Introduction

Intimate partner violence (IPV) is a persistent public health crisis that affects many women in the United States. IPV affects disproportionately affects women but also affects people of all genders. It has a wide range of negative effects on women’s physical and mental health, such as physical injuries, pregnancy complications, and substance use. IPV also has psychosocial impacts, affecting women’s safety, economic security and freedom, isolation, and ability to care for themselves and their children.

The 2024 KFF Women’s Health Survey provides data on women experiencing IPV in the past five years. This group includes women who said that in the past five years a current or former partner did at least one of the following: made them fear for their or their family’s safety, tried to control most or all of their daily activities, hurt them physically, forced them into sexual activity. However, this population does not include those who had experiences with IPV at earlier points in their lives or other forms of IPV and should not be used as an estimate of overall lifetime IPV prevalence Many women, particularly those who are older, may have experienced IPV prior to the last five years.

This analysis reports on a range of health topics affecting women who experienced IPV in the past five years, including their health care needs and use, barriers, and mental health. The impact on women who have been historically marginalized by society and health care systems, including those who are LGBTQ+, experience physical and mental disabilities, and those who are low-income is also examined. The survey was conducted from May 13 – June 18, 2024, online and by telephone among a nationally representative sample of 5,055 women ages 18 to 64.

Key Takeaways

• One in five (19%) women ages 18 to 64 say they have experienced intimate partner violence (IPV) in the last five years. Higher shares of women with lower incomes, LGBT+ women, and those who identify as disabled report recent IPV.
• Many women who have experienced IPV in the past five years contend with health challenges. Large shares characterize their physical (27%) and mental (46%) health as fair or poor. One in four say that a health condition keeps them from fully participating in work or other activities. Almost half of women who have experienced IPV in the past five years incurred a physical injury as a result.
• Over one in ten (14%) women who have experienced IPV in the past five years say that at some point they did not receive health care services they needed related to IPV. Privacy concerns, fear, and intimidation are leading reasons why people experiencing IPV do not obtain health care.
• There are differences in where women affected by IPV usually get health care. More than a third (35%) say their usual site of care is a clinic or health center. One in ten (9%) say it is the emergency room.
• IPV is a major concern during women’s reproductive years. Among women who experienced IPV in past five years, four in ten said they experienced violence during their most recent pregnancy or in the year before or after the pregnancy.
• Emergency contraception is an important back-up contraceptive for reproductive age women affected by IPV. One in five report using emergency contraception in the past year. One in ten also say they have obtained it since the Dobbs ruling in case they need it. These shares are approximately double the rates reported by women who have not experienced IPV in past five years.

Rates of IPV

One in five women ages 18 to 64 say they have experienced IPV in the past five years.

IPV presents in many forms, including physical, sexual, emotional, coercion, and online. The KFF Women’s Health Survey asked about a subset of IPV experiences that women have reported experiencing in the past five years. Approximately one in ten women say that in the past five years, a current or former partner has made them fear for their or their family’s safety (11%), tried to control most or all of their daily activities (11%), hurt them physically (9%), or forced them into sexual activity (9%) (Figure 1). In total, one in five (19%) women ages 18 to 64 said they have experienced at least one of these forms of IPV in the past five years.

Throughout this brief, this is the group referenced when discussing women who have experienced IPV.

Larger shares of women who are younger and have lower incomes consistently report experiencing IPV compared to those who are older and have higher incomes. Conversely, women who are Asian American or Pacific Islander report lower rates of IPV compared to women of other racial and ethnic groups. While women of all subpopulations experience IPV, rates are higher among some groups (Figure 2). More than one in four (27%) women who have lower incomes say they have experienced IPV in the past five years, about twice the share of those with higher incomes (14%). One in ten (9%) AAPI women report IPV in the past five years, which is lower than women of other racial/ethnic backgrounds.

One-third of women who are LGBT+ and one in four who identify as disabled report experiencing IPV in the past five years. Rates of all the IPV questions in the survey are higher among LGBT+ women compared to those who are not LGBT+ (Figure 2). Approximately one in five LGBT+ women said that in the past five years a current or former partner has made them fear for their or family’s safety (19%), tried to control most or all of their daily activities (20%), hurt them physically (18%), or forced them into sexual activity (18%). In total, twice as many LGBT+ women (32%) said they have experienced one of these forms of IPV in the past five years compared to non-LGBT+ women (16%). One in five women with a disability say they have feared for their or their family’s safety at the hands of a current or former partner (19%).  Overall, one in four (27%) women who identifies as disabled reports experiencing at least one form of IPV in the past five years.

On average, women who have experienced IPV in the past five years have lower incomes and lower rates of private health insurance.

More than half (54%) of women affected by IPV in the past five years have low incomes, compared to one-third of those who have not (Figure 3). Insurance profiles also differ between women affected by IPV and those who have not, with a lower rate of private insurance coverage and higher rate of Medicaid coverage among those who have experienced IPV in the past five years compared to those who have not.  Almost half (45%) of women who have experienced IPV in the past five years have young children, and half (54%) are not married. This is in part a reflection of the fact that many women experience IPV at young ages.

Women who have experienced IPV report higher rates of some health challenges, including disability and poorer health status. One in four women who have experienced IPV in the past five years rates their health as “fair” or “poor” (Figure 4). One in four (25%) also report having a chronic condition that keeps them from participating fully in work, school, or other activities. One in five (19%) say they identify as disabled. IPV may be a cause or contributor to these conditions or could exacerbate any of them.

Health Care Access and Barriers

Women who have experienced IPV in the past five years have heavier reliance on clinics and emergency rooms for their health care. Just under half (47%) of women who have experienced IPV in the past five years say they usually get health care in a private doctor’s office, whereas this is the site of care for the majority (62%) of those who have not experienced IPV recently (Figure 5). Three in ten (31%) women who have experienced IPV in the past five years say they usually obtain health care at a neighborhood clinic or health center, and one in ten (9%) usually get care at an emergency room. These differences in site of care may be driven by income, given that women who have experienced IPV are disproportionately lower-income.

Almost half of women who have experienced IPV in the past five years incurred a physical injury as a result. Some of the most common injuries reported by people who experience IPV include head trauma, gynecologic conditions, and fractures. Overall, 45% of women who experienced IPV in the past five years say that their IPV experience resulted in physical injury, which translates to about one in ten (9%) among all women ages 18 to 64 (Figure 6). Among women who experienced IPV in the past five years, majorities of those who identify as having a disability (61%) and have lower incomes (52%) report having physical injuries from IPV. The shares are similar across White, Black, and Hispanic women.

Over one in ten (14%) women who have experienced IPV in the past five years did not receive health care services they needed. Women who experience IPV may need a wide range of health care services related to the impact of IPV. However, 14% of women who recently experienced IPV were not able to get medical or mental health care services related to IPV (Figure 7). Three in ten women say they needed health care services and did obtain them, and more than half (56%) of women who experienced IPV in the past five years say they did not need health services related to their IPV experience.

Privacy concerns, fear, and intimidation are leading reasons why women experiencing IPV do not get care. People who experience IPV are typically dealing with multiple, complicated circumstances that can affect whether, when, and if they can disclose IPV and seek and obtain care. Among women who experienced IPV in the past five years and did not receive care that they needed, nearly six in ten (58%) say it is because they did not want anyone to find out (Figure 8). For some, fear of retribution from a partner is too high to seek care. Almost four in ten (37%) women who did not receive care say they feared the police or child protective services would get involved. Prior research finds that some women affected by IPV report that involvement of police authorities can backfire on them because they lose care of their children or are accused of crimes they did not commit. Health system barriers affect women experiencing IPV too. Almost four in ten (38%) say they could not afford to get care and one in ten (12%) say services were unavailable, which may be tied to their higher rates of uninsurance. Medical billing practices can make confidentiality challenging as violent partners may get a hold of billing statements and patient records.

