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Findings

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Affordability has dominated national conversations. High inflation rates, increased gas and grocery prices, and the constant rise in health care costs and insurance premiums have emerged as major political issues. Historically, national surveys find that many Americans report difficulties affording health care and have problems paying for health care services, particularly women, who have lower incomes, fewer financial resources, and use the health care system more than men. In recent years, people with health coverage have increasingly experienced difficulties affording care. The 2026 KFF Women’s Health Survey was fielded between March 11, 2026 to April 14, 2026 to better understand women’s experiences accessing and using health care services including barriers to care. The survey is a nationally representative survey of 4,688 women, ages 18 to 64, and 1,148 men, ages 18 to 64. This brief provides new information about the affordability challenges women report experiencing in the past 12 months and their impact on access and utilization of health care services.¹

Key Findings

• Many women, even those with insurance coverage, have delayed or postponed care they thought they needed in the past 12 months because of cost. Four in ten (42%) women, ages 18-64, and 35% of men, ages 18-64, report they have delayed or postponed care they thought they needed in the past year. While about two-thirds (68%) of uninsured women report putting off needed care due to costs, those with insurance are not immune from this problem. Half of women with individually purchased plans and a third of women with Medicaid (34%) and employer sponsored coverage (38%) report delaying or postponing needed care because of cost. 
• The cost of care is a barrier to a sizable minority of women in getting specific recommended tests and treatments. Three in ten (31%) women ages 18 to 64 report they have skipped or postponed recommended medical tests or treatments in the past year because of costs. Higher shares of uninsured women, women with low or modest incomes, and those with self-reported fair or poor health report skipping or postponing tests or treatments due to the costs of care.
• The cost of prescription drugs leads some women to alter their prescription drug use by not filling prescriptions, skipping doses, or cutting pills in half. A quarter (27%) of women ages 18 to 64 report they didn’t fill a prescription in the last year because of cost and almost a fifth (17%) report they cut pills in half or skipped doses of medicine because of cost. Four in ten women in fair or poor health didn’t fill prescriptions and one quarter cut pills or skipped doses because of costs.
• Health care costs can force some women to make tradeoffs in paying for other basic needs. One in four (25%) women ages 18 to 64 report that in the past 12 months they have spent less money on their basic needs, such as food, clothes and electricity so they could have enough money for health care. Among uninsured women, the share was 42%. Approximately three in ten women on Medicaid or with individually purchased insurance, who were Black or Hispanic, low-income or in fair or poor health report making health-related financial tradeoffs.

Affordability Challenges

Four in ten (42%) women report that they delayed or postponed care they thought they needed because of the cost in the last 12 months. While women and men both can feel the impact of health costs, such as insurance premiums, co-payments, and deductibles, they can be particularly burdensome for women who on average earn lower wages, have fewer financial assets, accumulate less wealth, and have higher rates of poverty than men. Four in ten (42%) women and 35% of men ages 18 to 64 report they have delayed or postponed care they thought they needed. One in three women (31%) report they have skipped recommended tests or treatments, over a quarter (27%) report they haven’t filled a prescription for a medicine, and 17% report they have cut pills in half or skipped recommended doses of medicine, all because of cost. Half of women and four in ten (42%) men report one of these cost delays or gaps in the past 12 months.

Many women, even those with insurance coverage, report having delayed or postponed care because of cost. Nearly seven in 10 (68%) uninsured women say theydelayed or postponed care in the past 12 months because of the cost. While younger adults, those with lower incomes, poor health and people of color have higher uninsured rates, even after controlling for these characteristics in a regression model, the association between being uninsured and delaying or postponing care remains. Even women with insurance are susceptible to cost barriers (Figure 1). Half of women ages 18 to 64 with individually purchased plans, which often have higher deductibles and premiums as well as narrower networks, report cost was a reason for delaying or postponing care in the past 12 months, as do 38% of women with employer sponsored plans. Medicaid, the national health coverage program for people with low incomes, is supposed to have only nominal out of pocket costs, but a third (34%) of women with Medicaid coverage also say they had to delay or postpone care due to costs. While Medicaid copayments are modest, they could still be a financial burden for low-income people. Women could also face challenges paying for uncovered services or services during a period when they were uninsured. Women with lower incomes, Hispanic women, and women with fair/poor and good health are also more likely to report having delayed or postponed care in the past year.

Affordability Challenges Lead Many Women to Delay Needed Care

Bar chart showing the share of women ages 18–64 who delayed or postponed needed care in the past 12 months because of cost, overall and by insurance, race/ethnicity, income, and health status. Forty-two percent of women delayed care, compared with 32% of men. Delayed care was highest among uninsured women (68%), women with fair or poor health (56%), and women with incomes below 200% of the federal poverty level (48%).

Subgroup analysis is among women 18 to 64. Income is based on 2023 ASPE income levels. Two hundred percent (200%) of the federal poverty level (FPL) in 2023 for an individual was $29,160. Persons of Hispanic origin may be of any race; other racial groups are non-Hispanic. The sample primarily includes English-speaking Asian adults and, therefore, may not be representative of the overall Asian population. *Estimate is statistically different than reference (ref) estimate within group (p < 0.05).

