How USAID cuts could undermine battle against fistula in Malawi
dailymail.co.uk -- Friday, August 15, 2025, 5:50:15 AM Eastern Daylight Time
Categories: Uncategorized
USAID cuts hit health services in aid-dependent Malawi
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Progress on maternal health, including fistula, threatened
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Donors, including UNFPA, support lone fistula clinic
By Charles Pensulo
LILONGWE, Malawi, August 15 (Thomson Reuters Foundation) - A linafe Lloyd's life could have been so different.
After suffering an obstetric fistula during the birth of her second child, she could have been left permanently damaged, incontinent and even cast out from her community.
But instead, the 31-year-old mother is standing in front of a hot stove in Kukawundu village outside Malawi's capital Lilongwe, excited about the scones she is cooking and will serve in the tea room she runs with her husband, Damston.
After losing her baby during a complicated labor in 2017 and suffering a fistula - a small hole between the birth canal and the bladder or rectum - Lloyd was able to get reconstructive surgery in the only specialized treatment center in Malawi.
Recuperating from the labor, "I discovered I was leaking urine," Lloyd said. "Then they explained to me the problem was fistula, but it is something that could be fixed."
The 35-bed Bwaila Fistula Care Centre in Lilongwe offers surgery, rehabilitation and community reintegration programs and is supported by the United Nations' sexual and reproductive health agency UNFPA and the Freedom from Fistula Foundation.
But now programs to treat fistula and other maternal health conditions are under threat in Malawi and elsewhere because of global aid cuts, including President Donald Trump's decision to gut the U.S. Agency for International Development.
UNFPA said in April that 43 grants worth about $330 million in total aid funding had been affected.
The grants included funds for critical maternal health care, protection from violence, rape treatment and other life-saving care in more than 25 crisis-stricken countries and territories.
"Women in crisis zones will be forced to give birth without medicines, midwives or equipment, putting their lives and their babies' lives in jeopardy," UNFPA's Executive Director Natalia Kanem said when the cuts were announced.
In Malawi, one of the poorest countries in the world and one of the hardest-hit by droughts and floods caused by climate change, the aid cuts have slammed critical sectors including health care, education and humanitarian relief, according to a July report by the Non-Governmental Regulatory Authority (NGORA), a government body that regulates NGOs in the country.
"Many NGOs were forced to scale down activities, lay off staff, suspend service delivery, and, in some cases, shut down entire programs," according to the report.
Richard Delate, UNFPA's acting representative in Malawi, described the funding situation as "fluid."
"We have seen a lot of donors, obviously, the (U.S. government) being the most prominent, where there have been big reductions in funding and very rough reductions in funding," he said to reporters in July.
"So that has resulted in governments having to really pivot and think through how they respond," he said, adding that initiatives like UNFPA's Maternal and Newborn Health Fund would seek to draw in new funds.
"But I don't think we will ever be able to fill the full gaps left behind by the U.S. government withdrawal," Delate said.
PROGRESS 'SLIDING BACK'
Obstetric fistula is often the result of prolonged or difficult labor, and most of the half million women suffering from the condition live in the Global South, according to the United Nations. Around 90% of the women who develop a fistula also lose the baby.
Women with untreated fistula are often shunned because of the smells caused by leaking urine and feces. This can lead to depression and worsen poverty.
A fistula can usually be repaired with reconstructive surgery, but often women do not know treatment is available or cannot afford to travel to specialist clinics.
UNFPA says the keys to ending fistula include ensuring that all women have access to skilled birth attendants and emergency obstetric care as well as family planning.
These are precisely the services being hit by global aid cuts.
Margaret Moyo, country director at Freedom from Fistula Foundation, said the organization would like to open other clinics in Malawi but is now more worried about survival.
"You never know for how long (the donors) will be here ... so sustainability is very key and the government is working towards that," she said.
She said funds to pay for women to travel to the clinic were drying up as well due to aid cuts.
Malawi's Health Secretary Samson Mndolo said the government was assessing the situation and hoping to avoid "sliding back" on progress already made.
"We as a country will prioritize and see how we can help fill the gaps ... because this will help us reduce a lot of potential complications downstream," he said. At the care center, women are trained in skills to help them become self-sufficient when they leave, which is how Lloyd learned about opening her own tea room. This is especially important for younger women - teenagers are particularly prone to obstetric fistula.
"Young women who experience fistula experience high degrees of social stigma due to a number of things, including body odors, even the fact that they've had a teen pregnancy," Delate said.
"Supporting those women is a way of also restoring their dignity and self-worth, and I don't think one can ever measure that in financial terms," he said.
At the Bwaila center, Lilian James, who traveled some 200 km (125 miles)from the Balaka district to undergo fistula surgery, is now sewing reusable menstrual pads, a skill she learned in her rehabilitation.
James received a sewing machine as well as a solar panel as part of her rehabilitation, allowing her to run a small business charging people's phones, which provides money for her to buy goats and chickens.
