President Donald Trump’s decision to dismantle the U.S. Agency for International Development and slash all of its global family planning grants has created chaos and uncertainty in developing nations that relied on the United States for critical sexual and reproductive health care.

Over the last decade, the U.S. has been the largest family planning donor for the international community — giving $607.5 million annually, which accounted for 40% of all global sexual and reproductive health funding, according to the Guttmacher Institute. Those grants provided health care to women and girls around the world, including things like birth control, abortion care and prenatal care.

They also maintained supply chains, stocked critical medical supplies and funded data collection. In some countries, U.S. funding held up the entire health care infrastructure: 77% of the medical system in the West African country of Mali was funded by the U.S.

But the Trump administration has now terminated all of those grants — putting the lives of women and girls around the world at risk.

During Trump’s first three months in office, 11.7 million women and girls were denied birth control due to the U.S. grant cuts, the Guttmacher Institute estimated. Of those, 4.2 million faced unintended pregnancies and 8,340 died from complications during pregnancy and childbirth, the group estimated.

If these funding cuts continue through 2025, which Trump has signaled they will, an estimated 47.6 million women and girls will be denied contraceptive care, 17.1 million will experience unwanted pregnancies and 34,000 will die.

“The administration’s decision to terminate all family planning grants represents for us an unprecedented abandonment of American leadership on the world stage,” Jonathan Wittenberg, co-president and CEO of the Guttmacher Institute, told reporters during a press call on the Trump administration’s impacts on global sexual and reproductive health.

Aid workers and advocates described confusion and despair when critical reproductive health care simply disappeared overnight in countries across sub-Saharan Africa and Asia. The sudden loss of funding led to a shortage of health-care providers and increased burnout for those who stayed. The supply chains that delivered vital medical supplies have vanished. Abortion stigma is back on the rise, deterring women and girls from seeking the health care that is available.

“These intersecting realities are deepening inequalities and eroding what little infrastructure we have to protect women and girls and gender minorities,” Fabiola Mizero, the regional director of Ipas Francophone Africa, told reporters on the same call.

Advocates are working tirelessly to update communities on next steps, but misinformation has permeated some communities grappling with the fallout. Shortly after the Trump administration issued the USAID stop-work order, rumors started in parts of Uganda that contraception would be banned and women would be penalized for using it. This led to women running to get their IUDs removed early.

“Our team has been working with local authorities to share correct information through radio, phone and shows, but we are seeing that sort of panic in many places,” said Anna Mackay, senior director of global programs and philanthropy at MSI Reproductive Choices, an organization working in 36 countries across six continents.

The anti-abortion movement’s return to power in the U.S. — following the repeal of Roe v. Wade and the criminalization of care in nearly half the country — has had an outsized cultural impact across the world, advocates said. Trump has compiled one of the most extreme anti-abortion administrations the U.S. has seen in a long time. On day one, the president reinstated the Global Gag Rule and the Helms Amendment — federal rules to ban U.S. funding to aid groups offering abortion services or any information about abortion care.

Aid workers told reporters they’ve already seen more aggressive anti-abortion campaigns play out in the countries where they work. One advocate said she’s seen an increase in health care clinic protesters and staff harassment, particularly in countries like Ethiopia where abortion care is more accessible.

“I think it is safe to say that the anti-rights movement is much deeper and much more embedded in local communities than they were before at the national level and at the sub-national level,” said Anu Kumar, president and CEO of Ipas, which has aid workers in over 30 states across Africa, Asia and South America.

“They’re not just based in the U.S. and parachuting in and out of countries, as they did previously. They are much more embedded in countries now,” Kumar added.

Advocates attributed the increased anti-abortion hostility on the ground in part to Trump’s decision to rejoin the Geneva Consensus Declaration, an extreme global anti-abortion and anti-LGBTQIA+ pact created during the first Trump administration that aligns the U.S. with socially conservative countries. Although it’s nonbinding, the Geneva Consensus sends a clear message to the rest of the world on where the U.S. stands on abortion and reproductive health.

The Trump administration has renewed its effort to get more countries to sign the declaration, specifically targeting several African nations. Mizero, from Ipas Francophone Africa, said the small West African country Benin has a progressive president and a government that is working to advance reproductive health care. But the country recently signed on to the Geneva Consensus, likely because the U.S. government approached an anti-abortion lawmaker who signed it on behalf of the entire country.

Reproductive rights groups have strongly criticized the Geneva Consensus since its creation in 2020 because of its deep anti-reproductive health sentiments and also because it disguises itself as an official international agreement. Unlike the Paris Agreement or the United Nations Charter, any person in a government can sign onto the Geneva Consensus, and their signature reflects that the country as a whole is in support of the anti-abortion and anti-LGBTQIA+ statements in the document.

“This is a moment for solidarity and those who champion bodily autonomy to really stand together and make the case for sexual and reproductive health and rights to make sure it’s not silenced and erased,” said Mackay of MSI. “Millions of women and girls are demanding [sexual and reproductive health] services across the countries where we work, and we can’t turn the clock back on that.”