KFF Women's Health Survey 2026

High costs can cause many women to skip specific recommended tests and treatments, even women with health coverage. Half (52%) of uninsured women ages 18 to 64 report skipping recommended tests or treatments due to cost, as do four in ten (41%) of women with individually purchased health plans, three in 10 (28%) women with employer sponsored plans, and one in five (22%) of women with Medicaid coverage (Figure 2). Higher shares of women with self-reported fair/poor health (40%) or good health (32%) report skipping recommended tests or treatments in the past year compared to a quarter of women (23%) who rate their health as excellent/ very good. Hispanic women and women with low or modest incomes (up to 399% FPL) are also more likely to report skipping recommended services compared to their White and higher income counterparts.

Three in Ten Women Have Skipped Recommended Medical Tests or Treatments in the Past Year

Bar chart showing the share of women who skipped recommended medical tests or treatments because of cost. Overall, 31% skipped care, with higher rates among uninsured women (52%), women with individually purchased coverage (41%), Hispanic women (35%), women with incomes below 400% of the FPL (35%), and women in fair or poor health (41%).

Subgroup analysis is among women 18 to 64. Income is based on 2023 ASPE income levels. Two hundred percent (200%) of the federal poverty level (FPL) in 2023 for an individual was $29,160. Persons of Hispanic origin may be of any race; other racial groups are non-Hispanic. The sample primarily includes English-speaking Asian adults and, therefore, may not be representative of the overall Asian population. *Estimate is statistically different than reference (ref) estimate within group (p < 0.05).

KFF Women's Health Survey 2026

Cost limits women’s ability to fill their prescriptions or take their medications as prescribed. The majority of women ages 18 to 64 (62%) report they take at least one prescription medication on a regular basis, yet many women report issues affording prescription drugs. A quarter (27%) of all women ages 18-64, report they didn’t fill a prescription in the last year and almost a fifth (17%) report they cut pills in half or skipped doses of medicine because of cost. Among the share who report currently taking a prescription medication, the share who say they have not filled a prescription increases to 32% and one in five say they have cut pills in half or skipped doses in the past year because of cost.

Women with self-reported fair/poor and good health and women with lower incomes are more likely to report they have either not filled a prescription or taken medications as prescribed. A higher share of uninsured women report not filling a prescription (42%) or taking medication as prescribed (17%), but substantial shares of insured women also report having trouble with their prescriptions because of cost in the past 12 months (Figure 3).

Cost Limits Many Women’s Ability to Fill Prescriptions or Take Medications as Prescribed

Bar chart showing the share of women ages 18 to 64 who skipped filling a prescription or cut pills/skipped doses in the past 12 months because of cost, broken down by insurance, race/ethnicity, income, and health status. Cost-related barriers are highest among uninsured women, those with lower incomes, and those in fair or poor health, while women with employer-sponsored insurance, higher incomes, and better health report the lowest rates.

Subgroup analysis is among women 18 to 64. Income is based on 2023 ASPE income levels. Two hundred percent (200%) of the federal poverty level (FPL) in 2023 for an individual was $29,160. Persons of Hispanic origin may be of any race; other racial groups are non-Hispanic. The sample primarily includes English-speaking Asian adults and, therefore, may not be representative of the overall Asian population. Estimate for not filled a prescription for a medicine (*) or cut pills in half or skipped doses of medicine (^) is statistically different than reference (ref) estimate within group (p < 0.05).

KFF Women's Health Survey 2026

Health care costs can force women to make tradeoffs in paying for other basic needs. One in four (25%) women ages 18 to 64 report that in the past 12 months they have spent less money on their basic needs, such as food, clothes and electricity so they could have enough money for health care (Figure 4). Four in ten (39%) women without insurance and three in ten women with Medicaid (31%) coverage and individually purchased coverage (30%) report spending less in their basic needs to have enough money for health care compared to one in five (18%) women with employer-sponsored plans. This is more common amongwomen with lower incomes, Black and Hispanic women, as well as women with poorer self-reported health status.

One in Four Women Have Spent Less Money on Their Basic Needs To Have Enough Money to Cover their Health Care Needs

Bar chart showing the share of women ages 18 to 64 who spent less on basic needs like food, clothes, or electricity in the past 12 months so they'd have enough money for health care, broken down by insurance, race/ethnicity, income, and health status. About one in four women overall report doing this, with the share notably higher among uninsured women, Black and Hispanic women, those with lower incomes, and those in fair or poor health.

Subgroup analysis is among women 18 to 64. Income is based on 2023 ASPE income levels. Two hundred percent (200%) of the federal poverty level (FPL) in 2023 for an individual was $29,160. Persons of Hispanic origin may be of any race; other racial groups are non-Hispanic. The sample primarily includes English-speaking Asian adults and, therefore, may not be representative of the overall Asian population. *Estimate is statistically different than reference (ref) estimate within group (p < 0.05).

KFF Women's Health Survey 2026

The majority of women 18 to 64 report they are insured, but almost one in five women 18 to 64 (18%) report they are either currently uninsured or were uninsured at some point in the past 12 months. Health insurance coverage is an important factor in making health care affordable and accessible to women.Seven percent of women say they are currently insured but were uninsured at some point during the past 12 months. Women can be uninsured for periods of time because of job loss or change, premium prices becoming unaffordable, or in the case of dependent coverage, a spouse’s job loss, divorce, or widowhood. Younger women, women with lower incomes and women with poor/fair health are uninsured at higher rates and larger shares report being currently insured but having been uninsured at some point during the year (Appendix Table 1).

