Aid to Africa has fallen over 25 percent and women and children are paying: in Kenya, closed clinics, empty contraceptive shelves and rising HIV infections trace back to the US aid collapse.
Published 9 October 2026 · 18:00 GMT
In Kilifi County on Kenya's coast, nurse Kephine Ojung'a keeps a tally she never wanted: unwanted pregnancies counted each day, women arriving septic or hemorrhaging after trying to end pregnancies alone, clinics with empty shelves where contraceptives used to sit. The cause is the collapse of American aid. United States funding that once paid for free birth control, maternity checkups and mobile reproductive health clinics across Africa vanished as the Trump administration dismantled USAID and slashed family planning support. Kenya shows the damage starkest: at least 24 HIV-positive sex workers have died after losing treatment and support, frontline workers told AFP, and new infections among Nairobi's sex workers rose 48 percent in the first half of 2026. Behind the numbers, a continental retreat: bilateral aid to sub-Saharan Africa fell 26.3 percent in a single year, the OECD found, and the United Nations calls the global decline the largest ever recorded. Women and children, least able to absorb the shock, are bearing the brunt.
For Judy, the treatment worked until the money stopped. The 36-year-old Kenyan sex worker had been managing her HIV with antiretroviral drugs from a clinic built for women like her: discreet, free, stocked with condoms and staffed by people who did not judge. Then the United States, Kenya's largest health donor, dismantled the aid architecture that paid for it. Frontline health workers told AFP that at least 24 HIV-positive sex workers have died in Kenya since losing access to treatment and support, Judy among them, and they warned the true number is likely higher. Kenya once had dozens of clinics specifically serving sex workers. Many have closed. The country's authorities estimate that about 285,000 women are engaged in sex work, with an HIV prevalence rate of 27.5 percent among them, and the Sex Workers Outreach Programme recorded a 48 percent rise in new infections among Nairobi sex workers in the first half of 2026 compared with the same period in 2024.
The deaths are the human edge of a continental collapse. The OECD's latest data show bilateral assistance to sub-Saharan Africa fell 26.3 percent in a single year, while humanitarian aid plunged almost 36 percent. A United Nations reform report, the UN80 Initiative progress report, records a 23 percent fall in international development assistance between 2024 and 2025, the largest decline ever recorded, and expects aid flows to fall by another 6 percent in 2026. The Economist's World Ahead 2026 report projects that donor spending by the 17 largest Western nations could fall more than 25 percent compared with 2024. In 2024, the United States provided about 30 percent of all global development aid, more than twice as much as Germany, the next largest donor. When Washington walked away, the floor fell out.
When the money stopped, the waiting rooms emptied first. The women were already in them.
In Kenya, the damage is measurable in closed doors and vanished services. PEPFAR-supported treatment in the country fell by about 12,000 people, and a Sh5.24 billion emergency fund kept some drugs and salaries moving but did not restore the outreach. The pattern across the continent is the same: the drugs held, the clinics did not. A July 2026 survey by the Foundation for AIDS Research, amfAR, conducted with Johns Hopkins University, found that 73 percent of US-funded organizations had been forced to end services to key populations, including sex workers, LGBTQ communities and people who use drugs. The survey covered 166 organizations across 46 countries. Globally, 1,714 health clinics once supported by PEPFAR closed last year. UNAIDS executive director Winnie Byanyima told AFP that decades of progress were at risk. "This is the most serious disruption in the HIV response since the world came together to fight this disease," she said.
They did far more than hand out pills. The clinics USAID and PEPFAR funded in Kenya provided antiretroviral drugs, condoms, pre-exposure prophylaxis, testing and treatment, but the crucial layer was the wraparound services: community health workers who followed up when a patient missed an appointment, mobile clinics that reached remote villages, nurses who kept girls in school by keeping contraception on the shelf. When it came to preventing mother-to-child HIV transmission, the work meant paying community workers to chase appointments and educating mothers about how the virus reaches babies. The amfAR survey found 63 percent of organizations reported disruptions to those mother-to-child services, and 22 percent said they had ended them entirely. Those are the first services to fall when money runs short, precisely because they are the ones least visible on a spreadsheet.
