When her mobile clinic shut down, Herisoa Bodo’s phone wouldn’t stop ringing. A client due for implant removal reached out again and again. The appointment never happened — and she became pregnant.
Bodo, a midwife with Marie Stopes International (MSI) Madagascar since 2012, kept fielding calls long after outreach teams had been forced to suspend services. “Women kept calling because they couldn’t find care,” she said. Her routes cover Analamanga, the region surrounding the capital Antananarivo, where MSI deploys buses converted into clinics and 4×4 teams into rural communities. For many women, those visits are the only reliable chance to see a midwife.
When they stop, the consequences surface quickly. Madagascar already has one of the world’s highest maternal mortality ratios — 445 deaths per 100,000 live births — and unsafe abortion is among the leading causes. Less than half of women use modern contraception, and roughly one in three has an unmet need for family planning. Even short interruptions widen the gap.
For years, MSI’s outreach depended almost entirely on UNFPA, the UN Population Fund. “100% of our family planning commodities come from UNFPA,” said Volonirina Ranorohery, Senior Programme Manager, MSI Madagascar. “They supply all our long-term [implants and IUDs] and injectable methods, and it’s all free for clients. They also cover things like fuel, car rentals, and petty cash for outreach.”
That support ended in January 2025, when the US government froze most foreign aid under an executive order. Within weeks, USAID terminated 48 UNFPA grants worth nearly US$377 million, and in March clawed back approved funding across seven countries, including Madagascar. By May, restrictions under the Kemp-Kasten Amendment cut off US support.
The shortfall was immediate. MSI expected US$500,000 from UNFPA this year. Instead, it received US$165,000. “We had to suspend six community sites and three mobile outreach teams,” Ranorohery said.
Health on hold
When the mobile clinics were suspended, the effects rippled quickly through the communities Bodo’s team usually serves. Women who had come to rely on MSI’s outreach suddenly found themselves without options. At public health centers, only short-term contraceptives such as pills and injectables were available, and always for a fee — a cost many families could not afford. “Most can’t pay,” Bodo said. “That’s why they prefer the long-term methods.” The suspension also disrupted basic care. Routine follow-ups never happened, and Bodo said she has seen more sexually transmitted infections (STIs), including syphilis and HIV, since the teams stopped bringing treatment kits to the field. “Before, the teams could provide treatment,” Bodo explained. “Now clients go to pharmacies, find medicines too expensive, and leave [the pharmacy] untreated.”
The fallout was personal, too. Bodo’s own contract shifted from permanent to consultancy, and her hours fell from 20 to 15 days a month — a reminder that providers are also living with uncertainty.
What Bodo and Ranorohery describe is not unique to Madagascar. UNFPA warns that midwifery and reproductive health support is also being cut back in places such as Somalia, Chad, Nigeria, and Afghanistan. In the four years before the freeze, U.S. contributions helped avert more than 17,000 maternal deaths, 9 million unintended pregnancies, and nearly 3 million unsafe abortions. With funding withdrawn, those gains are now at risk.
by Sarah El Gharib, Global Citizen. 30 October 2025. Image: MSI Madagascar/Rijasolo.