USAID

April 3, 2026

By Alexander Sanger

The Trump Administration today issued its budget proposal for the next fiscal year. It eliminates funding for family planning and other vital programs. Some background first:

Just when I thought that the Trump administration hit bottom in cruelty, depravity and disregard of the humanity beyond our borders, the administration recently had USAID destroy millions of dollars of contraceptives that had previously been bought by USAID for African countries. The contraceptives have been sitting in limbo in Belgium since the Trump administration in 2025 had dismantled the American foreign aid program. They were literally left to rot rather than be distributed to health systems and providers in Africa for whom they had been purchased. There will be forthcoming, I am sure, a report of the health impact of this callous act on women who have been denied family planning through increased and unwanted pregnancies, children spaced too close together and thus infant mortality, and pregnant women resorting to unsafe abortions.

Fos Feminista has issued a report, When Aid Becomes Empire: The Silent Recolonization of Global Health, which analyzes the detrimental effects of the America First Global Health Strategy (AFGHS) that has been issued by the Trump administration. https://fosfeminista.org/wp-content/uploads/2026/01/Recolonising-Global-Health_V3.pdf

The new US foreign aid strategy is focused on 1) addressing and preventing future outbreaks and epidemics that affect American health and security; 2) developing bilateral agreements with nations rather than multilateral agreements with intermediary NGOs; and 3) exporting American technology to advance global health outcomes. In addition, the strategy envisions recipient countries giving favorable consideration to the US purchasing “key minerals and rare earth elements” within their countries. All the above in service of fighting “Islamic Extremism”. The AFGHS’s rationale prioritizes Africa, which it describes as “a continent of strategic importance to U.S. national interests,” citing amongst other advantages, its deposits of “key minerals and rare earth elements needed as inputs into advanced technologies that fuel critical military and commercial applications.” The competition with China for resources is clear.

The Fos report accurately uses the word “recolonization” to describe the new foreign aid program.

Foreign aid as practiced by many countries has been around a long time. Some historians even have discovered it employed in ancient Greece and Rome. Perhaps the most egregious example of foreign aid by colonial powers being used to pillage and pirate natural resources from colonies was Spain looting the New World of gold and silver – the 15^thcentury equivalent of “key minerals and rare earth elements”.

One of the beneficial examples of foreign aid in our history was when France, before Liberité, Égalité and Fraternité, gave arms and advisors to the fledgling American Revolution in 1776 in order to bloody the nose of the British Empire. This example could be called de-colonizing.

Geo-political interests have been omnipresent in modern foreign aid. When our turn came in the Marshall Plan, our main goal was to stop the incursion of communism in Europe. And when foreign aid in the 50s and 60s and beyond became a regular part of the US budget, the goal similarly was to fight the spread of communism abroad.

President Kennedy said in a message on foreign aid: “Is a foreign aid program really necessary? Why should we not lay down this burden which our nation has now carried for some fifteen years? The answer is that there is no escaping our obligations: our moral obligations as a wise leader and good neighbor in the interdependent community of free nations—our economic obligations as the wealthiest people in a world of largely poor people … and our political obligations as the single largest counter to the adversaries of freedom.

“To fail to meet those obligations now would be disastrous…. For widespread poverty and chaos lead to a collapse of existing political and social structures which would inevitably invite the advance of totalitarianism into every weak and unstable area. Thus our own security would be endangered and our prosperity imperiled….”

https://www.americanforeignrelations.com/E-N/Foreign-Aid-John-f-kennedy-s-special-message-to-the-congress-on-foreign-aid.html#google_vignette

The West is not alone in political uses of foreign aid. China props up North Korea to prevent the expansion of the West near their borders.

There are plenty of studies about the effectiveness, or not, of foreign aid, but the world has developed economically and healthwise since the advent of the Marshall Plan and US foreign aid, as well as foreign aid from other Western European powers. Multinational aid organizations with staff on the ground and effective accounting mechanisms have been developed over the decades to distribute aid effectively in cooperation with local authorities and institutions and to monitor effectiveness and prevent waste.

