Supporting Reproductive Health for Underserved Women and Girls in Africa
By Dr. Peter Ddungu, Country Director, MSI Uganda
The past months have seen seismic changes for those of us working to bring reproductive health care to underserved women and girls in Africa. This work involves providing information and modern contraception methods, often in remote rural communities, for women who have limited options if they want to avoid pregnancy.
The dismantling of USAID, America’s overseas aid agency, by the Trump administration has had profound consequences for women and girls across Africa, as it has deprived the continent of its biggest external funder of family planning support. The respected Guttmacher Institute predicted the removal of family planning support would lead to millions of unintended pregnancies and an additional 34,000 pregnancy related deaths in a year.
In Uganda, we’ve been wrestling with the immediate consequences of the cuts and trying to protect decades of progress for women and girls.
First of all, we had to confront a wave of misinformation that quickly filled the vacuum left by suspended services. In western Uganda, rumours began circulating that contraception was being outlawed. Women started urgently requesting the removal of contraceptive implants, not because they no longer wanted them, but out of fear of possible fines or legal consequences.
It took a concerted communications effort to dispel the rumours, working with district health officials and community radio shows to share accurate information and reassure women.
In a country where donor funding supports much of the health infrastructure, the implications of the aid freeze were immediate and far-reaching. Outreach services to communities were disrupted and project supported staff were let go.
Our work was affected as MSI Uganda was partly supported by a multi-million-dollar USAID-funded initiative designed to bolster public health systems and service delivery. Through this program, we supported district-level health facilities, trained providers in delivering sexual and reproductive health care, and ensured women and girls, particularly in rural areas, had access to modern contraceptives via village health teams. This work came to a sudden halt and much of our partnership work with public health facilities was suspended.
Despite these challenges, we have managed to stabilise our Ugandan operations in the short term. While the funding from USAID was significant, we’ve been able to use other funds to continue services in about half of the areas previously covered under the USAID program. Teams are still in the field, outreach vehicles are operating, and essential contraceptive supplies remain available, albeit at a slightly smaller scale.
But this stability is temporary. Current funding will run out at the end of the year and contraceptive supply chains are uncertain for the last quarter of the year.
Looking ahead to 2026, there is no guarantee that we will be able to sustain our existing footprint. Without renewed funding, particularly for outreach and training programs, Uganda risks losing ground on critical reproductive health goals.
Uganda’s demographic realities make this situation especially urgent. The country’s median age is 17. Almost half of all pregnancies are unintended, and the teenage pregnancy rate has hovered around 24 per cent for over a decade. The modern contraceptive uptake rate, currently around 39 per cent, remains well below the national target of 50 per cent.
The consequences of reduced access to family planning services are devastating: girls dropping out of school as they fall pregnant, unsafe abortions, maternal complications, and a cycle of poverty that limits opportunities for girls, women and entire families. While Uganda has made gains in maternal health, including a reduction in maternal mortality, the risk of backsliding is real if access to services diminishes.
Family planning isn’t just a health issue—it’s a development issue. For every dollar invested in family planning, there is a projected return of $60–$100 in economic growth. Family planning increases women’s and girls’ education and labour force participation, which positively impacts economic growth and stability, building stronger families, communities and countries.
Uganda’s story is far from unique: it is playing out in many countries across the continent. We urgently need international donors – especially those in Europe, including Norway, Germany, and Denmark – to recognise the critical role they can play in sustaining reproductive health progress.
But now is also the time for us all to consider how to strategically deliver aid. Rather than abandon funding due to broader geopolitical shifts, there is an opportunity to refine and improve it, targeting investments where they are most effective, and partnering with local organisations that have deep reach and proven impact.
MSI Reproductive Choices is an international NGO working in 36 countries supporting women and girls to access reproductive healthcare.
