End of US aid poses death threat to women and girls in Africa

But the 35-year-old mother, who relies on free family-planning services, was out of luck when she arrived at the Chitakatira health clinic in eastern Zimbabwe.

Nurses at the public health facility, which is outside the city of Mutare and supported by charities including Population Services Zimbabwe, said they had run out of stock for that day.

"I am stressed. I do not have money to buy birth control pills," Mucheri told the Thomson Reuters Foundation.

"I cannot have more children. I am even struggling to feed the ones I have," said the unemployed mother of four.

Mucheri is among millions of women worldwide who rely on free contraceptives from aid programmes that have been plunged into turmoil since President Donald Trump gutted the U.S. Agency for International Development, a key global donor.

Lydia Zigomo, regional director for the United Nations sexual and reproductive health agency UNFPA, said the cuts would have "severe consequences" with hundreds of thousands in east and southern Africa losing access to contraception.

"Many countries in the region are expected to run out of contraceptives and life-saving maternal medicines within the next three to six months," Zigomo said by email.

"Given that countries like South Sudan, the DRC (Democratic Republic of Congo) and Madagascar already have high maternal mortality rates, the withdrawal of funding will have catastrophic consequences," Zigomo said.

The immediate loss of U.S funding for UNFPA in DRC, South Sudan and Ethiopia came to about $4 million, she said, noting that many local health providers had also lost U.S. funding.

"With the U.S. freeze, the entire ecosystem for improving sexual, reproductive, maternal, neo-natal, child and adolescent health has been compromised."

Violence against women, maternal mortality and unplanned pregnancies would all increase, while menstrual hygiene and pregnancy-related care would suffer, she added.

Longer term, there will be more sexually transmitted infections and unsafe abortions. Child marriage and teen pregnancies could also rise as families fall into poverty.

And there would be major disruptions in the supply chain for contraceptives and reproductive health medicines, Zigomo said.

UNSAFE PREGNANCIES

Pester Siraha, a country director at Population Services Zimbabwe, an affiliate of MSI Reproductive Choices, said the USAID cuts violate women's rights.

"This is a cruel decision," she said.

"The sudden suspension created a lot of chaos and uncertainty. Sudden stoppage of services without notice is not ethically right."

In 2024, USAID provided up to $360 million for health and agriculture programmes in Zimbabwe, whose own government has underfunded healthcare for decades.

Each year, the health budget falls far short of the target set in the 2001 Abuja Declaration, in which African Union governments committed to spend at least 15% of national budgets on health services.

Zimbabwe's deputy health minister Sleiman Kwidini said the government had been buying its own family planning supplies through the National Pharmaceutical Company, a government agency, with funding from donors.

"We have enough supplies and stock to provide family planning services around the country," he told the Thomson Reuters Foundation, without giving further details.

Siraha said more than half of all funding for sexual and reproductive health services in Zimbabwe came from USAID, so the cuts would inevitably boost unplanned pregnancies.

"(This leads) to unsafe abortions and maternal mortality. Teenage pregnancies lead to school dropouts and worsen the higher percentage of teenagers dying during delivery," she said.

In January, Trump also recommitted to two international anti-abortion pacts, cutting all U.S. family planning funds for foreign organisations that provide or promote abortions.

JOBS LOST

The fallout from the aid cuts is already rippling through Zimbabwe: thousands of health workers were told via WhatsApp to vacate work premises in late January after Trump's executive orders kicked in, according to some of those affected.

A 29-year-old single mother of two, who did not want to give her name for fear of reprisals, said on the eve of Jan. 28, she was told not to report for work the following day at a USAID-funded not-for-profit organisation providing sexual health services to young girls in Gokwe, in Midlands Province.

"I signed for unpaid leave. The last salary and savings is the one that I am using for all expenses and upkeep of my family," she said.

"I am trying to find ways to get income. I am buying and selling clothes and food, but it is not yielding much."

Ekenia Chifamba, director of Shamwari Yemwanasikana, a community-based organisation that promotes girls' rights, said the cuts were "unbearable" as they affected whole families.

"It is quite devastating and disturbing," she said.

Zigomo said UNFPA was seeking alternate funding, be it engaging with national governments, asking more of other donors or tapping the private sector and philanthropic organisations.

It is also trying to mobilise civil society and grassroots organisations to push for local solutions and funding.

"Despite these efforts, it appears highly unlikely that most (east and southern African) countries will mobilise resources to fill in the gaps ... in the short term," she said.

"There remains an urgent need for sustainable and predictable funding to prevent a devastating rollback in progress on women's health and rights."