Women with Medicaid coverage (11%) and those with individually purchased private plans (14%) are more likely to report having been uninsured at some point in the past 12 months compared to women covered by an employer-sponsored plan (5%) (Figure 5). In the coming years, the number of uninsured is expected to increase significantly due to recent federal policy changes in Medicaid and the expiration of the ACA enhanced tax credits. Many women with Medicaid coverage and ACA marketplace plans will be directly impacted by these policy changes and will likely see more periods without insurance coverage.

Higher Shares of Women with Medicaid Coverage and Those With Individually Purchased Plans Report They Were Uninsured at Some Point During the Year

Three pie charts showing the share of women ages 18 to 64 who are currently insured but were uninsured at some point in the past 12 months, broken out by current insurance type. Women with Medicaid or individually purchased plans are notably more likely to have had a coverage gap during the year than those with employer-sponsored insurance.

Among women 18 to 64. ^Estimate for currently Insured, but uninsured at some point in the last 12 months is statistically different than reference (ref) estimate (p < 0.05).

KFF Women's Health Survey 2026

Appendix

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Share of Women Who Are Currently Insured but Were Without Coverage at Some Point in Past 12 Months, by Selected Characteristics

Bar chart showing the share of currently insured women ages 18 to 64 who were without coverage at some point in the past 12 months, broken down by age, insurance type, income, race/ethnicity, and health status. Younger women and those with Medicaid, individually purchased plans, or lower incomes report the highest rates of a coverage gap during the year.

Among women ages 18 to 64. Income is based on 2023 ASPE income levels. Two hundred percent (200%) of the federal poverty level (FPL) in 2023 for an individual was $29,160. Persons of Hispanic origin may be of any race; other racial groups are non-Hispanic. The sample primarily includes English-speaking Asian adults and, therefore, may not be representative of the overall Asian population. *Estimate is statistically different from estimate for reference (ref) estimate (p < 0.05)

KFF Women's Health Survey 2026

Methodology

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The 2026 KFF Women’s Health Survey was designed and analyzed by women’s health researchers at KFF. The survey was conducted from March 11 – April 14, 2026, online and by telephone among a nationally representative sample of 5,854 adults ages 18 to 64, including 3,538 women ages 18 to 49. Women include anyone who selected woman as their gender. Sampling, data collection, weighting, tabulation, and IRB approval by the University of Southern Maine’s Collaborative Institutional Review Board were managed by SSRS of Glenn Mills, Pennsylvania in collaboration with women’s health researchers at KFF.

Throughout the reports of findings, we refer to “women.” This includes respondents who said their gender is “woman,” and includes those who selected “woman” in addition to another gender, such as “transgender,” or “non-binary,” or another gender. We followed this approach to try to include as many people as possible but recognize that some people who need and seek abortion and other reproductive health care services may not be represented in the findings or identify as women. Some questions about sexual and reproductive health were only asked among those with a specific sex assigned at birth (i.e. male or female).

The national sample was drawn from two nationally representative probability-based panels: the SSRS Opinion Panel and the Ipsos Knowledge-Panel. The SSRS Opinion Panel is a nationally representative probability-based panel where panel members are recruited randomly in one of two ways: (a) Through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Groups (MSG) through the U.S. Postal Service’s Computerized Delivery Sequence (CDS); (b) from a dual-frame random digit dial (RDD) sample provided by MSG. For the online panel component, invitations were sent to panel members by email followed by up to five reminder emails. 5,660 panel members completed the survey online and panel members who do not use the internet were reached by phone (n=194). Another 514 respondents were reached online through the Ipsos Knowledge Panel to help reach adequate sample sizes among subgroups of interest, specifically women ages 18 to 49. This panel is recruited using ABS, based on a stratified sample from the CDS. The questionnaire was translated into Spanish, so respondents were able to complete the survey in English or Spanish. 

The national sample was weighted by splitting the sample into three groups: [1] Women 18-49, [2] Women 50-64, and [3] Men 18-64 and each group was separately weighted to match known population parameters (see table below for weighting variables and sources). Weights within the three groups were then trimmed at the 4^th and 96^th percentiles, to ensure that individual respondents do not have too much influence on survey-derived estimates. After the weights were trimmed, the samples were combined, and the weights adjusted, so that the groups were represented in their proper proportions for a final combined, gender by age-adjusted weight.

Dimensions	Source
CPS 2024 Voting and Registration Supplement	Current Population Survey 2025
Education
Age by Education
Age by Gender
Census Region
Race/Ethnicity by Nativity
Home Tenure
Civic Engagement	2023 CPS Volunteering and Civic Life Supplement
Internet Frequency	Pew Research Center’s National Public Opinion Reference Survey (NPORS 2025)
Population Density	Claritas Pop-Facts Premier 2026
Voter Registration	CPS 2024 Voting and Registration Supplement

The margins of sampling error for the national sample of women ages 18 to 64 and reproductive age women ages 18 to 49 are plus or minus 2 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this survey.

Group	N (unweighted)	M.O.S.E.
National Women Ages 18-64	4,688	± 2 percentage points
White, non-Hispanic	2,262	± 2 percentage points
Black, non-Hispanic	767	± 4 percentage points
Hispanic	1,135	± 4 percentage points
Asian or Pacific Islander	347	± 6 percentage points
18-25	508	± 5 percentage points
26-35	1,313	± 3 percentage points
36-49	1,715	± 3 percentage points
50-64	1,152	± 3 percentage points
<200% FPL	1,641	± 3 percentage points
200%-399% FPL	1,232	± 3 percentage points
400%+ FPL	1,475	± 3 percentage points
Employer-Sponsored	2,490	± 2 percentage points
Individually Purchased	386	±6 percentage points
Medicaid	977	± 4 percentage points
Uninsured	537	± 5 percentage points

General Notes:

The sample primarily includes English-speaking Asian adults and, therefore, may not be representative of the overall Asian adult population. Despite this limitation, it is important to report the views of Asian adults on the topics in this study. As always, Asian adults’ responses are incorporated into the general population figures throughout this report.

