Idaho's near-total abortion ban violates the 14th Amendment when a pregnancy threatens a patient's health, US District Judge B. Lynn Winmill held on 13 August 2026, in the first federal district court ruling since Dobbs to find an affirmative constitutional right to a health-preserving abortion. The 81-page opinion in Seyb v. Members of the Idaho Board of Medicine, decided after a trial that opened in Boise on 8 June, applied strict scrutiny and grounded the right in five strands of history running from common-law protections for physicians through the maternal-health exceptions written into state statutes at the time the 14th Amendment was ratified in 1868.

"A pregnant woman's health is not a state resource to be allocated at the legislature's whim," Winmill wrote.

"The Fourteenth Amendment exists precisely to prevent subjugation like this." On mental health he wrote that "the brain is an organ of the body, and healthcare providers use empirical tools to reliably assess the risk of suicidality and the most effective treatments," and held that Idaho could not treat a life-threatening psychiatric condition differently from a physical one without violating equal protection. Claims involving fetal anomalies that pose no risk to the patient drew only rational-basis review and failed.

Winmill cut the reach of his own order 13 days later. On 26 August he limited the injunction to Dr Stacy Seyb, the Boise maternal-fetal medicine specialist who brought the case in 2024, citing recent Supreme Court authority against universal injunctions and writing that "an injunction limited to Dr Seyb will suffice to address the alleged harm." Every other doctor in Idaho is again exposed to the Defense of Life Act, which allows abortion only to prevent death and carries two to five years in prison plus loss of a medical licence. Seyb testified that he had been sending patients with serious conditions out of state, and that "it's been very, very difficult trying to figure out what types of procedures would not put you in harm's way."

Raúl Labrador, Idaho's attorney general, appealed to the Ninth Circuit on 20 August, six days before the narrowing. Winmill "legislated from the bench and manufactured a new constitutional right," Labrador said, and "has replaced Idaho's law with his own abortion standard." Dobbs, he said, made clear that abortion policy "belongs to the people and their elected state representatives, not the judiciary." The appeal is pending. Five of the 13 states with near-total bans carry no health exception at all: Idaho, Arkansas, Mississippi, Oklahoma and South Dakota.

Peer-reviewed studies published since March 2025 have measured an estimated 68 excess pregnancy-associated deaths across 14 US states that banned abortion after Dobbs, and an 11 per cent rise in maternal deaths in countries reliant on US aid when a Republican administration takes office. Modelling by the UN Population Fund puts the cost of the 2025 aid terminations at around 1,000 additional maternal deaths in six African countries in a single year. A separate analysis published in April 2026 found the gap between ban and non-ban states did not reach statistical significance.

Donald Trump appointed three of the five Supreme Court justices who voted to overturn Roe v. Wade. Thirteen states now enforce total bans and four more prohibit abortion at about six weeks. His administration reinstated the Mexico City Policy by presidential memorandum on 24 January 2025, moved to dissolve USAID on 28 March 2025 and issued final rules on 27 January 2026 extending the funding restriction to nearly $40 billion in non-military foreign assistance.

The women who died

Amber Thurman, a 28-year-old medical assistant, waited 20 hours at Piedmont Henry Hospital in Georgia in August 2022 while an infection from an incomplete medication abortion spread. "Promise me you'll take care of my son," she told her mother before surgeons finally operated. She died on the table. Georgia's maternal mortality review committee, a panel of 10 doctors, later found her death preventable, judged the impact of the hospital delay "large" and concluded there had been a "good chance" an earlier dilation and curettage would have saved her.

"She was alive when she went to the hospital," her mother Shanette Williams told Capital B News in March 2025. "It was the fact that they chose to allow her to suffer for 20 hours. How can you make logic of that? Twenty hours, a simple procedure."

Williams has since campaigned against the Georgia law.

"How is it that politics determines healthcare?" she told the Atlanta Journal-Constitution in May 2026. "And how is it that anybody can be OK with the decision of a politician who has no clue about a woman's body?"

Candi Miller, 41, died at home in Georgia on 12 November 2022 after ordering abortion pills online rather than seek care in a state where performing a dilation and curettage had become a felony. An autopsy found retained fetal tissue and a lethal combination of painkillers. Her sister Turiya Tomlin-Randall told ProPublica that Miller "was trying to terminate the pregnancy, not terminate herself," and that the family had been warned a hospital route "was going to be more painful and her body may not be able to withstand it." The state committee found that death preventable too.

Georgia dismissed every member of that committee in November 2024, weeks after ProPublica obtained its internal findings on Miller and Thurman. The state relaunched the panel in 2025 and has declined to name its members.

Josseli Barnica, 28, died of sepsis in Houston in September 2021 after waiting 40 hours during an inevitable miscarriage at 17 weeks.

Her husband, who has not been named in the reporting, said staff told him "they had to wait until there was no heartbeat" because "it would be a crime to give her an abortion." He said he "fully expected her to come home."

Nevaeh Crain, 18, was sent home from two Texas hospitals in October 2023 with a 103-degree fever and a positive sepsis screening before a third delayed intensive care until two ultrasounds had confirmed fetal death.

"She was bleeding," her mother Candace Fails told ProPublica. "Why didn't they do anything to help it along instead of wait for another ultrasound to confirm the baby is dead?" Fails said she would have made the choice the law took from her: "I know it sounds selfish, and God knows I would rather have both of them, but if I had to choose, I would have chosen my daughter."

Porsha Ngumezi bled through an 11-week miscarriage at Houston Methodist Sugar Land in June 2023 and was given misoprostol rather than the dilation and curettage that stops a haemorrhage.

"We all know pregnancies can come out beautifully or horribly," her husband Hope Ngumezi told ProPublica. "Instead of putting laws in place to make pregnancies safer, we created laws that put them back in danger."

The Texas Medical Board sanctioned three doctors over the Crain and Ngumezi deaths, disciplining Dr Andrew Ryan Davis and Dr William Noel Hawkins in October 2025 and Dr Ali Mohamed Osman in March 2026, with the actions reported in April 2026. Davis failed to quantify Ngumezi's blood loss and chose monitoring over an emergency procedure, and the board wrote that "this delay in care led to the patient's death." Each doctor was ordered to take eight hours of continuing education within a year and to notify his employer. No licence was suspended or revoked.

"What kind of justice is this for Porsha?" Hope Ngumezi said. "I feel like the doctor shouldn't be practising anymore." He called the sanction a slap in the face.

Tierra Walker, 37, died in Texas on 30 December 2024 of complications from preeclampsia after asking her doctors whether ending the pregnancy would be safer. "Wouldn't you think it would be better for me to not have the baby?" she said.

Her aunt Latanya Walker said afterwards: "They didn't want to offer to end the pregnancy, because the government or someone says you can't? So you'd rather let somebody die?" Her husband Eric Carson said she "was doing what they told her to do."

Emily Waldorf survived. Hospitalised in Arkansas in September 2025 during a pregnancy loss, she waited five days before being moved by ambulance across a state line.

