Study Spotlights Human Toll of Abrupt U.S. Foreign Aid Cuts

In January 2025, the Trump Administration announced a 90-day freeze on all United States Government (USG) foreign aid, which subsequently became a permanent shutdown of USAID in July 2025. New research finds that the abrupt cessation of foreign aid disrupted health and humanitarian systems worldwide, with disproportionate impacts on women, girls, and other marginalized populations.

Researchers from Columbia University Mailman School of Public Health collaborated with partners to document these negative impacts. The findings appear in the journal BMJ Public Health.

The researchers examined the impacts of the funding freeze during its early months. They conducted 53 interviews with NGO leaders, clinicians, community health workers, government officials, and humanitarian actors in Nepal, Kenya, and Colombia. Interviewees were selected based on their direct or indirect involvement in U.S. government-funded health programs. Ninety-eight global health practitioners also completed an online survey.

The study revealed immediate disruptions across sexual and reproductive health and rights (SRHR), HIV service interruptions and treatment access, the collapse of referral networks and service ecosystems, a mental health crisis among clients and health workers, and the rising vulnerability of marginalized populations—notably, LGBTQ+ populations, sex workers, people living with HIV, and migrants. Both survey and interview data highlighted growing inequities and anticipated reversals in longstanding health gains.

“For many decades, the U.S. government has been the world’s largest contributor of foreign aid, with much of that funding essential health services. The abrupt termination of foreign aid in 2025  was a systems-level shock that exposed structural weaknesses in global health financing and governance,” says first author Sarah Branoff, MPH’25, a research assistant in the Heilbrunn Department of Population and Family Health at Columbia Mailman School.

“Documenting the lived experiences of practitioners provides critical insight into the real-time consequences of funding disruptions. These insights must inform more resilient and rights-based approaches in the future,” adds senior author Sara E. Casey, DrPH, associate professor of population and family health at Columbia Mailman.

“The findings lay bare what many of us on the ground have known: The funding disruption was a systems-level shock with a deeply human cost. Adolescents lost access to family planning and SRHR services built over years of investment; pregnant women were turned away from facilities; communities that had made hard-won gains in reducing HIV transmission risked losing that progress. Each data point represents a real person: a health worker facing financial ruin, a girl without contraception, a mother without prenatal care. This research ensures those voices are heard, and insists that what appears to be a political decision thousands of miles away is, here in Kenya, a matter of life and death," adds co-author Julia Kosgei, MA, co-founder and head of health at policy/strategy group in Kenya.

“The global funding freeze derailed programs run by INGOs/NGOs, compelled program managers, including frontline staff, to quit their jobs, thereby crippling programs aimed at advancing nutrition care for mothers and newborns, SRHR of adolescents, married couples and transgender communities. The impact of the funding freeze has been devastating, especially for grassroots NGOs committed to prevention, screening and treatment of HIV/AIDS who neither have access to alternative funding sources to sustain their programs nor the required skills to shift their niche to an alternative development program in their working areas,” says co-author Anand Tamang, M.Phil., director of CREHPA in Nepal.

The study’s authors propose several ways to respond to the crisis, both in the short and long term. They call for diversified and resilient global health financing, stronger domestic preparedness, and rights-based approaches to global health. They also emphasize the importance of rapid-response research mechanisms and localization strategies to mitigate future policy shocks.

Additional study authors include Thoai D. Ngo, Sarah Engebretsen, and Claire Greene at Columbia Mailman School; Livia Merlim at policy/strategy group in Kenya, Achala Shrestha and Jyotsna Tamang at the Center for Research on Environment Health and Population Activities (CREHPA) in Nepal, and Camilo Ramirez at HIAS Colombia.

The study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare no conflicts.

Photo: A health officer assesses the nutritional status of a baby in a public clinic in Ramechhap, Nepal. Credit: brunoat/iStock