Global Health Politics in the Post-USAID Era

The Program in Global Health Studies

The United States Agency for International Development (USAID) has ceased operations and foreign aid has been dramatically cut.

555 Clark St

<p>As the United States Agency for International Development (USAID) has ceased operations and foreign aid has been dramatically cut, health outcomes in low- and middle-income countries (LMICs) are deteriorating. However, there is less attention given to the impact of the USAID shutdown on intermediaries, specifically non-governmental organizations (NGOs), providing health services in LMICs. How does US foreign aid withdrawal impact NGOs? To examine this question, I leverage the US’s Global Gag Rule (GGR), an historic example of aid withdrawal from sexual and reproductive health (SRH) NGOs who perform or advocate for abortions. Using data from 72 key informant interviews conducted from February 2020 to June 2025 with NGO leaders, physicians, government officials and researchers in Kenya, this paper shows that the 2017 implementation of the GGR impacted not only NGO service delivery, but also their relationships—even among NGOs who never received US funding. Interviews conducted in 2025 (post-USAID shutdown) highlight that the lessons learned from the GGR, particularly how NGOs built coalitions and cooperated in the face of scarcity, provide a model for other community service organizations in LMICs striving to survive current USAID funding cuts.</p><p>Kelly Hunter is currently a postdoctoral scholar in political science and global health studies and a participant in the Global Poverty Research Lab. Prior to joining Northwestern's political science department, Dr. Hunter was a Junior Visiting Scholar at Nuffield College at the University of Oxford (2022-2023) and Global Health Institute Doctoral Scholar (2019-2021) and Kenan Institute for Ethics Graduate Fellow (2018-2019) at Duke University where she obtained a joint PhD in political science and public policy studies. She is the recipient of numerous awards and fellowships such as the James B. Duke Fellowship, Joel L. Fleishman Civil Society Fellowship, Center for the Study of Philanthropy and Voluntarism Fellowship, Aleane Webb Dissertation Research Fellowship, two Duke Bass Connections Student Research Awards, Duke Graduate School Dissertation Research Travel Award, Duke Gender, Sexuality, and Feminist Studies Travel Award, multiple departmental research and travel grants, the Graduate Research Award and the Graduate Travel Award from Duke Center for International and Global Studies, and five Summer Research Fellowships from the Graduate School. Kelly holds two prior degrees in political science: a BA from BYU and a MA from the University of Utah and she has co-authored published articles on health, politics and policy.</p>

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Global Health Politics in the Post-USAID Era

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