"I feel like a ticking time bomb right now," she told the hospital's chief executive. "I've been here for five days, and you guys have not done anything for me." In her journal she wrote: "It all feels quite like the Handmaid's tale. I had to seek refuge, travel by ambulance across borders."

Waldorf's father Kenneth Rodgers, a gastroenterologist, said the standard of care he practises had been inverted.

"You don't sit around and wait for somebody to become septic. You do whatever it takes to prevent them from becoming septic. If I don't do what's medically indicated in a potentially life-threatening situation, then I am liable for neglect. Why isn't this the same thing?"

Waldorf's mother Linda Quattlebaum said:

"It's inhumane. I'm pro-life, but for the mother."

Amanda Zurawski, who developed sepsis in Texas in 2022 after being refused care for previable premature rupture of membranes, told Senators Ted Cruz and John Cornyn at a Senate Judiciary Committee hearing on 26 April 2023 that she "nearly died on their watch." Her written testimony said her medical team "was anguished as they explained there was nothing they could do because of Texas's anti-abortion laws." Samantha Casiano, who was denied a termination after a fatal anencephaly diagnosis and vomited on the stand while testifying in Zurawski v. State of Texas in July 2023, told a Senate Democratic forum on 23 June 2026: "My daughter, Halo, lived a few agonizing hours before she passed away."

Kayla Smith left Idaho for Washington state in 2022 after a fetal heart defect diagnosis, and testified in the state court challenge Adkins v. State of Idaho in November 2024. "If I were to continue the pregnancy, not only would I be risking my life of developing preeclampsia, but I was not willing to watch my son suffer and essentially gasp for air," she said.

Jillaine St. Michel, a plaintiff in the same case, said of the wait for care out of state: "It was the worst four days of my life, I can't describe it any other way. Each day was worse than the last."

Deaths in states with bans

Mothers in states with abortion bans were nearly twice as likely to die during pregnancy, childbirth or the postpartum period than mothers in states protecting access, the Gender Equity Policy Institute found in an April 2025 analysis of federal vital statistics covering 2019 to 2023. Maternal mortality fell 21 per cent in protective states over the same span.

Texas recorded a 56 per cent rise in maternal mortality in 2022, the first full year of its ban, against an 11 per cent national increase. By 2023 the Texas rate ran 155 per cent above California's, and Latina mothers in Texas faced nearly triple the risk of their counterparts in California.

Black mothers in ban states died at 60.9 per 100,000 live births, 3.3 times the rate for white mothers in the same states.

Sepsis rates among Texas women hospitalised for second-trimester pregnancy loss rose more than 50 per cent after the state's six-week ban took effect, ProPublica reported in February 2025 after analysing seven years of state hospital discharge data it purchased. Among patients whose fetus still had a heartbeat on admission the increase was 61 per cent. Houston hospitals recorded a 63 per cent rise, Dallas hospitals 29 per cent. Recorded sepsis diagnoses climbed from 67 in 2021 to 90 in 2022 and 99 in 2023. Maternal deaths in Texas hospitals went from 79 across 2018 and 2019 to 120 across 2022 and 2023.

"This is exactly what we predicted would happen," Dr Lorie Harper, a maternal-fetal medicine specialist in Austin, told ProPublica. Dr Tony Ogburn, an obstetrician-gynaecologist in San Antonio, said of the statute that "it's black and white in the law, but it's very vague."

Texas lawmakers passed Senate Bill 31, the Life of the Mother Act, unanimously in the Senate on 1 May 2025 and 134 to 4 in the House on 22 May, and Governor Greg Abbott signed it on 26 June 2025. The law removes the requirement that a life-threatening emergency be imminent, states that doctors may treat ectopic pregnancy, permits cancer treatment that threatens a pregnancy and protects clinicians who discuss abortion with patients. Criminal penalties remain, and the statute adds no exception for fetal anomaly, rape or incest. The American College of Obstetricians and Gynecologists opposed the bill.

The Department of Health and Human Services and the Centers for Medicare and Medicaid Services rescinded post-Dobbs guidance in June 2025 that had told hospitals the Emergency Medical Treatment and Labor Act requires stabilising care, including abortion, regardless of state law. Emergency physicians wrote to the department the same month asking what standard now applies. The administration had already dropped the federal lawsuit against Idaho that raised the same question, which the Supreme Court dismissed as improvidently granted in Moyle v. United States in 2024.

What the numbers can and cannot show

Pregnancy-associated deaths rose an estimated 9.2 per cent in 14 states with total or six-week bans, amounting to roughly 68 excess deaths through the end of 2023, according to a study published in the American Journal of Public Health on 23 April 2026 by Suzanne Bell of Johns Hopkins Bloomberg School of Public Health and Alison Gemmill of UCLA. The same team found no measurable increase in maternal mortality, the narrowest and rarest of the three measures they tested, and wrote that the absence of a signal there "should not be mistaken for the absence of harm." The authors called the findings highly uncertain given how rare such deaths are. The work was funded by the National Institute of Child Health and Human Development.

"Increases in these measures of mortality can be hard to detect," Bell said, adding that the findings point to preventable deaths in ban states. The authors excluded COVID-19 deaths and flagged inconsistent recording of pregnancy status on death certificates.

Yohannes Abraha, Jeffrey Buzas, Eyal Bornstein and Nansi Boghossian reached a different conclusion in JAMA Network Open on 3 April 2026, analysing 22 million live births and close to 13,000 pregnancy-associated deaths from 2018 to 2023 across 14 ban states and 37 states without bans. Pregnancy-associated mortality fell 9.8 per cent in states without bans, from 54.5 to 49.2 deaths per 100,000 live births, against declines of 2.4 and 3.3 per cent measured in the ban states. The difference between the groups did not reach statistical significance. Within ban states, deaths among non-Hispanic Asian women rose 41 per cent and among non-Hispanic Black women 17.8 per cent. The authors said the post-ban observation period was short and the confidence intervals wide.

Michael J. New of National Right to Life wrote in April 2026 that the same study showed states with strong anti-abortion laws recording slightly faster declines than states with permissive laws, and that "not one of these 14 states experienced a maternal mortality rate increase that was statistically significant." New's second claim matches the published result. His first inverts the direction of the raw declines the authors reported.

More than 22,000 births above the expected number followed Dobbs across the 14 ban states through 2023, Suzanne Bell and colleagues found in a companion paper published in JAMA on 13 February 2025, close to three-quarters of them in Texas.

The national maternal mortality rate was 17.9 deaths per 100,000 live births in 2024, or 649 deaths, against 18.6 and 669 deaths in 2023, 22.3 and 817 deaths in 2022 and a pandemic peak of 32.9 in 2021, Donna Hoyert of the National Centre for Health Statistics reported on 4 March 2026. The 2024 figure was not a statistically significant change from 2023. Black women died at 44.8 per 100,000 live births, against 18.1 for Asian women, 14.2 for white women and 12.1 for Hispanic women. Women aged 40 and over died at 62.3 per 100,000, more than four times the rate for women under 25.