IPV and Mental Health Care

Violence, control, and coercion have severe negative effects on an individual’s mental health and well-being.  IPV is associated with higher rates of depression, anxiety, and substance use.  Mental health care has been identified as one of the essential health services needed for women affected by IPV.

Women who have been affected by IPV in the past five years have poorer self-reported mental health status and emotional well-being than those who have not. Almost half (46%) of women who have experienced IPV in the past five years describe their mental health and emotional well-being as “fair” or “poor,” twice the share of those who have not (Figure 9). Conversely, 42% of women who have not been affected by IPV in the past five years describe their mental health as “excellent” or “very good,” over twice the share of women affected by IPV (18%). Just over one-third of each group rates their health as “good.”

Many women encounter barriers to mental health care, particularly those affected by IPV. Among women who have experienced IPV in the past five year who rate their health as fair or poor, two-thirds (66%) say that in the past year they did not obtain mental health care they thought they needed. This is also the case for half (50%) of women with fair or poor mental health who have not experienced IPV recently.

IPV and Reproductive Health

IPV often begins during women’s reproductive years, and research has documented associations between IPV and several sexual and reproductive health challenges, including higher risk for sexually transmitted infections, inconsistent use of contraception, and high rate of unplanned pregnancies.

Among reproductive age women who experienced IPV and were pregnant in the past five years, four in ten say they experienced violence around the time of pregnancy. Pregnancy can be a risky period for people experiencing IPV, as some people report that violence increases or intensifies during and after pregnancy. Experiences with IPV have been linked with greater risk for negative maternal and fetal health complications, including preterm birth, low birthweight, as well as maternal and fetal death in the most severe cases.  Among women of reproductive age (18 to 49 years old) who were pregnant and experienced IPV in the past five years, one in five say they experienced IPV in the year prior to their last pregnancy (21%), during their most recent pregnancy (22%), and in the year after (20%). Overall, four in ten women of reproductive age who have experienced IPV say they experienced IPV during one of these periods (Figure 10).

Among women who were pregnant in the past five years, a higher share of those who also experienced IPV (65%) said they needed mental health services during or within the first year after pregnancy, compared to those who were not affected by IPV (44%).

Eight in ten women of reproductive age who have experienced IPV in the past five years report using contraception in the past year. Preventing pregnancy is the leading reason for using contraception for this group, but one in five women who have experienced IPV in the past five years use it to prevent an STI.

The majority of reproductive age women who have experienced IPV, as well as those who have not, used contraception in the past year (Figure 11).  For most contraceptive methods, rates of use are similar between women who have experienced IPV in the past five years and those who have not. However, more women affected by IPV report using condoms (38%, 33% respectively) and withdrawal (32%, 21%) compared to those not affected by IPV, which is surprising given that these methods are controlled by men. One in four women affected by IPV report they have had a sterilization procedure, one in five use IUDs and one in five say they used EC. One notable difference is why women use contraception. One in five women who have experienced IPV in the past five years say they use it to prevent an STI, twice the share among women who have not experienced IPV in the past five years (9%).

Reproductive coercion, control by an intimate partner over reproductive health issues such as use of contraception or an abortion, is also a form of IPV. More than one in ten (13%) women who have experienced other forms of IPV in the past five years also report that a partner has tried to stop them from using contraception so they would become pregnant against their will (data not shown).

One in four reproductive age women who have experienced IPV in past five years says they or their partner made a change in contraception practices because of the overturning of Roe v. Wade. Since the 2022 Supreme Court ruling that overturned Roe v. Wade, many states have banned or severely restricted abortion access, which has prompted some people to make changes in their use of contraception. Overall, nearly twice as many women affected by IPV (26%) say they’ve made a change than those who have not recently experienced IPV (14%). In particular, 10% of reproductive age women who have experienced IPV in the past five year has obtained EC to have on hand in case they need it. Almost one in ten (8%) report starting contraception or switching to a more effective method (Figure 12).

On May 1, 2025, the Department of Health and Human Services (HHS) released Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, a report issued following the Executive Order, “Protecting Children From Chemical and Surgical Mutilation,” which directed the HHS Secretary to publish an evidence review related to gender dysphoria in young people within 90 days.

Access to gender affirming care has becoming increasingly contested political territory in the United States. A growing number of states have laws that ban youth access (27 to date), and there are numerous legal challenges underway, including a case that is before the Supreme Court. The issue also figured prominently in the presidential election cycle, with President Trump campaigning on promises to end access to such care. The Executive Order and report are in line with a range of other executive actions that question evidence around gender affirming care, aim to limit access to these medical services, particularly for youth, and, in some cases, promote misinformation or deny the existence of transgender people.

The report states that it is a review of the evidence and best practice regarding information about treatment of gender dysphoria. Its main conclusion is that the quality of evidence on the effects of any intervention is low, and evidence on harms is “sparse.” Still the report cites what it identifies as significant risks of medical transition, marking a departure from most medical associations and widely used guidelines in the U.S. Instead, the report supports the use of psychotherapeutic approaches, including an approach termed “exploratory therapy”, which can include conversion therapy.

Shortly after its release, the review received criticism by researchers, advocates, and medical association for its methods, lack of alignment with current guidance, promotion of misinformation, support of certain practices, and decision not to disclose the authors. A particular concern was raised about the review’s support of “exploratory therapy” Other groups including the Christian legal advocacy group Alliance for Defending Freedom and the Center for American Liberty supported the review’s assessment.

This policy brief reviews the main points raised by the report regarding its emphasis on psychotherapy, and recommendations around “exploratory therapy”, which could include gender conversion practices, as well as the current legal and policy environment across the country.

What does the report say about psychotherapy as treatment for gender dysphoria and conversion practices?

Psychotherapy is one of five dedicated parts in the review and a theme that receives significant attention is support for gender identity conversion based practices, sometimes called “conversion” or “reparative” “therapy,” which the report calls “exploratory therapy.” The report counters this description stating that “equating ‘exploratory therapy’ with ‘conversion therapy’ is misguided and that equating any “approach focused on reducing a minor’s distress about their body or social role [with conversion therapy] is a problematic.” Other reasons provided include: pointing to Dutch practices, stating that all therapy is exploratory, and noting that the label “conversion therapist” is damaging.

Conversion practices aim to “suppress or alter an individual’s sexual orientation or gender to align with heterosexual orientation, cisgender identity, and/or stereotypical gender expression. [These]…efforts are premised on or motivated by the belief that diversity in sexual orientation and/or gender identity and expression is a deficit, mental illness, or pathology.” Major medical associations (described in detail below) in the U.S. conclude that conversion practices lack evidence and are, at best, unfair or ineffective and at worst, harmful. The United Kingdom’s Cass Review, like the HHS report, reviewed evidence around gender affirming care for minors and made recommendations to the National Health Service. While it ultimately led to restrictions on access to this care in the UK, in discussing psychotherapy, it stated “that no LGBTQ+ group should be subjected to conversion practice.”

