Women in low-income Kenyan neighbourhoods face unsafe abortions and increased maternal deaths due to the US government’s plan to destroy stockpiles of contraceptives, experts have told openDemocracy.
After it was previously reported that $9.7m of intrauterine devices, hormonal implants and birth control pills earmarked for countries in Africa are sitting in a warehouse in Belgium, the International Planned Parenthood Federation (IPPF) in November confirmed that a further 20 truckloads of contraceptives are being held in an unknown location in another Belgian village. Some products have become unusable due to poor storage.
All the contraceptives were intended for family planning and reproductive health initiatives in Kenya, the Democratic Republic of the Congo, Tanzania, Zambia, and Mali. These initiatives were previously supported by the United States Agency for International Development, which Donald Trump dismantled this year.
His administration’s decision to destroy the products – despite philanthropic organisations offering to buy and transport them without cost to the US – will leave 1.4 million women and girls without access to birth control, according to the IPPF, a UK-based non-governmental organisation that promotes sexual and reproductive health and rights globally. The NGO estimates that this will result in about 170,000 unintended pregnancies and 56,000 unsafe abortions.
This plan is in line with Project 2025, a draconian policy framework authored by the US far-right think tank Heritage Foundation ahead of Trump’s second presidency, which seeks to reshape the US federal government and implement right-wing policies globally. One of the framework’s objectives involves limiting sexual reproductive rights around the world, including by reinstating the global gag order, which prevents US aid from going to foreign organisations that “provide abortion services, information, counselling, referrals or advocacy”.
The impact of this ban is already being felt around the world, as services delivered by health facilities and organisations that provide sexual and reproductive healthcare are disrupted. In low-income areas in Kenya, where there are already shortages in contraceptives due to health facilities being crippled by the gradual closure of USAID, the effect of the contraceptives in Belgium being destroyed will be particularly dire.
Ruaraka, a neighbourhood in Nairobi, has seen a rise in “unintended and repeated pregnancies among adolescents and women”, according to the Community Voices Network, a youth-led organisation in the neighbourhood. The USAID cuts have led several community-based health organisations in the area to shut down, and those that remain do not have the capacity to care for all those in need of their services.
“We are struggling to link adolescents and young people to the right and safe abortion services and regularly lose girls and women to unsafe abortions,” said Mercy Mugecha, the Community Voices Network’s communications lead.
Unsafe abortions are the primary cause of maternal deaths in Kenya. The 2014 Kenya Demographic Health Survey found that 41.9% of pregnancies in the country are unintended, while 14% result in unsafe abortions, according to a study by the African Population and Health Research Center in the same year. These terminations, the researchers said, are “performed by unskilled people, often in conditions that do not meet minimal medical standards and are not followed with the appropriate post-abortion care” and result in the deaths of 2,600 women in Kenya every year, especially in Nairobi’s informal settlements.
Lucy Njeri, a 22-year-old Ruaraka resident, gave birth after becoming pregnant at 17 when she “didn’t have enough information on sexual and reproductive health”. Today, Njeri works at Sauti Zetu, a sexual and reproductive health initiative affiliated with the Community Voices Network, and is cautious about her own health. But strained access to critical services threatens that.
The public hospitals where Njeri usually gets an injectable birth control (which offers protection against pregnancy for between eight and 13 weeks, depending on the product) have been out of stock several times this year, and in July, she was forced to go without it for almost two weeks.
“I had to go to a pharmacy, but not everyone has money for that,” Njeri told openDemocracy. “We depend on public healthcare, and when there’s a disruption in dispensing services, people are forced to wait because they can’t afford private facilities.” This was echoed by Mugecha, who said that people in Ruakara “can barely afford food” and are having to choose between survival and private healthcare.
As it gets harder to reliably offer contraceptives or find alternative facilities for their clients to attend, sexual and reproductive health and rights groups in Kenya have had to change their guiding philosophy on how they offer care.