Ingrid Skop of the Lozier Institute, which supplies research to the anti-abortion movement, wrote in February 2025 that Texas had elevated maternal mortality long before its ban because of poverty, uninsured and undocumented populations, chronic illness and rural maternity care deserts. Texas rates climbed in 2020 and 2021, before the state's six-week ban took effect, and the national rate has since fallen. Media misinformation, she wrote, "may be stoking unnecessary fears about pro-life laws."

The Texas Health and Human Services Commission recorded 203 medically necessary abortions in the 34 months after Dobbs, through April 2025. Texas Alliance for Life said that no doctor had been prosecuted, sued or sanctioned over any of them, and that no woman in the state had died for want of an exception. Three doctors have since been sanctioned by the state medical board over two deaths, though for treatment failures rather than for performing abortions.

Texas maternal mortality rose 33 per cent between 2019 and 2023 while the national rate fell 7.5 per cent, ProPublica's analysis found. More than 80 per cent of US pregnancy-related deaths are preventable, the Centers for Disease Control and Prevention concluded in September 2022 from 36 state review committees covering 2017 to 2019. Mental health conditions were the leading underlying cause at 23 per cent, followed by haemorrhage at 14 per cent and cardiac and coronary conditions at 13 per cent. Fifty-three per cent of the deaths occurred between seven days and one year after the end of pregnancy.

How the US compares

Nineteen deaths per 100,000 live births was the US maternal mortality rate in 2023, the highest of the 20 countries in the Commonwealth Fund's international comparison published on 28 May 2026. Eleven of the other 18 nations studied recorded fewer than five. Black women in the US died at 50 per 100,000.

Sweden, Japan, the Netherlands, Germany, the United Kingdom and France each record roughly a third of the US rate, the Commonwealth Fund found in a July 2025 analysis, which concluded that even the most conservative available measure "would place the U.S. last among high-income countries." The same paper recorded that the US is one of only seven countries worldwide, alongside Venezuela, Cyprus, Greece, Mauritius, Belize and the Dominican Republic, to report a significant rise in the share of pregnancies ending in the mother's death between 2000 and 2023.

Infant deaths in the US ran at 5.5 per 1,000 live births in 2024, against 1.8 in Japan, 2.0 in Norway and Sweden, 2.3 in South Korea, 3.1 in Australia and Germany, 3.4 in France, the Netherlands and Switzerland, 4.0 in New Zealand, 4.1 in the United Kingdom and 4.7 in Canada, according to the UN Inter-agency Group for Child Mortality Estimation. The average across high-income countries was 4.2. National Centre for Health Statistics figures published on 16 June 2026 put the US rate at 5.52 and neonatal mortality at 3.66, with 20,048 infant deaths in 2024, a rate of 10.98 among Black infants and a state range from 2.97 in New Hampshire to 9.65 in Mississippi.

US maternal mortality in 2023, at 18.6 per 100,000, sat between Palestine at 18.6 and Chile at 18.9 when the Commonwealth Fund ranked states and countries on the same scale in October 2025. Infant mortality at 5.6 per 1,000 sat between Qatar at 5.5 and Romania at 5.8. Louisiana recorded 41.9 maternal deaths per 100,000 and Mississippi 8.9 infant deaths per 1,000. Under-five mortality among Black children in the US, at 13.4 per 1,000, fell between Mexico at 13.0 and Laos at 13.5, and the US ranked in the 71st percentile among high-income countries on that measure, worse than two-thirds of them.

The US spent $14,885 a person on health care in 2024, adjusted for purchasing power, the OECD reported in November 2025, against $9,963 in Switzerland, $9,393 in Norway, $9,365 in Germany and an OECD average near $6,000. Health spending reached 18 per cent of US gross domestic product, one and a half times the share in Switzerland. Life expectancy was 79 years against an OECD average of 81, and the US recorded the second-highest rate of avoidable deaths among the 20 countries compared, behind Mexico alone.

Obstetricians and midwives in the US number 16 per 1,000 live births, the lowest supply in the Commonwealth Fund's study group; Canada is second lowest at 13, and every other country studied has two to six times the US level. Every country in that group apart from the US guarantees a postpartum home visit within a week of birth. The US is also, in the OECD's words, "the only OECD country to offer no statutory entitlement to paid leave on a national basis." Norway provides 86 weeks to mothers, Germany and Japan 58, Canada 51, France 42, the United Kingdom 39.

Labour and delivery units closed 96 times across 35 states between January 2024 and May 2026, the March of Dimes reported on 11 August 2026. Sixty per cent of the affected counties lost their only birthing facility, and average travel time to a delivery unit rose by 25 minutes. Maternity care deserts now cover 34.6 per cent of US counties, home to 2.4 million women of reproductive age and 149,000 births a year.

Adriana Smith, a 30-year-old nurse, was declared brain dead at Emory University Hospital in February 2025 after blood clots were found in her brain. She was nine weeks pregnant. Doctors kept her on organ support for roughly four months and delivered a boy by emergency caesarean on 13 June 2025 at about six months' gestation, weighing 1lb 13oz. Support was withdrawn on 17 June. Her family said the hospital had told them Georgia's LIFE Act required it. The office of Georgia Attorney General Christopher Carr said otherwise in late May 2025: "There is nothing in the LIFE Act that requires medical professionals to keep a woman on life support after brain death."

"My grandson may be blind, may not be able to walk, we don't know if he'll live once she has him," April Newkirk, Smith's mother, told WXIA Atlanta. "And I'm not saying we would have chose to terminate her pregnancy. What I'm saying is we should have had a choice." She said later: "Every woman should have a say in their body. They should. It's just not right."

Twenty-nine states restrict or void a pregnant patient's advance directive, Pregnancy Justice found in a review published in June 2025. Ten of them, Alabama, Indiana, Kansas, Michigan, Missouri, Oklahoma, South Carolina, Texas, Utah and Wisconsin, invalidate the document regardless of whether the fetus could survive. Nineteen more invalidate it where the fetus might survive. Michigan's exclusion was struck down on 16 April 2026 by Court of Claims Judge Sima Patel in Koskenoja v. Whitmer, brought by emergency physician Dr Viktoria Koskenoja under the state's 2022 Reproductive Freedom Amendment. A Kansas challenge, Vernon v. Kobach, was allowed to proceed on 22 May 2026.

Florida judges have ordered women to undergo caesarean sections over their objections, ProPublica reported in March 2026. Cherise Doyley took part in a Duval County hearing before Judge Michael Kalil by video link while in active labour. A second patient, Brianna Bennett, was the subject of a similar order. ProPublica said it knew of further cases.

Pregnancy Justice counted at least 412 prosecutions across 16 states charging people with crimes connected to pregnancy, pregnancy loss or birth in the two years to 23 June 2024. Alabama accounted for 192, Oklahoma 112 and South Carolina 62. Substance-use allegations featured in 399 of the cases and pregnancy loss in 31. The organisation said the true figure is higher because no central arrest database exists. "This data shows how giving separate legal rights to fertilized eggs, embryos, and fetuses has real and dangerous consequences for pregnant [people]," said Lourdes A. Rivera, the group's president.

