"I'm on your veranda."
That's the text Prossy Muyingo would get each night for years, sent by a 28-year-old standing outside her home in central Uganda.
Immediately, Muyingo would pour a glass of water and, from the sideboard in her living room, fetch a birth control pill and bring it outside.
"She was swallowing [the pill] from my house," explains Muyingo, who served as a community health worker in Mityana District for 12 years. The woman had told Muyingo that she feared her husband would beat her if he knew about the birth control. "The man is ever asking for a child," the woman said to Muyingo. She already had three children and didn't want another one, at least not right now. So she used Muyingo's home as a place to store and take her pills. Muyingo has similar arrangements with many neighbors.
Now all of that has changed.
In September 2025, Muyingo lost her job. Her stipend had been paid for by U.S. foreign aid. Now, she says, instead of providing contraception, she's informally counseling neighbors through unintended pregnancies.
A historic disruption
Muyingo's story is part of what reproductive health experts are describing as the largest disruption ever to international family planning efforts.
The second Trump administration has moved to eliminate programs for contraception and other family planning work abroad. Congress actually appropriated funds for this work, but the administration has not spent it. And it has shut down programs aimed at helping people choose when to have children, such as efforts to improve access to birth control and provide resources for treating sexually transmitted diseases. The issue here is not abortion. For more than 50 years, it's been illegal for foreign aid to fund abortions.
Asked at a Congressional hearing about appropriations for family planning in May 2025, Secretary of State Marco Rubio said: "There's no plan to spend that money. We're not going to be in that business globally. We're not going to do it."
Besides this public statement, the change has happened without much fanfare. But the new approach becomes clear by looking at the Trump administration's budget documents and memos that show family planning has repeatedly been targeted for cuts.
"Very disruptive, very significant"
For well over a decade, the United States has been the top contributor to international family planning and reproductive health efforts, responsible for over 40% of donor funding worldwide to the tune of over $500 million.
Indeed, family planning had been a priority since the U.S. Agency for International Development was first established in 1961.
The U.S. support has changed millions of lives. The Guttmacher Institute — a nonprofit research organization that supports access to family planning — estimates U.S. funds gave over 47 million women and couples access to modern contraceptive care each year. That, in turn, prevented 17.1 million unintended pregnancies annually and saved 34,000 lives because women and girls did not die from complications during pregnancy or childbirth.
It's been a bipartisan undertaking, supported during Republican and Democratic administrations.
Now, with the sudden loss of programs, family planning work abroad is in jeopardy.
The Women's Refugee Commission, a non-governmental organization, found that almost 95% of U.S. foreign aid for sexual reproductive health and family planning was cut in 2025. Another report, from late 2025, by the Reproductive Health Supplies Coalition and its partners, estimates that in 2026 there will be a massive shortfall in funding needed to provide contraceptives globally.
As a result of the cuts rural clinics were shuttered, community health workers and nurse midwives fired and technical experts pulled from ministries of health. There are shortages of contraceptive implants and birth control pills as well as other related medications.
The repercussions for individuals and communities have been dramatic. "It's been huge," says Shyami de Silva, former director of the Office of Population and Reproductive Health at the now-dismantled USAID.
De Silva says the abruptness of the cuts compounded the impact on the 41 countries where the U.S. had supported family planning programs. "For the top five [recipient] countries — which are these very large, high-need countries mostly in sub-Saharan Africa: Nigeria, Ethiopia, Uganda, Tanzania and the Democratic Republic of Congo — the loss was very disruptive, very significant," she says.
"It's a really challenging period," says Muyingo. Former community health workers, she says, "are facing direct pressure from community members who are not receiving services. They tell you a lot of problems, but you can't help them. The bag on your back is empty — we don't have supplies."
"The United States should not pay for the world's birth control"
The irony is, the money to support family planning exists. Congress has appropriated almost the same sum as in the past dozen years —$575 million for family planning and reproductive health plus more for the United Nations Population Fund.
But the appropriated money "is not being spent, and it is not going out the door," says Elizabeth Sully, director of international research at the Guttmacher Institute.
When NPR reached out to the State Department to clarify its current position on U.S. aid for family planning, it sent a statement saying it "is still evaluating family planning programs and funding" for this fiscal year.
