etee Suah plays with her baby after benefiting from a USAID funded program for the child’s delivery. Credit: Nukanah Kollie/New Narratives.
- US aid cuts have ended an ongoing $US100+ million-dollar program, which was providing free treatment and drugs for thousands of pregnant women
- Experts fear this will worsen Liberia’s already rising maternal and infant mortality rates
By Nukanah Kollie with New Narratives
ALALA, Bong County — There is joy, excitement, smiles and relief for Tetee Suah as she plays with her newborn daughter, just a day old, in the maternal waiting room of the Palala Clinic in Bong County. At 43, Suah is at an age where pregnancy and childbirth can be more risky. She is grateful for a safe delivery.
“I feel good,” says Suah, speaking Liberian English. “I give birth. I na sick. I alright in my body and I eating. My baby sucking. The people give me medicine there.”
Health officials here say Suah’s safe delivery was helped by funding from the United States Agency for International Development (USAID) funded program known as the Fixed Amount Reimbursement Agreement or FARA. Launched in February 2011 to help tackle Liberia’s extremely high maternal and infant mortality rates –among the worst in the world – the program provided more than $US100 million directly to the government in the following years for hospitals, clinics and health facilities across the country to strengthen maternal, neonatal, and child health care services. It provided malaria medication and mosquito nets to protect pregnant mother and babies. In 2020 USAID committed an additional $US6.1 million to boost healthcare delivery in initially in Bong, Lofa and Nimba counties but then expanded to Margibi, Grand Bassa, Grand Gedeh, River Gee and Grand Cape Mount counties.
In March FARA funding ended, a victim of incoming US President Donald Trump’s decision to cut nearly all international aid. Medical officials here now fear for future deliveries of medicine and other support.
Mr. Augustin Ngafuan, Liberia’s finance and development planning minister, has said the government is still assessing the full impact of the US government funding cuts – USAID alone contributed $US150 million in 2024 – and US cuts to the World Health Organization and other international multilateral organizations will also hurt Liberia.
A bare maternal waiting home in Forequelleh town, Bong County in 2022. Credit: Cental
The minister told a retreat with the international community last month that the full annual costs of the cancelled projects would be nearly $300 million. That’s equivalent to about 35 percent of the government’s $800 million yearly budget. Government allocations to the health sector had already increased by nearly 20 percent to $US91 million in the 2025 national budget. Experts said diverting government funds to health will require painful cuts in other areas.
In an email response to questions, Catherine Cooper, the chief medical officer, said the finance minister is taking the lead and “is analyzing and strategizing on how domestic funding can mitigate this effect on the overall health system.”
Here in Bong County, money disbursed under the project is still supporting about 48 health facilities including CB Dunbar, Phebe and Bong Mines hospital, according to Dr. Jefferson Sibly, the county health officer.
“We are still doing the project in a way that it will benefit us,” says Dr. Sibly in an interview. He is worried about the messaging going out to expecting mothers that they should stay away from clinics and give birth at home without the possibility of intervention by trained professionals. “We continue to preach for institutional deliveries. Those things that carried our records back like allowing people to deliver in their homes, we are completely against that.”
Dr. Silby is worried about the long-term consequences of the US aid cuts.
“In about six months, we will feel the impact,” Dr. Silby says. “There will be impact. You talk about money to support a project, and you cut it off, it’s a lot of stress even if you have to look for means to support these projects.”
World Bank data showing number of maternal deaths per 100,000 live births indicates Liberia has made minimal progress since FARA started in 2011.
But some experts question just how successful the FARA intervention has been. The project was started to try to bring down Liberia’s maternal and infant mortality. At the time 632 mothers were dying out of every 100,000 births. Twelve years later that number had climbed to 652. The Ebola crisis caused a large spike in 2014-2015 but the number has stayed above where it was when the project started in 2011. That contrasts with the rest of Sub-Saharan African where the number has fallen steadily over the same period.
In the period since the last World Bank data in 2020 experts say the numbers have been growing as facilities for mothers in rural areas have been starved of funding. Front Page Africa reporting in 2024 detailed the lack of medicine, food and bedding in maternal waiting rooms and the poor standard of facilities at birth clinics in rural areas.
A 2024 United Nations (H6) joint mission visited the country to highlight the “urgent need for action to combat the high burden of increasing maternal and newborn deaths in the country,” revealing that 1100 women and 8510 newborns die annually during childbirth. The H6 is a partnership of six United Nations agencies: UNAIDS, UNFPA, UNICEF, WHO, UN Women, and the World Bank, working together to improve the health and well-being of women, children, and adolescents. The delegation blamed the rise in deaths on “lack of quality care during childbirth and antenatal care, among other factors.”
Dr. Anshu Banerjee, H6 Mission Team Lead and WHO’s Director of the Department of Maternal, New-born, Child, and Adolescent Health and Ageing, urged the government to prioritize access to healthcare services, reduce high out-of-pocket costs for health services, improve health infrastructure, and enact legal frameworks to address gender-based violence, female genital mutilation, child marriages, and teenage pregnancies, among other issues.
Dr. Jefferson Sibly, Bong County health officer.
It is possible that without USAID funds things could have been even worse. Women here don’t want to find out. They say they don’t trust the government to replace lost funding.
“When it stops, plenty people will die,” said Suah. “So, we begging them that program not stop. We want talk to the American government, say they not stop that program for us. Let them help the people.”
Fatu Brown, 20, is another mother taking advantage of the free health services here. Five months pregnant with her first child, she is afraid of what the cuts could mean for her and her baby.
“We will die, our children will die,” said Brown. “We are begging them. They must not stop it for us. It can help the body, help the baby. Malaria medicine, it can help pregnant women too. The mosquito net can make it so we can’t get malaria.”
Fatu Brown, five months pregnant, at the C.B Dumbar Hospital for a checkup
Hospitals and clinics across the country are bracing for potential shortages of essential medications.
“This shutdown creates a noticeable gap,” said Dakermue A. Kollie, a healthcare expert working with the FARA project in the Bong County Health Team. “The U.S has supported us with malaria drugs, family planning commodities, and maternal healthcare. If this support stops completely, it will be a serious gap, especially since the Liberian government will take time to adjust. We have to find ways to fill the gap, but that will take time.”
The cuts present more challenges to security and social cohesion for the government at a time when poverty is rising in rural areas according to Cllr. Tiawan Gongloe, a veteran human rights lawyer and rival presidential candidate in the 2023 election.
“The government has to change now because health services are so important,” said Cllr. Gongloe. “It’s about the safety and survival of the people, which should be the number one priority of any government.”
Since the aid cuts, the government has cut salaries, allowances, gas slips, and foreign travels of cabinet officials. Cllr. Gongloe is one of many who have called on government officials and legislators to cut their salaries as well. Liberian lawmakers are among the highest paid in the world, despite having one of the smallest economies.
“It doesn’t make any country have sympathy for us,” says Cllr. Gongloe “It is a misapplication of resources, and we have to change it. They are extremely irresponsible and insensitive to the suffering of the people.”
For women in rural areas of the country like Tetee, Fatu and Lydia, the cuts have brought fear and stress. Though she is a long way from the United States and the ear of its president, Lydia has a message for the man she blames for her situation. “Donald Trump should stop what he is doing,” she pleads.
Additional reporting by Anthony Stephens. This story is a collaboration with New Narratives as part of the West Africa Justice Reporting Project. Funding was provided by the Swedish embassy in Liberia. The donor had no say in the story’s content.
