The Trump Administration’s Foreign Aid Review: Status of U.S. Family Planning and Reproductive Health Efforts

Background on U.S. Global Family Planning & Reproductive Health (FP/RH) Efforts

• The U.S. government has supported FP/RH efforts for 60 years and has been the largest donor to the sector. It has also been one of the largest purchasers and distributors of contraceptives internationally.
• Still, each year, about 260,000 women die from complications during pregnancy and childbirth, almost all in low- and middle-income countries. Almost one-third of these deaths could be prevented with greater access to contraception. Worldwide, an estimated 257 million women have an unmet need for modern contraception.
• Recent decades have seen major gains in access to family planning and reproductive health services. The U.S. government has contributed significantly to this progress, reporting that in the 41 countries it supports, modern contraceptive prevalence has increased from less than 10% in 1965 to 34% in 2023 and family size fell from more than 6 to 3.9. The program estimated that it would reach up to 24 million women and couples with contraceptive services and supplies, helping to prevent 14,000 maternal deaths and 8.1 million unintended pregnancies, in 2023.
• USAID has served as the lead U.S. implementing agency for FP/RH activities, working in 41 countries, with focused effort in 29 high-need countries and the Francophone West African region. The CDC has also supported some global FP/RH activities primarily through research, surveillance and technical assistance. While Congress has funded them separately, USAID’s FP/RH and maternal and child health programs coordinated efforts, working in many of the same countries.
• The U.S. role in global FP/RH has often been contested, influenced by differing views and political debates primarily related to abortion. As a result, U.S. funding for FP/RH is governed by several legislative and policy requirements, including the Mexico City Policy (which has been implemented and rescinded along Presidential party lines and was significantly expanded by the first Trump administration), the Helms Amendment, and the Kemp-Kasten Amendment.
• The FY 2025 Continuing Resolution that passed in March included level funding for FP/RH activities at USAID of $607.5 million (and level funding for contributions to UNFPA, the primary international agency supporting FP/RH programs worldwide).

Current Status of U.S. FP/RH Programs

The following administration actions have had a significant impact on FP/RH program operations:

• Funding freeze/stop-work order: The stop-work order initially froze all FP/RH programming and services, halting USAID’s FP/RH programming including procurement and delivery of contraceptive commodities. Because the order halted payments, many implementers had to let go of staff and end some services.
• Limited waiver: While the State Department issued a waiver of the stop-work order allowing certain “life-saving services” to continue, family planning services were specifically prohibited from continuation, including in the blanket humanitarian waiver issued on January 28 and the limited global health waiver issued on February 4.
• Dissolution of USAID: As the main government implementer of FP/RH efforts, the dissolution of USAID and loss of most staff have significantly affected FP/RH implementation capacity and operations. In addition, recent announcements of reductions at CDC could further affect global FP/RH efforts.
• Canceled awards: It was recently reported that the administration has canceled 86% of all USAID awards. KFF analysis finds that of the 770 global health awards identified, 233 included FP/RH activities, 85% of which were terminated.
• Legal actions: In response to two lawsuits filed against the administration’s actions, a federal judge issued a preliminary injunction ordering the government to pay for work completed by February 13, 2025, although not all payments have been made and the court has not stopped the government from canceling awards.
• Reorganization: The administration notified Congress on March 28, 2025, of its intent to permanently dissolve USAID and that any remaining USAID operations would be absorbed by the State Department with remaining global health activities to be integrated into its Bureau of Global Health Security and Diplomacy (GHSD) which oversees PEPFAR. However, FP/RH is not included in the list of activities to be maintained.
• Policy restrictions: The Trump administration reinstated the expanded Mexico City Policy on January 24, and an implementation plan is expected soon. It also directed a program review under the Kemp-Kasten Amendment, which has been used in the past to prohibit funding for UNFPA, and recently announced its intention to do so going forward. UNFPA also reports that more than 40 humanitarian projects, totaling approximately $335 million, have already been canceled by the U.S.

Impact on FP/RH Services and Outcomes

• A recent rapid assessment survey of 108 WHO country offices found that more than four in ten reported moderate or severe disruptions to FP and contraception services, with 38% reporting such disruptions for commodities specifically, due to the U.S. foreign aid freeze and other shortages.
• A recent estimate found that cessation of U.S. FP/RH funding for 3 months would mean 11.7 million women and girls would be denied access to contraceptive services, resulting in 4.2 million unintended pregnancies and 8,340 deaths from complications during pregnancy and childbirth (i.e., maternal deaths), while ending support for a year could result in 17.1 million unintended pregnancies, including 5.2 million unsafe abortions and 34,000 maternal deaths.
• A recent modeling study found that cessation of U.S. FP/RH funding for contraceptives alone could result in an additional 40-55 million unintended pregnancies and an additional 12-16 million unsafe abortions between 2025 and 2040.

What to Watch

• Foreign aid review results: The administration could soon release results of its 90-day foreign aid review (which has already been extended by 30 days), but it has already signaled that it will seek to discontinue FP/RH programs. It is unknown how or if Congress will respond to this recommendation.
• Funding/Budget Request: The administration’s initial FY 2026 budget request includes significant reductions in funding for global health, as well as rescissions to prior year funding amounts, and suggests that funding for FP/RH will be eliminated. A more detailed budget request is expected in the next few weeks.
• Policy restrictions: The administration may seek to institute additional policy restrictions on other U.S.-funded global health and development programs regarding abortion and family planning services, such as a further expansion of the Mexico City Policy.