Nurse Ireen Makata sits on a cracked wooden bench outside a near-empty health post in southern Malawi, the once-busy clinic now open just once every two weeks.
The beige building, surrounded by red-brick huts with thatched roofs, used to deliver antenatal care, family planning, vaccinations and safe births to women who live hours from the nearest hospital. Today the medicine cupboard is almost bare and the ambulance rarely moves for lack of fuel.
At least 20 similar rural health posts have closed across Malawi and dozens more are on the brink after President Donald Trump ordered a freeze on U.S. Agency for International Development programs in February as part of a sweeping foreign-aid review.
The cuts have abruptly ended USAID’s $80 million MOMENTUM project that supported 249 outreach clinics in 14 districts since 2022. Mobile teams have stopped, thousands of community health workers have been laid off, and equipment has been sold off in fire sales.
Makata, who specializes in maternal and newborn care, used to visit this post several times a week. Now she comes only occasionally.
“Women can’t afford to lose a whole day walking or paying for transport to the district hospital,” she said. “Many are skipping antenatal visits entirely — especially in the critical first trimester.”
Community leader Massitive Matekenya said some pregnant women are already giving birth on the roadside while trying to reach medical help.
“That puts mother and baby at risk of bleeding to death,” he said. He described a neighbor, a 40-year-old mother, who recently died of malaria because no vehicle was available to take her to hospital.
Without the family-planning services once offered at the post, Matekenya expects more unintended pregnancies and fears a surge in maternal deaths.
Malawi had been slowly reducing its maternal mortality rate, but health officials and aid workers warn the gains are now in jeopardy.
Fistula center braces for more patients
In the capital, Lilongwe, the Bwaila Fistula Center, which repairs childbirth injuries that leave women incontinent and often ostracized, is preparing for a wave of new cases.
“Fewer check-ups mean more obstructed labors and more fistulas,” said center coordinator Margaret Moyo. “We’re also losing the chance to educate girls about delaying pregnancy, which is one of the biggest risk factors.”
The government had already forecast a $23 million shortfall in reproductive and maternal health funding for 2025 even before the latest cuts.
Government vows to adapt
Health Secretary Dr. Samson Mndolo said Malawi survived a similar USAID freeze in 2017 during Trump’s first term and will do so again by making workers multi-task and leaning on community networks and digital tools such as WhatsApp groups for remote consultations.
“We didn’t panic then and we’re not panicking now,” Mndolo said. “Every crisis is an opportunity to build a stronger, more efficient system.”
But in the villages, the mood is bleak.
Twenty-two-year-old Tendai Kausi, holding her 4-year-old son Saxton outside the shuttered Musa health post, said women in her community now carry entire pregnancies without a single check-up.
“This hurts the future of our children and our country,” she said. “We feel abandoned.”
For thousands of Malawi’s poorest mothers, an aid decision made thousands of miles away in Washington has turned into a daily fight for survival.
Al Jazeera contributed to this report
