{
  "abstract": "Introduction 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–March 2025) on global health programmes.Methods 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.Results 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.Conclusions 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.",
  "authors": [
    {
      "affiliations": [
        "Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"
      ],
      "name": "Sarah Branoff"
    },
    {
      "affiliations": [
        "Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"
      ],
      "name": "Thoai D Ngo"
    },
    {
      "affiliations": [
        "Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"
      ],
      "name": "Sarah Engebretsen"
    },
    {
      "affiliations": [
        "Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"
      ],
      "name": "M Claire Greene"
    },
    {
      "affiliations": [
        "policy/strategy group, Nairobi, Kenya"
      ],
      "name": "Julia Kosgei"
    },
    {
      "affiliations": [
        "policy/strategy group, Nairobi, Kenya"
      ],
      "name": "Livia Merlim"
    },
    {
      "affiliations": [
        "HIAS, Bogota, Colombia"
      ],
      "name": "Camilo Ramirez"
    },
    {
      "affiliations": [
        "Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal"
      ],
      "name": "Achala Shrestha"
    },
    {
      "affiliations": [
        "Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal"
      ],
      "name": "Anand Tamang"
    },
    {
      "affiliations": [
        "Center for Research on Environment Health and Population Activities (CREHPA), Kathmandu, Nepal"
      ],
      "name": "Jyotsna Tamang"
    },
    {
      "affiliations": [
        "Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA"
      ],
      "name": "Sara E Casey"
    }
  ],
  "title": "Global health consequences of the 2025 US foreign aid freeze: rapid assessments in Colombia, Kenya and Nepal",
  "uid": "07352458-d408-5258-9b93-0db03bd1a2d1"
}