Income is based on 2023 ASPE income levels. Two hundred percent (200%) of the federal poverty level (FPL) in 2023 for an individual was $29,160.

Endnote

1. The data in this brief report affordability challenges for adults ages 18 to 64. Other KFF polling data includes estimates for all adult women and men, including those 65 and older. ↩︎

Background on PMI

• The U.S. government has been involved in global malaria activities since the 1950s and has been the largest donor to the sector. In 2005, the President’s Malaria Initiative (PMI) was launched to scale up funding and activities to address malaria in the hardest hit African countries, helping to contribute to global success in driving down malaria cases and deaths.
• Still, in 2024, there were 282 million cases of malaria, a life-threatening disease spread to humans by mosquitoes, and 610,000 malaria deaths (the majority of which were among children under age five), a slight increase over the prior year.
• Recent decades have seen major gains in reducing the impact of malaria, and PMI is credited with having helped to save 11.7 million lives and prevent 2.1 billion malaria cases. Indeed, as of 2024, in countries where PMI worked, global efforts supported a 29% decrease in malaria case rates and 48% decline in deaths. In addition, U.S. malaria assistance has been found to bolster the national economies in countries and communities most heavily affected by the disease with an analysis finding that every dollar of U.S. malaria assistance increased GDP in recipient countries nearly six-fold. The introduction of two malaria vaccines in 2021 and 2023 has increased optimism in the potential to further strengthen global malaria control.
• Prior to the dissolution of USAID in 2025, PMI had operated as an interagency initiative led by USAID and implemented in partnership with CDC, focused in 30 countries that account for most of the world’s malaria cases and deaths. It had been overseen by a U.S. Global Malaria Coordinator, a position created by Congress in 2008 to be appointed by the President and based at USAID.
• While the Trump administration has requested significantly less funding for PMI in its budget requests, prior to the start of the Trump administration U.S. funding provided to malaria control efforts and research activities was approximately $1 billion in FY 2024, including about $805 million to PMI and other bilateral global malaria efforts at the State Department and CDC; funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) was $1.65 billion.

Current Status of PMI/Malaria Activities

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

• Stop-work order: The stop-work order initially froze all PMI programming and services, halting existing PMI activities, including bed net provision, residual spraying and delivery of antimalarial medicines. Because the order halted payments, many implementers had to terminate staff and end some services.
• Limited waiver: Malaria programs received a limited waiver on February 4, 2025, allowing “life-saving services” to continue, including those that “must resume within 30 days to ensure malaria diagnosis and treatment, as well as prevention through distribution of nets and indoor residual spraying targeting highest burden areas…and lifesaving malaria medicines for pregnant women and children”. 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: USAID was the main government implementing agency for malaria efforts, obligating almost all bilateral malaria assistance in FY 2023 (96%). Without USAID and most of its staff, PMI’s implementation capacity and operations have been affected. In addition, announcements of reductions at CDC could further affect global malaria 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, 157 included malaria activities, 80% 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 malaria, 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. Malaria has been included in most of the agreements signed to date, although there is little information available on activities and funding. A U.S. Malaria Coordinator has yet to be appointed.
• 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 PMI and other malaria efforts in its budget requests and canceled funding for numerous malaria-related projects and awards. Despite this, Congress has continued to appropriate level funding for malaria control efforts and research activities, reaching approximately $1 billion in FY 2026 (including about $805 million for PMI and other bilateral global malaria efforts at the State Department and CDC). It also appropriated $1.25 billion for the Global Fund in FY 2026.

Impact on PMI Services and Outcomes

• An internal USAID memo from 2025 estimated that an additional 12.5-17.9 million malaria cases and an additional 71,000-166,000 deaths could occur annually if PMI was halted permanently.
• A rapid assessment survey of 108 WHO country offices in 2025 found that of the 64 malaria-endemic countries surveyed, more than half reported moderate or severe disruptions to malaria services, including for medicines and health products, due to the U.S. foreign aid freeze and other shortages.
• In early April 2025, almost 30% of planned insecticide treated net (ITN) distribution campaigns were off-track or at risk of being delayed due to funding shortages, and such risks continue today. Several countries also face stock-out risks for key commodities including for rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT). Reductions in funding also threaten investments in new and improved malaria prevention, diagnostic, and treatment interventions. Such disruptions pose significant risks, particularly during peak malaria seasons across Africa where seasonal malaria campaigns are needed to protect millions of people. In a court filing challenging the funding freeze, for example, a major U.S. implementer reported that it had to delay the start of anti-malarial campaigns in Africa last year.
• A modeling project estimated that a full year U.S. funding cuts could result in an additional 2.4 million malaria cases among adults and an additional 7.2 million malaria cases among children.

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 malaria efforts and contributions to the Global Fund
• Impact of the PHFFA Policy on U.S. funding and programs
• Impact of U.S. changes to global health programs on health outcomes

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 MCH activities was approximately $1.31 billion in FY 2024, including $865.7 million for bilateral MCH activities, $300 million for Gavi and $142 million for UNICEF.

