resources have vanished in many countries, many girls and women are at risk of “severe repercussions,” according to the WHO.
Complications from pregnancy and childbirth are some of the leading causes of death for girls between the ages of 15 to 19 across the world, according to the WHO.
“So, when we talk about maternal mortality rates, we are talking about girls in a lot of cases,” said Rachel Clement, senior director of U.S. government affairs at PAI, a reproductive rights advocacy group. “Girls whose bodies are not ready to be pregnant and who are not ready to give birth and who are emotionally, financially are not really prepared to become parents.”
The Guttmacher Institute estimated in its January analysis that at least 8,340 pregnant people would die during the 90-day foreign funding freeze.
A leaked memo from Nicholas Enrich, acting assistant administrator for global health at USAID, shows that the agency estimated that 16,800,000 pregnant women across 48 different countries would not be reached through life-saving services as a result of the pause. Enrich was put on leave two days after sending the memo to staff.
Some health experts are particularly concerned about how the reduction of U.S. foreign aid will break referral networks for emergency obstetrics care.
The effectiveness of women’s health interventions is dependent on health systems becoming stronger through improved emergency transportation systems and health workforce training programs, according to Rachel Milkovich, a global health policy specialist at Doctors Without Borders.
“USAID programs have been pivotal in supporting maternal and neo-natal care in low-income countries—from training midwives to supplying essential medicine (like oxytocin for hemorrhage or magnesium sulfate for pre-eclampsia),” the leaked memo reads.
“A permanent halt would mean that many of these supply chains will collapse.”
The agency’s near closure, and the subsequent end of maternal care services, could have a ripple effect, experts say. Enrich mentions in the memo that a breakdown in the global supply chain of “maternal health commodities” could impact the availability of the drugs and equipment in the U.S.
And if maternal health crises worsen abroad, the fallout could result in “increased medical evacuation cases, migration of high-risk patients, or calls on U.S. humanitarian responders, all of which ultimately put pressure on U.S. hospitals,” the memo notes.
“The U.S. has never given funding through foreign aid out of anything but our own self-interests,” Clement said. “Undermining reproductive health care weakens the system that keeps crises from spreading.”
