The funding cuts that could endanger Rohingya refugee mothers

In Cox’s Bazar refugee camp, Zanat, a 20-year-old Rohingya refugee, recently gave birth to a healthy baby girl. Both she and her newborn, who was born in a primary care center, were among the lucky few to access maternal care. Many are unable to. While accurate figures are difficult to parse due to the high number of home births, official figures indicate that 84 mothers died out of approximately 30,000 recorded births in the camp in 2023. Those numbers could rise not just in Cox’s Bazar but globally, amid the aid budget cuts expected as the Trump administration takes the reins in the United States, according to experts. The U.S. allocated $608 million in family planning and reproductive health funding in 2023 — funding that’s expected to be in jeopardy when Donald Trump is sworn in as U.S. president next week. Meanwhile, several other countries have reduced their aid budgets amid economic cutbacks. “This is new territory and the impact of that is going to be huge, particularly for humanitarian programming,” said Sarah Shaw, associate director of advocacy at reproductive health care organization MSI Reproductive Choices, which estimates it will lose $20 million of its funding under the Trump administration — a loss that Shaw says would be “catastrophic.” President-elect Donald Trump has already talked about his plans for an “America First” agenda and “efficiency” cuts, which indicate a reduction in the foreign aid budget. For several years, including 2024, the U.S. has been the biggest donor to the Cox’s Bazar humanitarian crisis. Some are also predicting that the United Nations, which funded $24 million or 4% of the Rohingya Humanitarian Crisis Joint Response Plan 2023, will also be defunded by the U.S. while UNFPA, the U.N.’s sexual and reproductive health agency, in particular, could be acutely affected. During the last Trump presidency, from 2017-2021, the State Department withdrew its funding, an estimated annual $69 million, from this agency but that loss is estimated to climb to $160 million this time around. UNFPA provides crucial sexual and reproductive health and gender-based violence services, reaching over 250,000 people each year within Cox’s Bazar alone. “The Trump government will try to cut funding to organizations like UNFPA and others that support access to family planning and SRHR,” said Jean-Claude Mulunda, director of Ipas Democratic Republic of Congo, explaining that the U.S. Agency for International Development is also a big help in terms of access to family planning commodities and anything to jeopardize that will be felt globally. More women will die in childbirth around the world as a result of these cuts, Mulunda said. It’s thought that under Trump’s second presidency, further barriers will also be implemented to abortion access. The last Trump presidency brought the implementation of the global gag rule, which saw an end of U.S. funding to NGOs working on sexual and reproductive health and rights, or SRHR, services globally. Cox’s Bazar is home to nearly 1 million refugees currently seeking shelter in Bangladesh, the majority having arrived in 2017 when the Myanmar military launched an assault against the ethnic Rohingya minority. Maternal mortality is 44% higher within the camps than in the general population of Bangladesh. That’s largely due to delayed access to care and limited resources, said Sumana Akter, a midwife based at a camp hospital that specializes in treating labor complications. “I have sometimes seen mothers who had labor pains at midnight but then will not reach the facility until the next day [at] 6 p.m., not even early morning or anything,” she said. Many do not know that they should even be accessing prenatal care, she explained — and the delays due to that knowledge gap can lead to life-threatening complications such as obstetric hemorrhage, the biggest cause of death among mothers in the camp. According to UNICEF, only 1 in 5 mothers gives birth in a health center inside Cox's Bazar. Home birth brings an added risk in the unsanitary one-roomed bamboo camp shelters, while a lack of medical care can mean conditions such as hypertension go undiagnosed. At the same time, the high rates of child marriage and gender-based violence in the camp mean more early pregnancies, which themselves are higher risk. Numerous health facilities run by UNFPA as well as NGOs such as Médecins Sans Frontières, Ipas, and RTM International, have been working over the years to reduce maternal mortality. The Rohingya refugee community has in the past lacked access to education about women’s health and the needs of pregnant people. But Faheem Hussain of Arizona State University, who has conducted research on Rohingya refugees, said, “Over this last six, seven years, I have seen societal changes, where women of Rohingya origin are coming out of their homes or shelters and taking charge.” That could all be jeopardized if the overall budgets and limited resources these NGOs have are further diminished, he said. As it stands, there are already shifts, said Akter, when the ward sees more patients than it can accommodate. In the hospital where she works, there are only three beds in the labor ward — sometimes only enough for half the women in active labor. 20 minutes away in one of the primary health centers, Zanat and her baby girl were given one of only four beds in the health center maternity ward. Funding impacts “Everybody knows the importance of midwives, the work they are doing, and the difference they are making in the community,” said Akter. “I don’t understand why somebody would not fund a midwife considering the important work they are doing.” But it may simply be an effect of fewer available resources. The Rohingya Humanitarian Crisis Joint Response Plan 2024 was already only half funded last year, while in 2022-2023, the United Kingdom cut its funding to the Rohingya crisis by over 80% and funding to UNFPA by 60% in 2024. Last year, a $125 million funding shortfall meant that the World Food Programme was forced to reduce its food assistance to the camps. As it stands, “the Bangladesh government doesn’t have the resources themselves to provide this crucial support and if the U.S. cuts funding significantly or even moderately,” said Thomas Kean, senior consultant on Myanmar and Bangladesh at the International Crisis Group. Regardless of geopolitics, Kean said it is not realistic to expect funding to return to previous levels or even to be maintained at current levels, given the protracted nature of the refugee crisis. “Bangladesh is really going to have to confront this together with its partners… and allow the response to evolve in a way that makes it more sustainable and less reliant on external support,” said Kean, adding that that could look like allowing the Rohingya community to work so that they can support themselves and become less reliant on international aid. But ultimately, Hussain hopes the U.S. continues to support the Rohingya people. “I really hope that the U.S. keeps its course there and does more, for the sake of the people who are displaced.”