The Trump Administration’s Foreign Aid Review: Status of U.S. Global Maternal and Child Health Efforts

Background on U.S. Global Maternal and Child Health (MCH) Efforts

• The U.S. government has been involved in supporting global maternal and child health (MCH) efforts for more than 50 years, as a top donor and provider of technical assistance and other support, helping to contribute to worldwide success in reducing maternal and child mortality.
• Still, in 2024, 4.9 million children under the age of 5 (more than 13,000 every day) died, with the highest rates of under-5 mortality in sub-Saharan Africa. About 260,000 women (or nearly one every two minutes) died during and following pregnancy and childbirth in 2023 – 92% of them in low- and middle-income countries. The majority of these deaths are preventable with proper interventions and access to care.
• Recent decades have seen major gains in preventing maternal and child mortality. Both the number and the rate of children dying before age 5 have fallen by more than 60% since 1990, and almost 100 countries have cut under-five mortality rates by at least two-thirds in that time. From 2000 to 2023, the annual number of maternal deaths worldwide fell by 40%. The U.S. government has contributed significantly to these gains, reporting that it helped to save the lives of more than 9.3 million children and 340,000 women over the past decade alone.
• Prior to its dissolution in 2025, USAID had served as the lead U.S. implementing agency for MCH activities, reaching more than 40 countries, including 25 “high priority” countries, primarily in Africa and southern Asia. The CDC also supported global MCH activities, primarily through immunization and technical assistance to build in-country capacity.
• Prior to the start of the Trump administration, U.S. funding provided to bilateral MCH activities in FY 2024 was $865.7 million; funding for Gavi was $300 million and for UNICEF was $142 million.

Current Status of U.S. MCH Programs

The following administration actions have had a significant impact on MCH program operations:

• Stop-work order: The stop-work order initially froze all MCH programming and services, halting USAID’s MCH programming, including pre- and post-natal health services and lifesaving maternal health care. Because the order halted payments, many implementers had to terminate staff and end some services.
• Limited waiver: Maternal and child health activities were included in a limited waiver issued by the State Department on February 4, 2025, allowing “life-saving services” to continue, defined as essential services related to the prevention, diagnosis and treatment of severe illnesses and conditions which–if not addressed–lead to mortality in women, newborns, and children under five. Listed in the waiver were antenatal care and post-partum services, essential newborn care, essential immunizations and treatment of acute child illness. Even with the waiver, services remained disrupted and implementers faced challenges in getting permission to resume programming and difficulties in getting paid.

• Dissolution of USAID: As the main government implementer of MCH efforts, the dissolution of USAID and loss of most staff significantly affected MCH implementation capacity and operations. In addition, announcements of reductions at CDC could further affect global MCH efforts.
• Canceled awards: In early 2025, it was reported that the administration canceled 86% of all USAID awards. KFF analysis found that of the 770 global health awards identified, 266 included MCH activities, 86% 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, including for MCH, to be integrated into its Bureau of Global Health Security and Diplomacy (GHSD) which oversees PEPFAR. On May 29, 2025, the State Department further notified Congress of its proposed reorganization plan, and with the dissolution of USAID, programs moved in July 2025.
• 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. MCH has been included in several of the agreements signed to date, although there is little information available on activities and funding.
• 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.
• Funding: The Trump administration has requested significantly less funding for MCH in its budget requests and canceled or suspended funding for numerous MCH-related projects and awards. This includes suspending funding for Gavi (unless it meets certain conditions) and rescinding funding for UNICEF. Despite this, Congress has continued to appropriate level funding for these programs including $845 million for bilateral MCH activities (at the State Department and CDC), $300 million for Gavi, and funding for UNICEF “consistent with prior year levels” in FY 2026.

Impact on MCH Services and Outcomes

• An internal USAID memo from 2025 reported that the cessation of USAID programming for MCH would affect services for 16.8 million pregnant women annually, eliminate postnatal care for 11.3 million newborns within the first two days of life, and prevent 14.8 million children under 5 from receiving treatment for pneumonia and diarrhea.
• A rapid assessment survey of 108 WHO country offices in 2025 found that almost half reported moderate or severe disruptions to MCH services, including for medicines and health products, due to the U.S. foreign aid freeze and other shortages. WHO also said that funding cuts have “led to facility closures and loss of health workers, while also disrupting supply chains for lifesaving supplies and medicines such as treatments for haemorrhage, pre-eclampsia and malaria – all leading causes of maternal deaths.”
• In addition, several modeling studies have found that cuts in or termination of U.S. MCH funding could result in significant increases in maternal and child deaths and, as a result, the maternal mortality ratio, under 5 mortality rate, and stillbirth rate in coming years.

What to Watch

• Implementation of the America First Global Health Strategy multi-year agreements with countries
• Status of U.S. funding appropriated by Congress for bilateral MCH efforts and contributions to Gavi and UNICEF
• Impact of the PHFFA Policy on U.S. funding and programs
• Impact of U.S. changes to global health programs on health outcomes