Dynamics of Foreign Aid: Global Sexual and Reproductive Health and Rights

This briefing examines the current dynamics of foreign aid for global sexual and reproduction health and rights. It looks at U.S. aid cuts, the reactions of donor governments and multilateral partners, and diplomatic & normative narratives. This piece was written by Lillian Schar and edited by Tanvi Sureka.

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Introduction

The United States has long played a leading role in international cooperation and efforts to promote sexual and reproductive health and rights. The U.S. is, historically, one of the largest contributors to institutions and agencies supporting family planning, maternal and newborn health, and HIV prevention, including the U.S. Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), and the President’s Emergency Plan for AIDS Relief (PEPFAR). Beyond funding agency programs and research, the U.S. also contributed to data collection initiatives that provide evidence for health planning and population monitoring. This approach to foreign aid in sexual and reproductive health mirrored international norms set forth by the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the International Covenant on Civil and Political Rights (ICCPR). The principles set forth in these agreements highlight how sexual and reproductive health contribute to non-discrimination, substantive equality, and individual autonomy, embedded in broader frameworks of public health, gender equality, and human rights.

In early 2025, the Trump administration began announcing policy changes that would shift U.S. engagement with international sexual and reproductive health initiatives. These changes included funding freezes, the termination of grants, and the dismantling of agencies like USAID. The Trump administration justified these shifts by reinstating the Kemp-Kasten Amendment, a U.S. legal provision that allows the president to withhold funds from programs deemed to enact coercive family planning practices. The UNFPA, the UN agency tasked with promoting global sexual and reproductive health, released a statement outlining how the termination of grants totalling $377 million would critically harm and heighten risks for pregnant people, rape survivors, refugees, children, and healthcare providers—particularly in countries and territories facing humanitarian crises. A Guttmacher Institute analysis noted these policy changes indicated a departure from the U.S. 's established role as both a financial anchor and a normative leader in global health governance. This departure is now establishing new patterns of bilateral and multilateral cooperation as countries, governmental organisations, and international agencies attempt to fill the gaps left by the U.S. and challenge long-held expectations about the U.S. as a reliable donor to global sexual and reproductive health.

Reactions of Donor Governments and Multilateral Partners

The U.S. withdrawal from major UNFPA and sexual and reproductive health programs prompted adjustments by other governments, multilateral institutions, and countries most affected by the termination of healthcare programs and services. After the U.S. announced it would end crucial grants, the UNFPA called on the Trump administration to reconsider and began soliciting donations from other sources. The International Planned Parenthood Federation (IPPF) described the funding disruptions as imposing a "devastating impact” on service delivery, particularly in low-income settings, and noted widespread uncertainty among national affiliates that previously relied on U.S. support for reproductive health and HIV services. Countries including Norway, Germany, the UK, Australia, and Spain, have recommitted to sexual and reproductive health programs and pledged further donations to UNFPA. The Gates Foundation pledged an additional $2.5 billion to global women’s health initiatives in obstetric care and maternal immunisation, maternal health and nutrition, gynaecological and menstrual health, contraceptive innovation, and sexually transmitted infections  explicitly to close gaps left by the U.S. These responses are not only attempting to compensate for lost funds but also rebalance donor influence. By filling these gaps, governments and philanthropic donors assume a more visible leadership role in global sexual and reproductive health governance. The shifts are also reinforcing a move toward multilateral coordination mechanisms. In particular, the UNFPA Supplies Partnership pools contributions from multiple sources to secure contraceptives and maternal health in over 50 countries. This type of partnership is becoming more prominent and necessary as the UNFPA substitutes large U.S. contributions with smaller contributions from a range of donors.

