Prossy Muyingo spent a dozen years as a well being employee in central Uganda. She’s been on the forefront of offering info and providers for reproductive, maternal and baby well being. U.S. assist cuts eradicated her wage.
Edward Echwalu for NPR
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Edward Echwalu for NPR
“I am in your veranda.”
That is the textual content Prossy Muyingo would get every evening for years, despatched by a 28-year-old standing outdoors her dwelling in central Uganda.
Instantly, Muyingo would pour a glass of water and, from the sideboard in her lounge, fetch a contraception tablet and convey it outdoors.
As a neighborhood well being employee, Prossy Muyingo stored contraception drugs in addition to HIV medicine inside a field in her lounge within the central Ugandan city of Mityana.
Edward Echwalu for NPR
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Edward Echwalu for NPR
“She was swallowing (the tablet) from my home,” explains Muyingo, who served as a neighborhood well being employee in Mityana District for 12 years. The lady had instructed Muyingo that she feared her husband would beat her if he knew about the contraception. “The person is ever asking for a kid,” the girl stated to Muyingo. She already had three kids and did not need one other one, not less than not proper now. So she used Muyingo’s dwelling as a spot to retailer and take her drugs. Muyingo has related preparations with many neighbors.
Now all of that has modified.
In September 2025, Muyingo misplaced her job. Her stipend had been paid for by U.S. overseas assist. Now, she says, as a substitute of offering contraception, she’s informally counseling neighbors by way of unintended pregnancies.
A historic disruption
Muyingo’s story is a part of what reproductive well being specialists are describing as the most important disruption ever to worldwide household planning efforts.
The second Trump administration has moved to remove packages for contraception and different household planning work overseas. Congress really appropriated funds for this work, however the administration has not spent it. And it has shut down packages aimed toward serving to individuals select when to have kids, reminiscent of efforts to enhance entry to contraception and supply assets for treating sexually transmitted illnesses. The difficulty right here shouldn’t be abortion. For greater than 50 yearsit has been unlawful for overseas assist to fund abortions.
Requested at a Congressional listening to about appropriations for household planning in Could 2025, Secretary of State Marco Rubio stated: “There is not any plan to spend that cash. We’re not going to be in that enterprise globally. We’re not going to do it.”
In addition to this public assertion, the change has occurred with out a lot fanfare. However the brand new strategy turns into clear by trying on the Trump administration’s finances paperwork and memos that present household planning has repeatedly been focused for cuts.
“Very disruptive, very vital”
For nicely over a decade, america has been the highest contributor to worldwide household planning and reproductive well being efforts, accountable for over 40% of donor funding worldwide to the tune of over $500 million.
Certainly, household planning had been a precedence for the reason that U.S. Company for Worldwide Improvement was first established in 1961.
The U.S. assist has modified tens of millions of lives. The Guttmacher Institute — a nonprofit analysis group that helps entry to household planning — estimates U.S. funds gave over 47 million girls and {couples} entry to trendy contraceptive care annually. That, in flip, prevented 17.1 million unintended pregnancies yearly and saved 34,000 lives as a result of girls and women didn’t die from issues throughout being pregnant or childbirth.
It has been a bipartisan endeavor, supported throughout Republican and Democratic administrations.
Now, with the sudden lack of packages, household planning work overseas is in jeopardy.
The Girls’s Refugee Fee, a non-governmental group, discovered that nearly 95% of U.S. overseas assist for sexual reproductive well being and household planning was minimize in 2025. One other reportfrom late 2025, by the Reproductive Well being Provides Coalition and its companions, estimates that in 2026 there shall be an enormous shortfall in funding wanted to supply contraceptives globally.
Because of the cuts rural clinics had been shuttered, neighborhood well being staff and nurse midwives fired and technical specialists pulled from ministries of well being. There are shortages of contraceptive implants and contraception drugs in addition to different associated drugs.
The repercussions for people and communities have been dramatic. “It has been large,” says Shyami de Silvaformer director of the Workplace of Inhabitants and Reproductive Well being on the now-dismantled USAID.
De Silva says the abruptness of the cuts compounded the impression on the 41 international locations the place the U.S. had supported household planning packages. “For the highest 5 (recipient) international locations — that are these very massive, high-need international locations principally in sub-Saharan Africa: Nigeria, Ethiopia, Uganda, Tanzania and the Democratic Republic of Congo — the loss was very disruptive, very vital,” she says.
“It is a actually difficult interval,” says Muyingo. Former neighborhood well being staff, she says, “are going through direct strain from neighborhood members who usually are not receiving providers. They let you know loads of issues, however you’ll be able to’t assist them. The bag in your again is empty — we do not have provides.”
“The USA mustn’t pay for the world’s contraception”
The irony is, the cash to assist household planning exists. Congress has appropriated nearly the identical sum as previously dozen years —$575 million for household planning and reproductive well being plus extra for the United Nations Inhabitants Fund.
