U.S. cuts to global health funding are putting reproductive rights, healthcare access and human rights at risk worldwide. Human rights experts discuss exactly what’s happening—and what would stop the suffering.
The U.S. has long been the largest donor to global health programs, but under the Trump administration, that support is rapidly disappearing. The resulting funding cuts are devastating reproductive health access, disease prevention efforts and human rights around the world.
In this Q&A, global health and human rights experts Jaime M. Gher, Payal Shah and Floriane Borel break down the global ripple effects—and the urgent need for action.
Jaime Gher: To understand the United States’ cuts to foreign aid, we should first take a broad view of the devastating impacts. What healthcare services have been eliminated? How have these interrupted services affected levels of disease and death around the world?
Payal Shah: The Trump administration is claiming that it’s tackling waste, fraud and abuse. But what we are actually seeing around the world is that the impact of these cuts have been incredibly wasteful, fraudulent and abusive. The administration’s actions are allowing children and pregnant women to die of preventable causes, jeopardizing stockpiles of life-saving medical supplies, and reversing decades of global health progress.
Physicians for Human Rights has done studies on the U.S. aid cuts across the Democratic Republic of the Congo, Kenya, Ethiopia, Uganda and Tanzania. And what we’re seeing across the board is really devastating stories of preventable health harm. If you’re the parent of a child who has died from malaria, if you’re a pregnant woman who can’t prevent HIV transmission to your child, if you’re a health worker who hasn’t received your salary in months, the early impacts of the Trump aid cuts have already been devastating.
Yet it’s important to underscore that it’s not too late to try to reverse some of these trends. The infrastructure responsible for decades of progress on global health can still be salvaged. Clinics are still standing, health workers are still trained. And if the funding were restored, we could still make a concrete impact and prevent the kinds of death and suffering that we’ve been seeing.
The administration’s actions are allowing children and pregnant women to die of preventable causes, jeopardizing stockpiles of life-saving medical supplies, and reversing decades of global health progress.
Payal Shah, Physicians for Human Rights
Gher: News recently broke that the Trump administration is trying to destroy a nearly $10 million stockpile of contraceptives. How does this fit within the administration’s broader attack on reproductive healthcare?
Floriane Borel: So these contraceptive products were already bought and paid for by American taxpayers and intended for distribution in low and middle-income countries. But right now they still remain in limbo, in a warehouse in Belgium. These contraceptives alone could have provided pregnancy prevention to nearly 1.6 million women in low and middle-income countries. But this is just one part of the story.
Our recent research estimates that, over the course of one year without U.S. global family planning funding, 47.6 million women and couples in low and middle-income countries will be denied modern contraceptives. This will result in about 17.1 million unintended pregnancies and 34,000 preventable pregnancy-related deaths worldwide.
This is about more than these specific supplies—it’s an attack on contraception more broadly. The U.S. State Department made that clear when they falsely claimed that the supplies could “potentially be abortifacients,” when what’s being destroyed are contraceptive methods that prevent unwanted pregnancies.
The antiabortion movement has long worked to deliberately and inaccurately conflate contraception and abortion, and seeing this misleading language come from the U.S. State Department is very alarming. It’s a deliberate effort to confuse and stigmatize contraceptive use, and ultimately undermine reproductive autonomy and people’s ability to make decisions about their own bodies.
The antiabortion movement has long worked to deliberately and inaccurately conflate contraception and abortion, and seeing this misleading language come from the U.S. State Department is very alarming.
Floriane Borel, Guttmacher Institute
Gher: What are the impacts of these cuts beyond reproductive healthcare?
Shah: Some of those contraceptives, for example, are intended to go to countries like the Democratic Republic of the Congo, where ongoing fighting has led to thousands of cases of conflict-related sexual violence and risk of unintended pregnancies. Providing healthcare—including contraceptive access that would allow for prevention of such pregnancies—to these survivors is an area where the U.S. has historically led, and now we’re effectively abandoning women and girls in war zones.
These aid cuts are also intersecting with infectious disease prevention. This is really culminating in a polycrisis that will make everyone, including Americans, less safe and less healthy.
For example, we’re seeing how aid cuts are leading to women feeling like they cannot continue healthy pregnancies if they’re HIV positive and they no longer have access to the medications that would prevent mother-to-child transmission. This is the story of a woman we documented in Tanzania.
I’m also hearing from our researchers that LGBTQIA+ individuals in some countries were reporting an increase in stigma, fear and violence when seeking healthcare following the global aid cuts, at times accompanied by language invoking President Trump’s name. It’s really chilling to think about how these policy changes are coming together to translate into very direct acts of violence.
