The U.S. Foreign Aid Suspension: A Public Health Crisis with a Gendered Impact in East & Southern Africa

By: Dr Thenjiwe Sisimayi

Introduction: A Policy Decision with Deep Gendered Consequences
The recent suspension of U.S. foreign aid is not just a financial setback for health systems in East and Southern Africa—it is a gendered crisis that disproportionately affects women, girls, and community health workers (CHWs). Countries like Kenya, Zambia, Ethiopia, and Mali rely heavily on U.S. funding to sustain HIV/AIDS programs, maternal and child health services, and gender-based violence (GBV) response efforts.

At Financing Alliance for Health (FAH), we have witnessed firsthand how donor-funded health programs transform the lives of vulnerable populations. The current aid suspension threatens to reverse decades of progress in public health, with women and girls facing the harshest consequences.

This is not merely a funding issue; it is a matter of gender equality, health equity, and human rights. Here is how the Suspension Worsens Gender Inequality in Health.

1. Increased Maternal Mortality and Unmet Reproductive Health Needs

U.S. foreign aid supports lifesaving maternal and child health services, including antenatal care (ANC), emergency obstetric care, and access to contraception. The suspension will likely lead to:

• Higher maternal mortality rates due to reduced access to skilled birth attendants and emergency obstetric care.
• Increased unintended pregnancies, particularly among adolescent girls, as family planning services face disruption.
• More unsafe abortions, especially in countries with restrictive abortion laws, as access to reproductive health services diminishes.

In Kenya and Zambia, U.S. funds support free maternity programs and family planning initiatives. Without alternative funding sources, women in poor and rural communities will have limited or no access to essential care.

2. Community Health Workers (CHWs) – The Backbone of Health Systems at Risk

Across Africa, CHWs—70% of whom are women—play a critical role in delivering healthcare to underserved communities. U.S. funding provides stipends, medical supplies, and training programs for these frontline health workers.

• In Ethiopia, CHWs serve as the first point of contact for women seeking prenatal care and contraceptives. With funding uncertainties, they face unpaid labor, resource shortages, and burnout.
• In Mali, CHWs provide home-based HIV care and malaria prevention services. The funding suspension jeopardizes these efforts, increasing preventable deaths among pregnant women and children.

Without donor support, many CHWs—predominantly women—may be forced to work without pay or abandon their roles entirely, deepening gendered economic inequality.

3. A Setback in the Fight Against HIV/AIDS – Women and Girls at the Center

The President’s Emergency Plan for AIDS Relief (PEPFAR) has been a cornerstone of HIV/AIDS prevention and treatment in Africa. However, women and adolescent girls remain the most vulnerable to new infections.

• In sub-Saharan Africa, young women (15-24) account for 63% of new HIV infections (UNAIDS, 2023).
• In Kenya, PEPFAR funds 70% of ART programs. The suspension could cause stock-outs of antiretroviral drugs, increasing mother-to-child transmission rates.
• In Zambia, U.S. funds support access to pre-exposure prophylaxis (PrEP) for high-risk populations. Without this funding, young women will face greater exposure to preventable infections.

This is not just a health issue—it is a gendered crisis that risks undoing years of progress in HIV prevention and care.

4. Gender-Based Violence (GBV) Response Services Under Threat

Women and girls experiencing domestic violence, sexual assault, and harmful practices rely on donor-funded GBV response services, such as:

• Rape crisis centers
• Emergency contraception and post-exposure prophylaxis (PEP) for sexual violence survivors
• Safe shelters for women fleeing abuse

The suspension of U.S. aid could lead to the closure of these critical services, leaving survivors with nowhere to turn. In Ethiopia and Mali—where GBV rates are already high—the lack of resources will trap more women and girls in cycles of violence and poverty.

5. Economic Consequences – Women Bear the Burden

As public health funding declines, the unpaid care burden shifts onto women. This results in:

• More women leaving paid employment to care for sick family members.
• Increased financial dependence on male partners, worsening economic inequality.
• Fewer income-generating opportunities, as donor-funded health jobs (such as CHWs and program coordinators) disappear.

Women—especially in rural areas—will bear a double burden: losing access to healthcare while taking on greater unpaid caregiving responsibilities.

A Call to Action: Urgent Steps to Protect Women’s Health and Rights

The U.S. foreign aid suspension is a wake-up call for African governments, development partners, and civil society organizations to:

1. Prioritize Domestic Health Financing for Gender-Responsive Services

• Governments must increase national health budgets to reduce donor dependency.
• Implement gender-responsive budgeting (GRB) to ensure women’s health needs are central to policy and funding decisions.

2. Strengthen Regional Collaboration for Sustainable Health Systems

• The African Union (AU), ECOWAS, and SADC must take leadership in mobilizing regional health financing.
• Cross-country supply chains for essential medicines must be developed to reduce reliance on single-donor funding.

3. Invest in Women-Led and Community-Based Health Solutions

• Support women-led health enterprises that provide affordable maternal and reproductive health services.
• Partner with grassroots women’s organizations to strengthen GBV prevention and response efforts.

4. Hold International Donors Accountable for Gender-Equitable Funding

• Advocate for the U.S. to prioritize gender-equitable funding, even amid financial constraints.
• Explore alternative funding mechanisms, including private-sector partnerships and South-South cooperation, to sustain gender-focused programs.

Conclusion: A Gender-Just Approach to Health Financing is Essential

The U.S. aid suspension is not just a budgetary challenge—it is a gendered crisis with life-or-death consequences for millions of women and girls. Without urgent action, we risk losing decades of progress in maternal health, HIV/AIDS response, CHW support, and GBV prevention.

At FAH, we urge governments, donors, and civil society to act decisively to protect women’s health, economic security, and human rights. This is about more than just sustaining health programs—it is about advancing equity, justice, and the right to health for all.

Now is the time to invest in women, prioritize gender equity, and build resilient health systems that are not solely dependent on external funding.

Join the Conversation

How can African countries better protect women’s health amid funding uncertainties? Share your thoughts in the comments. Let’s push for sustainable, gender-responsive solutions.

References

• UNAIDS (2023). Global HIV/AIDS Statistics.
• Kenya Ministry of Health (2023). National Health Financing Report.
• UNFPA (2023). State of World Population Report.
• World Bank (2023). Health Expenditure Trends in Africa.
• PEPFAR (2022). Annual Report to Congress.