Annette was just 16 and walking to school in rural Uganda when she was brutally raped – an attack which left her pregnant, penniless and alone.
Her family and community blamed her and cut her off, leaving the teenager to struggle with her baby by herself.
A friend at the same school also fell pregnant. Rather than struggle like Annette, she decided to hide it and get a backstreet abortion.
“She didn’t want her parents to know about it so she decided to abort,” says Annette, now 19, with a disarming frankness. “She was given some drugs and lost a lot of blood but didn’t want to be rushed to hospital as she was scared her parents would find out. She bled to death.”
Terrified of a similar fate, Annette continued with her pregnancy, dropping out of school to wash clothes for 50p a time.
“People talked a lot about me behind my back and no one helped me. No one believed that I had been raped.”
Annette feared she might be attacked again and turned to MSI Reproductive Choices – a global charity providing contraceptives to nearly 40 million women and girls worldwide.
Today at a MSI-supported clinic 65km north of the capital Kampala, she is being given a three-year contraceptive implant that costs just $10 but is impossibly expensive for her. She credits it with allowing her to get her life back and finish her education.
But that contraceptive support is now in jeopardy after Donald Trump cut hundreds of millions of dollars of US foreign assistance to family planning programmes worldwide by dismantling USAID.
According to analysis by The Independent from United Nations data, there could be as many as 16 million more unintended pregnancies each year, leading to the deaths of 32,000 women and girls, as maternal mortality rates will soar.
And it can be revealed that 16 countries that received family planning assistance, mostly in Africa, are running out of key contraceptives.
Three identified by The Independent – Tanzania, Kenya and Zambia – have run out of certain brands of implants and injections. A helpline in Kenya is already reporting cases of unsafe abortions linked to these shortages.
Sitting behind Annette, the makeshift waiting room in this clinic is overflowing with women. Many of them have hiked in the blistering heat for four hours, with babies strapped to their backs, because they want to get life changing and life-saving contraceptives before it’s too late.
“We are worried because we heard reports that Trump has stopped all support for women. All the women from my village came today,” says Deborah, 45, who already has five children and cannot cope with a sixth. She worries about the pressure being constantly pregnant puts on her body as well as the cost.
“I’m cannot afford to take care of their school fees. We beg for help.”
Suzanne Obalim, who works with MSI in Uganda and is looking after the women, says many have been in tears: “We are going to lose hundreds of young girls. We beg Trump to reconsider, reconsider the decision. Women need help.”
Just hours into his new term in office, Trump signed a slew of executive orders freezing almost all foreign assistance for 90 days, saying he was rooting out “tremendous waste and fraud and abuse” of USAID.
The searing focus of his wrath was the $600 million of spending on global family planning.
In a press conference in January, he even claimed USAID funded “$50 million being sent to Gaza to buy condoms for Hamas” – allegations quickly debunked.
“[Hamas] used them as a method of making bombs. How about that?” he joked.
His swingeing aid cuts mean that every week nearly one million women and girls worldwide will be denied contraceptive care costing lives.
The State Department confirmed that the funding will not be reinstated after the original pause.
On his first day in office, Secretary of State Marco Rubio announced a “new era of foreign assistance” which would be “guided by whether it makes America safer, stronger, and more prosperous”.
“In line with President Trump’s policies and as part of the review of foreign assistance, USAID awards for family planning and reproductive health activities ended,” the spokesperson said.
“In line with President Trump’s Executive Order, no American tax dollars will be funding elective abortions abroad.”
In August, Trump’s administration went one step further, spending tens of thousands of dollars destroying nearly $10 million worth of contraceptives sitting in a warehouse in Europe that had already been paid for by taxpayers’ money, and was earmarked for use by women in need.
They even reportedly turned down offers from the United Nations and family planning organisations to buy or ship the supplies to low income nations.
The State Department said a preliminary decision was made to destroy certain “abortifacient birth control commodities”, a vague term meant to describe any substance which can terminate a pregnancy.
They added that “no HIV medications or condoms are being destroyed,” without elaborating.
One of the main concerns in Uganda is the deadly impact of the cuts.
Twenty-five years ago, its maternal mortality rate was among the highest in the world. The work on family planning has been a major factor in reducing that rate by more than half.
