USAID fallout: In Nepal, when the aid workers stopped coming, the women
and babies started dying
[August 13, 2026]
By KRISTEN GELINEAU
GAUR, Nepal (AP) — The young mother’s breath had grown ragged. Inside
her mud home in rural Nepal, she hunched over in agony, pain pummeling
her pregnant belly, her swollen legs scarcely able to support her.
Kabita Mukhiya was in the midst of an emergency, but didn’t know it. For
weeks, she’d suffered at home, because there was nobody around to tell
her to rush to a hospital. The aid workers who once regularly visited
her village to help pregnant women had stopped coming, after foreign aid
cuts by the United States shuttered a program aimed at saving mothers’
and babies’ lives.
Kabita was uneducated and impoverished, and she did not know what was
happening to her body. In desperation, she turned at last to her aunt
for help, who hauled her off to the hospital, where both women wept as
the doctors said things neither could understand.
Which is why Kabita — confused and confined to her hospital bed — turned
to something she could understand: prayer.
“Please save the baby,” she begged God through her tears. “Please save
me.”
Then, through the chaos, came the words that Kabita finally grasped, but
could not bear: It was too late. Her baby was dead.
And her own life was now hanging by a thread.
___
This story was funded by a grant from the Pulitzer Center. The
Associated Press is responsible for all content.
___
One baby at a time, the world is marching toward a grim milestone:
Because of global cuts to foreign aid, the Gates Foundation has
predicted that 2025 will be the first year this century where child
deaths will increase.
For many experts, the health of a country is measured by the health of
its smallest: Children under the age of 5. And while global child
mortality data for 2025 won’t be available for several months, health
officials are already bracing for a surge in deaths among the world’s
youngest and most vulnerable.
The decision by U.S. President Donald Trump’s administration to dissolve
the United States Agency for International Development — once the
world’s largest humanitarian donor — gutted maternal and neonatal care,
decimated nutrition programs for millions of pregnant women and children
and left scores of birthing centers devoid of equipment, medicine and
staff. The U.S. cuts, followed by foreign aid cuts from several other
countries, forced 60% of women’s organizations to reduce their services,
according to the World Health Organization.
The U.S. government has repeatedly insisted that no one — and,
particularly, no children — have died because of its funding cuts. But
the AP has documented the deaths of women and children from Myanmar to
Nigeria.
A study published in The Lancet journal, meanwhile, said the U.S. cuts
could lead to more than 14 million deaths, including more than 4.5
million children under age 5, by 2030.
“It’s heartbreaking to see what’s happening. It’s decades of progress
being washed away,” says Rajat Khosla, executive director of WHO’s
Partnership for Maternal, Newborn and Child Health.
In a statement to The Associated Press, the U.S. State Department said
the Trump administration had reinvigorated its assistance programs to
focus on efficiency, effectiveness and partnership. The department also
said the U.S. spends more on health and humanitarian assistance than any
other country, and still supports programs in Nepal aimed at improving
maternal and child health.
“The rest of the world needs to contribute more and share the burden,”
the department said.
In Nepal, cuts to nutrition and reproductive outreach programs have
already increased pregnancy complications and deaths, according to
health workers, government officials, aid workers and families
interviewed by the AP.
“The number of deaths of mothers, young mothers, during delivery has
really increased,” says Mona Sherpa, country director for the aid group
CARE Nepal, which lost more than half its funding from the U.S. cuts.
“The expected number within a year is happening within four to six
months.”
Maternal and child health programs are perhaps the clearest foreign aid
example of small, relatively cheap interventions leading to the greatest
good. Packets of fortified peanut paste that cost less than a dollar
each can bring a malnourished child back from the brink of death within
weeks. Clean birth kits that cost a few dollars slash the risk of
mothers and newborns dying from infections.
In Nepal, a five-year, $35 million program canceled by the U.S. cuts
reached more than 100,000 women and girls in its first three years. The
program equipped birthing centers and trained nurses, midwives and
outreach workers known as female community health volunteers. These
workers regularly visited pregnant women’s homes, explained the warning
signs of complications and urged them to attend prenatal appointments,
often escorting them there.
When the program was canceled, many pregnant women were left to navigate
a medical system they struggle to trust or understand, Sherpa says.
The consequences can be found in the dusty, sun-scorched villages of
Nepal’s Rautahat district, home to Kabita’s family and one of the
poorest and least-literate parts of the country. At a birthing center in
Rautahat’s municipality of Dewahi Gonahi, the number of women coming for
prenatal checks has halved since the funding cuts, says the officer in
charge, Kishori Shah. Because of that, women aren’t identifying
complications fast enough, he says, leading to emergencies.
“There would have been a decrease in complications if the USAID program
was still running,” he says.