Selena Chandler-Scott miscarried a 19-week non-viable fetus in Tifton, Georgia, on 20 March 2025 and was arrested the next day on felony charges of abandoning a dead body and concealing a death. Tift County District Attorney Patrick Warren dropped the charges on 4 April, saying he could "not locate any specific Georgia statute or case law that addresses an individual's choice to dispose of a naturally miscarried, nonviable fetus" and that prosecution was "not legally sustainable and not in the interest of justice."

The Alabama Supreme Court held on 20 February 2024 in LePage v. Center for Reproductive Medicine that cryopreserved embryos are children under the state's 1872 wrongful death statute, halting IVF at several clinics until Governor Kay Ivey signed an immunity bill on 6 March. Chief Justice Tom Parker's concurrence held that "human life cannot be wrongfully destroyed without incurring the wrath of a holy God." Seventeen states and one territory introduced 36 fetal personhood bills during 2026, the Guttmacher Institute counted in June, none of which had been enacted. Twenty-one states introduced 58 bills criminalising the distribution of abortion medication, of which four passed, in Iowa, Mississippi, Oklahoma and South Dakota.

A Johnson County, Texas, sheriff's officer searched Flock Safety's licence-plate reader network on 9 May 2025, logging the reason for the query as "had an abortion, search for female." The first search reached 1,295 camera networks and 17,684 cameras; a second covered 6,809 networks and 83,345 cameras with a month-long lookback. 404 Media obtained the search logs. Sheriff Adam King described the query publicly as a missing-person welfare check, and Flock called the reporting misleading; court records later obtained by the Electronic Frontier Foundation showed it formed part of a death investigation involving a non-viable fetus. The House Oversight Committee opened an inquiry into the company.

Texas Attorney General Ken Paxton sued Dr Margaret Carpenter of Ulster County, New York, on 13 December 2024 over abortion pills prescribed by telemedicine to a Collin County woman, and a Texas judge entered a judgment against her of more than $100,000 in February 2025. Acting county clerk Taylor Bruck refused to file it, citing New York's shield law, and Paxton sued him too. Justice David Gandin dismissed the Texas action on 31 October 2025 in the first test of the New York statute. Texas has appealed. A West Baton Rouge Parish grand jury separately indicted Carpenter in January 2025 on Louisiana felony charges, and Governor Kathy Hochul refused extradition on 13 February: "I will not be signing an extradition order that came from the governor of Louisiana. Not now, not ever."

Applications from graduating US medical students to residency programmes in states with complete bans fell 4.2 per cent in the 2023-24 cycle, against 0.6 per cent in states where abortion remained legal, the Association of American Medical Colleges reported in May 2024. For obstetrics and gynaecology the decline in ban states was 6.7 per cent while states without restrictions saw a 0.4 per cent increase. Idaho lost 35 per cent of its obstetrics providers between August 2022 and December 2024, according to a study published in JAMA Network Open in July 2026.

Rape survivors and exceptions that go unused

An estimated 64,565 pregnancies resulted from rape in the 14 states with total bans during the 18 months to January 2024, Samuel Dickman, Kari White and colleagues calculated in JAMA Internal Medicine on 24 January 2024, working from 519,981 completed rapes recorded in federal victimisation surveys and a 14.9 per cent pregnancy rate. Texas accounted for 26,313 of them, 45 per cent of the total. Nine of the 14 states offered no rape exception at all, and 58,979 of the pregnancies, 91 per cent, occurred in those states.

Samuel Dickman said, "I was horrified,"

Nine states with bans or early gestational limits have no exception for rape or incest, KFF recorded in its tracker updated on 1 April 2026. Where exceptions exist they carry conditions. Mississippi's statute permits abortion after rape "only if a formal charge of rape has been filed with an appropriate law enforcement official." Idaho requires a copy of a police report. West Virginia requires a report to law enforcement 48 hours before the procedure, plus a 24-hour wait, counselling and an ultrasound. Only 21 per cent of rapes are reported to police, the Dickman paper recorded.

Indiana granted nine abortions under its rape and incest exception during 2024, out of 146 performed in the state that year, according to the state health department's terminated pregnancy report. West Virginia recorded 23 abortions between January 2023 and June 2024 and none under its rape exception. Mississippi recorded none in 2023. No national database tracks abortions granted under state rape exceptions, NPR found in October 2024. "I've never seen someone get an exemption," said Laurie Bertram Roberts of the Mississippi Reproductive Freedom Fund.

Dr Jessica Tarleton, an obstetrician-gynaecologist in South Carolina, said she knew of one patient in two years who had sought a legal abortion under the exception, and that:

"I think we're turning patients into potential criminals."

A 10-year-old girl in Ohio, raped at nine and six weeks and three days pregnant when the state's ban took effect on 24 June 2022, travelled to Indianapolis for a medication abortion performed by Dr Caitlin Bernard on 30 June. Gerson Fuentes, 27, pleaded guilty to two counts of felony rape in July 2023 and was sentenced to life with a 25-year minimum. Indiana Attorney General Todd Rokita opened an investigation into Bernard on 27 July 2022 and asked the medical board to discipline her that November. The board reprimanded her and fined her $3,000 in May 2023 over a patient privacy violation, while clearing her of failing to report child abuse. Indiana's disciplinary commission filed professional misconduct charges against Rokita in September 2023.

A 13-year-old in Clarksdale, Mississippi, raped in autumn 2022 by an unknown man, gave birth in August 2023. Her mother did not know the state's rape exception existed, TIME reported, and the nearest provider was a nine-hour drive away in Chicago. Clarksdale police took nearly three days to collect DNA from the newborn. "It's a pretty high priority, as a juvenile," assistant chief Vincent Ramirez said. "Sometimes they slip a little bit."

West Virginia Senator Patricia Rucker introduced Senate Bill 43 on 20 January 2026 to delete the state's rape and incest exception, which currently runs to 14 weeks. Louisiana legislators have rejected a rape exception for children twice in two years: House Bill 164, covering girls aged 16 and under, failed 7 to 4 on 8 May 2024, and House Bill 248, covering those under 17, failed 3 to 9 on 3 June 2025. Both were filed by Representative Delisha Boyd. Representative Lauren Ventrella said during the 2024 hearing that teenagers might feign rape or incest to obtain an abortion.

Dr Neelima Sukhavasi told the committee that "one of these teenagers delivered a baby while clutching a teddy bear." No state has added a rape exception since 2024.

The money behind the laws

Alliance Defending Freedom, the Scottsdale legal organisation that represented Mississippi in Dobbs, reported revenue of $119,839,751 in the year to June 2025, up from $101,821,939 two years earlier, with $112,233,785 in assets. Chief executive Kristen Waggoner was paid $584,869. Denise Burke, then an ADF senior counsel, told the Evangelicals for Life conference in January 2018 that Mississippi's 15-week ban was drawn from the organisation's model legislation: "We're kind of basically baiting them; come on, fight us on turf that we have already set up," with an eventual aim of "a complete ban on abortion, except to save the life of the mother." ADF rejects characterisations of its work as extreme and describes its role in Dobbs as representing the state.