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 rescinding funding for UNICEF; the administration also suspended funding for Gavi unless it met certain conditions (in July 2026 it announced that the withheld funds would be released following discussions with Gavi, and funding has since been provided to the organization). Despite this, Congress has continued to appropriate level funding for these programs, totaling approximately $1.29 billion in FY 2026 (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”).

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

Introduction

The 2025 reconciliation law includes new eligibility restrictions for many lawfully present immigrants for federally-funded health programs, including Medicaid and the Children’s Health Insurance Program (CHIP), subsidized Affordable Care Act (ACA) Marketplace, and Medicare coverage. The eligibility restrictions for Medicaid and CHIP become effective October 1, 2026. These restrictions will eliminate eligibility for many groups of lawfully present immigrants, including refugees and asylees without a green card, among others. Under longstanding federal policy, undocumented immigrants already are ineligible for federally funded health coverage. The Congressional Budget Office (CBO) estimates that eligibility restrictions in Medicaid or CHIP will reduce federal spending by $6.2 billion and lead to an additional 100,000 individuals becoming uninsured by 2034.

The Centers for Medicare & Medicaid Services (CMS) released guidance and an implementation toolkit for states to implement the eligibility changes. Beyond those losing coverage because they are no longer eligible, there may also be coverage losses among individuals who remain eligible due to administrative barriers, particularly if they have challenges understanding or responding to notices requesting information and documentation. States will also face increased administrative burdens to implement the changes. This brief provides an overview of implementation of the immigrant eligibility changes and issues to consider for affected individuals and states.

Medicaid Immigrant Eligibility Changes

Starting October 1, 2026, the 2025 reconciliation law will restrict Medicaid and CHIP eligibility to lawful permanent residents (LPRs or “green card” holders), Cuban and Haitian entrants, people residing in the U.S. under Compacts of Free Association (COFA), and lawfully residing children and pregnant immigrants in states that cover them under the Medicaid and/or CHIP option (Table 1). The law will eliminate eligibility for many other groups of lawfully present immigrants, including refugees and asylees without a green card, among others. Prior to the 2025 reconciliation law, undocumented immigrants were already ineligible for Medicaid and CHIP. Additionally, the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) limited Medicaid and CHIP eligibility to certain groups of lawfully present immigrants deemed to have a “qualified status” and required many of these groups to wait at least five years before they could enroll even if they met other eligibility criteria. The 2025 reconciliation law does not change the application of PRWORA. Under PRWORA, LPRs are generally subject to the five-year waiting period subject to some exceptions. Cuban and Haitian entrants and COFA migrants are exempt from the waiting period.

States will continue to have the option to provide coverage to lawfully residing children and pregnant people without a five-year wait under the Immigrant Children’s Health Improvement Act (ICHIA) option (also referred to as the CHIPRA 214 option). They will also continue to have the option to provide prenatal care and pregnancy related benefits to targeted low-income children beginning from conception to end of pregnancy (FCEP) regardless of their parent’s immigration status.

Emergency Medicaid and CHIP Health Services Initiative expenditures also are exempt from the new immigrant eligibility restrictions. Emergency Medicaid reimburses hospitals for emergency care they are obligated to provide to individuals who meet other Medicaid eligibility requirements (such as income), but who do not have an eligible immigration status, including undocumented immigrants and lawfully present immigrants who are not eligible for Medicaid or CHIP. CHIP Health Services Initiatives allow states to use a limited portion of CHIP funding to implement public health services aimed at improving the health of low-income children.

Implementation of Immigrant Eligibility Changes

States must redetermine eligibility for all “potentially affected” existing Medicaid enrollees under the new rules by October 1, 2026, and conduct new eligibility determinations consistent with the new rules beginning October 1, 2026. CMS describes potentially affected beneficiaries as those receiving full Medicaid or CHIP benefits who do not have an eligible immigration status under the new rules. CMS indicates that because states vary in the information they keep on file for enrollees, they may have differing ability to identify potentially affected enrollees. As such, some states may need to reverify eligibility for a broader group of noncitizen enrollees.

For potentially affected enrollees, states must first attempt to reverify satisfactory immigration status under the new rules through existing information and automated data matches before contacting the enrollee. States will seek to verify immigration status through the Department of Homeland Security’s (DHS) Systematic Alien Verification for Entitlements (SAVE) program and using Social Security Administration (SSA) databases. If the state verifies satisfactory immigration status, including eligibility under the option for lawfully residing immigrant children or pregnant people, the enrollee will maintain full coverage and should be notified by the state. However, CMS notes that SAVE provides “point in time” verification and does not update past SAVE verification responses when there is a change in immigration status or category. As such, potentially affected beneficiaries may have applied for and been granted adjustment of status to that of an LPR or may have another qualifying immigration status or category that is not reflected in SAVE.

If the state is unable to verify satisfactory immigration status through existing information and data matches, it must request additional information from the enrollee and give the enrollee a reasonable period of time to respond. If the enrollee responds and declares citizenship or a satisfactory immigration status but the state is still unable to verify this information through the SAVE database, the state must provide the enrollee with a 90-day reasonable opportunity period to verify status, during which the state must continue to provide coverage, which may extend beyond October 1, 2026. If the enrollee provides documentation of satisfactory immigration status which is verified with SAVE, the enrollee will retain coverage and should be notified by the state. If the enrollee provides information or documentation that indicates they do not have a satisfactory immigration status or if they do not respond within the specified timeframe, the state must consider whether the enrollee is eligible under the option to cover lawfully residing immigrant children and/or pregnant people (if the state has elected the option), if the enrollee remains eligible for Emergency Medicaid, or if the enrollee is no longer eligible for any coverage. After this determination, the state must provide advance notice, including the right to a Medicaid fair hearing or CHIP review, before terminating coverage or reducing benefits for the enrollee. For Medicaid, states must provide at least ten days advance notice, and, for CHIP, states must provide timely and adequate written notice of the proposed termination and an opportunity for review.

