When the mobile clinic where Herisoa Bodo worked suddenly shut down, her phone began ringing nonstop. One of the callers was a woman desperate to have her contraceptive implant removed. She called repeatedly, but the appointment never happened. Eventually, she became pregnant.
Bodo, a midwife who has served with Marie Stopes International (MSI) Madagascar since 2012, continued answering messages long after MSI’s outreach teams were forced to suspend operations.
“Women kept calling because they couldn’t find care,” she said.
Her service area spans Analamanga, the region surrounding Madagascar’s capital, Antananarivo. Here, MSI deploys buses converted into mobile clinics and rugged 4×4 outreach teams to reach remote villages. For thousands of women, these periodic visits are the only dependable opportunity to see a trained midwife.
So when the outreach stops, the impact is immediate.
A Fragile System Under Strain
Madagascar already faces some of the highest maternal health risks in the world.
- 445 maternal deaths per 100,000 live births
- Unsafe abortion remains a major cause
- Less than 50% of women use modern contraception
- One in three has an unmet need for family planning
Even brief interruptions widen dangerous gaps ,and that is exactly what happened in early 2025.
Funding Collapse After U.S. Aid Freeze
For years, MSI Madagascar’s outreach programs were sustained almost entirely by UNFPA, the UN Population Fund.
“100% of our family planning commodities come from UNFPA,” explained Volonirina Ranorohery, Senior Programme Manager at MSI Madagascar.
“They supply all our long-term methods, implants, IUDs, and injectables. And for clients, everything is free.”
UNFPA’s support didn’t stop at commodities. It also covered:
- Fuel
- Car rentals
- Operational cash
- Transportation for outreach teams
But this funding chain collapsed in January 2025, after the U.S. government froze most foreign aid under an executive order. Within weeks:
- USAID terminated 48 UNFPA grants, worth nearly US$377 million
- Access to previously approved funds in seven countries was revoked
- By May, the Kemp-Kasten Amendment cut off all U.S. support to UNFPA
MSI Madagascar had expected US$500,000 from UNFPA for the year.
Instead, it received just US$165,000.
“We had to suspend six community sites and three mobile outreach teams,” Ranorohery said.
Communities Left Without Care
The suspension was felt immediately across the rural and peri-urban communities Bodo’s team used to serve. Women who had relied on regular visits suddenly had no access to contraceptives, counselling, or basic health services.
Public health centres offered only short-term contraceptive options, pills or injectables, and always for a fee.
“Most can’t pay,” Bodo said. “That’s why they prefer long-term methods like implants or IUDs.”
The interruption didn’t just affect family planning. Routine follow-ups, wound care, treatment for infections, and STI prevention all came to a halt.
Bodo said she is now seeing more cases of:
- Syphilis
- HIV
- Other untreated STIs
“Before, the teams could provide treatment,” she added. “Now clients go to pharmacies, see the prices, and leave without buying anything.”
The Human Cost for Providers
The cuts have been deeply personal for health workers, too.
Bodo’s own permanent contract was downgraded to a consultancy. Her working days dropped from 20 per month to 15, reducing both income and stability.
Providers who dedicated years to outreach now face the same uncertainty as the women they serve.
A Wider Crisis Beyond Madagascar
What is unfolding in Madagascar mirrors a growing crisis across several UNFPA-supported countries.
Midwifery and reproductive health programs are being scaled back in:
- Somalia
- Chad
- Nigeria
- Afghanistan
Before the U.S. aid freeze, American contributions played a critical role in preventing:
- 17,000 maternal deaths
- 9 million unintended pregnancies
- Nearly 3 million unsafe abortions
With major funding withdrawn, health advocates warn that many of those gains could rapidly reverse.
A Setback With Long-Term Consequences
For women in Madagascar, especially those in remote communities, the mobile clinics represented more than a health service, they were a lifeline. Without them, unintended pregnancies rise, unsafe abortions increase, and preventable complications go untreated.
And as the calls to Bodo’s phone show, women are not just losing access to services. They are losing the only health workers they trust.