AILSA CHANG, HOST:
Just about $600 million - that is the amount of money that Congress has allocated for family planning and reproductive health globally. For more than a decade, that number has not changed, and it's made the U.S. the top donor. But as NPR's Gabrielle Emanuel reports, this year, that money has not been spent.
GABRIELLE EMANUEL, BYLINE: For years, at 8 p.m. each night, Prossy Muyingo would get a text message from a 28-year-old on her veranda. The message simply said...
PROSSY MUYINGO: I'm on your veranda.
EMANUEL: Muyingo would pour a glass of water, and from the sideboard in her living room, she'd pick up a small birth control pill and bring it outside.
MUYINGO: So she was swallowing that from my house.
EMANUEL: For 12 years, Muyingo has been a health worker in Central Uganda, going house to house, working as a bridge between the local health facility and the community. Many women confided in her that they wanted contraception, but they'd ask her to store the pills, saying...
MUYINGO: Please help me and keep this medicine.
EMANUEL: The woman on the stoop - she already had three kids and wanted some space before another. But her husband...
MUYINGO: That man is ever asking for a child.
EMANUEL: And she told Muyingo she fears her husband would beat her if he knew about the birth control. Muyingo says many women have this fear, so they stop by her house to take their pills. But last year, Muyingo suddenly lost her job. The small U.S.-funded nonprofit where she worked had its contract with the U.S. government terminated. Still, Muyingo keeps checking on her community.
MUYINGO: Now we are not paid, but these are our neighbors, the people we share the churches, where we all fetch water.
EMANUEL: She tells her patients now to go to the local clinic to get medications. But many would leave empty-handed. She says it's because waiting in the long lines would make their family members suspicious. That's what happened to the 28-year-old.
MUYINGO: After two months, she realized that I'm now pregnant. Then I told her that, are you sure?
EMANUEL: She was sure. In May 2025, Congress members asked Secretary of State Marco Rubio about the money lawmakers had appropriated for family planning.
(SOUNDBITE OF ARCHIVED RECORDING)
MARCO RUBIO: There's no plan to spend that money. We're not going to be in that business globally. I mean, we don't - we're not going to do it.
EMANUEL: In a statement to NPR, the State Department said it is still evaluating family planning programs and funding. What exactly the administration means by family planning is key, says Brett Schaefer, an expert on international aid at the conservative American Enterprise Institute. It's long been illegal for U.S. foreign aid funds to pay for abortions, and Trump's team has added further restrictions. But Schaefer thinks the administration may be OK with something like condom distribution.
BRETT SCHAEFER: Where it can be tied to combating HIV/AIDS and other sexually transmitted diseases. I think the administration would be supportive of those types of initiatives.
EMANUEL: This fiscal year, Congress again appropriated money for family planning. Elizabeth Sully is with the Guttmacher Institute, a research organization that supports access to family planning. She says international aid for contraception has traditionally had bipartisan support. It was seen as a health issue and a development one because research shows that...
ELIZABETH SULLY: For women, when they can control pregnancies, then they decide to stay in school longer, or they pursue different economic job opportunities.
EMANUEL: With foreign aid cuts and a lot of data gathering halted by the Trump administration, Sully says it's been hard to measure any spike in unintended pregnancies.
SULLY: It is definitely playing out. It's just we don't have visibility into how it's playing out right now.
EMANUEL: In Uganda, Muyingo has an idea of what's happening. She's now coaching neighbors through unintended pregnancies, including the 28-year-old.
MUYINGO: If she wanted that - maybe I can abort. You know, in Uganda, abortion is illegal. It's not allowed. So I did a lot of counseling for her to love her pregnant.
EMANUEL: She had the baby, a boy, who's now three months old. Muyingo says she's hopeful the Trump administration will resume aid. But in the budget request the administration released this month, it says, quote, "the budget eliminates global health activities that do not make America safer, such as family planning and reproductive health." Gabrielle Emanuel, NPR News. Transcript provided by NPR, Copyright NPR.
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