The review describes “exploratory psychotherapy,” in part, as “trying to help children and adolescents come to terms with their bodies” and goes on to equate the distress related to gender dysphoria with general “discomfort with the sexed body or with societal sex-based expectations is common during puberty and adolescence.” This goes against identified best practice which encourages clinicans to recognize to recognize that transgender and gender non-conforming people “are more likely to experience positive life outcomes when they receive social support or trans-affirmative care.”

The report promotes therapeutic approaches as first line treatment and suggests that they can be an “alternative to endocrine and surgical interventions for the treatment of pediatric gender dysphoria.” This runs contrary to guidelines which suggest a range of approaches to gender affirming care, which is highly individualized, to be delivered as clinically appropriate. The review presents therapeutic modalities and describes how they can be applied to treat gender dysphoria, noting especially their potential to interrogate the wish for gender transition. For example, of psychodynamic therapy, the review states that this modality “can help patients gain deeper understanding of their personal identity, including any external factors that may contribute to their cross-sex identification and desire for medical/surgical interventions…”

The report, and the Executive Order, also question Standards of Care issued by the World Professional Association for Transgender Health (WPATH), which are widely relied on guidelines that providers look to in delivering evidence based best practice gender affirming care. These standards are regularly referenced by major medical associations including the American Psychological Association. While the report suggests that psychotherapy is not common in delivering gender affirming care to minors, psychological wellbeing is promoted within WPATH’s guidance. WPATH recommends “health care professionals working with gender diverse adolescents undertake a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns and seek medical/surgical transition-related care, and that this be accomplished in a collaborative and supportive manner.”

What is the aim of conversion efforts and what does evidence say about them?

Gender conversion practices are based on the premise that non-cisgender identities are a pathology and that transgender people would benefit from changing their gender identity. Medical evidence does not support this and, as noted below, most major medical associations have concluded that such interventions stand to cause harm. Yet, the efficacy of and ability to provide these services, due to local regulations, remains somewhat contested.

Research has shown that lifetime exposure to gender identity conversion efforts are associated with adverse mental health outcomes, including higher odds of depression, suicidality, and suicide attempts and substance abuse.

Where does the medical establishment stand on conversion practices?

Sexual orientation and gender identity have a long history of being pathologized, including in the mental health field. It was not until 1994 that “transsexualism” was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) when it was replaced with “gender identity disorder.” This diagnosis was then replaced with “gender dysphoria” in 2013. Today, it is widely accepted by established medical groups that the full spectrum of sexual orientations and gender identities are not pathologies and do not need treatment. The American Academy of Pediatrics, for example writes “variations in gender identity and expression are normal aspects of human diversity, and binary definitions of gender do not always reflect emerging gender identities.” Rather, some gender diverse people experienced distress “caused by the body and mind not aligning and/or societal marginalization of gender-variant people.” Thus, care is typically provided to relieve distress, not to try to treat certain gender identities.

Broadly, gender affirming care is supported by practically all major medical associations in the U.S., including, the American Medical Association, American Academy of Pediatrics, and the American Psychological Association. It is also supported through guidance from the Endocrine Society and the World Professional Association for Transgender Health (WPATH).

Specifically, conversion approaches to gender dysphoria contrast with recommendations from these medical associations, which criticize conversion practices, stating that they lack evidence, are ineffective, and can create harm. In August 2023, 28 medical and mental health associations signed onto a joint statement opposing conversion practices. Additionally, many have provided independent statements addressing their concerns regarding these practices. For example:

• An American Academy of Pediatrics (AAP) policy statement (reaffirmed in 2023) states that “reparative approaches have been proven to be not only unsuccessful but also deleterious and are considered outside the mainstream of traditional medical practice. The AAP described reparative approaches as ‘unfair and deceptive.’”
• In a 2018 policy statement The American Academy of Child and Adolescent Psychiatry (AACAP) wrote of “conversion therapies” that “these interventions are provided under the false premise that homosexuality and gender diverse identities are pathological. They are not; the absence of pathology means there is no need for conversion or any other like intervention. Further, there is evidence that ‘conversion therapies’ increase risk of causing or exacerbating mental health conditions in the very youth they purport to treat…AACAP asserts that such ‘conversion therapies’ (or other interventions imposed with the intent of promoting a particular sexual orientation and/or gender as a preferred outcome) lack scientific credibility and clinical utility. Additionally, there is evidence that such interventions are harmful. As a result, ‘conversion therapies’ should not be part of any behavioral health treatment of children and adolescents.”
• The American Psychological Association (APA) writes that “to consider …[gender identity change efforts (GICE)]…as therapies or treatments is inaccurate and inappropriate because, the incongruence between sex and gender in and of itself is not a mental disorder…so, any behavioral health or GICE technique or treatment that seeks to change an individual’s gender identity or expression is not indicated; thus, any behavioral health or GICE effort that attempt to change an individual’s gender identity or expression is inappropriate.”
• National Association of Social Workers (NASW) states that “NASW upholds that sexual orientation, gender identity, and gender expression are real and irrefutable forms of identity. Thus, NASW condemns any and all forms of conversion practices, as they are harmful to the mental health and well-being of LGBTQIA2S+. These practices stand in direct conflict with NASW’s professional code of ethics, and these practices represent a significant risk of harm by subjecting individuals to forms of treatment.”

How common is it for transgender people to experience conversion practices?

While conversion practices are widely discredited, KFF polling finds that one-in-ten transgender adults report having attended “conversion” or “reparative” therapy that tried to change their sexual orientation or gender identity as a teen or child. Since the share is much lower among LGBT adults as a group (1%), it is likely that many of these experiences were aimed at gender identity. Similarly, the Trevor Project finds that “13% of LGBTQ+ young people reported being threatened with or subjected to conversion therapy.”

What is the policy and legal landscape regarding conversion practices?

As noted, while medical consensus is against the use of conversion practices, this matter has not been settled in the policy realm. States have increasingly stepped in to regulate the practice in clinical settings, with almost half banning it in full or in part. According to data from the Movement Advancement Project, currently:

• 19 states and DC have bans on the practice of conversion therapy.
• 4 states have a partial ban in their state (e.g. banning the practice among those with only certain licenses or banning the use of state funds in the provision conversion therapy).
• 4 states prohibit local level bans on conversion therapy either via state law or a court ruling.
• 19 states have no policy.

Beyond these state actions, some cities and counties have enacted policies prohibiting at least certain conversion practices.

Notably, states currently have the ability to regulate therapeutic practice and prohibit conversion efforts by certain mental health professionals but conversion efforts also take place within religious settings and those are not included in these prohibitions. KFF polling finds that 25% of transgender adults report that they attended religious services that tried to change their sexual orientation or gender identity as a child or teen.

The ability of states to ban conversion therapy will soon be reviewed by the Supreme Court, which, on March 10, 2025, granted certiorari in Chiles v. Salazar, a case challenging Colorado’s conversion therapy ban for minors. The state’s ban, which prohibits mental health professionals from attempting or purporting to change a minor’s sexual orientation or gender identity, was upheld by the Tenth Circuit Court of Appeals in September 2024. Chiles, a Christian counselor, has appealed this decision and asked the Supreme Court to review “whether a law that censors certain conversations between counselors and their clients based on the viewpoints expressed regulates conduct or violates the Free Speech Clause.” A decision in Chiles’ favor could limit the ability of states to regulate such practices.

This review could be used as support for other actions the administration seeks to take (some described here) aimed at limiting minor access to gender affirming care. With respect to therapeutic practices, it could shift how some practitioners approach gender affirming care or potentially provide support to those using conversion related approaches. The report could also fuel misinformation in other areas, particularly around regret rates and the share of transgender young people seeking a medical transition.