The family planning collapse may be the deepest wound of all. In Kilifi County, nurse Kephine Ojung'a, who has worked in reproductive health for nearly three decades, told CNN that clinics across Kenya have run out of birth control. "Each day in Kilifi, we count several unwanted pregnancies," she said. She described women trying to end pregnancies with high doses of painkillers, drugs bought without prescriptions, and toxic substances like detergent. The supply chain behind her is a global one: nearly $10 million worth of USAID-procured contraceptives were stranded in a warehouse in Belgium and ordered destroyed instead of distributed, and assessment data show more than 1.4 million contraceptive products intended for Tanzania alone were blocked, about 28 percent of that country's annual requirement. MSI Reproductive Choices has been forced to scale back mobile health services for young people and remote communities in Kenya and elsewhere.
Because the services that vanished were the services built for them. Family planning, prenatal care, skilled birth attendants, emergency obstetric care, mother-to-child HIV prevention: these are not generic health budgets, they are the specific infrastructure that keeps women alive through pregnancy and keeps girls in school. When contraceptive shelves empty, unintended pregnancies rise, and with them unsafe abortions. In Tanzania, one in five maternal deaths is linked to unsafe abortions, and MSI's country director Patrick Kinemo notes that about 8,000 girls discontinue school each year because of pregnancy. "Family planning is a life-saving intervention," he told NPR. Across Africa, providers report a surge in maternal deaths, widespread layoffs of trained nurses and community health workers, and a rise in teenage pregnancies, eroding years of progress in cutting maternal mortality.
Into this gap steps an institution built for exactly this kind of abandonment. The African Women's Development Fund, headquartered in Accra, Ghana, was founded in 2001 as a pan-African grantmaking fund for women's rights organizations. Since then it has awarded more than $59 million in grants to women's organizations across the continent, supporting more than 100 groups each year, with focus areas that read like a map of the current crisis: women's human rights, reproductive health and rights, HIV/AIDS, economic empowerment. Its small-grants program operates in Kenya, Ghana, Uganda, Sierra Leone and Liberia, putting $1,000 to $5,000 directly into the hands of small women's groups that no large donor would ever find. The fund's philosophy is that African women's organizations are the first responders to every crisis, and its grantmaking is designed to build a culture of learning and partnership within the African women's movement. The arithmetic is brutal: AWDF's entire lifetime grantmaking is a fraction of what a single year of American cuts has removed. But its model, funding women-led groups already embedded in their communities, is the one donors are now being told to copy.
Washington has begun signing new bilateral health agreements, but they are not the same thing as what was lost. By September 2026, 35 countries had signed new US health memorandums, 24 of them in Africa, including Kenya, Nigeria, Ethiopia, Uganda and Tanzania. The deals total about $24.2 billion for 2026 to 2030, with Kenya receiving up to $1.6 billion in US funds and adding $850 million of its own. They took effect on October 1, 2026, and grant money was not yet flowing. They cover HIV, tuberculosis, malaria and maternal health, but they do not reopen the NGO clinics the stop-work orders closed, and family planning is largely absent from them. Patrick Kinemo's verdict on the new American approach is blunt: it focuses on HIV, general maternal health and infectious diseases, but family planning is not included. Meanwhile African governments are improvising. Nigeria has absorbed 28,000 health workers previously employed through US programs at a cost of $200 million. Ghana lost $78 million in USAID funding that had supported maternal healthcare, malaria treatment and nutrition. And Ghana's president, John Dramani Mahama, is leading the Accra Reset, a global health initiative whose "A Sovereign Future For Health" report argues that African countries must control their own health development rather than depend on Western aid.
The forecasts are grim. A study published in The Lancet by researchers at the Barcelona Institute for Global Health estimates that ongoing aid cuts could lead to 9.4 million additional deaths by 2030 if current trends continue; under a more severe scenario, deaths could rise by as many as 22.6 million. The IMF notes that in 2025 bilateral aid to the region fell about 26 percent in a single year, that sub-Saharan Africa had the highest aid dependency in the world in 2024, with aid averaging 3 percent of GDP, and that about half of all aid financed health, education and humanitarian assistance. The UN expects flows to fall another 6 percent in 2026. The Rockefeller Foundation's Rajiv Shah, a former USAID administrator, called the moment the dismantling of an architecture that took 80 years to build.
The architecture took 80 years. The dismantling took months. In Kenya's clinics, the consequences arrive one woman at a time: a missed appointment that no community worker follows up, a contraceptive shelf that stays empty, a girl who leaves school pregnant and does not return. The numbers, 26.3 percent, 73 percent, 24 deaths, 9.4 million, will be revised and argued over. What is not in dispute is the direction of travel, or who is absorbing it. Across Africa, the programs that died first were the programs that served women and girls, because those programs lived almost entirely on foreign money. The continent is now being told, by everyone from Washington to Accra, that the future is domestic financing and sovereign health systems. The women of Kilifi cannot wait for the future. They needed the clinic last week.