Countries directly affected by the termination of U.S. grants are also adopting diverse mitigation strategies. UNFPA publicly identified Afghanistan, Sudan, Yemen, Mali, Chad, and Nigeria among the countries facing disruptions to sexual and reproductive healthcare programs, especially those supporting midwifery. These countries are now attempting to both assess the damage left by funding gaps and resolve these gaps through domestic policies. Ethiopia’s parliament passed legislation establishing a national payroll-based health financing mechanism, a small percentage of which would go towards sexual and reproductive health. The measure is intended to partially replace funding previously provided through USAID and the CDC and to emphasise fiscal sovereignty and resilience by protecting key HIV-prevention initiatives and maternal health programs from donor volatility. In Zimbabwe, UNAIDS modelling projected that funding reductions could result in an additional 10,000 HIV infections and 2,000 preventable maternal deaths between 2025 and 2030. To mitigate these projections, researchers argue that the Zimbabwean government must strengthen domestic funding and resources for HIV/AIDS programs through taxes and other revenue streams. The intended effect is to reduce dependence on foreign aid and attract donors to invest in domestic projects in progress. Collectively, broader trends toward domestic reprioritisation are emerging through the refocusing of scarce resources on sustaining antiretroviral therapy, maternal emergency care, and HIV prevention among pregnant women, with the consequence of scaling back community-based and preventative programs. This juxtaposition highlights the tension between maintaining continuity of essential services while reducing the risk of aid volatility.

Diplomatic and Normative Narratives

Not only has withdrawal of U.S. funding resulted in changing financial flows, but the diplomatic postures and normative frames used globally to define sexual and reproductive health obligations are also being reestablished. In contrast to the U.S., Central Asian states, including Kazakhstan, the Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan, issued a joint pledge in early February at a UN Women meeting to recommit to gender equality under the Beijing Declaration and the Sustainable Development Goal framework. The statement focused on financing gender equality and expanding gender-responsive budgeting. In March 2025, the Commission on the Status of Women (CSW69) reaffirmed its member states’ commitments to accelerating progress toward gender equality, noting the increasingly turbulent landscape affecting humanitarian crises. Civil society groups and NGOs continue to frame sexual and reproductive health as a state obligation under international law, emphasising equality, autonomy, and non-discrimination, rather than treating it as a discretionary development priority. Diplomatic statements like these reflect that despite changes in donor behaviour, many states are willing to publicly align themselves with norms embedded in international human rights frameworks, even in the midst of funding disruptions and the loss of U.S. support.

When states work with regional bodies and transnational institutions such as UN Women and the European Economic and Social Committee, they also demonstrate a commitment to shaping policy statements and accountability frameworks for gender equality and health financing through alternative pathways rather than unilateral financial support. These coalitions also redistribute leverage in multilateral fora. European governments, which historically contributed alongside the U.S., may now play a more pronounced role in agenda-setting and monitoring. The absence of U.S. influence also signals the rise of subtle normative pluralism in multilateral negotiations. States and donors less ideological constrained by U.S. policy positions now have greater flexibility to shape priorities and fund allocations. These developments suggest that U.S. funding cuts are reshaping power hierarchies in multilateral agencies and altering individual state capacities to stabilise funding and domestic measures when entering partnerships.

Conclusion

The abrupt nature of U.S. policy changes towards sexual and reproductive health has generated uncertainty but has also prompted rapid responses that have led organisations to prioritise crisis interventions in the short-term while reconsidering how to sustain long-term planning. As new donors replace U.S. contributions, the expectations and conditions attached to funding are also evolving. For recipient governments, this transition introduces new forms of oversight and reporting. Implementation partners must now navigate diverse donor expectations and funding cycles. As noted by IPPF, these changes have prompted NGOs to redesign partnership models, diversify funding resources, and expand collaboration practices with regional development banks and philanthropic foundations. Beyond financial consequences, UNFPA’s public communications framed the funding cuts in terms of broader implications for health, gender equality, and human rights, which, in turn, shape how states position themselves in multilateral negotiations and affect perceptions of leadership in global health governance. The soft power dimension of sexual and reproductive health diplomacy has evolved. Long regarded as a central convenor and donor, the U.S. has weakened its influence in multilateral forums. From a structural perspective, this shift illustrates how global coalitions adapt when a primary partner withdraws: through diplomatic realignments, changing donor hierarchies, and renewed emphasis on shared governance.