“Given the current shortage, we are urging adolescents to abstain from having sex to avoid unintended pregnancies,” Mugecha told openDemocracy. The US’s plan to destroy the contraceptives would be an egregious “intentional act of reproductive coercion to adolescents and young people struggling economically” and a huge rollback of reproductive rights, she added.
In September, the Trump administration told the New York Times that the contraceptives had been incinerated at a French facility that handles medical waste. Belgian authorities disputed this days later, saying they had entered one of the known warehouses and seen that the contraceptives were still there.
Despite the lived experiences of Njeri and others in Ruaraka, the National Family Planning Programme manager at Kenya’s Ministry of Health, Dr Albert Ndwiga, claimed “there is no immediate risk” from scrapping USAID because the Kenyan government has put in place measures to remedy the situation.
Ndwiga said a health ministry committee has formulated a policy brief in response to the cuts, after finding that Kenya’s health systems have been overreliant on donor funds. Its long-term plan to fix this involves building “local ownership, diversifying funding sources and strengthening both administrative and technological capacities”.
The ministry has received a special allocation from the national budget to meet contraception needs in the short term, along with “the remnant support” from the United Nations Population Fund, which supports sexual and reproductive health programmes in Kenya. Neither the government nor the ministry has said how much this allocation is.
The ministry is now awaiting additional financing from the state for a long-term solution, although it is not clear when this might be delivered. The committee has recommended that any future funding be spent on “investment in local manufacturing of essential drugs and health commodities, expansion of social health insurance benefits towards coverage of critical conditions and commodities and restructuring of key health human resources and service delivery systems to rebuild capacity and restore resilience in Kenya’s public health sector”.
But experts such as the Sexual and Reproductive Health and Rights Alliance, a consortium of civil society organisations that support young people, women and marginalised groups in Kenya, have suggested the government is ill-prepared to deliver these proposals.
The alliance was among stakeholders invited to a meeting by the Ministry of Health to discuss the policy recommendations in September. Ramwaka Nyadzuwa, the organisation’s communications and youth engagement officer, described the proposals as well-considered interventions that could “significantly strengthen the health system if fully implemented” but said the government is still unequipped to adopt them due to its lack of domestic financing.
In her opinion, a solid policy framework alone is insignificant. To address the gaps created by the USAID funding cuts, there must be dedicated financing and political will to see it through, she said.
“While the government has shown willingness on paper, translating these commitments into action requires sustained funding, clear budget allocations, and consistent follow-through. Without adequate domestic investment, progress on local manufacturing, expanding insurance coverage and restructuring human resources may remain slow or uneven,” said Nyadzuwa.
Although governments must play a pivotal role, they alone cannot resolve the problems caused by the dismantling of USAID-funded services, according to Mallah Tabot, the sexual and reproductive rights and health lead at the International Planned Parenthood Federation Africa.
Tabot described the US’s planned destruction of contraceptives as “another indefensible man-made and senseless act based on a dangerous ideology, which is taking advantage of political power to control how people plan their families”. She believes that this is a critical moment that calls for global solidarity in coming up with solutions and for African governments and partners to reimagine financing for reproductive health.
Tabot said there’s already promising movement in creating solutions within some African countries. This includes impact investing – investments intended to generate positive, measurable social impact alongside a financial return and blended finance models, which attract private capital into public health delivery, whether through social impact bonds, contraceptive supply-chain financing, or partnerships with local manufacturers.
“Of course, the government is crucial to creating solutions, but so are other partners like the United Nations and other donors. IPPF is supporting member associations and working closely with other partners to make this happen while also pushing for the withheld contraceptives to be released. Finding sustainable solutions to manage contraceptive shortages requires shared responsibility and renewed global solidarity,” Tabot said.
Ultimately, the idea is to shift from politics of dependency to politics of shared responsibility, where women’s health and rights are protected and recognised as non-negotiable by governments and societies, she said. But while there is some optimism for the future, Tabot admitted that, regardless of any government intervention, the situation is likely to get worse before it gets better.
“I think when 2026 comes, we will see the impact, which unfortunately translates to increased mortality and morbidity, especially for African women and girls,” said Tabot.
