It’s hard to believe it’s been over a year since the Trump administration sent termination letters to USAID staff and began shutting the agency down along with other foreign aid programs.
In retrospect, it was a kind of soft launch, signalling a new era. Little did we realise it then, but it was the beginning of the end of foreign aid for a range of global health, humanitarian, anti-poverty, democracy, and environmental programs.
Among the many casualties was U.S. leadership in global family planning and reproductive health, including terminating longstanding US investment in programs that enabled people of reproductive age worldwide to access family planning services, prevent sexually transmitted infections, ensure healthy, wanted pregnancies, and plan and space births.
This de-funding translated into many billions’ worth of losses, because family planning investments generate immense returns — higher than any other form of aid (except trade liberalisation). From a health perspective, every additional $1 spent on contraceptive services saves $2.48 in maternal, newborn, and abortion care costs.
The broader return on investment is many multiples of that. For example, family planning reduces unintended pregnancies, enabling girls to stay in school, develop professional skills. and ultimately fully participate in the economy and society, yielding an estimated $8.40 in economic returns for every $1 spent on family planning.
The loss of U.S. government investment and the high returns it generated is monumental. Before funding was cut, the U.S. was by far the largest bilateral donor for family planning services, providing 43 per cent of all donor government support.
But there are ways to recoup the losses. First, philanthropy must step into the breach. It would take just one additional cent beyond every $10 of current U.S. charitable giving to restore US family planning aid, a new Population Institute report points out.
That would provide a short-term boost to mitigate service disruptions, meet women and girls immediate needs, and signal that reproductive autonomy remains a priority. And it would give us room to re-think how we can sustain this critical work absent a reversal in U.S. policy.
FP2030, a global partnership for universal family planning access, calls for renewed investments from other governments and alternative donors. UNFPA, the UN’s sexual and reproductive health agency, is mobilising more domestic funding for in-country services as aid from abroad declines. The governments of Democratic Republic of the Congo, Zambia, and Zimbabwe recently announced they will invest more in contraceptive supplies.
Scaling up domestic investments will take time. Meanwhile, philanthropy can be a vital bridge, directly funding family planning programs and services while helping develop civil society sectors so they can better hold their governments accountable for sustaining them. With targeted investments in movement-building—research, communications, legal advocacy, strengthening coalitions—philanthropy can help forge true partnerships between governments and civil society.
These partnerships will be all the more important as the Trump Administration pushes its own approaches, including its bilateral health compacts with 26 countries in Africa and Latin America. They make aid contingent on complying with onerous and possibly illegal US demands to share health data and report on and share specimens of emerging pathogens.
Governments are treated as transactional customers in a one-sided ‘America first’ framework, with the benefits accruing to US businesses. These compacts don’t mention family planning at all, but may be highly punitive for countries providing reproductive health services the administration opposes. And they may lock countries into long-term agreements affecting future aid funding for years and send entire health systems into gridlock.
Now the U.S. has launched a new $4.5 billion platform for projects that the State Department deems will complement, extend, and/or fill in gaps left by those bilateral deals, and invited nonprofits, universities, and faith-based organisations to apply. But at the same time, the Administration is signaling that any funding will likely be tied to its own ideological priorities.
In January it vastly expanded the global gag rule, also known as the Mexico City policy, which restricts U.S. foreign aid to nongovernmental organisations that provide any abortion services or referrals, counselling, or advocacy for abortion access, even if they use their own (non-U.S.) funds. The expanded rule also adds new restrictions on activities and speech related to what the Administration considers ‘gender ideology,’ and diversity, equity and inclusion. Soon, these restrictions may get applied to all U.S. bilateral assistance, including humanitarian assistance.
Meanwhile, this year the US Congress appropriated more than $600 million for international family planning, but that commitment is on paper only. The Administration has already made it clear that family planning is not meant to be part of its bilateral aid.
Amid all the disruption, philanthropy needs to step in to provide short-term respite for women and girls already suffering from the loss of services, and to seed and lead a new movement that can sustain results in a radically reshaped policy environment.
There is no time to lose. Notwithstanding doomsayers decrying declining birthrates, the reality is that the world’s population is growing. We’ll add about 70 million people this year and some 2 billion overall this century.
Every day, for the rest of our lives, the cohort of girls transitioning to adulthood will expand, growing the number of women of childbearing age by 200 million this century.
Denying them critical health services and information prevents them from determining their reproductive lives. That will lead to bad outcomes for their health and well-being, for the families they wish to create, for their societies and economies, and for our collective futures on this small planet. But amid the leadership vacuum the U.S. has created, a small push from philanthropy could make all the difference.