Perhaps the earliest evidence of the Trump administration's opposition to international family planning work came just over a week after inauguration.
On Jan. 28, 2025, the State Department announced a waiver aimed at allowing lifesaving humanitarian aid to continue despite the administration's blanket pause on foreign aid. An emailed note sent to staff at USAID said: "the waiver does not extend to activities related to abortion services, family planning, conferences."
In their Budget Request for fiscal year 2027, released this month, administration officials again targeted contraception as an area to cut in the global health budget, saying "the United States should not pay for the world's birth control." And in a list of eliminated activities it highlighted "reproductive health education and access to birth control" in Ghana and "providing condoms and contraception in Kenya."
The accompanying FY27 Congressional Budget Justification provides an explanation, saying "the Budget eliminates global health activities that do not make America safer, such as family planning and reproductive health."
In response to questions from NPR about funding for family planning, the State Department defended the administration's changed position: "President Trump has restored common sense to U.S. foreign assistance. The American people expect their tax dollars to support programs that save lives, advance U.S. interests, and reflect American values, not fund abortion-related activities, left-wing social agendas, or wasteful overseas bureaucracies."
"We stand to benefit"
But Shatha Elnakib — deputy director of the Center for Humanitarian Health at the Johns Hopkins University School of Public Health — takes issue with the Trump administration's opposition to family planning work and their rationale. She says unmanaged population growth tends to lead to instability and poverty, which eventually, leads people to migrate to places like Europe and the U.S. as they seek a more stable environment.
In the past, she says, there was an understanding in the U.S. that "we stand to benefit from having a healthy global population."
De Silva, who worked at USAID for 25 years through both Republican and Democratic administrations, points out that access to contraception is an effective way to reduce abortions and prevent maternal deaths. "When the U.S. government is associated with supporting live-saving care around the world, we build goodwill internationally and that makes us safer and stronger — that's the soft power part of the foreign assistance argument."
However, some analysts think the U.S. stance is still evolving and could be more nuanced than it seems.
Brett Schaefer is a senior fellow at the conservative American Enterprise Institute. He speculates that the administration may support programs like condom distribution "where it can be tied to combating HIV/AIDS and other sexually transmitted diseases. I think the administration would be supportive of those types of initiatives because they do continue to support global health."
"I'm now pregnant"
Sully — of the Guttmacher Institute — says it's been hard to gauge the repercussions of the cuts on the lives of individuals.
When the U.S. dramatically cut foreign aid at the start of President Trump's second term, it halted many surveys and data-gathering operations that used to shed light on unintended pregnancies and unmet need for contraception. "It is definitely playing out. It's just we don't have visibility into how it's playing out," she says.
But there are eyewitnesses — like Muyingo in Uganda.
Working for a local nonprofit — and paid by a U.S. grant — she'd go house-to-house, checking on neighbors and acting as a bridge between their health facility and the community. She'd address many health issues: providing bed nets to protect folks from malaria-carrying mosquitoes, coaching families on immunizations. When Muyingo learned that she lost her job, she knew she could not stop her work.
"Now we are not paid, but the heart we had for our communities, that is the only thing pushing us [to keep working]," she says. "These are our neighbors, the people we share our churches with, the borehole where we fetch water."
She started telling her former patients to go to the local clinic to get medications, including some form of birth control if they wanted it. But many would leave empty handed, she says. Some were uncomfortable talking to an unfamiliar clinician. Others found the birth control options were limited and they couldn't get the same form of contraception as before, having to switch from, say, a pill to an implant. And still others — like the 28-year-old — worried that waiting in the long lines would make their family suspicious about their absence from home, Muyingo says.
"After two months, she realized: 'I'm now pregnant,'" Muyingo says. "Then I told her, 'Are you sure?' "
She was sure.
She confided in Muyingo that she was considering an abortion. Muyingo started worrying: "In Uganda, abortion is illegal. It's not allowed."
"So I did a lot of counseling for her to love her [pregnancy]," Muyingo says. Now the woman and her husband have a 3-month-old son.
Immediately after the birth, Muyingo helped the mom get long-acting birth control in the form of an implant. She says this is one neighbor who won't need to worry about finding contraception — at least for a few years.
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