Gher: The Trump administration has also defunded and disengaged from the United Nations and other international institutions. Where exactly are they disengaging, and how is this affecting access to sexual and reproductive healthcare?
Borel: So in some cases, yes, they’re completely withdrawing from U.N. agencies and creating massive funding shortfalls that are extremely harmful. But there are also these political forums where they’re staying engaged and actively trying to undo progress on certain agreements.
Starting with the disengagement, the Trump administration abruptly terminated 48 grants to the United Nations Population Fund (UNFPA), which totaled $377 million. This happened despite UNFPA having a humanitarian waiver from the government to continue delivering lifesaving services, including family planning, during the aid freeze. Then, a few months after the stop-work order came out, they moved to prohibit any future funding to UNFPA as well.
They also withdrew from the World Health Organization. The full withdrawal process will take a year, but we know already that withdrawing from the WHO is going to mean a significant shortfall in the budget, since the U.S. was its largest contributor. They also withdrew from UNESCO, the main U.N. body advancing global cooperation on education, science and combating discrimination and hate speech.
But as I was saying, there are some areas where the administration has remained engaged in disrupting processes. Significantly, they have signed back on to the Geneva Consensus Declaration, which is an anti-abortion framework that they’re trying to make sound like an official U.N. document. But it’s just an anti-gender, anti-human rights declaration.
There’s a long list of examples of this administration’s disruptive behaviors over the last nine months, but a particularly interesting one is when Secretary of Health and Human Services Robert F. Kennedy Jr. showed up to the U.N. General Assembly’s high-level U.N. meeting on non-communicable diseases (NCDs) a few weeks ago. NCDs encompass a wide range of diseases that affect everyone, including heart disease, diabetes, respiratory illnesses and mental health conditions.
There is strong consensus amongst U.N. member states that NCD prevention and control is a global health priority, and they had planned to adopt a consensus declaration on integrating care for these diseases into health systems. The declaration had been negotiated for months and Secretary Kennedy abruptly withdrew U.S. support for it on the day of the high-level meeting, citing, without basis, the text’s support for abortion rights.
Gher: Can you talk a little bit more about the Geneva Consensus Declaration? How did it come to be, and what are its potential impacts?
Borel: I feel like the most important thing to convey is that the name of it does not reflect what it actually is. It’s this kind of political statement that the administration wants to pass off as a legal declaration in order to undermine the basic norms that have developed over the last 30 years on gender equality, sexual and reproductive rights, LGBTQ rights and more. The GCD was initiated under the first Trump administration to try to push countries to advance a hostile agenda in various U.N. forums, but it was never officially adopted by any U.N. body.
Many of the governments that signed are known to be hostile to human rights. But there are some who signed on who also have legal frameworks that protect various aspects of sexual and reproductive health and rights, or that made progressive commitments in other forums. Other countries, such as Brazil, signed and then withdrew following domestic political change. After taking office in 2021, the Biden administration even removed the U.S. from the list of signatories, so it goes to show how governments can sign on and off very freely.
It will be important for all of us to closely monitor how the second Trump administration decides to deploy the GCD, particularly given some worries that the State Department might more aggressively push other countries to sign on as they are negotiating foreign aid agreements. That would be devastating.
Gher: The Trump administration is reportedly looking to expand the global gag rule, which blocks organizations that receive certain U.S. funds from offering any abortion services. What would this expansion look like?
Borel: As we know, the global gag rule was reinstated on week 1 of the second Trump administration. I can’t imagine looking at the devastation wrought by this policy and thinking, “This doesn’t go hard enough.” But that is where we’re at. The first Trump administration already expanded it, and now they’re looking to go further.
Based on Project 2025 and what the State Department has recently previewed, we anticipate that all foreign aid except military assistance would be included in the expanded ban. This would encompass programs run by U.S.-based organizations, U.N. partners, other governments and more. Basically, recipients of any foreign aid would be barred from supporting not only abortion and gender-affirming care, but also gender equity efforts, LGBTQ programs, and anything else the Trump administration thinks is “DEI.”
Gher: We have human rights to health, non-discrimination, freedom from torture and cruel, inhuman and degrading treatment and more. How do these rights protect access to reproductive healthcare and what is the long-term impact of cuts in U.S. foreign assistance on the realization of these rights abroad?
Payal Shah: We know that the abrupt suspension of global health aid from the United States, as well as from others, is leading to a retrogression in the realization of the right to health, the right to life, and other human rights globally, particularly in countries that were significant recipients of U.S. aid.
