AILSA CHANG, HOST:
The State Department shut down most foreign aid in January and started canceling hundreds of contracts. Sub-Saharan Africa, which receives more than a quarter of that U.S. foreign assistance, has been especially affected by these cuts. Ari Daniel reports that communities across the continent are grappling with the fallout.
ARI DANIEL, BYLINE: Ernestine Nedjoumbaye is a midwife in Chad, and with the cuts to USAID programs, her job is now on the line. Nedjoumbaye is based at the Gaga Refugee Camp in the east. She mostly tends to women fleeing the violence in neighboring Sudan.
ERNESTINE NEDJOUMBAYE: (Speaking French).
DANIEL: Nedjoumbaye says one woman in particular touched her heart.
NEDJOUMBAYE: (Speaking French).
DANIEL: Her name was Fatmeh. She was pregnant, and her husband and son had been killed in Sudan. Shortly after she arrived at the camp, Nedjoumbaye says Fatmeh showed up at the health center and went into labor almost immediately.
NEDJOUMBAYE: (Through interpreter) When she was giving birth there, she had absolutely nothing.
DANIEL: Nedjoumbaye stayed with her, helping her have a successful delivery.
NEDJOUMBAYE: (Through interpreter) I spoke with her, with words to try to console her. I personally helped her by bringing clothing for the baby. So I created a bond by helping her trust me.
DANIEL: Fatmeh is not alone in her vulnerability. The World Health Organization says that Chad has the second-highest maternal mortality rate globally. Many women there don't have access to a safe and sterile place to deliver.
NEDJOUMBAYE: (Through interpreter) And when they give birth at home, there are more risks of infections and bleeding out, and more women die in childbirth. And so I help women give birth not at home.
DANIEL: By getting them to a health center or a mobile clinic. Nedjoumbaye is 1 of 148 midwives across Chad who are employed by a program that's run by the U.N. and funded partly by the U.S.
YEWANDE ODIA: This is critical, lifesaving work that they do.
DANIEL: Yewande Odia runs the program in Chad. Last year, she says U.S. money provided prenatal care to 100,000 women in the country and safe deliveries to 26,000. Now, the State Department has canceled thousands of contracts worldwide, and that includes the program that Odia relies on to pay her midwives.
ODIA: Losing the U.S. funding is huge. The lack of midwives to support these women means that women will die in childbirth. That's the immediate impact.
DANIEL: Beyond this project, HIV treatment programs have shuttered, tuberculosis screenings have stopped, food assistance for malnourished children discontinued. The State Department didn't reply to NPR's request for comment. At a recent health conference held in Rwanda, this new reality of a world with only a trickle of U.S. assistance was an urgent topic of discussion.
GITHINJI GITAHI: The overriding message is that we must never waste a crisis. And this is a crisis.
DANIEL: Dr. Githinji Gitahi runs Amref Health Africa, a continent-wide African NGO and the organizer of the conference. He says Africans have been talking about the need for self-reliance for years, but now there's a sense of urgency.
GITAHI: So already there have been workshops in Zambia for this reorientation. The same we see in Kenya. The same we see in Uganda.
DANIEL: At these meetings, government officials are discussing how to handle the new gaps by altering projects, finding new funding or jettisoning programs altogether. Some of this effort was already underway because a fundamental change to USAID has been anticipated for some time.
GITAHI: So it is catastrophic, unprecedented, but not unexpected. The challenge is if there was actually a plan for transition, then we would not say it's a bad thing. What is a bad thing is actually the sudden, unplanned nature.
DANIEL: This is what's left so many in Africa and elsewhere in the world scrambling. Africa CDC has called the gutting of USAID a wakeup call, one that may well be an opportunity in the long term, but for right now, officials say is causing desperation and heartache.
MARY LOUISE KELLY, HOST:
Ari Daniel for NPR News. Transcript provided by NPR, Copyright NPR.
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