The devastating consequences of the US government scrapping 85 per cent of USAID programs is continuing to reverberate across the globe, with the cuts now forcing the UN reproductive health agency (UNFPA) to curtail its support for midwifery.
This week, the agency released a statement, revealing that in several countries, the agency will only be able to fund 47 per cent of the 3,521 midwives it had planned to support this year due to the severe funding cuts.
“Midwives are often the first and only responders delivering life-saving care to pregnant women and their newborns in crisis settings, where the risk of dying during pregnancy or childbirth doubles,” the agency said.
“[They] are vital frontline workers who can provide up to 90 per cent of essential sexual, reproductive, maternal, and newborn health services – from safely delivering babies to caring for survivors of sexual violence.”
According to UNFPA, three-quarters of all maternal deaths each year occur in just 25 countries, with most of them located in sub-Saharan Africa and South Asia, including Nigeria, Chad, South Sudan and Central African Republic. In Yemen, a country with a high mortality rate, over 590,000 women of childbearing age are expected to lose access to a midwife.
“Midwives save lives,” said Natalia Kanem, Executive Director of UNFPA. Marking the International Day of the Midwife on Monday, Kanem said that midwifery continues to be under-recognised and under-resourced — a situation magnified during crises.
“Midwives often put themselves at great risk to reach women and girls in remote or crisis-affected communities,” she said. “Already, midwives are reporting rising death rates among women and newborns in conflict zones and fragile contexts, an ominous sign in places where more than 60 percent of global maternal deaths occur.”
Kanem noted that midwives could prevent two-thirds of maternal and newborn deaths while also generating broad economic and social benefits, including reduced healthcare costs and a more productive workforce.
“Women and entire societies would be both less vulnerable to crisis and more equipped to recover from it [due to the work of midwives],” she added.
Amid the funding cuts, UN support for midwives in humanitarian settings such as training, providing supplies and equipment and transportation for mobile health clinics will all be cut back.
“When crises strike and systems break down, midwives step up,” said UNFPA.
Amid the global shortage of nearly 1 million midwives, an increasing number of women and newborns are dying in conflict zones following the budget cuts.
Fabrice Bishenge, the director of a hospital in DR Congo, said his department is “lacking everything, from blood bags to medicines.”
“With the support of UNFPA and other partners, we can still provide services – but for how long?” he said.
Deaths during childbirth in fragile and conflict-affected areas now make up 60 per cent of all maternal deaths globally. Natalia Kanem has called on governments and international donors to support UNFPA’s Global Midwifery Accelerator — a coordinated initiative to improve midwife-led care in countries with the highest maternal mortality rates.
The initiative aims to scale up financial and programmatic investments in midwifery by setting out a cost-effective roadmap focused on saving lives and improving national health systems, even in the most volatile areas.
The program hopes that by increasing funding, training, and advocacy for midwifery, universal midwife-led health coverage can prevent maternal and newborn deaths, reduce healthcare costs, and bring about more productive workforces.
Across the world, the impact of USAID’s withdrawal is being felt by the most vulnerable communities, taking a toll on the local economies that previously supported humanitarian efforts.
It comes after Elon Musk’s Department of Government Efficiency dismantled the US Agency for International Development in February, eliminating billions of dollars of life-saving assistance to dozens of countries.
According to Abby Bloom, a public health and epidemiology expert, USAID has been a leader among nations in funding and providing reproductive health services globally. “Its family planning programs have offered contraception, maternal health care, and HIV treatment to millions,” she wrote earlier this year, adding that “the abrupt cessation of these services is expected to lead to increased maternal mortality, unintended pregnancies, and the spread of sexually transmitted infections.”
Bloom said that due to the cuts, prenatal care is being cancelled, leading to widespread complications in childbirth and preventable maternal deaths.
“Mothers deliver vulnerable underweight infants and are helpless to save their weak and starving children,” she wrote for this masthead. “The shutdown of USAID funded programs for women will reverberate and cause ripple effects.”
Historically, USAID has also funded the education of girls as well as boys to redress the gender gap in education and support both literacy and economic empowerment for women. But since the cuts, millions of girls will have ended their chance at an education, limiting their future opportunities and perpetuating the cycle of poverty.
Weeks after the cuts were announced, a group of nearly eighty Afghan women studying in Oman on US-funded scholarships faced expulsion when they were informed their scholarships were ending.
The women were pursuing graduate and postgraduate degrees under the Women’s Scholarship Endowment (WSE), a USAID program launched in 2018 to fund studies in science, technology, engineering, and mathematics. On 28 February, they were informed their scholarships were ending and they would be sent back to Afghanistan within a fortnight.
“We are relieved now, but we are still deeply concerned about our future,” an anonymous student told the BBC. “If the scholarship is not renewed, we will be left with no option but to return to Afghanistan, where we cannot study, and our safety could be under threat as well.”
Professor Amin Saikal, from the Australian National University, said that more than half of Afghanistan’s estimated 40 million population is dependent on international handouts for their survival.
“In the last three years, Afghanistan’s economy has contracted by 27 per cent, with staggeringly high unemployment and inflation,” she wrote in February. “Living conditions are so bad that some families are selling their children in order to feed the rest of the family.”
Analysis from the Guttmacher Institute predicted the deaths of several thousand women and girls from complications during pregnancy and childbirth as a result of the funding cuts.
“Over the course of the full 90-day review period, 11.7 million women and girls will be denied this essential care,” a report from the Institute explained. “When people are not able to access contraceptive care, they are put at risk of unintended pregnancy. If 11.7 million women and girls are denied access to contraceptive care in 2025, 4.2 million will experience unintended pregnancies, and 8,340 will die from complications during pregnancy and childbirth.”
Meanwhile, stop-work order on USAID funded research has left thousands of people across the world with experimental drugs and devices inside their bodies, unable to access further care.
As reported in the New York Times, researchers conducting trials had to either violate the stop-work orders and continue to care for their research volunteers, or abandon them to face potential side effects and harm alone. In South Africa, medical staff violated the stop-work order in order to help a women remove a silicone ring inserted into her vagina for a research study testing a device to prevent pregnancy and H.IV. infection.
Dr. Leila Mansoor, a scientist with the Centre for the AIDS Programme of Research in South Africa, told the Times: “My first thought when I saw this order was, There are rings in people’s bodies and you cannot leave them. For me ethics and participants come first. There is a line.”
In the UK, trial participants are being left without post-research support from clinical trial staff. In the Dominican Republic, where up to a quarter of the female population are unable to make decisions about their sexual and reproductive health, women are being left with biodegradable hormonal devices inside their bodies after a clinical trial supported by USAID was abruptly cut off.
One researcher working on developing an HIV vaccine in South Africa’s University of the Witwatersrand said he felt like his years of studying has been “all such a waste.”
“It’s all such a waste…It seemed like it was all just for nothing,” he told Aljazeera.
Image credit: Shutterstock
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