Aid Cuts and Stigma Leave African Girls Without Access to Contraception

Being a teen mother was not the path Zimbabwean Kelly Nhedega envisioned. Her plan was to finish school and train as a nurse before starting a family. However, when she became sexually active, contraception felt out of reach due to the stigma associated with young girls seeking services at crowded clinics. The fear of being judged by other patients or health workers, or having her parents informed, kept her away. She became pregnant at 16 and subsequently dropped out of school.

Nhedega, now caring for an 18-month-old child, recently managed to obtain contraception discreetly as she attempts to return to education. "That’s a mission I have to complete first. More babies will mean less or no time for school,” she said.

As aid cuts and global shipping disruptions threaten access to contraception for girls in Africa, Nhedega's experience highlights a complex challenge that extends beyond the availability of contraceptives. Parental opposition, restrictive policies, stigma, and the fear of social judgment can create significant barriers. Experts emphasize that contraception is crucial for adolescent girls to avoid unintended pregnancies and the associated risks of childbirth, especially given Africa's high maternal mortality rates.

Sub-Saharan Africa, which has the world's fastest-growing population, accounts for 70% of global maternal deaths, with around 180,000 pregnancy-related deaths recorded annually.

The United Nations Population Fund estimates that current aid cuts will result in a $185 million global shortfall in contraceptive funding this year. According to the International Planned Parenthood Federation, nearly 1,400 reproductive health service facilities had closed globally by December, with 1,175 of those in Africa, leaving an estimated 5.9 million women without services.

Girls like Nhedega often rely on discreet services. In Epworth, Zimbabwe, a converted caravan serves as a mobile clinic, offering adolescents a private space to access contraception away from judgmental eyes. Since 2021, this mobile clinic has provided services to over 100,000 adolescents. However, this vital service is under strain due to shrinking international aid.

Population Services Zimbabwe, an affiliate of MSI Reproductive Choices, lost a significant grant after the Trump administration dismantled many aid programs. While Swedish funding helped fill some of the gap, it ended in August after the Swedish government phased out development assistance to Zimbabwe and other countries to prioritize Ukraine. This withdrawal could force the organization to curtail its outreach activities or even close its entire country program, according to Pester Siraha, director of Population Services Zimbabwe. She warned of potential increases in unplanned pregnancies and unsafe abortions.

Despite these challenges, Zimbabwe's Health Minister Douglas Mombeshora stated that the country has spent $6.3 million on contraceptives since 2022 and pledged further funding for 2026 and 2027.

However, across the continent, the availability of contraceptives does not always guarantee access. In Zambia, uncertainty over parental consent rules poses an additional hurdle. "How many young people can go and say, ‘Mommy, I want to have sex tonight. Can you allow me to go and get a contraceptive method?'” asked Inonge Wina Chinyama, director at MSI Zambia. "It doesn’t happen in Africa."

Girls may also find that their preferred contraceptive method is unavailable at the clinic. The loss of U.S. support for distribution in Zambia has impacted the "last mile" delivery of contraceptives to rural health centers. Furthermore, global shipping disruptions have added to the uncertainty. In March, the UNFPA noted that carriers were rerouting shipments to avoid conflict zones, causing delays. A contraceptive shipment ordered in Zambia in November did not arrive until months later.

In Zimbabwe's remote communities, the impact of reduced outreach is stark. In Binga, funding cuts forced Population Services Zimbabwe to reduce its mobile clinic operations. When the clinics briefly resumed after a six-month absence, adolescent girls, some already mothers, rushed towards the vehicles. Engeline Mawere, operations director for Population Services Zimbabwe, described the scene, noting that they sometimes park in secluded areas to ensure the safety and privacy of young girls.

For girls like Nhedega, access to contraception is about more than just availability; it is about the ability to obtain it without shame or social repercussions. "So here, you just do it secretly and plan better,” Nhedega said. “There is no child who should be attributed to a mistake. We should be able to plan and decide when to have a baby.”