States must update eligibility systems and financial claiming and enrollment data reporting to be consistent with the new eligibility rules. CMS indicates that states must ensure appropriate claiming for individuals eligible only for Emergency Medicaid. It also indicates that they must ensure systems can identify and isolate costs, including administrative costs, related to state-only funded health programs for immigrants so that they do not claim federal matching funds for that coverage. CMS notes that if states cannot make changes to comply with the law, they risk losing federal financial participation (FFP) for Medicaid claims. CMS notes that states may also need to make updates to other materials including Medicaid application and renewal forms; notices to applicants and enrollees; outreach communications to applicants, enrollees, and community-based organizations; and call center scripts, automated messages, and worker guidance. CMS also notes that states should update all presumptive eligibility applications and train providers and caseworkers to correctly assess presumptive eligibility under the new rules. States use presumptive eligibility to expedite Medicaid enrollment for children and pregnant people to access care while their regular application is being processed.

Issues to Consider

Individuals no longer eligible for Medicaid under the new rules will be disenrolled from coverage and left with limited comprehensive coverage options. Individuals in Medicaid may still qualify for Emergency Medicaid but will only be covered for emergency services. Lawfully residing immigrant children and pregnant people will be able to maintain coverage in states that have adopted this option, but coverage varies by state. Subsidized ACA Marketplace coverage will also be limited to lawfully present immigrants who are LPRs, Cuban and Haitian entrants, and people residing in the U.S. under COFA beginning January 1, 2027. Other lawfully present immigrants would be eligible to purchase Marketplace coverage at full cost, but it would likely be unaffordable. Individuals who lose coverage may utilize community health centers for free or sliding-fee scale health care services, but they may have access to a limited scope of services. Some states may provide fully state-funded coverage to those losing Medicaid coverage. However, several states have recently scaled back state-funded coverage programs for immigrants or have reached enrollment caps due to budget pressures and higher than expected demand.

Individuals who remain eligible for Medicaid may experience procedural disenrollments or coverage disruptions due to fear, confusion, or challenges completing verification requirements. Individuals may have difficulty understanding new eligibility rules and whether they remain eligible. Confusion and fears about enrolling in coverage may be amplified by other immigration policies like public charge, new agreements for CMS to share Medicaid data with DHS and Immigration and Customs Enforcement (ICE), and other increased federal immigration enforcement actions. Eligible enrollees may also face challenges submitting required documentation to verify immigration status.

Adequate and accessible outreach, information, and assistance will be key for preventing potential administrative coverage losses. CMS encourages states to use robust, clear, and consistent outreach and communication strategies to help enrollees and applicants understand the upcoming Medicaid eligibility changes and prepare for redetermination and renewals. CMS also suggests that states emphasize notices are time-sensitive, such as by labeling envelopes as such. Outreach through trusted, community-based organizations can help boost awareness among those who will be affected, and community partners may be able to help individuals consider alternatives, including how to access free or low-cost care. Additionally, ensuring linguistic access to information and notices will be key for individuals with limited English proficiency.

Comprehensive information on notices provided to enrollees about Medicaid immigrant eligibility changes is not publicly available across states, but KFF analysis of notices collected from 16 states illustrates there is variation in the information they provide and their accessibility. Most of the examined notices list which groups of lawfully present immigrants remain eligible for coverage, but fewer identify the groups losing coverage. Some states, such as California and Oregon, are transitioning immigrants losing federally funded coverage to state-funded coverage so they include language about how coverage is changing versus potential disenrollment. The examined notices also vary in the information and options provided to enrollees to verify immigration status. Some provide specific lists of acceptable documentation while others request proof of status without identifying specific documentation or direct enrollees to a website or other contact to identify acceptable documentation. Most examined notices offer multiple pathways for enrollees to submit proof of immigration status, including through online accounts or websites, mail, fax, phone, or in-person, while some offer more limited options such as in-person or mail only. The examined notices also vary in the extent to which they advise enrollees about other potential coverage sources, including Emergency Medicaid, and the types of assistance they highlight for enrollees, with some highlighting assisters or legal service organizations as resources. Among the examined notices, only a few were available in another language and/or provided taglines in other languages. However, states may have additional in-language resources that they are providing directly to enrollees that were not publicly available. Reading literacy levels also varied substantially across the examined notices, from a fourth-grade level to a tenth-grade level, as assessed using the SMOG readability calculator, a formula commonly used to evaluate the readability of health-related materials.  

States will face increased administrative burden to conduct outreach, reverify enrollees, and update systems and other materials to reflect new immigrant eligibility rules amid implementation of other Medicaid changes included in the 2025 reconciliation law. States are implementing the immigrant eligibility changes at the same time they are implementing Medicaid work requirements and more frequent eligibility redeterminations for ACA expansion adults. Implementing these changes on a short timeline will increase administrative burdens for states and require state budget investments. States may also make additional investments to expand outreach and to hire and train workers. Enhanced funding is available to support technology systems costs, with a 90% federal match available for design, development, and installation activities and a 75% match available for ongoing operations of CMS approved systems. However, at the same time, states are facing reductions in federal Medicaid funds due to broader changes in the reconciliation law and tightening fiscal conditions due to slowing revenue growth. With regard specifically to immigrants, the law reduces the federal Medicaid matching rate provided to states for Emergency Medicaid services provided to expansion adults who would otherwise be eligible for Medicaid except for their immigration status to the regular matching rate starting October 1, 2026.

