In war-torn zones like Sudan, pregnant women are facing the devastating consequences of having no United Nations-supported midwives available because of severe funding cuts to the organization’s sexual and reproductive health agency, the UN Population Fund, or UNFPA.
The New York-based agency issued a warning in May that funding shortfalls, driven partly by the United States terminating approximately $335 million in grants this year, are forcing UNFPA to curtail essential programs for midwives in some of the world’s worst crisis zones. Nowhere is the fallout more likely to be devastating than in Sudan, where UNFPA can no longer support any midwives this year — a drop from 460 last year — amid its relentless civil war and damaged health infrastructure.
The US, which allocated $32.5 million to UNFPA in 2024 for core funding, has left a vacuum in which pregnant women desperately need help and experts say will mean much higher infant deaths. Midwives are not only locally skilled people but they also offer essential services to women — like assisting in childbirth — at relatively low cost. (The US contributed over $250 million in humanitarian funding to the agency in 2024 in addition to the $32.5 million, making it the largest donor.)
“People will die,” said Sarah Mendelson, a former American diplomat in the Obama administration and a representative to the UN Economic and Social Council. “The impact is devastating, particularly for women and children, and this is only exacerbated in places where there’s conflict.”
Mendelson pointed to the sudden nature of the cuts, which began under the Trump administration this year and has forced UNFPA to scramble. “No one can fill this gap,” she added.
According to UNFPA, the US suspension of hundreds of millions of dollars in aid this year to the agency, most of it earmarked for humanitarian and lifesaving programs — has decimated programs in many countries where the UN agency operates.
In Afghanistan, for example, $101.7 million was cut (72 percent of UNFPA’s 2025 budget) for health facilities. The number of supported midwives is being halved from 974 to 565.
In Sudan, the US had accounted for 35 percent of UNFPA’s 2025 budget and 57 percent of its 2025-2026 budget projections. As a result of cuts, support for 80 percent of health facilities has now ended, according to the agency, and planned midwifery schools have been canceled. UNFPA said that only $49 million in US funding has been allowed to resume, while all future contributions have been stopped indefinitely.
“This means that effectively, all funding from our largest donor will now stop immediately, with devastating effect,” Eddie Wright, the UNFPA communications specialist, told PassBlue.
Sudan is only one of many countries affected by the US budget slashes. In Yemen, the poorest country in the Mideast and embroiled in a civil war, only 700 out of 1,492 planned midwives will be financed. Midwifery services will disappear entirely in the Central African Republic, where women in rural areas contend with chronic instability.
Sudan’s maternal death rate is among the world’s highest (1,223 maternal deaths per 100,000 live births); 26 percent of pregnancies are unplanned and nearly half of those end in abortion. Many pregnancies are the result of rape, including by gangs, armed militias such as the Rapid Support Forces and forced marriage, according to studies by the Guttmacher Institute.
Médecins Sans Frontières recently reported that “women and girls in the Darfur region of Sudan are at near-constant risk of sexual violence.”
Shoko Arakaki, the director of UNFPA’s Humanitarian Response Division, recently returned from Sudan. She said that women and girls there are facing dire consequences as midwives are not working on the frontlines of maternal care and can’t respond to gender-based violence.
“The midwifery program is the flagship for us — they really are our lifeline for the health and well-being of women and girls in emergencies,” Arakaki said. “In Sudan, women are giving birth in unimaginable conditions. Midwives are often the only point of care, not just for childbirth but for detecting and responding to sexual violence. And they’re displaced themselves. Many have lost everything, yet they keep working.” Training for 470 new midwives this year is out of the question.
Arakaki described witnessing the collapse firsthand: “I visited Sudan last year, and again recently. The difference is stark. Everyone’s exhausted. We’re seeing more survivors of sexual violence, more pregnancies resulting from rape, more cases of HIV and STIs.” (Sexually transmitted infections.)
The crisis is compounded by the prevalence of female genital mutilation, which often requires pregnant women to undergo Cesarean sections. “But our facilities lack basic drugs. It’s overwhelming,” Arakaki said.
Reza Eshaghian, an emergency medical coordinator for MSF in Sudan, told PassBlue that the health care system had been woefully inadequate long before UNFPA’s midwifery program ended.
“There are overwhelming gaps in the provision of sexual and reproductive health care across Sudan,” Dr. Eshaghian said. “The needs were nowhere near being met. MSF is seeing that in all fields of health there is not a sufficient response. We are striving continuously to expand and increase our capacity due to this big need, which is exacerbated by actors who are withdrawing support.”
In 2024, MSF provided 173,908 sexual and reproductive health consultations and assisted more than 24,000 deliveries in Sudan, despite operating amid violence. As of January 2025, MSF was working in 10 of Sudan’s 18 states, including in parts of conflict-ravaged Darfur and Gedaref, with more than 1,800 staff based in hospitals, clinics and mobile sites. However, MSF says it cannot absorb the workload left by UNFPA.
Sudan’s diplomats at the UN did not answer questions from PassBlue about US budget effects on Sudanese midwives.
The US retreat from global development under the Trump administration has been swift and severe. The administration said in February that it planned to cut more than 90 percent of the USAID’s foreign aid contracts and $60 billion in overall assistance around the world.
When asked about the withdrawal of funding to UNFPA, a State Department spokesperson told PassBlue: “Although the Department is no longer funding UNFPA, we remain committed to supporting women through pregnancy and childbirth through other partners and programs.” No details were provided.
While UNFPA recently launched a Global Midwifery Accelerator program to expand access to quality care, particularly in crisis zones, through more investment, education and deployment, donors are stretched thin. Mounting geopolitical pressures, especially in Europe, have forced many wealthy countries to focus on increasing their defense spending.
“It’s not just the United States that is pulling back,” Mendelson said. “There’s a huge crisis in Europe, where Russia is clearly a threat. So, governments are going to spend money on defense rather than development.”
The collapse of midwifery care coincides with widespread sexual violence, according to UN experts, who have documented not only countless cases of rape but also forced marriages in displacement camps in Sudan, often with no medical follow-up or psychological care available.
“There is still time for the U.S. to recommit to this essential work,” Dr. Natalia Kanem, UNFPA’s executive director, said in a statement on May 5. “Women do not stop giving birth in war. But the world seems to be walking away from them when they need it most.”
Arakaki said: “Our midwives are facing these new challenges while being displaced themselves. This is a common trend in emergencies. I see similarities between Sudan, Tigray and Yemen. All midwives have lost everything and are displaced.”
“Yet they persist,” she added. “We often call them heroes.”
The article was updated to reflect the total amount of US donations to UNFPA in 2024.
We welcome your comments on this article. What are your thoughts on US cuts to midwifery programs globally?
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Anisha Dutta is a New York-based award-winning journalist with a decade experience covering politics, foreign policy and conflict. She holds a master’s degree in political journalism from Columbia University and is a Chevening Fellow.
Anisha thank you for the contribution, however my fundamental question is who are the actors in the war in Sudan? Why are they killing their own people including their children, women and pregnant mothers? Why are they destroying their health and other infrastructures? Why are they displacing their own people from their towns and villages? Let us stop blaming the US and forgetting the war mongers who are putting their own people in harmful ways. The war in Sudan has to stop and immediately, the war on Gaza has to stop and immediately, the war in Yemen has to stop and immediately, the war in Ukraine has to stop and immediately, the war in Somalia has to stop and immediately and the war in DRC has to stop and immediately, and the terrorism has to stop and immediately in the Sahel.