However the appropriated cash “shouldn’t be being spent, and it’s not going out the door,” says Elizabeth Sullydirector of worldwide analysis on the Guttmacher Institute.
When NPR reached out to the State Division to make clear its present place on U.S. assist for household planning, it despatched a press release saying it “remains to be evaluating household planning packages and funding” for this fiscal yr.
Maybe the earliest proof of the Trump administration’s opposition to worldwide household planning work got here simply over every week after inauguration.
On Jan. 28, 2025, the State Division introduced a waiver aimed toward permitting lifesaving humanitarian assist to proceed regardless of the administration’s blanket pause on overseas assist. An emailed observe despatched to workers at USAID stated: “the waiver doesn’t prolong to actions associated to abortion providers, household planning, conferences.”
Of their Funds Request for fiscal yr 2027, launched this month, administration officers once more focused contraception as an space to chop within the international well being finances, saying “america mustn’t pay for the world’s contraception.” And in a listing of eradicated actions it highlighted “reproductive well being schooling and entry to contraception” in Ghana and “offering condoms and contraception in Kenya.”
The accompanying FY27 Congressional Funds Justification supplies a proof, saying “the Funds eliminates international well being actions that don’t make America safer, reminiscent of household planning and reproductive well being.”
In response to questions from NPR about funding for household planning, the State Division defended the administration’s modified place: “President Trump has restored widespread sense to U.S. overseas help. The American individuals anticipate their tax {dollars} to assist packages that save lives, advance U.S. pursuits, and replicate American values, not fund abortion-related actions, left-wing social agendas, or wasteful abroad bureaucracies.”
“We stand to learn”
However Shatha Elnakib — deputy director of the Heart for Humanitarian Well being on the Johns Hopkins College Faculty of Public Well being — takes concern with the Trump administration’s opposition to household planning work and their rationale. She says unmanaged inhabitants progress tends to result in instability and poverty, which finally, leads individuals emigrate to locations like Europe and the U.S. as they search a extra steady setting.
Up to now, she says, there was an understanding within the U.S. that “we stand to learn from having a wholesome international inhabitants.”
De Silva, who labored at USAID for 25 years by way of each Republican and Democratic administrations, factors out that entry to contraception is an efficient technique to scale back abortions and stop maternal deaths. “When the U.S. authorities is related to supporting live-saving care all over the world, we construct goodwill internationally and that makes us safer and stronger — that is the gentle energy a part of the overseas help argument.”
Nevertheless, some analysts suppose the U.S. stance remains to be evolving and might be extra nuanced than it appears.
Brett Schaefer is a senior fellow on the conservative American Enterprise Institute. He speculates that the administration might assist packages like condom distribution “the place it may be tied to combating HIV/AIDS and different sexually transmitted illnesses. I feel the administration could be supportive of these varieties of initiatives as a result of they do proceed to assist international well being.”
“I am now pregnant”
Sully — of the Guttmacher Institute — says it has been exhausting to gauge the repercussions of the cuts on the lives of people.
When the U.S. dramatically minimize overseas assist initially of President Trump’s second time period, it halted many surveys and data-gathering operations that used to make clear unintended pregnancies and unmet want for contraception. “It’s positively enjoying out. It is simply we do not have visibility into the way it’s enjoying out,” she says.
However there are eyewitnesses — like Muyingo in Uganda.
Working for a neighborhood nonprofit — and paid by a U.S. grant — she’d go house-to-house, checking on neighbors and appearing as a bridge between their well being facility and the neighborhood. She’d deal with many well being points: offering mattress nets to guard of us from malaria-carrying mosquitoes, teaching households on immunizations. When Muyingo realized that she misplaced her job, she knew she couldn’t cease her work.
“Now we’re not paid, however the coronary heart we had for our communities, that’s the solely factor pushing us (to maintain working),” she says. “These are our neighbors, the individuals we share our church buildings with, the borehole the place we fetch water.”
She began telling her former sufferers to go to the native clinic to get drugs, together with some type of contraception in the event that they needed it. However many would go away empty handed, she says. Some had been uncomfortable speaking to an unfamiliar clinician. Others discovered the contraception choices had been restricted and so they could not get the identical type of contraception as earlier than, having to change from, say, a tablet to an implant. And nonetheless others — just like the 28-year-old — frightened that ready within the lengthy traces would make their household suspicious about their absence from dwelling, Muyingo says.
“After two months, she realized: ‘I am now pregnant,'” Muyingo says. “Then I instructed her, ‘Are you certain?’ “
She was certain.
She confided in Muyingo that she was contemplating an abortion. Muyingo began worrying: “In Uganda, abortion is illegitimate. It is not allowed.”
“So I did loads of counseling for her to like her (being pregnant),” Muyingo says. Now the girl and her husband have a 3-month-old son.
Instantly after the beginning, Muyingo helped the mother get long-acting contraception within the type of an implant. She says that is one neighbor who will not want to fret about discovering contraception — not less than for just a few years.