Mental health continues to be a growing area of health concern for people, with 90% of Americans saying there is a mental health crisis in the U.S. in a 2023 KFF-CNN poll. Women’s mental health often differs from men’s, with women experiencing some mental health symptoms more commonly than men but also conditions that are unique to women, such as perinatal and perimenopausal depression.

This brief analyzes data from the 2024 KFF Women’s Health Survey (WHS), a nationally representative survey of 6,246 adults ages 18 to 64, including 5,055 women and 1,191 men, conducted from May 15 to June 18, 2024. In addition to several topics related to reproductive health and well-being, the survey asked respondents about their mental health and their experiences accessing mental health services in the past year. This issue brief presents KFF WHS data on access to mental health services among women and men ages 18 to 64, and it also takes a closer look at mental health coverage among women. See the Methodology section for details.

Key Takeaways

• Nearly three in ten women ages 18 to 64 (28%) describe their mental health or emotional well-being as “fair” or “poor”, including higher shares of women with low incomes (38%) and those who identify as LGBT+ (45%). Nearly three quarters of those who say they have a mental health-related disability (73%) report having “fair/poor” mental well-being.
• Three in ten (29%) women say they received mental health services in the past 12 months. About half of women who describe their mental health as “fair/poor” say they received mental health care in the past year (48%). While eight in 10 ten women with a self-reported mental health-related disability (81%) say they received care, one in five did not.
• Among women who report receiving mental health services, the most commonly reported services are one-on-one care with a provider, in-person (60%) and/or via telehealth (55%). Just over half of this group report receiving a prescription for medication (52%). Few women say they received care through a mental health therapy app (7% of those who report receiving services) or other services like in-patient hospitalization or group therapy (8%).
• Four in ten women overall (38%) say it is difficult for women to get mental health services in their state. One-third (32%) of all women say they did not get mental health services despite needing them, citing barriers such as cost, stigma, or inability to get time off from work.
• Among women who were able to get mental health care, half (50%) say it is difficult for women to access mental health services in their state, and more than half say they experienced barriers during care-seeking (55%). These challenges include trouble finding a provider that was accepting new patients (25%) or one that accepted their insurance (21%). The large majority of women with Medicaid say their most recent mental health care visit was covered completely by Medicaid (85%), whereas most women with private insurance had to pay some (48%) or all (14%) costs out-of-pocket.
• Cost is a significant barrier to obtaining mental health services. More than one in ten women 18 to 64 (13%) say they did not get mental health care or could not continue to afford the mental health care they were receiving because of cost. More than twice as many women without insurance (29%) cite cost as a reason for not getting care.

Self-Described Mental Health

In general, slightly larger shares of women describe their mental health status as “fair” or “poor” compared to men (28% vs. 23%). Most women (72%) and men (77%) describe their mental health as either “good” or “excellent/very good” (Figure 1).

As other research has found, younger adults report mental health challenges at higher rates than older adults. Over one third of younger women ages 18 to 25 describe their mental health status as “fair” or “poor” (36%), compared to a smaller share of women ages 50 to 64 (21%). A higher share of 50 to 64 — about half (49%) – describe their mental well-being as “excellent” or “very good,” which is considerably higher than just three in ten (30%) younger women ages 18 to 25.

About 4 in 10 women (38%) who have low incomes (below 200% of the federal poverty level (FPL)) report fair or poor mental health status, nearly double the rate reported by those with higher incomes (21%). Nearly two times as many women who identify as LGBT+ (45%) say their mental health is “fair” or “poor” compared to those who do not identify as LGBT+ (24%). Not surprisingly, nearly three-quarters of women who identify as having a mental health-related disability (73%) say they have “fair” or “poor” mental health, three times the rate of those who do not identify as being disabled (24%) or who have another non-mental health disability (27%).

Mental Health Care Utilization

Not only do a slightly larger share of women than men report poorer mental health status, but compared to men, a somewhat larger share of women report receiving mental health care in the past 12 months (Figure 2). Roughly three in the ten women (29%) say they received mental health services from a mental health professional, compared to 22% of men.

Younger women are also more likely to use mental health services than older women. One in three women under the age of 50 say they received professional mental health care in the past year, compared to just 22% of women between age 50 and 64. Compared to their White counterparts (31%), smaller shares of Asian (19%) and Hispanic (24%) women say they received mental health care in the past year, consistent with previous mental health findings from KFF polling. Black (30%) and White women report obtaining mental health care at similar rates.

Consistent with the findings on self-described mental well-being, nearly twice as many women who identify as LGBT+ (45%) than those who do not (27%) say they received mental health care in the past 12 months. Similarly, eight in ten women who identify as having a mental health-related disability (81%) say they received mental health services, compared to 27% of women who identify as having another disability and 18% of women who do not identify as disabled.

Higher shares of women with lower incomes and those covered by Medicaid say they obtained mental health services compared to their higher income and privately insured counterparts. While mental health services can be very costly and private insurance coverage is often limited and associated with high out-of-pocket costs, Medicaid, a program designed for people with low incomes, typically has nominal or very low out-of-pocket costs for enrollees.

While use of mental health services is higher among many of the subpopulations that rate their mental health lower, still about half (48%) of women who rate their mental health as “fair” or “poor” say they obtained mental health care, suggesting that many women with “fair” or “poor” mental health who could benefit from care are not getting it. The survey also shows that mental health services are used by people across the mental health continuum. Three in ten (31%) women who rate their mental health as “good” and more than one in ten (13%) who describe it as “excellent” or “very good” say they received care in the past year.

When asked what kind of mental health services they received in the past 12 months, most women who say they received care say they received 1-on-1 care with a provider, either in-person (60%) or via telehealth (55%). About half of women who say they received mental health care in the past year report getting a prescription for a medication (52%).

Fewer than one in ten women who report receiving care (7%) say they received care through a mental health therapy app, like BetterHelp or Talkspace, which connect patients to a clinician for virtual appointments but outside of the traditional medical system, or through another avenue (8%) such as inpatient hospitalization or group therapy (Table 1).

The types of mental health services women use vary by demographics. While similar shares of women across all age groups say they received in-person 1-on-1 care with a provider, larger shares of women ages 26 to 35 compared to women ages 50 to 64 say they used digital services for care, such as telehealth services (59% vs. 49%, respectively) and care through a mental health therapy app (8% vs. 3%, respectively). One in ten women ages 18 to 25 who say they received care say they received care through a mental health therapy app. There were no statistically significant differences by age for prescription medications and other mental health services.

Among those who report receiving mental health services in the past year, nearly six in ten (59%) women who rate their mental health as “fair” or “poor” report receiving a prescription medication, as do half (50%) of women who describe their mental health as “good” and more than a third (37%) of those who rate it as “excellent/very good.”

Among those who report receiving mental health care, larger shares of women who identify as LGBT+ than those are not LGBT+ say they accessed mental health care through telehealth service (65% vs. 52%) or through a mental health therapy app (12% vs 6%). More women who identify as LGBT+ also say they received a prescription for a medication compared to their non-LGBT+ counterparts (60% vs. 50%).

Over half of women say they received more than one type of mental health service in the past 12 months (58%). Higher shares of women with “fair” or “poor” mental health (65%) and/or who identify as having a mental health-related disability (73%) say they received more than one type of service in the past year.

