Why the US aid cuts are a moment to prioritize reproductive health

Amid USAID’s dismantling, the narrative around reproductive health and family planning needs to change, making it more central to global development, a panel of experts told Devex. The recent U.S. aid cuts “are a wake-up call to say, ‘Why have we not been prioritizing health financing in general and reproductive health financing in particular?’” said Dr. Samukeliso Dube, executive director of FP2030, at a Devex event last week in Geneva, Switzerland, during the World Health Assembly. “It’s about human beings,” she said. “So why do we deprioritize it when it’s inconvenient?” Dube noted that the U.S. has traditionally provided about 30% of all global health funding and 40% of family planning funding. If that aid is not replaced, the next five years could see an additional 34,000 maternal deaths, 17.1 million unintended pregnancies, and 116,000 unsafe abortions, according to FP2030. This year, her organization has launched a campaign called “Made Possible by Family Planning” to raise awareness of reproductive health and to raise $1 billion from governments and others by the end of the year. Another goal of the campaign is to mainstream family planning as a core part of development, Dube said. Dube emphasized that preventative care must include reproductive health, and must be prioritized. For example, she and another panelist suggested that coverage for contraception could be included in national health care schemes. The recent dismantling of USAID is also interrupting the system that global family planning service delivery relies on — such as data systems, supply chains, health workers, and innovation. Global reproductive health organizations also went through a rough patch during the first administration of U.S. President Donald Trump, in which foreign NGOs were required to comply with the “Mexico City Policy,” aka the global gag rule. That meant certifying they would not “perform or actively promote abortion as a method of family planning” using funds from any source — including non-U.S. funds — as a condition of receiving U.S. global family planning assistance. The first Trump administration expanded the condition to most other U.S. global health assistance. Though the policy was rescinded under the Biden administration, Donald Trump reinstated it in the opening days of his second term this January. MSI Reproductive Choices, a global NGO that provides abortions, opposed the Mexico City Policy, refused to sign the policy, and lost its U.S. funding as a result. Seventeen percent of its income in 2017 came from USAID contracts, according to Susan Camara, the organization’s head of European Union programs, who was also on the Devex panel. “It was a huge hit financially,” she said. “But it was also a lesson: We realized we needed to diversify our funding. We’ve worked with philanthropic donors … and we also have a social enterprise model where we work in the private sector and we generate income and we use that to subsidize services for women and girls who can’t pay.”