Susan B. Anthony Pro-Life America reported revenue of $25.7 million in 2024, roughly double its 2019 figure, and paid president Marjorie Dannenfelser $425,000. The group announced a $92 million electoral programme in February 2024 covering eight states, and says it spent $56 million in 2020 and pledged $78 million in 2022. Those are the organisation's own figures rather than audited expenditure.

The Charlotte Lozier Institute, cited by anti-abortion legislators and in the Texas material quoted above, is not a separate corporation. It files under the same employer identification number as the Susan B Anthony List Education Fund, which reported revenue of $10,922,264 in 2024. Ingrid Skop, the institute's vice-president and director of medical affairs, was paid $162,250 and appears on the same return as Dannenfelser.

Sage retracted three papers from Health Services Research and Managerial Epidemiology on 6 February 2024, citing undeclared conflicts of interest and expert reviewers who found "a lack of scientific rigor that invalidates or renders unreliable the authors' conclusions." Lead author James Studnicki was the Lozier Institute's vice-president for data analytics and sat on the journal's editorial board. US District Judge Matthew Kacsmaryk had cited one of the papers in the mifepristone case Alliance for Hippocratic Medicine v. FDA. The institute disputes the retractions and took legal action over them in October 2024.

The Texas Department of State Health Services appointed Skop to the state Maternal Mortality and Morbidity Review Committee on 22 May 2024 as the community member representing a rural area. The American College of Obstetricians and Gynecologists objected, saying committee members should be "unbiased, free of conflicts of interest and focused on the appropriate standards of care" and that they should be "clinical experts whose work is informed by data, not ideology and bias."

Roger Severino, who ran the HHS Office for Civil Rights in Trump's first term, wrote the health chapter of the Heritage Foundation's Mandate for Leadership, the Project 2025 volume. It calls for the CDC to require every state to report "exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother's state of residence, and by what method," and to separate "spontaneous miscarriage; treatments that incidentally result in the death of a child (such as chemotherapy); stillbirths; and induced abortion." Such reporting is currently voluntary. FactCheck.org rated as false the separate claim that the document proposed a register of all pregnancies. Heritage reported revenue of $133.9 million in 2024, up 33 per cent, and paid president Kevin Roberts $682,571.

Russell Vought, a Project 2025 author, runs the Office of Management and Budget, the agency that has withheld the global health money described below. Stephen Billy, previously vice-president of state affairs at Susan B. Anthony Pro-Life America, is a senior adviser at the same office. Hannah Anderson, deputy chief of staff for policy at HHS, came from the America First Policy Institute.

The Department of Veterans Affairs published a final rule on 31 December 2025, effective 30 January 2026, returning veterans' abortion coverage and CHAMPVA benefits to their state of 8 September 2022, before the interim rule that had removed restrictions. A life-of-the-mother exception remains, along with treatment for ectopic pregnancy and miscarriage. Ending VA abortion services was a Project 2025 recommendation.

Acting Attorney General Todd Blanche told religious leaders on a White House Faith Office conference call on 30 July 2026 that the administration means to make Dobbs "permanent in every single state," and said "victory will be soon and it will be permanent," according to The Nation. At his confirmation hearing he agreed to review the Biden justice department's legal opinion that the Comstock Act of 1873 does not bar mailing abortion medication absent unlawful intent. That opinion has not been withdrawn and no Comstock prosecution has been brought.

Crisis pregnancy centres, which counsel against abortion and are not required to employ clinicians, received nearly $1.3 billion from state governments between 2019 and 2024 across 1,259 centres, States Newsroom reported on 4 March 2026, including $491 million from 21 states in the post-Dobbs period. Texas committed between $140 million and $180 million across the 2024 to 2027 financial years and Florida raised its funding from $4.5 million to $25 million in 2023, a rise of 455 per cent. Louisiana auditors found centres paid more than the cost of the services they provided; Oklahoma auditors found one organisation disbursed less than 7 per cent of $1.6 million promised and served 6 per cent of its projected clients. The Government Accountability Office identified $34 million in direct HHS obligations to 16 such centres between the 2018 and 2024 financial years in a report issued on 2 March 2026, and said the true federal total "is unknown because CPCs are not easily identified in USAspending.gov." Estimates of the number of centres nationally ranged from 2,400 to 2,800.

Contraception funding withdrawn at home

Federal Title X payments were withheld from 144 Planned Parenthood sites across 20 states in spring 2025. Planned Parenthood participation in the family planning programme fell to 247 clinics in 29 states from 297 clinics in 34 states a year earlier, and 57 clinics across 20 states have closed or consolidated since January 2025.

Health and Human Services issued a funding notice in June 2026 redirecting Title X from preventing unintended pregnancy toward strengthening family formation and helping clients achieve healthy pregnancies. Grantees must reapply under the new terms by 9 January 2027. The notice promotes fertility-awareness methods, tracking apps, body literacy education, counselling on male fertility and what it calls restorative reproductive medicine. Title X served 3.9 million patients in 2018; enrolment fell by 844,000 during the first Trump administration's changes to the programme in 2018 and 2019, including 225,000 fewer oral contraceptive users, 86,000 fewer IUD recipients and 50,000 fewer hormonal implant users.

The Supreme Court ruled in Medina v. Planned Parenthood South Atlantic on 26 June 2025 that states may disqualify the provider from Medicaid networks. The tax and spending law Trump signed on 4 July 2025 barred federal Medicaid reimbursement to Planned Parenthood for one year. Congress let that prohibition lapse on 4 July 2026 and payments resumed in most states. One in 10 women of reproductive age on Medicaid who receive family planning services get that care at a Planned Parenthood clinic.

Texas, Arkansas, Mississippi, Missouri and South Carolina continue to block payments under pre-existing state bans. An Indiana district court vacated a 2013 injunction in July 2026 and the provider remains suspended there pending appeal. Governors in Oklahoma and Nebraska issued executive orders in July 2025 and November 2025 citing Medina. Planned Parenthood counted roughly 30 clinic closures and about 250,000 fewer patient visits over the year the ban ran, including three Michigan clinics in July 2026 and sites in Lakeland and Gainesville, Florida, the Lakeland clinic after 50 years. Gainesville patients now travel 80 miles to Jacksonville.

Mexico City Policy

The Mexico City Policy, which bars foreign organisations receiving US funds from providing, counselling on or referring for abortion using any money from any source, returned by presidential memorandum on 24 January 2025. A State Department waiver on 4 February 2025 allowed life-saving services to resume, including antenatal care, newborn care and immunisation.

USAID awards were terminated at a rate of 86 per cent in early 2025. Of 770 global health awards, 266 covered maternal and child health activities, and 86 per cent of those were cut, according to KFF tracking. Maternal and child health programmes moved to the State Department's Bureau of Global Health Security and Diplomacy in July 2025, and the administration published its America First Global Health Strategy that September.