Coverage of Mental Health Services

While federal laws require parity for insurance coverage of mental health care, gaps in coverage remain. All state Medicaid programs provide coverage for mental health services for beneficiaries with low incomes, and the Affordable Care Act (ACA) requires most individual and small group insurance insurers to cover behavioral health care, which includes mental health services. However, the scope of coverage varies, provider networks are limited in many plans, and mental health providers may not accept all insurance plans or in some cases, any insurance.

The large majority of women with Medicaid coverage who access care say their most recent visit was completely covered by Medicaid (85%) (Figure 3). Of the remaining 15%, 4% say they received free services at a clinic or health center. Medicaid is the single largest payer of behavioral health services, which includes mental health care and substance use services. By design, Medicaid charges very little cost-sharing.

Most women with private insurance say they had to pay at least some out-of-pocket costs for their most recent mental health care. Nearly half (48%) paid some of the cost out-of-pocket while their insurance covered part of the cost and 14% paid the full cost out-of-pocket. About one in three (32%) women with private insurance say their most recent visit was completely covered by their insurance plan.

Barriers to Accessing Mental Health Care

Overall, four in ten women (38%) say it is difficult to access mental health services in their state, but this share rises to half (49%) among women who say they recently received mental health care in the past year (Figure 4).

One in three women (32%) say they did not get mental health services in the past year even though they needed them (Figure 5). More than one third of women younger than 50 say they did not get the care they needed compared to 22% of women 50 to 64. Four in ten uninsured women (40%) say they needed mental health care but did not get it, compared to 31% of women with private insurance. Half of women who identify as LGBT+ (50%) say they needed mental health care but did not get it, compared to three in ten who do not identify as LGBT+ (29%). Similarly, nearly half of women with a mental health disability (47%) say they did not get mental health care even though they needed it. More than half of women with “fair” or “poor” mental health did not get the care they say they needed (55%).

When asked to indicate the reason(s) why they did not get the care they needed, many women say they did not get care because they felt better or dealt with their mental health issues by themselves (38%) (Figure 6). However, three in ten women who say they did not get needed care cite cost (32%), being unable to take time off from work or being too busy (29%), or feeling afraid, embarrassed, or ashamed to seek care (31%). A small share of women cites some other reason (8%), such as transportation barriers or challenges with reaching providers to coordinate a visit.

It is not uncommon for those who receive care to also experience challenges while trying to find care. Among women who received mental health care in the past 12 months, more than half (55%) say they experienced a barrier during their care seeking journey (Figure 7). One in four women who say they received care say they had trouble finding a provider that was accepting new patients (25%) and about one in five had trouble finding a provider that accepted their insurance (21%). One in four women who received mental health care in the past year say they had trouble scheduling an appointment in a reasonable amount of time (24%).

There were few differences between women of different subgroup, with the exception of higher shares of LGBT+ women experienced challenges getting mental health services (66%) compared to 52% of women who do not identify as LGBT+, including trouble finding a provider, and affording the cost. These findings reflect well documented shortages, burnout, and high demand among clinicians in the mental health profession.

While only 5% of all women say they had difficulty finding a provider who spoke their language or one from a similar racial or ethnic background as themselves, these findings vary by race/ethnicity. Significantly larger shares of Hispanic (11%) and Black (8%) women report facing this challenge, compared to just 1% of White women (Figure 7). These findings are consistent with previous KFF polling, underscoring the additional and disproportionate challenges people of color face when accessing mental health care.

Cost continues to be a commonly reported barrier to mental health care. More than one in ten women 18 to 64 (13%) say they did not get mental health care or could not continue to afford the mental health care they were receiving because of cost (Figure 9). Thirteen percent (13%) of women with private insurance say they did not get care because of cost, and more than twice as many women without insurance (29%) cite cost as reason for not getting care. The share is lower among women with Medicaid, reflecting the program’s important role in providing access to mental health services, but still 8% cite cost as a barrier. The barriers are multi-pronged. Insurance networks can be very narrow for mental health care, and a significant portion of mental health clinicians do not participate in insurance networks. These findings on cost barriers underscore the ongoing challenges with affordable mental health care, especially among the uninsured, but even for those with coverage.

Five years after the start of  COVID-19 pandemic and the communications challenges, divisions, and false claims that followed, less than half of the public say they have at least some confidence in the federal government’s health agencies like the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) to carry out many of their core responsibilities, a new KFF Tracking Poll on Health Information and Trust finds.The low levels of confidence apply to federal agencies’ ability to ensure the safety and effectiveness of prescription drugs (46% express at least some confidence) and vaccines (45%), and to respond to outbreaks of infectious diseases (42%). Even fewer (32%) express at least “some” confidence in the agencies to act independently without interference from outside interests. 

When it comes to vaccines specifically, close to six in 10 adults have at least “a fair amount” of trust in either the FDA (57%) or CDC (59%) to provide reliable information. That leaves about four in 10 who say they trust the two institutions “not much” or “not at all” when it comes to vaccines (43% for the FDA, 41% for the CDC).The overall level of trust in each case is similar to where it stood in September 2023, though the poll reveals significant partisan shifts as the second Trump administration and Health and Human Services Secretary Robert F. Kennedy Jr. have started to change vaccine policies and messaging.The shares of Democrats who say they trust the FDA and CDC have fallen by nearly 20 percentage points since 2023, while the shares of Republicans who trust each of the agencies have increased by about 10 points. While those shifts have narrowed a partisan divide on trust, Democrats remain more likely than Republicans to say they trust each agency’s vaccine information.

“There are remarkably low levels of trust in the nation’s scientific agencies, shaped by partisan perspectives, and that presents a real danger for the country if and when another pandemic hits,” KFF President and CEO Drew Altman said. 

Amid the Trump administration’s ongoing changes to vaccine policy that could affect COVID-19 vaccines relying on mRNA technology, the poll finds that nearly half (45%) of the public say they’ve heard or read about the false claim that the mRNA vaccines such as those used for COVID-19 can change their DNA. 

Very few (3%) say the false claim is “definitely true,” while a quarter (24%) say it is “definitely false.” Most are unsure, saying the claim is “probably true” (26%) or “probably false” (45%).

About a third (32%) of adults say vaccines that use mRNA technology are “generally safe” compared to about one in six (16%) who say they are “generally unsafe.” At the same time, about half of the public (52%) say they do not know enough about this technology to say. At least one in five Republicans (23%) and independents (18%) say they think mRNA vaccines are unsafe compared to far fewer Democrats (3%).

Other findings include:

• Six in 10 adults (60%) say that under the Trump administration, federal health agencies are not paying enough attention to science. This includes most Democrats (73%) and independents (63%) but less than half of Republicans (45%).
• Large majorities of the public are at least somewhat confident in the safety of most vaccines, including those for measles, mumps and rubella (83%), the flu (74%), and, among those ages 50 and older, pneumonia (82%) and shingles (79%). A narrower majority (56%) has confidence in the safety of COVID-19 vaccines, reflecting low confidence among Republicans (30%). 

The poll is part of KFF’s Health Information and Trust Initiative, which is aimed at tracking health misinformation in the U.S., analyzing its impact on the American people, and mobilizing media to address the problem. 

Designed and analyzed by public opinion researchers at KFF, this survey was conducted April 8-15, 2025, online and by telephone among a nationally representative sample of 1,380 U.S. adults in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on other subgroups, the margin of sampling error may be higher.