States have limited federal guidance to implement the new eligibility rules among certain groups of noncitizens. CMS indicated that it would provide additional guidance related to eligibility changes for individuals enrolled in both Medicare and Medicaid, referred to as dual-eligible individuals, as Medicare immigrant eligibility will be restricted on a different timeline than Medicaid. However, this guidance is not yet available, creating uncertainty for states regarding how Medicaid eligibility changes may interact with Medicare enrollment and cost-sharing assistance for affected individuals. Additionally, many states will need to verify eligibility among noncitizens who are automatically enrolled in Medicaid through Supplemental Security Income (SSI) approval. SSI is a means-tested federal program administered by the SSA that pays monthly cash assistance to people who are unable to work because of a disability and generally qualifies people to receive health coverage through Medicaid, which may be their only source of coverage for long-term services and supports and disability-related services. The 2025 reconciliation law does not change immigrant eligibility rules for SSI, but some immigrants will lose their Medicaid coverage. CMS notes that guidance on the changes the SSA is making to the State Data Exchange (SDX) file to identify eligible noncitizen SSI recipients is forthcoming, but it has not yet been made available.

States may face additional uncertainties due to a lack of CMS guidance. CMS is updating the Transformed-Medicaid Statistical Information System (T-MSIS) Data Guide and plans to provide additional information on T-MSIS data reporting in forthcoming guidance. However, states do not yet have final guidance on how T-MSIS enrollment data submissions will specify enrollee immigration status. CMS also requires all states to submit updated State Plan Amendments (SPAs) with new immigrant eligibility restrictions by December 31, 2026, but has only indicated revised Medicaid and CHIP SPA templates will be forthcoming. Likewise, CMS plans to provide additional technical assistance to states about the potential impact for currently approved Section 1115 waiver demonstrations. CMS also directs states with Medicaid Managed Care programs to evaluate whether the immigrant eligibility changes require capitation rate adjustments or amended rate certifications based on guidance released in September 2025, leaving some actuarial judgments to the states. States will also need to utilize a separate and distinct contract and payment system with any managed care plan they contract with to provide state-funded health coverage services, which may be subject to CMS scrutiny.

Since the start of the second Trump administration, the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. global HIV/AIDS program credited with saving 26 million lives, has undergone significant changes and disruptions as part of a broader foreign aid review. Recent changes include: a temporary stop work order and eventual limits to what services could be continued; the cancellation of numerous PEPFAR awards; and a reorganization of U.S. global health programs, including the launch of a new “America First Global Health Strategy” which is anchored to bilateral agreements with countries, a focus on frontline commodities and services, and a shift from disease-specific programming to a more integrated approach. While modeling estimates and field surveys have provided some information about the potential impact of these changes and disruptions, there has been limited data available for such assessments. PEPFAR’s flagship data platform has historically posted financial and program level results, including from PEPFAR’s Monitoring, Evaluation, and Reporting (MER) system (MER was launched more than a decade ago). However, the data platform was temporarily removed in early 2025 and, when restored, it did not include any program data from FY 2025.   

On April 17, 2026, the State Department released Fiscal Year (FY) 2025 fourth quarter (Q4) MER data (covering the July 1 to September 30, 2025 period), providing the first program-level data made available since the changes of last year. Data for quarters 1-3 were not released, which, per the State Department, is due to data reporting and implementation challenges due to the changes. To provide a snapshot of PEPFAR results after these changes, and given this limitation, this analysis compares PEPFAR’s FY 2025 Q4 results to Q4 results from the previous four fiscal years for a subset of MER indicators. By comparing the same time period for each fiscal year, this approach helps to capture seasonal or other reporting fluctuations that could occur. However, it does not allow for an assessment of disruptions or other changes that may have occurred for the full FY 2025 period.¹

While these data are limited (see box on methodology and data limitations) and provide only a snapshot view, they nevertheless provide insights into understanding how PEPFAR is performing following changes by the Trump administration. Overall, the data show that for some indicators, progress  declined in FY 2025 Q4, including support for prevention services such as pre-exposure prophylaxis (PrEP) and the DREAMS program for adolescent girls and young women, both of which were significantly scaled back by the administration. Reduced access to prevention could lead to increases in new HIV infections in the future. There was also a drop in the number of people with HIV newly enrolled on antiretroviral therapy (ART), an important measure of access. At the same time, without more complete data, there is ambiguity in some of the indicators. For example, both the number of HIV tests conducted and the number testing positive for HIV fell, which could represent an actual decline in new infections or simply a decline in access to testing. Finally, there are areas where progress has been maintained or potentially improved, including the total number of people with HIV on ART, which was stable, and an increase in the number of people living with both HIV and TB who are receiving ART. Going forward, the future of transparent PEPFAR data monitoring and reporting remains uncertain, as it’s unclear whether or not these data updates will continue to be provided given the shift in the U.S. global health strategy to country governments and from disease-specific programming to a more integrated approach.  Without such data, it will be difficult to understand the implications and outcomes of these significant changes. 

