The United States is ending its financial support for family planning programs in developing countries, cutting nearly 50 million women off from access to contraception.

This policy change has attracted little attention amid the wholesale dismantling of U.S. foreign aid, but it stands to have enormous implications, including more maternal deaths and an overall increase in poverty. It derails an effort that had brought long-acting contraceptives to women in some of the poorest and most isolated parts of the world in recent years.

And in the U.S., the federal government has paused $27.5 million for organizations that provide family planning, contraception, cancer screenings and sexually transmitted infection services as it investigates whether they’re complying with the law.

The National Family Planning and Reproductive Health Association says 16 U.S. organizations received notice Monday that funding is on hold. At least 11 Planned Parenthood Federation of America regional affiliates and all recipients of federal family planning, or Title X, grants in seven states, had funding withheld.

Implications abroad

The United States provided about 40% of the funding governments contributed to family planning programs in 31 developing countries, some $600 million, in 2023, the last year for which data is available, according to KFF, a health research organization.

That funding provided contraceptive devices and the medical services to deliver them to more than 47 million women and couples, which is estimated to have averted 17.1 million unintended pregnancies and 5.2 million unsafe abortions, according to an analysis by the Guttmacher Institute, a sexual health research organization. Without this annual contribution, 34,000 women could die from preventable maternal deaths each year, the Guttmacher calculation concluded.

“The magnitude of the impact is mind-boggling,” said Marie Ba, who leads the coordination team for the Ouagadougou Partnership, an initiative to accelerate investments and access to family planning in nine West African countries.

The funding has been terminated as part of the Trump administration’s disassembling of the U.S. Agency for International Development. The State Department, into which the skeletal remains of USAID was absorbed Friday, did not reply to a request for comment on the decision to stop funding international family planning. Secretary of State Marco Rubio has described the terminated aid projects as wasteful and not aligned with U.S. strategic interest.

Support for family planning in the world’s poorest and most populous countries has been a consistent policy priority for both Democratic and Republican administrations for decades, seen as a bulwark against political instability. It also lowered the number of women seeking abortions.

Among the countries that will be significantly affected by the decision are Afghanistan, Ethiopia, Bangladesh, Yemen and Congo.

The money to support international family planning programs is appropriated by Congress and was extended in the most recent spending bill that keeps the government operating through September.

The Trump administration has also terminated funding for the United Nations’ sexual and reproductive health agency, UNFPA, which is the world’s largest procurer of contraceptives.

Stuck in transit

An estimated $27 million worth of family planning products already procured by USAID are stuck at different points in the delivery system — on boats, in ports, n warehouses — with no programs or employees left to unload them or hand them over to governments, according to a former USAID employee who was not authorized to speak to a reporter. One plan proposed by the new USAID leadership in Washington is for remaining employees to destroy them.

Supply chain management was a major focus for USAID, across all areas of health, and the United States paid to move contraceptive supplies such as hormonal implants, for example, from manufacturers in Thailand to the port in Mombasa, Kenya, from where they were taken by trucks to warehouses across East Africa and then to local clinics.

“To put the pieces back together is going to be very difficult,” said Dr. Natalia Kanem, executive director of UNFPA. “Already this has had a catastrophic impact — it’s literally affecting millions of women and families. The poorest countries don’t have the resilient buffer.”

In the U.S.

Regard the move to defund some family planning services in the U.S., the U.S. Department of Health and Human Services declined to say which laws or executive orders the groups are being investigated for violating, though the National Family Planning and Reproductive Health Association said some of the letters cited civil rights laws. President Donald Trump has issued executive orders targeting programs that consider race in any way, some of those orders have been put on hold by judges.

Health and Human Services, which is in the midst of deep layoffs, also said that “no final decisions on any spending changes for Planned Parenthood have been made.”

Republicans have long railed against the millions of dollars that flow every year to Planned Parenthood and its clinics, which offer abortions but also birth control, cancer and disease screenings, among other things. Federal law prohibits taxpayer dollars from paying for most abortions.

Providers said the impact on health care will especially hit lower-income people.

“We know what happens when health care providers cannot use Title X funding,” Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, said in a statement. “People across the country suffer, cancers go undetected, access to birth control is severely reduced, and the nation’s STI crisis worsens.”

This report contains information from the Associated Press.