Without funding, the fear is that rate will now rise – particularly with an expected surge in unsafe abortions, which, according to the UN, are one of the leading causes of maternal deaths worldwide.
In another MSI clinic on the outskirts of Kampala, Bridget, a mother-of-five, thinks a great deal about deadly impact of backstreet abortions. That is because two of her friends, who had no access to contraception and couldn’t afford to keep their babies while in abusive relationships, died from unsafe abortions.
She describes how untrained practitioners inserted sticks and herbs into their uteruses in a bid to open the cervix.
“When one of them went to the hospital she was told that some things had remained and got rotten inside of her uterus,” she adds quietly. “By the time she got to the hospital it was too late.”
Also waiting in the makeshift waiting room of the clinic is Joyce, who had her baby five years ago when she herself was just 13.
The birth was painful and dangerous, she recalls. Like Annette, she was also thrown out of school and rejected by her family and community.
“My parents mistreated me. Sometimes they would not give me the basic needs and they would send me away from home to stay with my neighbour,” she said.
“The village residents would also talk about me and insult me. It made me to be so lonely.”
Like Annette, Joyce says contraception and care has meant that she has been able to go back to school and plans to train as a nurse, to work with other girls in her predicament.
Their stories underscore why contraception can bring huge economic benefits, as well as save lives.
Monica Ferro, UK director of the United Nations Population Fund (UNFPA), says, contrary to Trump’s claims that it was dangerous waste, investing in family planning might be one of the highest yielding development investments available.
“For each dollar invested in voluntary, rights-based family planning, you can yield the return as much as $26 in economic benefits.
“Access to contraception allows girls to stay in school. It allows women to enter the workforce and contributes to economic growth, boosting GDP and the country’s long-term prosperity, as well as increasing women’s participation in decision making processes.”
She said something as simple as a $1 condom or $10 implant can “break cycles of poverty” as women are able to contribute to economic growth – keeping a country on its feet, and reduce the need for global help.
One of the biggest problems is not only that funding is gone but the abruptness of its departure.
In Zimbabwe, Pester Siraha, who heads up MSI Choices’ office, describes how they received an email one Monday morning from the White House explaining all funding had been suspended and they had to issue stop work orders.
“Our teams were in four provinces. They had to immediately suspend services, stop, bring back all the cars to the head office, halt all operations.”
They could not even tell their clients in rural areas who were waiting for them to turn up that they would not be coming.
These clinics work by driving around remote communities and announcing via microphone the future dates of the upcoming consultations so families can attend.
Faced with the instant stop work order, they couldn’t even use their vehicles to warn people the clinics would be suspended, as the cars were funded by USAID.
Other providers reliant on USAID said they couldn’t use their laptops to even track who was affected, as their services were also instantly frozen.
It has left utter chaos on the ground, as organisations have struggled and failed to fill the gaping shortfall.
In Manicaland in eastern Zimbabwe, medical teams failed to turn up, leaving women confused and stranded.
“When I came here and the tent was not there, I panicked because their services are vital to me,” says Chido Luanda, 45, mother-of-five, who is worried about getting pregnant again.
Now, UN data shared exclusively with The Independent shows stocks of crucial contraceptives and maternal drugs are dwindling in national medicines warehouses in several countries. In some cases, supplies are stuck in warehouses in those countries and can’t be sent to the health facilities where they are running out, because of the axing of USAID.
MSI has scrambled to find enough funding to support its work until September, but there is no plan after that. They have already had to fire at least 30 members of staff, and put the rest on limited schedules.
An estimated 1,700 midwives worldwide were paid for by USAID funding.
“We have no idea what will happen if we lose our jobs for good,” says Lovejoy, a nurse for MSI who is a breadwinner.
Back in Uganda, Joyce says she is now studying to be a nurse so she can help other girls in her predicament.
“I want to advise other teenage girls to consider coming for family planning because it enables them to be like me: I never had the hope or the dream that I could go back to school. But by God’s will I am now.”
Ferro said global solidarity on contraception was now needed “more than ever”.
“We need to allow countries to mobilise their own domestic resources. We need to fundraise for the programs that are now being cut because the priority for us is very clear.
“This is an investment that changes lives, that saves lives. And my ask would be, please don’t let women and girls die.”
Additional reporting by Rachel Schraer and Alicja Hagopian
This article is part of The Independent’s Rethinking Global Aid project