Findings

PEPFAR’s Q4 treatment results over the period were mixed. While there were some stable results, particularly for the number of people receiving ART, others dropped, such as those newly enrolled on ART.

• The number of individuals with HIV on antiretroviral therapy (ART) remained relatively stable in FY 2025 Q4 compared to FY 2024 Q4 (20.3 million² compared to 20.4 million) and was higher than the prior fiscal years.
• At the same time, the number newly enrolled on ART in FY 2025 Q4 was the lowest over the period, including 16% lower than FY 2024 Q4 (389.1K compared to 463.5K). This is part of a broader decline over the past five years but one of the steepest year-to-year quarter declines.
• Similarly, the number of pregnant women testing positive for HIV and receiving ART in FY 2025 Q4 was also the lowest over the period, including a 14% decline compared to FY 2024 Q4 (189.3K compared to 220.7K).   
• Finally, individuals on ART with documented viral load suppression (VLS) declined in FY 2025 Q4 by 7% compared to FY 2024 Q4 (14.6 million compared to 15.8 million), but was higher than the prior fiscal years.

HIV testing and diagnostic results were mixed in FY 2025 Q4 compared to FY 2024 Q4, although there were fluctuations over the five-year period.

• Both the number of individuals tested for HIV and the number testing positive fell. The number of individuals tested fell by 17% in FY 2025 Q4 compared to FY 2024 Q4 (19.6 million compared to 23.7 million), though was still higher than in prior years. The number testing positive similarly fell by 15% in FY 2025 Q4 compared to FY 2024 Q4 (380.2K compared to 449.8K), continuing a downward decline and reaching the lowest number over the period.
• Despite these drops, the number of pregnant women attending antenatal care who know their HIV status in FY 2025 Q4 was highest over the period, including a 10% increase compared to FY 2024 Q4 (3.9 million compared to 3.6 million).
• In addition, the number of HIV-exposed infants tested for HIV within the first year decreased in FY 2025 Q4 compared to FY 2024 Q4 (135,000 compared to 162,000) and was the lowest in recent years.

Key PEPFAR prevention results saw large declines, including for PrEP.

• The number of individuals who newly initiated PrEP declined by 41% in FY 2025 Q4 compared to FY 2024 Q4 (388K compared to 659.4K), falling to FY 2022 levels. Access to PrEP with PEPFAR support had increased steadily in recent years, before this drop.
• Also declining significantly was the number of adolescent girls and young women (AGYW) who completed the DREAMS package of prevention services in FY 2025 Q4 compared to FY 2024 Q4 (a drop of 86%, from 1.9 million to 253.4k), its lowest level over the period and less than a quarter of those served in the prior years analyzed. DREAMS had been a major PEPFAR initiative to address the drivers of high HIV incidence rates among AGYW, including gender-based violence, gender inequality, poverty, and inadequate access to education. These broader services are no longer being prioritized by PEPFAR.
• Similarly, the number of children and family members served by the Orphans and Vulnerable Children (OVC) program declined significantly in FY 2025 Q4 compared to FY 2024 Q4 (1.7 million compared to 6.5 million), falling to its lowest level in the last five years, and less than a quarter of those served in Q4 of 2022.
• PEPFAR eliminated reporting on key and priority populations (those who were marginalized or faced particular barriers to HIV services, including men who have sex with men, people in prison, displaced persons or mobile communities, and others) reached with prevention and other interventions. Reporting on voluntary medical male circumcision (VMMC) was also eliminated.

PEPFAR has also provided significant support to address HIV and TB co-infection, and risk of TB among those with HIV. These results were varied.

• The number of individuals living with HIV who know their TB status slightly declined in FY 2025 Q4 compared to FY 2024 Q4 (199k compared to 208.7k) but was higher than prior years.
• The number of individuals living with HIV and TB who are receiving ART declined considerably in FY 2025 Q4, compared to previous fiscal years, including a 33% drop compared to FY 2024 (138.9k compared to 208.1k).
• Similarly, the number of individuals receiving ART who initiated TB prevention therapy declined in FY 2025 Q4 (467.7k compared to 823k), reaching its lowest level over the period and continuing a declining trend. The number for FY 2025 Q4 was a third of the number in FY 2021.
• At the same time, the number of individuals receiving ART who initiated TB treatment increased in FY 2025 Q4 compared to FY 2024 Q4, to its highest level over the period.  

PEPFAR has, for many years, also worked to address the elevated risk of cervical cancer among women living with HIV. While screening for cervical cancer declined, the share receiving treatment for cervical cancer held steady.

• The number of women living with HIV and receiving ART who were screened for cervical cancer declined in FY 2025 Q4 compared to FY 2024 Q4 (806.4K compared to 1.4 million), its lowest level over the period.
• Of the women living with HIV and receiving ART and screened positive for cervical cancer, the share receiving treatment was only slightly below the prior period (89% in FY 2025 Q4 compared to 92% in FY 2024 Q4).

1. One recent analysis, submitted for publication, attempts to address some of these issues by looking at reporting continuity across facilities over time. See, Honermann B, Grimsrud A, Lankiewicz E, Sherwood J, Millett G, The impact of the United States foreign aid freeze on HIV service delivery in PEPFAR-supported countries: a facility-level analysis of 2024–2025 programme data, https://www.medrxiv.org/content/10.64898/2026.04.17.26351143v1. ↩︎
2. The number of individuals on ART in FY 2025 Q4 in the publicly available dataset is 20.3 million. The State Department’s press release about the data cites 20.6 million people. ↩︎