The House and Senate are working on legislation to meet the requirements in the budget resolution, specifying cuts to Medicaid of up to $880 billion or more over 10 years. Large reductions in Medicaid spending are likely to have direct implications for the 83 million people covered by Medicaid, state budgets, and health care providers, including hospitals. Medicaid accounted for about one fifth (19%) of all spending on hospital care in 2023 and cuts to payments for care or loss of coverage could have implications for hospitals’ finances, the cost and quality of care, and people’s ability to access hospital services. There could be consequences for the broader economy too given that hospitals are the sixth largest employer in the country across industry subsectors.

To inform these discussions, this analysis describes the percent of inpatient hospital days that are covered by Medicaid (also referred to as the “Medicaid inpatient share”), nationally and by state. The analysis uses Medicare cost report data from 2023 (the most recent year available) and focuses on hospitals that are non-federal (see Methods for more details about the hospitals included and analysis).

Medicaid covered at least one in five inpatient hospital days in 48 states and the District of Columbia (hereafter referred to as a state) in 2023. Medicaid covered at least 25% of inpatient days in 30 states and at least 30% of days in 10 states (see Figure 1). The Medicaid share ranged from 11% in Wyoming to 37% in New Mexico. Medicaid covered about one in four (26% of) inpatient days nationally. Variation across states is driven by Medicaid eligibility levels—including whether a state has opted to expand under the Affordability Care Act—as well as demographics. Medicaid’s share of hospital use is likely higher than its share of hospital revenues in part because Medicaid payment rates are generally lower than what commercial insurers pay.

States with the highest Medicaid shares included a mixture of red and blue states. For example, among the 10 states with Medicaid shares of at least 30%, five were states that voted for President Trump in the 2024 election (Alaska, Kentucky, Louisiana, Nevada, and Oklahoma) and five were states that voted for Vice President Harris (California, Colorado, DC, New Mexico, and New York).

Medicaid covered about four in ten (41% of) births nationally in 2023, almost half (47%) of births in rural areas, and at least 40% of births in 26 states according to prior KFF analysis. The vast majority of births occur in hospitals.

With hospital care accounting for about one third of Medicaid spending in 2023, large Medicaid cuts would be likely to affect hospitals. Some policy options under discussion would affect hospitals directly by reducing the payments made to hospitals through managed care organizations (by limiting what are known as state directed payments) or restricting states’ ability to fund Medicaid through provider taxes, which often support higher payments for hospitals. Also being considered are options to reduce federal spending on the Affordable Care Act (ACA) Medicaid expansion, which has helped improve hospital finances and may have especially benefited rural hospitals. The hospital industry has been lobbying Congress against proposed cuts, arguing that reductions in Medicaid spending would threaten access to hospital care for all patients—not just Medicaid beneficiaries—and the National Rural Health Association has argued that Medicaid spending reductions would lead rural hospitals to reduce or eliminate the services they offer or close altogether.

Also on the horizon is the expiration of the enhanced Affordable Care Act (ACA) subsidies in 2026; there would likely be implications for hospitals if the subsidies are allowed to expire, as the number of uninsured people would increase by 3.8 million per year on average according to Congressional Budget Office (CBO) projections.

1115 waivers generally reflect priorities identified by states as well as changing priorities from one presidential administration to another. The Biden administration encouraged states to propose waivers that expand coverage, address health-related social needs (or “HRSN”), and assist individuals with reentry from incarceration. In contrast, the first Trump administration focused on work requirements and eligibility restrictions with a limited focus on enrollee social determinants of health; however, the administration approved a first-of-its kind waiver in North Carolina that allowed the state to provide limited housing and nutrition supports to targeted Medicaid enrollees. In addition, the Biden administration expanded waiver financing tools that had been limited under the first Trump administration.

While the future direction of demonstration waivers is uncertain, recent actions from the Trump administration could signal efforts to curtail waivers related to social determinants of health and to limit waiver financing tools and flexibility. Two major changes demonstrate this shift: (1)  rescinding Biden-era guidance on covering health-related social needs (HRSN) services, and (2) phasing out federal funding for “Designated State Health Programs” (DSHP) in waivers. This waiver watch examines these recent actions in the context of the recent history of Medicaid waivers aimed at addressing enrollee social determinants of health and DSHP.

Use of 1115 Waivers to Address Social Determinants of Health Under Biden and Trump Administrations

The first Trump administration generally had a limited focus on enrollee social determinants of health. Historically states have had limited ability to use Medicaid to help address social determinants of health. Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age. SDOH include but are not limited to housing, food, education, employment, healthy behaviors, transportation, and personal safety. Despite a limited focus in general on SDOH, in 2018 the first Trump administration approved North Carolina’s “Healthy Opportunities Pilots,” allowing the state to cover certain non-medical services that target social needs, including housing, nutrition, transportation, and interpersonal relationship supports to specific and limited enrollees. The Pilots operated in three regions of the state and did not go as far as to provide coverage of rent/temporary housing or meal supports equivalent to three meals a day. The Trump administration later released guidance in 2021 highlighting existing federal authorities and opportunities for states to use Medicaid to address enrollee social determinants of health, including under Section 1115 authority.

The Biden administration moved to a more expansive 1115 “health-related social needs” framework and approved 18 waivers authorizing evidence-based housing and nutrition services for specific high-need populations under this framework. (Figure 1). Under the Biden administration, the Centers for Medicare and Medicaid Services (CMS) released a series of guidance documents (which were updated in 2024) on a new waiver opportunity to expand the tools available to states to address enrollee health-related social needs (or “HRSN”). The guidance included federal guardrails and requirements related to expenditure limits, service delivery requirements, and monitoring and evaluation requirements. The HRSN framework allowed for coverage of rent/temporary housing and utilities for up to six months and meal support up to three meals per day, departing from longstanding prohibitions on payment of “room and board” in Medicaid. CMS indicated broadening the availability of HRSN services was “expected to promote coverage and access to care, improve health outcomes, reduce health disparities, and create long-term, more cost-effective alternatives or supplements to traditional medical services.” CMS stressed new HRSN initiatives were not intended to replace other federal, state, and local social service programs but rather to complement and coordinate with these efforts. One of the final Biden administration HRSN approvals was an extension of North Carolina’s waiver under the new HRSN-framework. Reflecting findings from the evaluations of the initial waiver (discussed below in Box 1), the renewal expands the Healthy Opportunities program statewide, introduces new HRSN-framework services (e.g., short-term rental assistance, nutrition supports that were equivalent to three meals a day), and includes new DSHP funding authority.

Use of DSHP Under Biden and Trump Administrations

Spending on certain Designated State Health Programs (DSHP) have been used to draw down federal matching dollars, but support for this policy has varied across the Trump and Biden administrations. HHS has authorized states to access federal Medicaid matching funds for certain types of state-funded health programs in waivers pre-dating the first Trump administration. Generally, this policy may expand available resources by freeing up state funds to finance new Section 1115 waiver initiatives. These state health programs (called DSHPs) do not otherwise qualify for federal funding, must have existed prior to 1115 waiver implementation, and often provide safety-net health care services for low-income or uninsured individuals (such as addiction recovery treatment or support for individuals with intellectual and developmental disabilities). With DSHP authority, states can claim federal match (up to set limits) for state programs approved by CMS.

The first Trump administration announced in 2017 it would no longer accept state proposals for new or renewing 1115 demonstrations that rely on federal matching funds for DSHP. In the guidance, the administration noted oversight concerns and stated there was no “compelling case that federal DSHP funding is a prudent federal investment.” At the time, authority for DSHP in active / current demonstrations was not affected but they could not be extended or renewed. Prior to the Trump administration, DSHP was often used to help finance Delivery System Reform Incentive Payment (DSRIP) waivers, which provided states with significant federal funding to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries. Along with phasing out DSHP funding, the first Trump administration reduced funding for DSRIP renewals and did not approve new DSRIP demonstrations.