An internal USAID memo projected that the terminations would disrupt services for 16.8 million pregnant women a year, postnatal care within two days of birth for 11.3 million newborns and pneumonia and diarrhoea treatment for 14.8 million children under five.

Vice President JD Vance announced the second expansion at the March for Life rally on 23 January 2026, the day the State Department posted interim rules. "Every country in the world has the duty to protect life," Vance said. Final rules followed on 27 January and took effect on 26 February, imposing three award terms on recipients: Protecting Life in Foreign Assistance, Combating Gender Ideology and Combating Discriminatory Equity Ideology. Immediate termination is the presumed penalty for a breach. The Secretary of State may waive the terms for national security or foreign policy reasons.

$39.8 billion in US foreign aid across 160 countries falls under the expanded restriction, measured against 2024 spending, KFF calculated, against $7.3 billion of global health assistance under the first Trump administration's version and $300 million to $600 million of family planning assistance under earlier presidents. Of 2,562 prime recipients funded in 2024, 2,111 were newly subject to the rules, and sub-recipients must comply as well. Ninety-three per cent of the prime recipients are NGOs and 4 per cent are multilateral organisations.

Beth Schlachter of MSI Reproductive Choices said the administration is "exporting the same playbook worldwide." Keifer Buckingham of the Council for Global Equality said the change turns US foreign assistance into an instrument of ideology.

US law has barred foreign aid from paying for abortion as a method of family planning since the Helms Amendment of 1973. The Mexico City Policy goes further, conditioning US health funding on what a recipient does with money raised elsewhere.

Aid-dependent countries

Maternal deaths rise about 11 per cent in countries reliant on US aid when the presidency switches from Democratic to Republican control, researchers reported in BMJ Global Health on 24 March 2026, drawing on 150 countries between 1985 and 2023. The increase works out at roughly 45 additional deaths per 100,000 live births and erodes about one-fifth of the global decline in maternal mortality achieved since 1985.

Latin America showed the largest proportional effect at 16 per cent, followed by Asia at 15 per cent and Africa at 7 per cent, with Africa carrying the largest absolute toll. US family planning aid runs 48 per cent higher under Democratic administrations, and per capita aid to heavily reliant countries drops 34 per cent under Republican ones, against 10 per cent in countries less reliant. Skilled birth attendance falls about 1 per cent and contraceptive prevalence about 2 per cent. The authors cautioned that maternal deaths are under-reported and misclassified in many low and middle-income countries.

Around 1,000 additional maternal deaths in a single year among populations in humanitarian need across Burkina Faso, the Central African Republic, Chad, Mali, Niger and Nigeria followed the January 2025 funding suspension, Matthew Cummins of the UN Population Fund's West and Central Africa office calculated in Health Policy and Planning on 10 March 2026. The figure represents a 45 per cent rise against a baseline of about 2,900 deaths in those populations, and follows an average 45 per cent cut in per capita public health spending, about $13 a person. Niger showed the steepest proportional increase at over 90 per cent, the Central African Republic more than 50 per cent, Chad and Mali about 35 per cent each and Burkina Faso about 20 per cent. Nigeria recorded the largest absolute toll at more than 300 deaths. Cummins used a deterministic model assuming no substitute funding arrived from domestic budgets, other donors, philanthropy or households, and wrote that the estimate covers humanitarian populations only and so understates the total.

Cutting US family planning support would deny modern contraceptives to 47.6 million women and couples, produce 17.1 million unintended pregnancies and cause 34,000 additional pregnancy-related deaths in a year, Elizabeth Sully and Amy Friedrich-Karnik of the Guttmacher Institute calculated in March 2025. Every day without the aid, they wrote, 130,390 women lose access to contraceptive services. The US appropriated $607.5 million for international family planning in the 2024 financial year and previously supplied more than 40 per cent of global donor funding for it.

Nearly 95 per cent of US foreign aid for sexual and reproductive health was cut during 2025. Nigeria, Ethiopia, Uganda, Tanzania and the Democratic Republic of Congo were the largest recipients. Prossy Muyingo, a community health worker in Uganda's Mityana District for 12 years, lost her stipend in September 2025 and now counsels neighbours informally, among them a 28-year-old woman who became pregnant after losing access to contraceptive pills.

Secretary of State Marco Rubio said in May 2025 that "there's no plan to spend that money. We're not going to be in that business globally." The administration's budget request for the 2027 financial year, published in April 2026, said "the United States should not pay for the world's birth control," listing reproductive health education and contraceptive access in Ghana and the supply of condoms and contraception in Kenya among the activities eliminated. A State Department statement said Trump "has restored common sense to U.S. foreign assistance" and would "not fund abortion-related activities, left-wing social agendas, or wasteful overseas bureaucracies."

Some 260,000 women died of maternal causes worldwide in 2023, one every two minutes, WHO and partner agencies reported on 7 April 2025 while warning that aid cuts threatened progress. Maternal deaths fell 40 per cent between 2000 and 2023, but the current rate of decline is 1.5 per cent a year against the 15 per cent needed to meet the 2030 target. "Solutions exist to prevent and treat complications causing most maternal deaths," said WHO Director-General Tedros Adhanom Ghebreyesus.

Six in 10 maternal deaths worldwide, or 160,000 women in 2023, occurred in conflict-affected or institutionally fragile states, WHO and its human reproduction research programme reported on 17 February 2026. Conflict-affected countries record 504 maternal deaths per 100,000 live births and institutionally fragile ones 368, against 99 in stable countries. A 15-year-old girl in a conflict zone faces a lifetime maternal death risk of one in 51, against one in 79 in a fragile state and one in 593 elsewhere.

The UN Population Fund appealed for $1 billion for 2026 on 11 December 2025 after more than 1,000 health facilities and mobile teams and more than 250 safe spaces for women and girls closed or came close to closing during the year, with its 2025 appeal a third funded. Some 7.7 million pregnant women will need humanitarian assistance during 2026.

"In many crisis settings, we are seeing the collapse of essential health systems," said UNFPA Executive Director Diene Keita. "When hospitals are bombed to rubble, when delivery rooms have no midwives, when clinics have no medicines, women are left to give birth alone."

The deaths aid workers counted

Kabita Mukhiya, 20, died in Rautahat district in southern Nepal in December 2025 of eclampsia complicated by severe anaemia, carrying a fourth child she and her husband had planned to name Shivraj. The baby was stillborn. A $35 million five-year community health programme run by CARE, which had reached more than 100,000 women in three years, had closed months earlier along with the stipends of the volunteers who checked on pregnant women in the village.

"I would have asked her, 'Is the baby kicking? When did you last feel movement?'" said Rajkumari Patel, one of those volunteers. "I would have checked for swelling in her hands and face." Mukhiya's aunt Shraddha Mukhiya said the visits "would have saved her life," and that "she was too young to die."

Prempur Gonahi, the village where Mukhiya lived, recorded no newborn deaths in 2024. The first came in December, after the programme closed, and five had followed by March. Before the programme the village lost 10 to 15 newborns a year. "The expected number within a year is happening within four to six months," said Mona Sherpa, CARE's country director in Nepal. Child wasting in the area rose from 7.4 per cent to 12.3 per cent. Municipal records logged two infant deaths in one area where a local organisation counted eight.

