{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:53:23Z","timestamp":1791726803580,"version":"4.3.4"},"reference-count":22,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,6,19]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In January 2025, the Trump Administration announced a 90-day freeze on all US government (USG) foreign aid, which subsequently became a permanent shutdown of the US Agency for International Development in July 2025. The sudden withdrawal of USG financing disrupted health and humanitarian systems worldwide, with disproportionate impacts on women, girls and other marginalised populations. This study documents impacts of the funding freeze during its early months (February\u2013March 2025) on global health programmes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This rapid mixed-methods assessment combined a global online survey with qualitative case studies in Nepal, Kenya and Colombia. The survey was distributed via email through networks and relevant listservs. Semistructured key informant interviews (KIIs) (n=53) were conducted with non-governmental organisation leaders, clinicians, community health workers, government officials and humanitarian actors, all purposively selected based on their direct or indirect involvement in USG-funded health programmes. Interview transcripts were thematically analysed and triangulated with quantitative findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Survey respondents reported initial impacts of the USG funding cuts across health sectors and functions, including humanitarian and emergency response\/preparedness, gender-based violence and mental health and psychosocial support. Five key themes arose from the KIIs with stakeholders in three case study countries: disruptions to sexual and reproductive health and rights (SRHR) services, HIV service interruptions and treatment access, the collapse of referral networks and service ecosystems, a mental health crisis among clients and health workers and the rising vulnerability of marginalised populations. Both survey and interview data highlighted growing inequities and anticipated reversals in longstanding health gains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 2025 US foreign aid freeze generated immediate and widespread disruptions across health and humanitarian systems, revealing systems-level vulnerabilities. These early findings point to the need for more diversified and reliable financing, stronger domestic preparedness and policy approaches that centre SRHR and marginalised populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2026-004904","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:30:27Z","timestamp":1784640627000},"page":"e004904","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Global health consequences of the 2025 US foreign aid freeze: rapid assessments in Colombia, Kenya and Nepal"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6433-0687","authenticated-orcid":false,"given":"Sarah","family":"Branoff","sequence":"first","affiliation":[{"name":"Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4792-9260","authenticated-orcid":false,"given":"Thoai D","family":"Ngo","sequence":"additional","affiliation":[{"name":"Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Engebretsen","sequence":"additional","affiliation":[{"name":"Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4631-4764","authenticated-orcid":false,"given":"M Claire","family":"Greene","sequence":"additional","affiliation":[{"name":"Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Kosgei","sequence":"additional","affiliation":[{"name":"policy\/strategy group, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia","family":"Merlim","sequence":"additional","affiliation":[{"name":"policy\/strategy group, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilo","family":"Ramirez","sequence":"additional","affiliation":[{"name":"HIAS, Bogota, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achala","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Tamang","sequence":"additional","affiliation":[{"name":"Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyotsna","family":"Tamang","sequence":"additional","affiliation":[{"name":"Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8476-0327","authenticated-orcid":false,"given":"Sara E","family":"Casey","sequence":"additional","affiliation":[{"name":"Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"2026072106301879000_4.3.e004904.1","unstructured":"House TW . eevaluating And Realigning United States Foreign Aid. The White House. 2025. Available: https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/reevaluating-and-realigning-united-states-foreign-aid\/ [Accessed 21 Aug 2025]."},{"key":"2026072106301879000_4.3.e004904.2","unstructured":"Department of State[@StateDept] . July 1, 2025 - X post. Twitter. 2025. Available: https:\/\/x.com\/StateDept\/status\/1940037342732894345 [Accessed 25 Aug 2025]."},{"key":"2026072106301879000_4.3.e004904.3","unstructured":"UN News . Guterres calls on US to exempt development and humanitarian funds from aid \u2018pause\u2019. 2025. Available: https:\/\/news.un.org\/en\/story\/2025\/01\/1159486 [Accessed 31 Jul 2025]."},{"key":"2026072106301879000_4.3.e004904.4","unstructured":"FA.gov. Available: https:\/\/foreignassistance.gov\/ [Accessed 31 Jul 2025]."