The Biden administration rescinded the 2017 DSHP guidance and approved 1115 demonstrations in eight states (nine total demonstrations) that provide federal funding for DSHPs (Figure 1). CMS only approved DSHP expenditure authority in a subset of states with HRSN 1115 approval (in waivers including CalAIM, New York’s Medicaid Redesign, and MassHealth). CMS approved the use of “freed up” state funds for HRSN initiatives (in all states with DSHP expenditure authority) and approved limited other uses (e.g., reentry and workforce initiatives) that varied across state approvals. In waiver approvals, CMS notes that only new waiver initiatives that were determined to promote the objectives of the Medicaid program (such as by “improving access to high-quality covered services”) could be financed with freed up state funds; new DSHP-funded initiatives were expected to not supplant existing services or programs. DSHP authority was described as time-limited and states were expected to submit sustainability plans that describe the state’s strategy to fund and maintain these initiatives beyond the current demonstration approval period. With these DSHP approvals, the Biden administration also introduced new guardrails, including that federal funding for DSHPs could not exceed 1.5 percent of the state’s total Medicaid spending and that states must use non-federal funding sources for at least 15 percent of the state’s share of the cost of new waiver initiatives. Similar to its guidance for HRSN programs, as a condition of DSHP approval CMS required states to meet provider payment rate requirements for core Medicaid services.

Recent Actions Taken by the Trump Administration Related to Waivers

In recent months, the Trump administration rescinded HRSN guidance issued by the Biden administration and announced it would be phasing out DSHP funding authority. Neither action affects currently approved / existing waivers but both may limit new HRSN / SDOH state waiver requests or waiver extension requests. CMS indicates in its March 2025 letter that rescinding HRSN guidance does not nullify existing HRSN approvals but going forward they will consider HRSN / SDOH requests on a “case-by-case” basis. The Trump administration also announced in April 2025 that it does not intend to approve new or extend existing requests for federal matching funds for state expenditures for DSHP. The guidance also says it does not intend to renew a funding mechanism for state health programs specific to Tennessee’s waiver called “designated state investment programs” or DSIP, approved by the Trump administration in 2021 and renegotiated by the Biden administration in 2023. Similar to the 2017 letter, the 2025 letter notes that federal DSIP and DSHP funding have “appeared to serve primarily as a financing mechanism for states” rather than as an integral part of demonstrations. The CMS press release said that “DSHPs and DSIPs have grown from approximately $886 million in 2019 to nearly $2.7 billion in eligible expenditures in 2025, representing increasing costs to the federal government without a sustainable state contribution.” Phasing out DSHP authority may limit states’ ability to finance new 1115 initiatives.

Future waiver approvals and CMS guidance will provide additional insight into the waiver priorities and financing approach of the new Trump administration.  With regard to waiver financing, in addition to phasing out DSHP the first Trump administration made other changes to 1115 waiver budget neutrality policy in 2018 designed to limit the amount of federal funds that could be used for waiver spending. Limits included changing the amount of savings states can carry over between demonstrations and establishing new rules on spending trend rates used in budget neutrality calculations. The Biden administration made changes to Section 1115 budget neutrality policies that provided greater flexibility for states to design and implement 1115 demonstration programs, including HRSN initiatives (such as not requiring offsetting savings for HRSN services). More broadly, the first Trump administration’s Section 1115 waiver policy emphasized work requirements – which were challenged in court – and other eligibility restrictions and capped financing. Since the Trump administration has taken office, some states are again pursuing Medicaid work requirements through Medicaid demonstration waivers. Work requirements in Medicaid are also being considered as part of a broader federal legislative package of potential changes to Medicaid designed to significantly reduce federal Medicaid spending. The future of work requirement waivers may depend on the outcome of these legislative debates, as legislation may mandate work requirements.

This fact sheet provides a historical overview of U.S. funding for global health by program area over the past decade. Funding totals are based on amounts specified by Congress in annual appropriations bills, as well as some amounts that are determined at the agency level. See our Budget Tracker for more detail on historical funding and our Budget Summaries for the latest on ongoing appropriations discussions.

U.S. Global Health Budget: Overview

The U.S. Government is the largest donor to global health in the world and includes support for both disease (HIV, tuberculosis, malaria, and neglected tropical diseases) and population (maternal and child health, nutrition, and family planning and reproductive health) specific activities as well as global health security. Most U.S. funding for global health is provided bilaterally (approximately 80%). Of the multilateral share, the majority is provided to The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). The U.S. investment in global health grew significantly in the early 2000s, largely due to the creation of new initiatives including the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI). However, over the last decade, U.S. funding for global health has remained relatively flat, with spikes in some years due to emergency supplemental funding for disease outbreaks, including Ebola, Zika, and COVID-19. In FY 2025, global health funding was provided through a continuing resolution (CR) which maintained the prior year (FY 2024) amount of $12.4 billion.

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U.S. Global Health Budget: Global HIV Funding, Including PEPFAR

The U.S. first provided funding to address the global HIV epidemic in 1986. U.S. efforts and funding increased slowly over time until the launch of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, which initiated a period of significant increases and is the largest effort devoted to a single disease in the world. The majority of U.S. global HIV funding is for PEPFAR bilateral efforts (89%) with additional funding for UNAIDS and international HIV research activities. As part of its global HIV response, the U.S. also provides funding to the Global Fund (see below for details). PEPFAR funding is specified by Congress in annual appropriations bills and is largely provided to the Department of State, which is responsible, through the Bureau for Global Health Security and Diplomacy (GHSD), for coordinating all U.S. programs, activities, and funding for global HIV efforts. Other agencies that receive HIV funding under PEPFAR include the U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and Department of Defense (DoD). In addition, the National Institutes of Health (NIH) supports international HIV research activities, (funding which is not counted as part of PEPFAR). Global HIV funding through regular appropriations¹  has historically accounted for the largest share of the U.S. global health budget (ranging from 42% to 50% between FY 2016 and FY 2025). In FY 2025, global HIV funding was provided through a continuing resolution, which maintained the prior year (FY 2024) amount and totaled $5.4 billion, of which $4.9 billion is for PEPFAR²  ($4.8 billion for bilateral HIV and $50 million for UNAIDS), and approximately $575 million is for international HIV research activities at NIH.

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U.S. Global Health Budget: Tuberculosis (TB)

Since 1998, when the U.S. Agency for International Development (USAID) began a global tuberculosis (TB) control program, U.S. involvement in global TB efforts has grown and it is now one of the largest donors to global TB control in the world. U.S. bilateral TB funding is provided through USAID and includes U.S. contributions to the TB Drug Facility (additional U.S. support for TB activities is provided through its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria). U.S. funding for TB has grown over the past decade, with much of the increase occurring in more recent years. U.S. funding for TB rose from $240 million in FY 2016 to $406 million in FY 2025 and currently accounts for approximately 3% of the U.S. global health budget. FY 2025 funding was provided through a continuing resolution, which maintained the prior year (FY 2024) amount.