Mary Oluoch, 25, bled to death at Karabok in western Kenya after an illicit abortion, unable to afford a private clinic and ineligible for the public hospital service. Seven women die each day in Kenya from complications of unsafe abortion.

"By the time the women come, we are often dealing with a life-threatening situation," said Dominic Omollo, a reproductive health coordinator in Bondo.

Hannah Ruguru, who works at a Marie Stopes clinic in Kisumu and whose own sister died after a backstreet abortion, has faced protests and online abuse.

"Sometimes you can get scared," she said, but "at the end of the day, I'm helping women."

Suzan Akello, 23, was found dead on a veranda in Namataala, in eastern Uganda, after using herbal medicine to end a pregnancy she could not afford to have terminated at a clinic, The Elephant reported on 7 May 2026.

Refugees International documented 161 preventable deaths in Afghanistan attributable to the withdrawal of US assistance, in a survey published on 13 August 2026 that collected 555 responses from health workers across 30 of the country's 34 provinces, most of them practising midwives, alongside facility data from more than 320 clinics and hospitals in six provinces. Eighty of the deaths were maternal, 30 were newborn or fetal and 14 were older children. More than two-thirds of Afghan midwives lost their jobs after the cuts.

"My sister was sick and in labor. We transferred her to the health center, but it was closed," said a man identified as Gull, in Nimruz province. "Then we found a vehicle with many difficulties and carried her to Nimroz Province. When we took her there due to the lack of professional healthcare services, we lost our sister after two hours. Our sick sister was pregnant with twins, and they handed them over to us stillborn."

International Planned Parenthood Federation member associations closed or failed to open 1,394 health sites during 2025 and terminated 969 jobs across 34 countries, losing $87.2 million in funding through 2029, the federation reported on 17 December 2025. Nine million people lost access to contraception, HIV testing and violence services. Africa absorbed $26 million of the loss and 1,175 of the closures.

"We're talking about clinics in remote areas, conflict zones, and places where IPPF member associations are often the only providers," said Director-General Alvaro Bermejo.

MSI Reproductive Choices, which reported that USAID had supplied 35 per cent of the world's donated contraceptives across 23 countries, calculated that the funding lost in Zimbabwe alone would have averted 1,400 maternal deaths.

"This past year has been crushing," said Pester Siraha, its country director there. "Trust and hope have been eroded." Dr Walter Obita, the organisation's country director in Kenya, said in January 2026 that "current supplies will last less than five months, well below the required 16-month minimum."

Roughly $10 million of US-procured contraceptives sat in a Belgian warehouse awaiting destruction.

Médecins Sans Frontières, which provides abortion care in its projects, said the January 2026 rules restrict funding for the care of rape survivors, and that unannounced US government site visits "could compromise patient privacy, confidentiality, and safety, particularly for survivors of sexual violence." Tirana Hassan, chief executive of the organisation's US section, said the changes "raise serious concerns for patient well-being, safety, and continuity of care," and that MSF had "witnessed firsthand the irreparable damage caused by previous versions of the Global Gag Rule." Rachel Milkovich, its senior specialist for global health advocacy, put the added administrative cost to providers at $340 million a year. In MSF's own study of two hospitals in the Central African Republic and northern Nigeria, complications of abortion accounted for about a quarter of maternal deaths in Bangui, and about 95 per cent of the Nigerian patients had used dangerous methods.

Anu Kumar, chief executive of Ipas, said the expanded policy "weaponizes U.S. foreign aid to force the administration's harmful agenda on people around the world" and that "bullying countries into complying with anti-rights and extremist ideology is despicable and unacceptable."

Dr Musoba Kitui, who directs the organisation's Africa Alliance, said that "Kenya and many other countries are still reeling from the loss of USAID, but our health privacy and reproductive health care cannot and should not be the cost to resume aid agreements with the United States." Sixteen African countries have signed health agreements with the US since mid-December 2025.

Rape in Sudan and eastern Congo

US foreign aid has been barred since the Helms Amendment of 1973 from funding abortion "as a method of family planning," wording that on its face leaves room for rape, incest and life endangerment. Ten administrations have applied it as a blanket prohibition, and no rape carve-out has ever been put into operation.

Section 602.20(a)(2) of the rule the State Department published on 27 January 2026 excludes from the prohibition an abortion where "the pregnancy is the result of an act of rape or incest," but only "provided that the abortion is lawful under local law." In Sudan, across much of the Sahel and in practice in eastern Congo, local law does not permit abortion after rape, or permits it only on documentation survivors cannot obtain. The exception lapses in the places that produce the most pregnancies from rape.

United Nations human rights investigators verified 546 incidents of rape and other sexual violence across 16 of Sudan's 18 states in the three years to June 2026, involving 838 victims, all but 15 of them women and girls. At least 13 died. The youngest was nine. At least 85 were held in sexual slavery, nearly a quarter of the incidents were gang rapes, and at least 59 women and girls became pregnant or gave birth as a result. "This is a war crime and, if committed as part of a widespread or systematic attack, a crime against humanity," said Volker Türk, the UN High Commissioner for Human Rights.

One in four facilities offering clinical management of rape across Sudan's 18 states was fully functioning when the UN Population Fund reported on the funding collapse on 4 June 2025. Eleven of 61 safe spaces had closed, support had been withdrawn from more than half of the 93 health facilities the agency had backed, and 1.1 million pregnant women were without antenatal, delivery or postpartum care. Demand for services for survivors of violence had tripled in a year, and more than half of those seeking help had been raped or sexually assaulted. Less than 20 per cent of the $62.8 million needed for that response was funded in 2024. "The world is turning its back on the women and girls of Sudan," said Laila Baker, the agency's regional director for the Arab states.

Nesma, 26, was raped by three Rapid Support Forces fighters in Khartoum and gave birth to a son, Yasser.

"It's not my son's fault, just like it is not mine," she told Agence France-Presse in May 2026, in a report that used pseudonyms for the women it interviewed. Hayat, 20, raped while fleeing the Zamzam camp in Darfur, said of her four-month-old son: "I just want a better future for him. I don't want him to grow up like us."

IMA World Health ordered 116,000 post-rape kits for eastern Congo in early 2025 under a USAID contract that had been supplying 80 per cent of health centres across three provinces. The funding was withdrawn before the kits were delivered. Between March and September 2025 the kits, which contain HIV post-exposure prophylaxis effective only within 72 hours, antibiotics, testing for sexually transmitted infections and emergency contraception, were almost entirely absent across eastern Congo, Human Rights Watch reported on 12 January 2026. Seven of North Kivu's 34 health zones had even minimal supply in May 2025. By September the entire province had 895 complete kits left. The UN Population Fund recorded more than 80,000 rapes in eastern Congo in the first nine months of 2025, 32 per cent more than in the same period of 2024. "Armed groups and military forces are using sexual violence as a weapon of war across eastern Congo," said Ida Sawyer, the organisation's crisis and conflict director.

