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 had supported FP/RH efforts for 60 years and was the largest donor to the sector. It also was 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 259 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 contributed significantly to this progress, reporting that in the countries it supported, modern contraceptive prevalence increased from less than 10% in 1965 to 34% in 2023 and family size fell from more than 6 to 3.9. It also 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.
• Prior to its dissolution in 2025, USAID had served as the lead U.S. implementing agency for FP/RH activities, working in 41 countries, with focused efforts in 29 high-need countries and the Francophone West African region. The CDC also supported some global FP/RH activities primarily through research, surveillance and technical assistance.
• 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. foreign assistance funding 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by several legislative and policy requirements, including the Mexico City Policy (which has been implemented and rescinded along Presidential party lines and was significantly expanded by both Trump administrations), the Helms Amendment, and the Kemp-Kasten Amendment.
• Prior to the start of the Trump administration, U.S. funding provided to bilateral FP activities in FY 2024 was $575 million; funding for UNFPA was $30.5 million.

Current Status of U.S. FP/RH Programs

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

• 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 terminate 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, 2025, and the limited global health waiver issued on February 4, 2025.
• Dissolution of USAID: As the main government implementer of FP/RH efforts, the dissolution of USAID and loss of most staff significantly affected FP/RH implementation capacity and operations. In addition, announcements of reductions at CDC could further affect global FP/RH efforts.
• Canceled awards: In early 2025, it was reported that the administration has canceled 86% of all USAID awards. KFF analysis found 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 did not stop the government from canceling awards. The government appealed the ruling and after several subsequent rulings in the case, the Supreme Court ultimately allowed the government to rescind (cancel) a portion of expiring global health funds before the end of the fiscal year. Further proceedings have been stayed, pending the outcome of a separate case.
• Reorganization: The administration notified Congress on March 28, 2025, of its intent to permanently dissolve USAID and move any remaining USAID operations to the State Department, with global health activities to be integrated into its Bureau of Global Health Security and Diplomacy (GHSD) which oversees PEPFAR. FP/RH programs were not continued.
• America First Global Health Strategy: In September 2025, the administration released the America First Global Health Strategy, its roadmap for future U.S. government global health engagement. Per the strategy, the U.S. is negotiating bilateral, multi-year agreements with countries receiving U.S. global health assistance with an aim to transition the majority of countries to full self-reliance by the end of the agreement period. FP/RH activities are not included in these agreements.
• Policy restrictions: In January 2025, the Trump administration reinstated the expanded Mexico City Policy from Trump’s first term and further expanded it in January 2026 to apply to almost all non-military foreign assistance, many more entities, and additional areas of restrictions including activities related to diversity, equity and inclusion and “gender ideology” under a broader umbrella known as the “Promoting Human Flourishing in Foreign Assistance” (PHFFA) Policy. The administration also withdrew from membership in and support of UNFPA on January 7, 2026.
• Funding: The Trump administration has requested no funding for FP in its budget requests and stopped supporting this work in 2025, including rescinding FP funding and withholding funding from UNFPA. Despite this, Congress has continued to appropriate level funding for these programs including $575 million for bilateral FP activities and $32.5 million for UNFPA in FY 2026.

Impact on FP/RH Services and Outcomes

• A rapid assessment survey of 108 WHO country offices in 2025 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.
• Reports have indicated that millions of dollars in shipments of already purchased contraceptive commodities intended for low- income countries expired while the administration assessed whether to incinerate the supplies or transfer them to another distributor.
• It is estimated that the loss of U.S. funding in 2025 resulted in a global contraceptive procurement funding gap of approximately $250 million.
• In addition, several modeling studies have found that cuts in or termination of U.S. FP funding could result in significant increases in unintended pregnancies, unsafe abortions, and maternal deaths.

What to Watch

• Implementation of the America First Global Health Strategy multi-year agreements with countries and whether countries will choose to continue any FP activities previously supported by the U.S. government.
• Status of U.S. funding appropriated by Congress for bilateral FP efforts and contributions to UNFPA
• Impact of the PHFFA Policy on U.S. funding and programs
• Impact of U.S. changes to global health programs on health outcomes