And one of the most effective aid programs has been in maternal and child health and family planning. Life expectancy has grown, birth rates have been reduced and child mortality drastically reduced. All this is due largely to family planning and maternal and child health funding for pregnancy prevention and for safe delivery services. Childhood vaccines have been an integral part of the success. The status of women has risen as a result.

All this is gone in the new US policy – no intermediate organizations (those hotbeds of Woke leftists!) and no family planning with maternal and child health and childhood vaccines not mentioned. What better way to attack Planned Parenthood and similar international organizations than eliminate them from funding. Also, no gender or DEI programs permitted. And the expanded Gag Rule is back. No discussion of abortion and more. No climate work. Faith-based organizations (i.e. Christian ones) are to be favored. There is, however, a focus on HIV/AIDS funding, from a prevention of epidemic viewpoint rather than humanitarian. Now we have US policies and products being a cornerstone of local health systems which will become markets for US innovation and product testing. Sounds like the Tuskegee experiments brought into the modern age. Products will have to comply with US standards, not those of the WHO – another multilateral organization tossed aside. This an excuse to ban mifepristone abroad which the Trump administration is maneuvering to get discredited by the FDA.

There are more questions than answers, especially about how this new system will work and whether governments can use their own funds for their own projects and priorities. But what is clear is that the Trump administration sees Africa as a takeover target, where the US comes in with much needed financing and structures the deal to give it voting control over the nation’s health and natural resource systems, no matter that it doesn’t have a clue how the country works. Some art of the deal.

The one thing we do know is that the new U.S. budget proposal has a vastly reduced amount for foreign aid from the United States. Unfortunately, other countries are following suit, including the UK.

The Administration’s new budget proposal unveiled today provides $18 Billion combined for targeted investments overseas and securing critical minerals. Humanitarian assistance is cut $2 Billion, Food for Peace is cut $1.2 Billion and Global Health is cut $4.3 Billion, leaving $5.1 Billion for Global Health. There are no disease specific accounts, leaving the administration the power to allocate “across HIV and other infectious diseases, such as malaria, tuberculosis and polio to strengthen global health, security and protect Americans from disease.”

There is “no funding that supports abortion, unfettered access to birth control, and also eliminates funding for circumcision and Lesbian, Gay, Bisexual, Transgender, and Queer services to better focus funds on life-saving assistance. The United States should not pay for the world’s birth control and therapy.”

Examples of programs eliminated:

“Promoting reproductive health education and access to birth control and other harmful programs

couched under ‘family planning’ in Ghana;

…

Promoting health equity and providing condoms and contraception in Kenya.”

So, birth control is out. This and destroying contraceptives are deliberate slaps at women. The anti-family planning agenda of the Trump administration is clear. This is a fight over who controls reproduction – the administration wants men to.

The fight is now in Congress which in the past has supported family planning programs.

The need for international family planning assistance remains. See: https://www.guttmacher.org/adding-it-up?utm_source=Guttmacher+Email+Alerts&utm_campaign=922864ee96-EMAIL_CAMPAIGN_2026_03_26_12_19&utm_medium=email&utm_term=0_-922864ee96-260655221

The battle is on.

In the midst of the tariff forest, or conflagration to switch the metaphor, we cannot lose sight of the trees – Administration’s devastating attack on reproductive, and general, health of people here and abroad. And the attacks are just beginning.

The Administration has suspended Title X funding for family planning clinics in this country but also USAID grants for reproductive and other health around the world. Title X supports the provision of reproductive healthcare, including family planning and the treatment and prevention of sexually transmitted diseases in family planning clinics in this country. Many of those clinics are operated by Planned Parenthood. None of the funds can be used for abortion services. A total of $66 Million in Title X funding has been suspended, including $21M for Planned Parenthood clinics. These programs have been audited repeatedly to make sure that this does not happen, yet this administration under the guise of fiscal probity has suspended the funds to do yet another investigation. The effect of this suspension will be that clinics will be turning away low-income patients who will have nowhere else to go and will lead to increases in sexually transmitted infections, cervical cancer and pregnancy rates, and therefore abortion rates.