"You never forget standing in front of that person and telling them that you don't have any medicine, that you don't know how to help them, and asking them to leave," a health worker in South Kivu told Reuters.
Amadou Bocoum, CARE International's country director, said the kit "is truly important to reassure the woman who has been really traumatized that she won't get AIDS, that she won't have an unwanted pregnancy, and that she won't contract venereal diseases."

Women-led organisations in 52 crisis-affected countries reported that more than a million women and girls had lost access to humanitarian support since January 2025, in a survey of 855 groups published by UN Women on 10 July 2026. Sixty-two per cent had closed or cut back safe spaces, 86 per cent reported rising violence against women and half had introduced waiting lists or were turning people away. "Every dollar withdrawn from women's organizations is a dollar withdrawn from survivors of conflict-related sexual violence, displaced mothers, girls forced from school, and communities struggling to survive," said Sofia Calltorp, UN Women's chief of humanitarian action.

Newborns and children

Some 4.9 million children died before their fifth birthday in 2024 and 2.3 million of them were newborns, the UN Inter-agency Group for Child Mortality Estimation reported on 18 March 2026. Complications of preterm birth caused 36 per cent of the newborn deaths and complications of labour and delivery a further 21 per cent. Sub-Saharan Africa accounted for 2.8 million of the total. Roughly 80 per cent of newborn deaths are preventable with care delivered around the time of birth.

Under-five mortality fell 3.9 per cent a year between 2000 and 2015 and 1.5 per cent a year between 2015 and 2024, a slowdown of more than 60 per cent. "No child should die from diseases we know how to prevent," said Catherine Russell, UNICEF's executive director. "But progress in child survival is slowing, at a time with global budget cuts." A further 1.9 million babies were stillborn in 2023, one every 17 seconds, and the rate of decline in stillbirths has slowed by 53 per cent since 2015.

Child deaths rose in 2025 for the first time this century, from 4.6 million to 4.8 million, according to modelling by the Institute for Health Metrics and Evaluation published by the Gates Foundation on 3 December 2025. Development assistance for health fell 26.9 per cent below its 2024 level. The institute's counted baseline differs from the UN's, which puts 2024 deaths at 4.9 million.

Defunding on the current trajectory would cause 22.6 million additional deaths across 93 low and middle-income countries by 2030, of which 5.4 million would be children under five, Davide Rasella and colleagues modelled in Lancet Global Health on 2 February 2026. A milder scenario gives 9.4 million deaths, 2.5 million of them children. An earlier Lancet analysis published on 30 June 2025 projected 14.1 million additional deaths by 2030 from the withdrawal of USAID funding, 4.5 million of them children under five, and found the agency's work had been associated with 32 per cent lower under-five mortality across two decades.

Neonatal mortality rose nearly 60 per cent across six district hospitals in Afghanistan's Nangarhar province during 2025 against the previous year, and 133 per cent at Farah Provincial Hospital, where neonatal deaths rose 167 per cent even as institutional deliveries increased by 15 per cent. Maternal mortality at Herat's facilities rose 109 per cent in the first half of 2026.

The world is short of about 980,000 midwives, the Partnership for Maternal, Newborn and Child Health and WHO reported on 19 January 2026 from a study covering 181 countries. Universal access to midwife-delivered care would prevent about two-thirds of maternal and newborn deaths and stillbirths.

Infant deaths in the US numbered 20,048 in 2024, a rate of 5.52 per 1,000 live births, of which 13,272 were newborns, the National Centre for Health Statistics reported on 16 June 2026. Congenital malformations caused 4,091 of the deaths and short gestation or low birth weight 2,945. Provisional figures for the 12 months to the end of 2025 put the rate at 5.36, a record low. Fetal deaths at 20 weeks or later totalled 20,005 in 2023.

Mississippi recorded 9.65 infant deaths per 1,000 live births in 2024, 3.25 times the rate in New Hampshire, which recorded 2.97. Seven of the nine worst-performing states, Mississippi, Arkansas, Louisiana, South Carolina, Oklahoma, Alabama and West Virginia, enforce abortion bans.

Excess infant deaths in the 14 ban states reached 478 through 2023, Alison Gemmill and colleagues found in JAMA on 13 February 2025, a rise of 5.60 per cent above the expected rate with a credible interval of 2.43 to 8.73 per cent. Texas accounted for 384 of them. Deaths of Black infants rose 10.98 per cent, or 265 deaths. Deaths from congenital anomalies rose 10.87 per cent, the sharpest movement in the study and the measure that tracks pregnancies carried to term after a fatal diagnosis.

The money Congress appropriated

Congress appropriated $9.42 billion for global health in the bill Trump signed on 4 February 2026, down from $12.4 billion the previous year and $5.7 billion above the $3.72 billion the administration requested. Family planning and reproductive health drew $575 million, including $32.5 million for the UN Population Fund, which the administration has moved to withdraw from. Bilateral maternal and child health work at the State Department and the Centers for Disease Control and Prevention drew $845 million for the 2026 financial year, close to the $865.7 million provided in 2024.

Of more than $9 billion appropriated for global health, $190 million had been obligated by the end of March 2026, about 5 per cent of the rate of the previous five years and a tenth of the roughly half normally committed by that point, ProPublica reported on 22 June 2026. The Office of Management and Budget labelled more than $500 million of global health money unallocated. Some $13 billion was clawed back from foreign aid during 2025 through pocket rescission, $661 million owed to the Global Fund to Fight AIDS, Tuberculosis and Malaria went uncontributed and $3.2 billion of 2025 global health money was set aside for USAID closeout costs, due to expire on 30 September if left unobligated. Congressional letters seeking answers by 8 May had gone unanswered by 16 June.

The Impoundment Control Act of 1974 limits a president's power to withhold appropriated funds, and the Government Accountability Office has found pocket rescissions unlawful. "It is a huge grab of power from the president, taking powers away from Congress," said David Super, a Georgetown University law professor.

Law and accountability

The Emergency Medical Treatment and Labor Act obliges any hospital taking Medicare money to stabilise a patient with an emergency medical condition, a duty federal guidance treated as covering abortion until June 2025. Winmill's Idaho ruling rests instead on the 14th Amendment and, since the 26 August narrowing, bars enforcement only as to Dr Seyb.

The Maputo Protocol, ratified by 45 African Union member states, requires signatories under Article 14 to authorise abortion where pregnancy endangers a woman's life or health, and in cases of rape, incest or sexual assault. US funding conditions restrict counselling that member states are treaty-bound to make available.

The US has signed but never ratified the International Covenant on Economic, Social and Cultural Rights, and remains one of a handful of states outside the Convention on the Elimination of All Forms of Discrimination against Women, leaving no treaty body with jurisdiction to review its record on either count.

Labrador's appeal of the Seyb ruling is before the Ninth Circuit. Title X grantees must reapply under the new terms by 9 January 2027. The $3.2 billion in USAID closeout funds expires on 30 September 2026 unless obligated.