Countries around the world relied on decades of U.S. funding and leadership to provide aid to their people–and they never would have expected that this funding would end without any notice at all. The sudden stop in aid made it all but impossible for states to move quickly enough to prevent deaths and suffering. Under a legal principle known as “legitimate expectation”—which is a robust legal concept in common law countries like South Africa—one can argue that the U.S. may be accountable for the harm caused even if the contracts are technically structured to allow such a drastic termination of grants.
Under international human rights law, the U.S. and other international donor governments are understood to have obligations to support countries in their progressive realization of human rights. While the U.S. hasn’t ratified this treaty, it is a signatory and therefore is obligated not to violate its object and purpose—including by abruptly stopping aid.
For example, the International Covenant on Economic, Social and Cultural Rights includes a duty that high-income states have to support the progressive realization of health rights in resource-limited settings. The International Covenant on Civil and Political Rights talks about states having an obligation under the right to life to take positive steps to avoid foreseeable and preventable deaths. It also affirms the obligation of states to respect and ensure the rights of all.
So there is a really significant human rights impact of the U.S. cuts. All countries have an obligation to promote the realization of these rights. In addition to high-income countries providing funding, it is also critical that these countries, along with countries that were receiving this funding, continue to prioritize identifying solutions to fill the gap.
Gher: So let’s turn to that. The U.S. government has historically been the largest donor to global health funding. Following the announcement of these cuts, have other countries offered to step in and fill the gap? If not, how should these governments and the broader international community restore funding?
Borel: This is an acute crisis brought on by the U.S., but it’s also a product of backlash against reproductive healthcare that was happening before. And other governments are not stepping up in the way we would like them to.
In addition to the loss of the U.S. funding, we’re seeing other historically strong donor countries announce cuts to international development funding. The Netherlands announced plans to cut aid by up to two-thirds by 2027. And the United Kingdom announced cuts to fund higher defense spending. These countries and the U.S. together provide about 70 percent of all global donor funding for family planning.
In terms of a path forward, we need to rebuild global health infrastructure and the way it’s financed. This means diversified financing mechanisms to reduce reliance on politicized donor aid, which many low- and middle-income countries have come to depend on.
There are also conversations starting to gain momentum about how to strengthen health systems through more efficient care delivery models. One example is the recently-launched Push Campaign led by a global alliance of midwives and other advocates to better embed midwifery and women-centered models of care into current health systems.
Shah: To address these cuts, donor governments should, in the short term, honor their existing commitments to global health funding and extend aid to include bridge funding to ensure continuity of services. They should also support phased handover strategies to prevent catastrophic disruptions to health services.
This also requires empowering, engaging and promoting leadership from regional health systems like the Africa Centers for Disease Control and Prevention, which really needs to step up to ensure effective tracking. Because we’re not just seeing a lack of services—we’re seeing a lack of health monitoring. We have no idea what the full impact of these cuts is because they are not being systematically documented—the systems that were allowing for documentation are part of what’s being destroyed.
International collaboration is also needed to ensure global coordination and cooperation, to close funding gaps, improve service delivery and protect health-related rights. This is affecting millions of people, and that cannot be overstated. The global community must tackle this issue as a global human rights crisis.
Jaime M. Gher, JD, LLM, is a senior legal advisor with the Global Justice Center, supporting national-level strategy development and advocacy to promote safe abortion access for all. She is a reproductive justice lawyer with over two decades of research, litigation and advocacy experience working within international and national NGOs, as an independent consultant and within the private sector.
Payal Shah is a global legal expert on health, gender and human rights and currently serves as director of research, legal and advocacy at Physicians for Human Rights (PHR). She previously directed PHR’s Program on Sexual Violence in Conflict Zones and led the Asia program at the Center for Reproductive Rights. Shah has documented and promoted accountability for gender-based violence, attacks on health, and reproductive rights violations in countries including India, the Philippines, the U.S., Ethiopia, Syria, Nepal, the DRC and Kenya.
Floriane Borel is the senior global policy associate at the Guttmacher Institute, where she brings policy analysis and Guttmacher data to global and regional discussions on sexual and reproductive health and rights, and leads the organization’s engagement with U.N. forums. Borel has 10 years of experience in international human rights advocacy. Before joining Guttmacher, she was a U.N. advocacy officer at Human Rights Watch in Geneva and New York, covering a range of issues before the Human Rights Council, General Assembly and Security Council, including women’s rights in humanitarian settings and LGBTI+ rights. She also worked at the Center for Reproductive Rights, advancing SRHR norms within U.N. and European human rights mechanisms. Borel holds a master’s in international human rights and humanitarian law from the University of Essex and is based in New York City.
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