The day Donald Trump took office as president of the United States, he issued an order temporarily pausing foreign aid, including the funding that flows through the US Agency for International Development (USAID). The funding freeze will have permanent consequences. It has already crippled global health programmes, including critical reproductive health services, placing millions of lives at risk – particularly those serviced by providers in lower-income countries.
is one such provider. It is among the country’s largest sexual and reproductive health organisations, and for more than a decade, it has operated a fleet of vehicles that criss-cross Zimbabwe to deliver reproductive healthcare such as condoms, long-acting contraceptives and HIV education to remote regions. These mobile health clinics serve millions of people in a nation where and more of the population lives in rural areas.
This is just one example of the life-saving care that has stopped under the US foreign aid freeze. “Women and girls woke up one morning and there was no care,” says at MSI Reproductive Choices, a non-governmental organisation that helps support Population Services Zimbabwe. “There was no forewarning, so there is a lot of panic.”
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A few weeks after the 20 January order, on 13 February, a US federal judge , ordering the Trump administration to resume humanitarian assistance.
However, , the director of Population Services Zimbabwe, says the programme still hasn’t received any money or communication from USAID, which supplies about half of its budget. “At the moment, we are just in the dark,” says Siraha.
The pause has forced Population Services Zimbabwe to suspend about a third of its roughly 120-person staff. Out of its nine mobile clinics, the organisation had to shut down four, each of which served one of Zimbabwe’s 10 provinces. As a result, about 100,000 women are losing access to care, says Siraha.
“We knew the second Trump term would be devastating for people across the globe, but the damage so far has been worse than we anticipated,” says at the Planned Parenthood Federation of America.
More than $607 million of USAID’s $40 billion aid budget goes towards global family planning services, such as contraceptives, prenatal care and educational outreach programmes, mostly in low- and middle-income countries with high rates of HIV, maternal mortality and adolescent pregnancy.
at the Guttmacher Institute, a reproductive rights research group in Washington DC, and her colleagues estimate that these funds prevented more than 17 million unintended pregnancies, 5.2 million unsafe abortions and 34,000 deaths among women and girls last year alone.
“Foreign assistance for international family planning and reproductive healthcare, the evidence clearly shows, is one of the best investments that you can make in global development. It saves and transforms lives,” says Sully.
Now, Trump’s pause is eroding these efforts. The analysis by Sully and her colleagues suggests it has led to nearly 3.3 million people being denied contraceptive care as of 18 February. If the freeze lasts the full 90 days, it could lead to .
Whether the Trump administration complies with the judge’s order remains to be seen. Both the White House press office and the US Department of State – which Trump has tasked with –  did not respond to a request for comment.
Even if it does abide, restarting many of these programmes will be challenging, if not impossible, due to the chaos of the past three weeks. Communication lines have collapsed, public health infrastructure has been gutted and mistrust has taken root in affected communities.
“These programmes have been built and honed over decades, and they need continuous and predictable support to deliver vital care that people in communities rely on,” says Sully. “They cannot be turned on and off like a light switch.”