The Western reading treats Kenya's clinics as the bill coming due for the USAID dismantling. In Washington's telling, the story is one of reform: the State Department calls the amfAR survey methodology flawed, says the administration has strengthened PEPFAR through country ownership and sharper focus, and points to the new bilateral health memorandums, $24.2 billion across 35 countries, as the replacement model. In the Western press and NGO world, the story is the opposite: a preventable catastrophe, counted in closed clinics, stockouts and deaths, and a betrayal of the populations PEPFAR was built to protect.
Both versions agree on the numbers; they disagree on what the numbers mean. Western analysts also urge caution about the hardest figures: one African outlet noted that no equivalent published list of confirmed sex-worker deaths exists, which means the true toll in Kenya is simultaneously undercounted by advocates and unverifiable by skeptics. The Western lens will keep watching two things: whether the October 1 memorandums actually disburse money, and whether family planning, deliberately excluded from the new American deals, finds any donor willing to fund what Washington no longer will.
The Eastern reading sees the aid collapse as confirmation of a long-standing argument: that Western development assistance is a political instrument, extended and withdrawn at the whim of elections in donor capitals, and therefore no foundation for national health systems. From Moscow and Beijing, the lesson of Kilifi is that dependence on American funding was always a vulnerability, and the prescription is the same one both capitals have offered for a decade: state-led development, South-South cooperation, and infrastructure-led partnerships that do not depend on the mood of a US Congress.
But the Eastern lens also carries an awkward silence. Neither Russia nor China has stepped in to replace the reproductive health funding that vanished; Chinese cooperation in Africa remains overwhelmingly infrastructure and resource oriented, not clinic oriented. So the Eastern reading functions more as critique than as rescue: it diagnoses the unreliability of Western aid accurately, while offering African health ministries little to put on the contraceptive shelves tomorrow morning.
The Global South reading is the one being written in Accra. Ghana's president John Dramani Mahama, through the Accra Reset initiative and its "A Sovereign Future For Health" report, argues that African countries must take control of their own health development rather than depend on Western aid, and the aid shock has given that argument urgency. Nigeria absorbing 28,000 former US-program health workers at $200 million, Kenya's Sh5.24 billion emergency fund, Ethiopia's IMF-backed reforms: the South reads these not as stopgaps but as the first draft of a post-aid health order.
Yet the Southern reading is clear-eyed about the cost of the transition. Domestic budgets are strained, debt pressures are rising, and the IMF itself notes that aid financed about half of health, education and humanitarian spending in the region's poorest states. The Southern demand is therefore twofold: that the transition be funded, through mechanisms like AWDF-style resourcing of women's organizations that are already first responders, and that it be African-led, not dictated by the same donor capitals that just walked away.
Because the services that disappeared were built for them. Family planning, prenatal care, skilled birth attendance, emergency obstetric care and mother-to-child HIV prevention lived almost entirely on foreign funding. When US money stopped, contraceptive shelves emptied, mobile clinics shut down and community health workers were laid off, driving up unintended pregnancies, unsafe abortions and maternal deaths while girls dropped out of school.
The US President's Emergency Plan for AIDS Relief, created in 2003, is credited with saving more than 26 million lives, mostly in Africa. After the Trump administration dismantled USAID in 2025, PEPFAR-linked services collapsed: a July 2026 survey found 73 percent of US-funded organizations ended services to key populations and 1,714 PEPFAR-supported clinics closed worldwide. The administration says it strengthened the program through country ownership; health workers describe the most serious disruption in the history of the HIV response.
A pan-African grantmaking fund headquartered in Accra, Ghana, founded in 2001 to finance women's rights organizations. It has awarded more than $59 million to women's groups across the continent, supporting over 100 organizations a year in areas including reproductive health and rights and HIV/AIDS, with a small-grants program in Kenya, Ghana, Uganda, Sierra Leone and Liberia. It funds women-led grassroots groups as first responders.
Only partly. By September 2026, 35 countries had signed new bilateral US health memorandums worth about $24.2 billion for 2026-2030, including up to $1.6 billion for Kenya. But the deals took effect on October 1 with money not yet flowing, they do not reopen the NGO clinics closed by the stop-work orders, and family planning is largely excluded from them.