Her newly found self-sufficiency allows her to turn to helping others, she added.
"I was stigmatized before but now ... I do volunteer work both in the church and the community," she said.
UNFPA facilitated travel for this reporting. (Reporting by Charles Pensulo. Editing by Clar Ni Chonghaile and Ellen Wulfhorst. The Thomson Reuters Foundation is the charitable arm of Thomson Reuters. Visit https://context.news/)
Sign Our PetitionThe recent cuts to the United States Agency for International Development (USAID) funding have far-reaching implications for maternal health care in Malawi, an issue that transcends borders and highlights systemic injustices in global health policy. In the case of obstetric fistula, a condition predominantly affecting women in developing nations, the loss of support jeopardizes years of progress made in women's health and rights. This situation is a stark reminder of the interconnectedness of global policy decisions and local realities, particularly in countries that are heavily reliant on foreign aid. The example of A linafe Lloyd, who received life-changing surgery at the Bwaila Fistula Care Centre in Malawi, underscores the critical role this support plays in transforming lives.
Historically, Malawi's health sector has been dependent on foreign aid, due in part to its economic challenges exacerbated by issues such as drought, flooding, and political instability. The country ranks among the poorest in the world, with a significant percentage of its population living below the poverty line. This economic context is crucial to understanding how cuts from powerful nations like the United States can dismantle essential services. The decision to slash funding reflects a broader trend of prioritizing political agendas over humanitarian needs, a pattern that has been observed since the 1980s with the rise of neoliberal policies. These policies often emphasize austerity and privatization at the expense of public health and social welfare, disproportionately affecting vulnerable populations, particularly women.
The implications of these cuts extend beyond immediate health crises. As UNFPA's Executive Director Natalia Kanem pointed out, women in crisis zones are particularly at risk, facing the dire possibility of giving birth without access to essential medical care. This situation is not merely a statistic; it translates into tangible suffering, with maternal health complications remaining one of the leading causes of death among women in low-income countries. The societal impacts of these health issues can be staggering, as women who suffer from conditions like fistula often face stigmatization, isolation, and loss of livelihood. This systemic disenfranchisement hinders not only individual recovery but also broader societal progress, perpetuating cycles of poverty and discrimination against women.
Moreover, the reduction of aid has forced many non-governmental organizations (NGOs) to scale back their operations, which is alarming given that these organizations often provide critical support in the absence of robust government health services. The report from the Non-Governmental Regulatory Authority (NGORA) highlights that numerous NGOs have been compelled to lay off staff and suspend services, leaving communities with even fewer resources to address their health care needs. This trend raises fundamental questions about the responsibilities of wealthier nations to support global health initiatives and the ethical implications of withdrawing life-saving assistance in the name of budget cuts. It calls for a reevaluation of priorities—where the well-being of marginalized populations should take precedence over political posturing.
In this context, the struggle for maternal health in Malawi serves as a microcosm of broader global health inequities. The fight against obstetric fistula is not just about addressing a specific medical condition; it embodies the struggle for women's rights, healthcare equity, and social justice. Advocates for these issues must elevate this conversation in public discourse, particularly with those who may dismiss international aid as unnecessary or excessive. By framing the conversation around the tangible impacts of aid cuts on women's health and rights, it becomes easier to challenge narratives that prioritize political agendas over humanitarian needs. In doing so, it is essential to underscore the interconnectedness of global health and justice, reminding all stakeholders that the fate of women like A linafe Lloyd is tied to the choices made by policymakers far removed from the realities on the ground.
The recent cuts to USAID, particularly in relation to maternal health care services in Malawi, reveal a troubling trend in how international aid is being allocated and prioritized. The impact of these reductions goes far beyond mere numbers; they represent a significant retreat from the global commitment to support vulnerable populations in crisis situations. History has shown us that maternal health issues, such as obstetric fistula, are not merely medical concerns but also deeply intertwined with social, economic, and political factors. The consequences of these cuts, which disproportionately affect women in the Global South, prompt us to consider the moral and ethical imperatives of international aid and the responsibilities of wealthier nations, particularly the United States.
The situation in Malawi is emblematic of a broader pattern observed in many developing nations where maternal health services are already underfunded and overstretched. Malawi, one of the poorest countries in the world, relies heavily on foreign aid to support its health care infrastructure. The Bwaila Fistula Care Centre in Lilongwe stands as a beacon of hope for women suffering from this debilitating condition, yet the very existence of such facilities is now jeopardized. Reductions in funding from the U.S. government and other international donors risk reversing hard-won progress in maternal health care that has taken decades to achieve. Historically, maternal mortality rates have been linked to societal attitudes towards women's health and gender equality, and the present cuts threaten to exacerbate these existing disparities.
