A blue, burgundy and white patterned wrapper hides the swell of Joanna Banda\u2019s belly. At eight months pregnant, she has had just three of the five antenatal appointments she should have had. She is unlikely to attend her final three either, as she still has to save 3,000 kwacha (\u00a31.28) for a bicycle to take her six miles on rutted dirt tracks to the nearest health centre when she goes into labour.<\/p>\n
In remote villages in Malawi, pregnant women such as 22-year-old Banda, who has one child after losing her first soon after giving birth, are struggling to get the medical care they need. In January, US aid cuts abruptly ended a rural healthcare outreach programme that had started to reduce the number of women dying in childbirth.<\/p>\n
Momentum Tikweze Umoyo, a $28m, five-year programme aimed at cutting maternal and infant mortality rates in five of Malawi\u2019s 28 districts, was meant to last until August 2027. It is just one of the casualties of US president Donald Trump\u2019s decision to suspend foreign aid<\/a> just hours after taking office in January, risking the lives of some of the world\u2019s poorest, most vulnerable people. In July, Congress approved $9bn in cuts to aid and public broadcasting. Last week, Trump said he would not be spending $4.9bn in aid<\/a> already approved by Congress.<\/p>\n Kafulatira, where Banda lives, is a scattered mud- and straw-walled village of almost 1,000 people in Salima district, east of the capital, Lilongwe. There is no piped water or electricity, and a bridge across the steep-banked river that divides it from the nearest health centre was washed away in December 2024.<\/p>\n A mobile clinic used to come every month or two to the community, providing a private space for women to get screening for cervical and other cancers, HIV testing and treatment, and vaccinations for children. It also provided antenatal checkups and family planning services, including contraception.<\/p>\n \u201cThe outreach clinics were helping a lot, because we could access services right here in the village,\u201d Mulirani Gerard says through a translator. \u201cSince last year, we had been waiting for the team to come, so we were just wondering what had happened.\u201d No one told villagers why their healthcare had been cut.<\/p>\n Gerard says she has been fine, as she has a contraceptive implant that lasts for three years, but that others were not so lucky. \u201cIt\u2019s a challenge, because this has led to unintended pregnancies,\u201d the 25-year-old says, pointing to her friend Banda, as they sit in the shade with other mothers, children playing around them.<\/p>\n Juliette Kannda, a 31-year-old mother of three, had been receiving bi-monthly contraceptive injections. Now, she says, she is saving up 10,000 kwacha for the 25-mile round trip to another health centre. \u201cI am looking forward to getting the [contraceptive] implant, considering the distances I travel to access services,\u201d she says.<\/p>\n Malawi is one of the world\u2019s poorest countries. In 2024, the landlocked southern African country had a per capita income of just $508, according to the World Bank<\/a>. It is incredibly vulnerable to the climate crisis<\/a>: 80% of the population work in agriculture<\/a> and it has been battered by repeated cyclones and droughts in recent years. The country, of about 22 million people, is also highly dependent on aid.<\/p>\n Aid from the US, both grants and low-interest loans, was equivalent to 2% of the country\u2019s GDP in 2024, according to the International Monetary Fund<\/a>. That compares with an average of 0.5% across sub-Saharan Africa.<\/p>\n In 2023, the US accounted for a quarter of all aid sent to Malawi, according to the International Food Policy Research Institute (IFPRI)<\/a>. The year before that, the Center for Global Development found US health spending was more than double that of the Malawian government<\/a>.<\/p>\n A US state department spokesperson said: \u201cThe US government supports life-saving assistance in Malawi, including approximately $160m to support efforts to address HIV, TB, malaria and other critical health risks.<\/p>\n \u201cAmerica continues to be the most generous nation in the world. It is imperative to remember that the American taxpayer was never meant to bear the full burden of taking care of every person on Earth \u2013 whether that be with food, medicine or otherwise.\u201d<\/p>\n Malawi\u2019s economy was already in a parlous state before the US aid cuts. For the past three years, inflation has been above 20%<\/a>, the economy has grown more slowly than the population<\/a>, and a scarcity of foreign exchange has led to shortages of fuel, fertiliser and medicine. An IFPRI study<\/a> in April estimated that US aid will fall 59% in 2025, leading to a 1% decrease in Malawi\u2019s gross domestic product.<\/p>\n The government has little means to make up the shortfall. Malawi\u2019s fiscal deficit (the gap between what the government spends and its revenues) was 10.1% in the year to 31 March. It is also under intense political pressure, with presidential and parliamentary elections on 16 September.<\/p>\n Funding healthcare in Malawi \u201cis indeed the duty of the government, but \u2026 the government doesn\u2019t have the resources,\u201d says Hester Nyasulu, the Malawi country director for Amref Health Africa, a Kenyan NGO that was one of seven delivering the Momentum Tikweze Umoyo project.<\/p>\n The funding cuts should have been a \u201ctransitional process\u201d, he says, adding: \u201cWe were starting to reap the benefits of the investment \u2026 The termination of the USAID [funds] \u2026 will definitely lead to more deaths of pregnant and lactating women and also newborns.\u201d<\/p>\n