In the village of Prempur Gonahi, it took just 10 months — a touch
longer than a typical pregnancy — for newborns to begin dying again
after the U.S. cuts, says the officer in charge, Sadho Baitha.
Before CARE’s program launched in Rautahat in December 2022, Baitha
says, the village averaged 10 to 15 neonatal deaths per year. By 2024,
records show, there were zero. But since the program’s cancellation,
newborns have begun dying again; the first was in December, and four
more followed by March.
Yet many deaths linked to the funding cuts will remain invisible, in
part because the cuts themselves left scores of mortality data
collectors jobless. In some places, there is simply no one left to count
those who died.
This is the case in Dewahi Gonahi, where mortality reporting and
recording services have collapsed, says Shatrudhan Singh, executive
director of Campaign Nepal, CARE’s partner. Which is why, he says, the
government record shows just two infant deaths in the municipality since
the funding cuts, despite his group knowing of eight.
“There must be more than that,” he says. “We just can’t identify them.”
The stories of loss are hidden inside the cramped homes of the loved
ones left behind and in the vacant eyes of now-motherless children.
From the shadows of her own home, Phula Devi tries to verbalize her loss
in a voice so halting and hushed it’s barely audible. She has never
spoken of her grief to anyone — not even to her husband.
Like most women in this village a few miles from Kabita’s, Phula never
attended school. She knew almost nothing about pregnancy; she does not
even know her own age, just that she is not yet 20.
Phula is the type of woman outreach workers say they would have
targeted. Instead, one morning in January, an informal village health
practitioner came to her home and said the fetal heartbeat was slow. He
told her to go to a hospital, then left.
Phula didn’t understand. And she was at the mercy of her relatives, who
waited until that night to take her to the hospital.
There, the doctors urged a C-section. But Phula didn’t know what that
meant. Terrified, she pushed the baby out on her own. He emerged silent
and still, declared dead and whisked away before Phula could hold him,
name him or even see his face.
He was overdue, hospital records show, a risk factor for stillbirth.
Nurse Guddi Rahami, who remembers Phula’s case, says the region’s
uneducated families often resist C-sections because they believe the
operation is somehow bad.
From inside her darkened home, Phula hides her tear-streaked face behind
a scarf.
“I think of my baby all the time,” she murmurs.
She would have done anything to save him, she says. If she’d only known
how.
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A woman collects water from a well in Gaur, Nepal, on May 19, 2026.
(AP Photo/Bram Janssen)
 Down a winding dirt path peppered
with bleating goats, Kabita’s two-room home emerges into view.
Outside, women trudge past in a rainbow of saris that cling to their
fragile frames, seared by the punishing sun.
This became Kabita’s home at 14, when she married her husband after
a life of loss. Her mother died when she was little, and her father
soon abandoned her to move to India with his new wife. Her three
siblings would later follow him.
Her wedding photo shows her as the child she still was when she
married: slender, with wide-set brown eyes, soft cheeks and a shy
smile. She struggled to bond with her mother-in-law, who shared
their home, but endeared herself to her aunt and neighbor, Shraddha
Mukhiya. Shraddha relished Kabita’s innocence and was amused by her
constant, occasionally nonsensical, chatter. She came to view the
girl as her daughter.
Kabita quickly fell pregnant with a daughter of her own, Sonam. Her
second daughter, Anushka, followed a year later, and her son, Yubraj,
a year after that.
Her husband, the family’s sole provider, was rarely home, forced to
chase construction jobs around Nepal and India that brought the
family around 12,000 Nepalese rupees ($80) per month. It was enough
to buy rice, lentils and vegetables, but little else.
Despite the difficulties, the 20-year-old Kabita was overjoyed to
learn she was pregnant with her fourth; she and her mother-in-law
longed for another boy. She scraped together enough money to buy
clothes for the baby, whom she planned to name Shivraj, and dreamed
that he would one day get the education she was never afforded.
When she was pregnant with Yubraj, she received a U.S.-funded
nutritious powder that helped supplement her limited diet. But by
the time she became pregnant last year, the funding cuts had
eliminated the local birthing center’s nutritional supplements and
food for pregnant women, says Punam Mahato, a nurse who treated
Kabita.
U.S.-funded nutrition programs were crucial to the region,
particularly for children, health workers say. The prevalence of
wasting — a life-threatening form of malnutrition — among children
under 5 in Kabita’s province was 7.4% before the U.S. funding cuts,
according to a survey conducted by the government and the United
Nations’ children’s agency. That number rose to 12.3% after the
cuts, according to a national malnutrition screening conducted in
May by the government and the aid group Helen Keller Intl, which saw
its nutrition program halted by the U.S. cuts.
As her pregnancy progressed, Kabita’s belly swelled while the rest
of her remained gaunt. Sometimes she only managed to eat two small
meals a day. And the mothers’ group meetings she attended while
pregnant with Yubraj had ceased.