},{"key":"2026072106301879000_4.3.e004904.5","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S0140-6736(25)01186-9","article-title":"Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis","volume":"406","author":"Cavalcanti","year":"2025","journal-title":"The Lancet"},{"key":"2026072106301879000_4.3.e004904.6","unstructured":"United States Department of State . America first global health strategy. Available: https:\/\/www.state.gov\/releases\/office-of-the-spokesperson\/2025\/09\/america-first-global-health-strategy\/ [Accessed 18 Nov 2025]."},{"key":"2026072106301879000_4.3.e004904.7","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26423","article-title":"Early impacts of the PEPFAR stop-work order: a rapid assessment","volume":"28","author":"Lankiewicz","year":"2025","journal-title":"J Int AIDS Soc"},{"key":"2026072106301879000_4.3.e004904.8","unstructured":"Mandavilli A , Trump Administration Halts H.I.V . Drug Distribution in Poor Countries. The New York Times; 2025. Available: https:\/\/www.nytimes.com\/2025\/01\/27\/health\/pepfar-trump-freeze.html [Accessed 18 Nov 2025]."},{"key":"2026072106301879000_4.3.e004904.9","unstructured":"The IRC . 25 Years Following the Beijing Platform for Action Finds Widening Gaps in Gender Equality for Women and Girls in Conflict Settings. Available: https:\/\/www.rescue.org\/press-release\/25-years-following-beijing-platform-action-finds-widening-gaps-gender-equality-women [Accessed 13 Oct 2025]."},{"key":"2026072106301879000_4.3.e004904.10","unstructured":"UNHCR . Mid-year trends 2025. 2025. Available: https:\/\/www.unhcr.org\/media\/mid-year-trends-2025 [Accessed 2 Jun 2026]."},{"key":"2026072106301879000_4.3.e004904.11","unstructured":"Bitar S . Migration in Colombia and Public Policy Responses | United Nations Development Programme nations development programme. 2022. Available: https:\/\/www.undp.org\/latin-america\/publications\/migration-colombia-and-public-policy-responses [Accessed 2 Jun 2026]."},{"key":"2026072106301879000_4.3.e004904.12","unstructured":"ReliefWeb . Reverse Migration Crisis Unfolds After USAID Cuts - Colombia. 2025. Available: https:\/\/reliefweb.int\/report\/colombia\/reverse-migration-crisis-unfolds-after-usaid-cuts [Accessed 2 Jun 2026]."},{"key":"2026072106301879000_4.3.e004904.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2022-008752","article-title":"Beyond abortion: impacts of the expanded global gag rule in Kenya, Madagascar and Nepal","volume":"7","author":"Maistrellis","year":"2022","journal-title":"BMJ Glob Health"},{"key":"2026072106301879000_4.3.e004904.14","unstructured":"Partnership for Maternal, Newborn & Child Health (PMNCH) . Snap survey conducted by PMNCH reveals global funding crisis threatening health and rights programs for women, children, and adolescents. Available: https:\/\/pmnch.who.int\/news-and-events\/news\/item\/20-10-2025-snap-survey-conducted-by-pmnch-reveals-global-funding-crisis-threatening-health-and-rights-programs-for-women-children-and-adolescents [Accessed 18 Nov 2025]."},{"key":"2026072106301879000_4.3.e004904.15","unstructured":"Godbole R . Analyzing USAID Program Disruptions: Implications for PEPFAR Programming and Beneficiaries. 2025. Available: https:\/\/www.cgdev.org\/publication\/analyzing-usaid-program-disruptions-implications-pepfar-programming-and-beneficiaries [Accessed 18 Nov 2025]."},{"key":"2026072106301879000_4.3.e004904.16","unstructured":"Byrnes T . Grandi\u2019s final briefing: the numbers that confirm system collapse | linkedin. Available: https:\/\/www.linkedin.com\/pulse\/grandis-final-briefing-numbers-confirm-system-collapse-thomas-byrnes-m5dde\/ [Accessed 18 Nov 2025]."},{"key":"2026072106301879000_4.3.e004904.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2025-020241","article-title":"What will it take to reimagine global health for 10 billion people?","volume":"11","author":"Ngo","year":"2026","journal-title":"BMJ Glob Health"},{"key":"2026072106301879000_4.3.e004904.18","unstructured":"Jerving S . Will African nations lose their leverage in an \u2018America First\u2019 health plan. Devex 2025. Available: https:\/\/www.devex.com\/news\/sponsored\/will-african-nations-lose-their-leverage-in-an-america-first-health-plan-111396"},{"key":"2026072106301879000_4.3.e004904.19","unstructured":"Maleche A , Sekalala S , Wafula T . Health Data Protection and Governance under the Kenya\u2013US Health Agreement. Health and Human Rights Journal 2025. Available: https:\/\/www.hhrjournal.org\/2025\/12\/17\/health-data-protection-and-governance-under-the-kenya-us-health-agreement\/"},{"key":"2026072106301879000_4.3.e004904.20","unstructured":"Fed Regist . Protecting Life in Foreign Assistance. 2026. Available: https:\/\/www.federalregister.gov\/documents\/2026\/01\/27\/2026-01519\/protecting-life-in-foreign-assistance [Accessed 9 Apr 2026]."},{"key":"2026072106301879000_4.3.e004904.21","unstructured":"OECD stat creditor reporting system. 2022. Available: https:\/\/data-explorer.oecd.org\/ [Accessed 11 Aug 2025]."},{"key":"2026072106301879000_4.3.e004904.22","unstructured":"Center For Global Development . USAID Cuts: New Estimates at the Country Level. Available: https:\/\/www.cgdev.org\/blog\/usaid-cuts-new-estimates-country-level [Accessed 11 Aug 2025]."}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2026-004904","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:30:52Z","timestamp":1784640652000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2026-004904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7,21]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjph-2026-004904"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2026-004904","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}