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An Afghan midwife describes how a woman died in childbirth, along with her baby. She was snowed into her village and couldn't reach a hospital. Just weeks before, the health clinic in her village had closed. If it was open, a midwife could have helped her.

Other midwives, based in hospitals, tell NPR that their facilities are seeing women rushed in from remote areas where clinics have closed too late: The mothers and babies often die, say the midwives.

These maternal and baby deaths, they say, is partly a consequence of a reeling blow to Afghanistan's fragile health system: the abrupt shuttering of USAID by the Trump administration, which of all aid to this deeply poor country of some 40 million people. The World Health Organization said that over 200 clinics in Afghanistan closed as a result of American funding cuts.

"USAID should not have left Afghanistan. We are devastated," says Fatima, a 27-year-old midwife, who has worked in maternal care for the past seven years.

Making matters worse, other major European donors have also announced cuts to their foreign aid programs.

"It seems to be that other donors are following the U.S. — what Trump has done is give everyone a license to give up on funding aid," says Heather Barr of Human Rights Watch. She has focused on Afghanistan closely for decades.

Already, the U.S. aid cuts have caused to shut down in Afghanistan, according to a World Health Organization count in late March. The WHO report said without around 200 more facilities would shut down by June, impacting around 2.4 million people.

To give a sense of the ramifications, by February 19 — just a month after Trump was inaugurated and announced a suspension of USAID funding — more than 320 health facilities had shuttered. By March 4, some 153 of the facilities managed to reopen as charities scratched together money, according to head of communications for WHO in Kabul. But within two weeks, another 39 health facilities had shuttered,

Who bears the brunt

The shrinking availability of health care "threatens the most vulnerable — women, children, the elderly and displaced populations — who now face heightened risks of disease, malnutrition and preventable deaths," Sultany told NPR via email.

Midwives spoke to NPR on condition of anonymity because they were critical of the Taliban and worried for their personal safety. They were also not authorized to speak to the media by the foreign-funded charities that employ them.

Most institutions impacted by the USAID cuts, from U.N. organizations to small charities, have repeatedly declined to comment on the record about the effects of the cuts on their work. Three aid workers told NPR, on condition of anonymity, that representatives of various Afghan charities are worried that if they speak out publicly, they'll draw the ire of the Trump administration even as they try to negotiate the resumption of some aid.

Complications and deaths

As yet there is no available and relevant data on deaths and serious complications related to pregnancy and childbirth since health facilities began closing in February — and there may never be. But the five midwives with whom NPR spoke offered anecdotal accounts of women showing up at regional hospitals in labor and with complications that are sometimes deadly for the mother and the baby. The midwives believe that some of those complications could have been addressed if the women had accessed maternal care earlier in their labor.

Faezeh, 25, is a midwife who had worked in a clinic in an isolated, mountainous district of the western province of Herat. She says villagers had been so happy to have a clinic in their locality because the next nearest health facility was four hours away on treacherous, unpaved roads.

"The clinic was active day and night. There were lots of people coming and going," says Faezeh, who adds that the clinic –- like many other similar facilities that were recently shuttered –- offered nutrition to malnourished children and their mothers as well as vaccines.

So a few weeks ago, "when the clinic was closed," she recalls, "people were really upset." She says village elders begged the public health officer to reopen the clinic, but "there was no donor" to fund its reopening.

Faezeh says since the clinic closed, she got word that a mother and her baby died in childbirth. She says it was "snowing and raining, the roads were blocked," and there was no way to reach the nearest health clinic. Faezeh says she believes that they would not have died if they had accessed health care. She noted that there had not been a single maternal death when she worked at the village clinic.

A doctor who worked at the clinic that was shuttered told NPR that even if roads were open, his patients had no means to get to the city. Even to the village clinic, he said, "families used to walk or ride animals like donkeys."

Other women have arrived at distant health clinics — only to die along with their babies.

One woman, Karima, who has worked in maternal care for decades in a regional hospital, tells NPR that she's seeing deaths because maternal care services "previously managed by foreign NGOs — are no longer operational."

She cited one pregnant woman who bled to death on the way to the hospital. Karima believes the woman likely could have been saved if she'd had a clinic closer to home. Another woman needed an emergency caesarean but arrived too late — her baby had died.

Another midwife in the western province of Herat, Somaya, told NPR that one of her rural patients was past her due date for delivery. The clinic in her area had shuttered, so the woman traveled into the city to give birth – but her baby had defecated in her womb, causing it to die. That is known as meconium aspiration syndrome – a potentially fatal condition that occurs in 5% to 10% of births but is treatable if diagnosed in time. In the midwife's view, "the woman lost her baby because there was no one to provide her professional care in the community."

Fatima, the midwife who works in the deeply impoverished province of Farah, says she is seeing harrowing cases of women arriving too late to hospital.

"They arrive in critical condition: babies stuck halfway – heads out, but legs trapped, or legs out, while heads remain [inside the birth canal]." In those cases, Fatima says the babies died.

Fatima says she believes she's only seeing a minority of cases. She says in her experience of working in poor, conservative communities, "most women give birth at home," – and if they die, she says, their deaths are not recorded. She says some women give birth at home because families can't afford a taxi to hospital — many Afghans do not own their own vehicles.

Fatima says there are cultural issues as well — which are getting worse under the rule of the Taliban, which has severely restricted the freedoms of women and girls. Some families, she says, "refuse to let women leave home" even when they are in labor. Instead, she says, they task elderly female relatives to assist in deliveries. And when those birthing women or their babies die, family members "dismiss these deaths as 'God's will.'"

Another blow

In that context, Fatima and other midwives say, the USAID cuts were a blow to women who already face so much hardship.

Even before these 2025 cuts, health care in Afghanistan has always been tenuous, especially for women. It worsened after the Taliban seized power over three years ago from a Western-backed government. International aid dropped off, even as the Taliban began ratcheting up rules that now prevent most women from leaving their homes without a male guardian, that bar women from most professions and ban most women and girls from studying after the sixth grade.

Even a pilot program to train young women to work as community nurses and midwives, greenlit by the Taliban government in February last year was shuttered in December, .

More and more countries make cuts

And the Trump administration's cuts have triggered a domino effect of sorts: soon after those cuts were announced. On February 25, British prime minister announced his country its budget for foreign aid. He said that decision was made to divert resources to defense spending in response to the Trump administration's call for NATO allies to contribute more money for defense.

Other major international aid donors followed suit. France said it planned to by up to 40%; announced foreign cuts as well. Belgium announced in foreign aid. Switzerland — moves that the described in a statement as "foreshadowing a significant drop in the assistance available to the world's most vulnerable." The statement followed news in December that the world's would cut over $2 billion for foreign aid as its economy contracted.

Fatima, the Afghan midwife, described the cuts in foreign aid this way: "No one prioritizes women's lives."

With additional reporting by Fariba Akbari in Paris, Ruchi Kumar in Istanbul, Zuhal Ahad in Toronto. Ghani reported from Fremont, California.

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