She missed the recommended first trimester appointment, and made her
first visit to the birthing center for a check at 16 weeks. Mahato,
her nurse, noticed she was pale. She suggested Kabita get a blood
test to check her hemoglobin, which can plummet in pregnancy amid
nutritional deficiencies.
But Kabita never got the test, and didn’t seem to understand its
necessity; she never mentioned it to her mother-in-law. At 24 weeks,
Mahato was worried by Kabita’s pallid complexion and again
recommended a blood test. Again, Kabita demurred, likely because she
didn’t grasp its importance, Mahato says.
Rajkumari Patel, a community health volunteer who worked under
CARE’s now-canceled program, said they would have acted as mediators
to explain to Kabita why the test was crucial.
Instead, Kabita returned home. She was tormented by stomach pains
that grew increasingly fierce. Her body swelled.
She suffered for weeks. By December, when she was 28 weeks pregnant,
Kabita had become so weak she could not walk. Her husband was
working in India, so she turned to Shraddha, her aunt, for help. The
elder woman took her to the hospital.
Doctors drew Kabita’s blood to check her hemoglobin levels, then
handed the results to the women. But Kabita and Shraddha didn’t know
what they meant. Nor did they understand the rush of activity and
tests and medical explanations that followed.
Their understanding finally came amid the absence of a heartbeat. A
test confirmed it: Kabita’s baby was dead.
___
Everything was happening so fast.
The hospital was not equipped to remove the baby’s remains from
Kabita’s womb. Staffers urged them to go to another hospital. But
with no money and no sense for the danger Kabita was facing, the
grieving women returned home.
By the next day, Kabita’s vision was distorted. Her head pounded.
She was delirious.
In desperation, Shraddha took her to another hospital with lower
fees. The doctors determined that she’d had a seizure from
preeclampsia, where dangerously high blood pressure can be fatal if
untreated, says paramedic Hridaya Narayan Mahato, who is not related
to Kabita’s nurse.
Doctors gave her oxygen while the staff rushed to prepare the ICU.
Kabita’s hemoglobin levels were critically low, leaving her short of
oxygen and straining her heart. She lay on her back, shaking and
gasping for air. Shraddha sat helplessly at the foot of the bed.
“You’ll be OK,” she told her niece through tears.
And then she watched as Kabita drew her final breath.
She was dead before they could get her into the ICU.
___
A short drive from Kabita’s home, Patel, the community health
worker, sits outside her home, her words laced with frustration.
Deaths like Kabita’s, she says, are precisely what she and her
colleagues had been trained to prevent.
Patel used to know every pregnant woman in her village, visiting
them at home. She would have done the same for Kabita, she says.
“I would have asked her, ‘Is the baby kicking? When did you last
feel movement?’ I would have checked for swelling in her hands and
face. I would have looked at her eyes for signs of anemia,” she
says. “These are the signs I would have noticed in Kabita and said,
‘This woman needs a hospital today -- not tomorrow.’ Maybe we could
have saved her life.”
Kabita died from complications of eclampsia, with severe anemia
contributing significantly, says Mahato, the hospital paramedic.
Both conditions can often be identified and managed through regular
prenatal care, he says.
The loss of Kabita and her baby so overwhelmed Shraddha that she
couldn’t bear to tell Kabita’s husband. Still working in India, he
was oblivious to the crisis until neighbors called him. His bus ride
home took so long that he didn’t arrive back in the village until
three days after Kabita’s funeral.
In the months since, he has frequently refused to work, lying in the
dark crying for days at a time. He speaks only of Kabita, never the
baby. Shraddha and his mother, Lachhiya Devi, remind him that they
will all starve unless he returns to work. And so he does.
Both in their 60s, Shraddha and Lachhiya worry about how long they
can care for Kabita’s little ones. From the bed she shares with her
grandchildren, Lachhiya strokes the leg of 4-year-old Anushka, who
slumbers next to her in the midday heat.
“How will I feed them? I’m old,” Lachhiya says, her bangles barely
clinging to her bony arms. “You can see how desperately I’m trying
to get by.”
Their home is quiet now without Kabita’s cheerful chatter or the
cries of the baby who never made it home. The last reminders of
Kabita’s life — her sparkly green sari, the pink and yellow tapestry
she knitted — are packed away in a box that will be given to her
children one day.
Shraddha remains tormented by what she didn’t know.
“We don’t have anyone to help us out here, to tell us about these
things. If there was someone, we would ask them, follow their
advice,” she says. “It would have saved her life.”
She looks at Kabita’s children and aches for their mother, who was
barely beyond childhood herself.
“She was too young to die.”
___
Journalist Tulsi Rauniyar contributed to this report.
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