The next shoe to drop is probably Medicaid funding going to Planned Parenthood and other reproductive healthcare clinics. Medicaid funding reimburses clinics for reproductive healthcare visits, including family planning and sexually transmitted disease provision for clients who are eligible for Medicaid. If and when these cuts are enacted, and there are sure to be challenges because these funds are budgetary provisions, enacted by Congress, and it will lead to the closure of many family planning clinics nationwide. Patients will have nowhere else to go. On top of this, the Supreme Court this week heard arguments about whether or not states can prohibit Medicaid recipients from using clinics which also provide abortion services, i.e Planned Parenthoods. Planned Parenthood receives about one-third of its revenue from Medicaid and Title X.

Planned Parenthoods nationwide are facing huge budgetary pressures, as are many healthcare providers, with rising costs, especially salaries for nurses, doctors and other trained personnel. My old affiliate, Planned Parenthood of Greater New York (PPGNY), recently announced that they were putting up for sale the building that houses its Manhattan clinic and would be closing the clinic. They said they hoped to open in Manhattan clinic at another site, but there are no definite plans. The affiliate, along with many other Planned Parenthood affiliates nationwide, have been closing under-performing clinics because they cannot be subsidized in the current climate. PPGNY and PP Illinois have recently closed four clinics each. This has led to greater travel, and other costs, being imposed on rural patients, as well as delay and forgoing of health care.

Planned Parenthoods around the country that provide abortion services are inundated by patients from states where abortion has been criminalized. The resulting subsidy that patients need, including travel costs and accommodations, as well as the fees that they are unable to pay are devastating the finances of Planned Parenthood. This is a human and public health crisis, and states that keep abortion legal must do more to make abortion as safe and accessible as possible. Women are going to resort to do-it-yourself abortion and not under a doctor’s care which could lead to injury and death. Those doctors who are mailing abortion pills internationally and across state lines are not reaching every woman who needs an abortion. About half of women coming to Planned Parenthoods nationwide are using abortion pills, but many are opting for surgery because the procedure can be done in the same day and the woman can return home without delay or risk of needed a followup visit in a state where abortion is criminal.

There is a curious intersection, and disconnect I believe, with much of the conservative ideology about white supremacy. The attacks on Planned Parenthood will reduce reproductive healthcare as well as abortion services in areas with large white populations. If the conservatives hope as a result the white birth rates will go up, that might happen (preliminary data shows an increase in births in criminalized states – the abortion rate has also gone up!). But these attacks will also end up resulting in the closure of clinics serving minority populations, so those birth rates will also go up. In all cases, there will be an increase in sexually transmitted diseases (and illegal abortions), which in many cases cause infertility, thereby decreasing the nation’s ability to increase the birth rate. Talk about counterproductive.

The middle of all this chaos, families have to sort out whether and when to have children. One of the factors that men and women will take into account is how they view the future. Certainly the tariff chaos will give financial pause to many in every state and of every political persuasion. People are now poorer than they were a month ago, and one can question whether they see any light at the end of the Trump tunnel. Some conservatives are beginning to see that they should offer incentives for married couples to have children, though incentives offered in various countries around the world have done little or nothing to increase birth rates.

The intersection of the tariff policy with the anti-immigration policy gives political concern. Many areas of this country have seen population growth and economic vitality from immigration. If these areas are depopulated through deportations, the economies there will stagnate and decline. One US study called it, “Depopulation, Deaths, Diversity and Deprivation: the Four D’s of Rural Population Change.” This scenario played out in the former East Germany recently, an area where people of ability left for greater opportunity in the former West Germany, leaving behind people with fewer opportunities and social services, who were full of resentment, and therefore voted for far right political parties. This would naturally buoy the Trump party even though he was the cause of it all.