As concerned citizens, Americans can take several actions to mitigate the negative effects of these cuts and advocate for a more humane and responsible approach to foreign aid. First, it is crucial to raise awareness about the implications of these funding reductions within our communities. By discussing the real human stories behind the statistics—like that of Alinafe Lloyd—we can personalize the issue and galvanize support for international health initiatives. Engaging in conversations with family, friends, and community members can help foster a sense of urgency around the importance of maintaining robust funding for maternal health services abroad.
Furthermore, we must hold our elected representatives accountable. Advocacy efforts should focus on urging Congress to restore and prioritize funding for USAID and other international development programs that directly support maternal health. Grassroots campaigns, petitions, and coordinated lobbying efforts can amplify our collective voices, ensuring that legislators understand the critical need for sustained investment in global health. In a world increasingly affected by climate change and geopolitical instability, addressing maternal health is not just a moral obligation; it is a matter of global security and economic stability.
Finally, it is essential to support organizations that are actively working on the ground to combat issues like obstetric fistula. Contributions to NGOs that provide direct services and advocacy for women's health can help buffer against the effects of governmental funding cuts. Collaborating with these organizations can also create opportunities for educational outreach and community engagement, fostering a deeper understanding of the interconnectedness of local and global health challenges. By rallying support for these entities, we can contribute to a more equitable health landscape, ensuring that the needs of women in crisis regions are not sidelined.
In summary, the cuts to USAID funding pose a significant threat to maternal health initiatives in Malawi and beyond, reminding us of the precarious nature of health care systems reliant on international support. By understanding the historical context of these issues, engaging with our communities, advocating for responsible foreign aid policies, and supporting grassroots organizations, we can take meaningful action against this injustice. The fight for global maternal health is not merely a matter of charity; it is a fundamental human right that deserves our unwavering commitment and advocacy.
The recent news article highlights the detrimental impact of USAID cuts on crucial health services in Malawi, particularly regarding maternal health and the treatment of obstetric fistula. As concerned individuals, there are actionable steps we can take to advocate for increased funding and support for programs that assist vulnerable populations, especially women in crisis situations. Here’s a detailed list of ideas and actions we can take:
### Personal Actions
1. **Educate Yourself and Others:** - Stay informed about the issues faced by maternal health programs in Malawi and similar contexts. Share this knowledge through discussions, social media, or community events to raise awareness.
2. **Support Relevant Organizations:** - Contribute to organizations actively working in Malawi, such as the UNFPA and the Freedom from Fistula Foundation. Volunteer your time or donate funds to support their work.
### Petitions and Advocacy
1. **Sign and Share Petitions:** - Look for online petitions advocating for the restoration of USAID funding for maternal health programs. Websites like Change.org or Care2 often host relevant petitions. Search for terms like "restore USAID funding for maternal health" or "support UNFPA initiatives in Malawi."
2. **Create Your Own Petition:** - If existing petitions do not meet your needs, consider starting your own. Use platforms like Change.org to gather signatures advocating for the protection of funding for maternal health services, particularly in Malawi.
### Contacting Representatives
1. **Write to Local and National Representatives:** - Identify your congressional representatives and write to them expressing your concerns about the USAID cuts and their impact on maternal health in Malawi.
- **Example Contact Information:** - Find your U.S. Representative: [House.gov](https://www.house.gov/representatives/find-your-representative) - Find your U.S. Senator: [Senate.gov](https://www.senate.gov/senators/senators-contact.htm)
- **Sample Message:** - Subject: Urgent Support Needed for Maternal Health Funding - Dear [Representative/Senator's Name], - I am writing to express my concern regarding the recent cuts to USAID funding that severely impact maternal health services in Malawi. Programs that treat obstetric fistula and support women’s health are essential for saving lives. I urge you to advocate for the restoration of these funds to ensure that women in crisis situations receive the care they desperately need. Thank you for your attention to this critical issue. - Sincerely, [Your Name, Your Address, Your Email]
2. **Reach Out to the UNFPA:** - Write directly to the UNFPA to show your support for their initiatives and inquire about how individuals can help. - **Contact Information:** - Email: info@unfpa.org - Mailing Address: United Nations Population Fund 605 Third Avenue New York, NY 10158 USA - **Sample Message:** - Subject: Support for Maternal Health Initiatives - Dear UNFPA Team, - I want to express my support for your vital work in maternal health, particularly in Malawi. The cuts to funding pose a significant threat to programs that save lives. Please let me know how I can further assist your efforts to advocate for increased support for maternal health funding. - Best regards, [Your Name, Your Address, Your Email]
### Organizing Community Efforts
1. **Host Awareness Events:** - Organize community events such as webinars, discussions, or fundraisers to raise awareness about the issues faced by women in Malawi and the importance of maternal health funding.
2. **Partner with Local NGOs:** - Collaborate with local NGOs or community groups focused on global health or women's rights to amplify your advocacy efforts.
### Conclusion
By taking these steps, we can collectively contribute to a movement advocating for the restoration and protection of essential health services in Malawi. Every action, from signing petitions to contacting representatives, plays a vital role in supporting those in need and ensuring that critical health care reaches the most vulnerable populations.