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U.S. Global Health Budget: Malaria/PMI

The U.S. government has been involved in global malaria activities since the 1950s and, today, is the second largest donor to global malaria efforts in the world (the largest is the Global Fund to Fight AIDS, Tuberculosis and Malaria). The U.S. response to malaria is driven by the President’s Malaria Initiative (PMI), an interagency initiative to address global malaria that was led by the U.S. Agency for International Development (USAID), and co-implemented together with the Centers for Disease Control and Prevention (CDC), with additional activities provided by the National Institutes of Health (NIH) and Department of Defense (DoD). In addition to its bilateral programs, the U.S. also supports malaria programs through its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. U.S. bilateral funding for malaria increased over the past decade from $873 million in FY 2016 to approximately $1 billion in FY 2025; while funding increased over the period, it has been relatively flat in recent years. In FY 2025, malaria accounted for 9% of the U.S. global health budget. FY 2025 funding was provided through a continuing resolution, which maintained the prior year (FY 2024) amount.

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U.S. Global Health Budget: The Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is an independent, public-private, multilateral institution which finances HIV, TB, and malaria programs in low- and middle-income countries. The Global Fund receives contributions from public and private donors and in turn provides funding to countries based on country-defined proposals. The U.S. provided the Global Fund with its founding contribution in 2001 and has since been its largest single donor (U.S. contributions to the Global Fund are counted as part of PEPFAR). However, Congress places a number of restrictions on U.S. contributions, including a funding match requirement that limits the amount the U.S. can contribute. The U.S. contribution to the Global Fund through regular appropriations has fluctuated over the past decade but reached its highest level to date ($2.0 billion) in FY 2023. In FY 2025, funding for the Global Fund was $1.7 billion, flat compared to the FY 2024 level, as funding was carried over due to the continuing resolution, and $375 million less than the FY 2023 level, though Congress stated the decline was due to the funding match requirement that limits the amount the U.S. can contribute. In addition to regular appropriations, Congress provided $3.5 billion in emergency supplemental funding to the Global Fund to address the impacts of COVID-19 on HIV programs in FY 2021.

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U.S. Global Health Budget: Maternal & Child Health (MCH)

The U.S. has been involved in Maternal & Child Health (MCH) efforts since the 1960s (and is the largest donor government to MCH activities in the world). MCH funding, which includes funding for polio and U.S. contributions to Gavi, the Vaccine Alliance (GAVI) and the United Nations Children’s Fund (UNICEF), is provided through the U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and the State Department. U.S. funding for MCH increased slightly from $1.14 billion in FY 2016 to $1.30 billion in FY 2025. This was primarily driven by increased funding to GAVI and polio during the period. In fact, when these are removed, bilateral MCH funding has remained relatively level for several years over the period. In FY 2025, MCH accounted for the third largest share of U.S. funding for global health (10%). FY 2025 funding was provided through a continuing resolution, which maintained the prior year (FY 2024) amount.

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U.S. Global Health Budget: Nutrition

The U.S. has a long history of supporting global efforts to improve nutrition and is the largest donor to nutrition efforts in the world. Historically, support for U.S. global nutrition activities was included as part of broader maternal and child health (MCH) funding; starting in 2010, Congress began to designate funding for nutrition activities, all of which is provided through the U.S. Agency for International Development (USAID).³  U.S. funding for nutrition increased from $144 million in FY 2016 to $165 million in FY 2025 and has accounted for approximately 1% of the total U.S. global health budget over the period. FY 2025 funding was provided through a continuing resolution, which maintained the prior year (FY 2024) amount.

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U.S. Global Health Budget: Family Planning & Reproductive Health (FP/RH)

The U.S. has been involved in Family Planning & Reproductive Health (FP/RH) efforts since the 1960s and is currently the largest donor to global FP/RH in the world. The majority of U.S. FP/RH funding is provided through the U.S. Agency for International Development (USAID) for bilateral activities, with additional funding provided through the State Department for the U.S. contribution to the United Nations Population Fund (UNFPA).⁴  U.S. funding for FP/RH rose steadily in its first two decades⁵  and more recently, has remained relatively flat at just about $600 million, accounting for approximately 5-6% of the U.S. global health budget each year from FY 2016-FY 2025. FY 2025 funding was provided through a continuing resolution, which maintained the prior year (FY 2024) amount.

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U.S. Global Health Budget: Global Health Security

Since the 1990s, there has been growing concern about new infectious diseases that threaten human health including, in more recent years, the emergence and spread of threats such as Ebola, Zika, H1N1 influenza, COVID-19, and antibiotic resistance. U.S. global health security efforts aim to reduce the threat of emerging infectious diseases by supporting preparedness, detection, and response capabilities worldwide. Funding designated by Congress for global health security through both emergency and regular appropriations has fluctuated over time, rising largely in response to outbreaks, including Ebola, Zika, and COVID-19.⁶  The share of global health funding that global health security represents has increased over time, rising from 4% in FY 2016 to 10% in FY 2025. In FY 2025, funding for global health security was $1.3 billion. FY 2025 funding was provided through a continuing resolution, which maintained the prior year (FY 2024) amount.

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U.S. Global Health Budget: Neglected Tropical Diseases (NTDs)

NTDs are a group of parasitic, bacterial, and viral infectious diseases that primarily affect the most impoverished and vulnerable populations in the world. The U.S. Congress first designated funding to address NTDs in 2006, through the U.S. Agency for International Development (USAID).⁷  Funding was flat at around $100 million for several years before rising to a peak of $115 million in FY 2023 and remained flat in FY 2024 and FY 2025. Funding for NTDs accounts for a relatively small share of the U.S. global health budget (1% in FY 2025). FY 2025 funding was provided through a continuing resolution, which maintained the prior year (FY 2024) amount.

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1. In addition to regular appropriations, Congress provided $250 million in emergency supplemental funding to address the impacts of COVID-19 on U.S. bilateral HIV programs in FY 2021. ↩︎
2. Total PEPFAR funding in FY 2025 is $6.5 billion ($4.8 billion for bilateral HIV, $50 million for UNAIDS, and $1.7 billion for the Global Fund). ↩︎
3. Totals do not include funding provided through Food for Peace (FFP) due to the unique nature of the program. ↩︎
4. Under current law, any U.S. funding withheld from UNFPA is to be made available to other family planning, maternal health, and reproductive health activities (see the KFF fact sheet on U.S. government international family planning and reproductive health statutory requirements and policies). ↩︎
5. PAI. Cents and Sensibility: U.S. International Family Planning Assistance from 1965 to the Present. Accessed September 2022 at https://pai.org/cents-and-sensibility. ↩︎
6. In FY15, Congress provided $5.4 billion in emergency funding to address the Ebola outbreak, of which $909.0 million was specifically designated for global health security. In FY16, Congress provided $1.1 billion in emergency funding to address the Zika outbreak, of which $145.5 million was specifically designated for global health security. In FY18, Congress provided $100 million in unspent Emergency Ebola funding for “programs to accelerate the capabilities of targeted countries to prevent, detect, and respond to infectious disease outbreaks.” In FY19, Congress provided $38 million in unspent Emergency Ebola funding for “programs to accelerate the capacities of targeted countries to prevent, detect, and respond to infectious disease outbreaks.” In FY20, Congress provided $1.235 billion in emergency COVID-19 funding to “prevent, prepare for, and respond to coronavirus” globally, and in FY21, Congress provided $9.4 billion in emergency COVID-19 funding “to prevent, prepare for, and respond to coronavirus, including for vaccine procurement and delivery.” While none of the FY20 funding was designated for global health security, all of the FY21 funding provided through CDC ($750 million) was designated by CDC as global health security. ↩︎
7. Additional NTD funding is used for NTD research at the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH), although this funding is not specified by Congress. ↩︎