‘There is anger’: UK aid cuts leave sexual health pledge in tatters

From his base in Kenya, Dr. Elias Girma contemplates the impact of U.K. aid cuts on promises to provide lifesaving contraception and family planning across East Africa. “Absolutely there is anger, it’s an injustice,” he says. “It will mean continuing the cycle of poverty, adolescents not being able to delay having a child, perhaps suffering the complications of an unsafe abortion, protracted illness, and possibly death.” The U.K. announced a third year of aid cuts in July, and Girma — director of the Women's Integrated Sexual Health Programme, or WISH, a program funded by the United Kingdom to offer sexual and reproductive health services — has seen the consequences all too clearly. Girma is speaking as the International Planned Parenthood Federation, which runs WISH, reveals the cuts’ devastating consequences for its work to bring sexual and reproductive health services to women and girls in poor and remote areas. It is a tale of help withdrawn from 104 health facilities in Uganda and Madagascar, and the loss of 648 community health workers in Sudan — and of a program that has shrunk from a planned 18 countries to operating in just nine. The WISH program was born exactly five years ago when then-U.K. Prime Minister Theresa May herself was in Kenya to launch it. May’s government promised the initiative would “save countless girls’ lives.” “It is a tragedy that so many young girls are needlessly robbed of their education and career aspirations,” Harriett Baldwin, May’s minister for Africa, said when WISH was launched, noting that 18% of Kenyan girls become pregnant or are mothers by the age of 19. WISH would, the U.K. said, provide “life-saving voluntary contraception” to a further three million people in “at least 18 countries in Africa and Asia” to give girls and women “the choice on whether, when and how often to have children,” and therefore “prevent the deaths of around 20 women every day.” IPPF, a movement of 150 member associations and partners, is a lead provider of the WISH program — which means, five years on, a lead provider of what is left of the original vision. Funding for WISH peaked at £38.2 million ($48.6 million) in 2021-22, was slashed to £23.9 million in 2022-23, and dropped to £10.3 million in 2023-24. The latest move is expected to cause around 1,500 extra maternal deaths, the U.K. government admitted in an assessment released earlier this month by the Foreign, Commonwealth & Development Office. In the last two years, WISH has pulled out of Bangladesh, Zimbabwe, Zambia, Mozambique, Afghanistan, and Pakistan. Now, IPPF has shared stark figures with Devex to illustrate the impact of the slice-by-slice cuts in countries where the program continues. • In Uganda: Just 180 health facilities are supported — down from 257 in April 2022 — and only six mobile outreach services, a decline from 13 in 2018 and 10 in April last year. • In Sudan: In 2018, WISH funded 1,288 community health workers to provide family planning advice and distribute contraceptives, but that number has shrunk to 640. • In Madagascar: The program is run in just nine regions, down from 22 five years ago, supporting only 32 health facilities instead of 59. The cuts came as a shock, Girma said. “Suddenly we received the news that ‘Sorry we are stopping this program in these countries’ — it was as sudden as that.” Other organizations were sought by IPPF to bridge the gap, but “in reality, it doesn’t happen like that, because it takes time for other projects to take root.” Girma stresses how, for so many women in far-flung parts of the countries lacking supplies and information, “easy access to these services is a life-changing decision” — making the WISH focus on underserved areas “a great approach.” “We could support facilities that are weak in training, in medical equipment and in drugs, helping them with transport and with having a meal during the day, so they could take services to those communities,” he said. Now, “people we promised to reach can no longer access those services,” Girma added. “For many, many girls it may mean they have to get married, drop out of school. Then there are the complications that arise from unwanted pregnancies. … Unsafe abortion accounts for 30% of maternal deaths in most of these countries.” Girma urges U.K. ministers responsible for cutting funding for WISH to recognize the program is also “beneficial to them in the long run.” “By contributing to the jigsaw of national development, it reduces the long-term health burden for these countries and for the global community,” he said. “These investments are relatively small, but with significant long-term gains.” The U.K. government has described its 2021 cut to aid spending from 0.7% to 0.5% of gross national income as “temporary,” but under current economic forecasts, it will not be reversed before 2028. Bilateral aid is planned to rise from £1.58 billion this year to £2.69 billion in 2024-25, with Africa set to receive £1.36 billion, up from £646 million in this financial year, it said.