In the 2024 financial year USAID allocated $607.5 million to family planning, including $32.5 million for UNFPA for core support. The Guttmacher Institute have estimated that over the course of one year, the non-renewal of these programmes will result in an estimated 47.6 million women and couples losing access to modern contraception, resulting in 17.1 million unintended pregnancies and 34,000 pregnancy-related deaths. Every day without this funding 130,390 women lose access to contraceptive services. As the impact cascades through communities, poorer and marginalised people are most affected, particularly those in conflict and humanitarian settings.
Countries most affected include Kenya, Nigeria, Ethiopia, Myanmar and Bangladesh. Services and programmes most affected include contraceptive supply chains and family planning services, primary health care, HIV prevention and treatment, maternal and newborn health, nutrition and food security, and humanitarian health services.
MSI is currently the only non-government provider of contraception, at scale, operating in Ethiopia and Uganda.
In Kenya, there have been 54,000 job losses in the health sector so far.
According to government data, 85% of NGOs have stopped programming in Ethiopia.
In Uganda in the weeks following the freeze our programme reported a sense of panic amongst communities, with myths circulating that contraception had been banned and women rushing to get their implants removed with some unscrupulous providers charging extortionate rates.
MSI is on the frontline of providing lifesaving SRHR services in 36 countries. As we continue to navigate and respond to these seismic shifts, and in an already limited funding environment we share here some initial insights on the immediate disruptions, priorities and risks across the building blocks of the health system, recognising this is a fast-moving situation and that the medium to longer term impacts are still unclear.
In Zambia the Ministry of Health have reported challenges in quantifying the gaps of programmes that have closed because implementing partners are no longer active, and in Nigeria, information is starting to trickle through at state level but is very challenging to collate on a national basis.
73% of USAID funding to Africa in 2024 supported health programmes. As such providers, governments and donors are having to be ever more flexible and willing to rapidly adjust their strategies and programmes to mitigate the damage, to proactively share intel and gaps, and to work together to find creative solutions, and to share costs and resources. Proven, cost-effective strategies such as community-based services, self-care, task shifting, and integration are becoming ever more crucial. As governments are forced to transition quickly from donor dependency, domestic and alternative financing models are being prioritised and fast tracked, learning from countries which are further along in this transition.
There is no doubt that this is a moment to rethink global health, development and SRHR and work to build an infrastructure that is more resilient, country led and progressive in its inclusion of abortion, particularly given the harmful impacts of the Helms Amendment and the Mexico City Policy. Whilst we welcome, and are part of, current and long overdue conversations around sustainability and what a more locally driven approach to aid and development could look like, this document focuses on the shorter-term, immediate impacts on the health system.
[This report continues at length.]
SOURCE: MSI Reproductive Choices – USAID and the current implications for access at a national level (PDF)