SARWORLOR, Liberia — In the West African nation of Liberia, Roseline Phay’s search for contraceptives highlights a growing crisis exacerbated by significant cuts to U.S. foreign aid.
Five months ago, Phay, a 32-year-old farmer, embarked on a journey to find contraceptives to prevent further pregnancies as she and her partner struggle to provide for their two daughters.
After consulting with a health worker in her village, Phay discovered that the necessary contraceptive pills, implants, and condoms had run out.
Determined, she traveled for hours along rugged red clay paths to the nearest clinic, only to find that they too were out of contraceptives.
Unbeknownst to her, the aid cuts which impacted Liberia’s healthcare were initiated just weeks prior by U.S. President Donald Trump, who suspended most foreign aid through the U.S. Agency for International Development, critical for supplying medications in the country’s public health system.
Following four arduous trips, during which hope dwindled, Phay found herself pregnant.
“I’m suffering,” she shared while holding her daughter Pauline, who was crying in her arms.
“I have this little child on my back, and the other child in my stomach is suffering.” Phay continues to labor on her farm throughout her pregnancy, fearing that without work, she and her family will go hungry.
After becoming pregnant, Phay had to wean Pauline from breastfeeding, leading to severe malnutrition in the young girl.
The lack of U.S. aid left no therapeutic food for her, and Pauline remains unwell.
Phay’s plight is emblematic of the millions across Africa who have been adversely affected by recent cuts in U.S. aid, particularly in Liberia, where American support has historically comprised almost 2.6% of the gross national income, the highest rate globally, according to the Center for Global Development.
Richlue O. Burphy, who spent over a decade working on USAID projects, points out that “the impact of USAID in Liberia cannot be overstated.”
He noted that the presence of USAID is ubiquitous throughout the country, with nearly all government institutions having partnerships with this agency.
Liberia, established in the early 1800s to provide a safe return for freed slaves and free-born Black people from the United States, maintains a complex and historically significant relationship with the U.S., often referring to it as their “big brother.”
Having been one of the first recipients of USAID support since 1961, officials assumed that Liberia would be immune to the cuts due to their longstanding partnership.
However, after enduring civil wars and an Ebola epidemic, Liberia’s survival has relied heavily on foreign aid, particularly from the U.S. and the World Bank.
Despite its rich natural resources, the World Bank reports that six out of ten Liberians now live in poverty, making Liberia one of the ten poorest countries in the world.
The aid cuts pose “a serious challenge,” advised Deputy Finance Minister Dehpue Y. Zuo to The Associated Press, highlighting that to keep the healthcare system afloat, significant adjustments to funding across the board must occur.
Between 2014 and 2023, Liberia received on average $527.6 million in annual aid, including an anticipated $443 million in 2023.
However, the total estimated impact of the cuts is a staggering $290 million, primarily reflecting funds that have yet to be disbursed.
U.S. funding has historically built schools and health clinics, trained doctors and teachers, and supported small-scale farmers while ensuring students had school meals.
Almost half of U.S. funding directed to Liberia supported its healthcare system, contributing to malaria control initiatives, maternal health programs, HIV/AIDS treatment, and community health outreach.
Now, healthcare facilities like those in Bong County, where Phay resides, face empty medicine shelves.
An ambulance funded by USAID is non-operational due to a lack of fuel, and hospitals are running low on vital supplies such as hand sanitizer and gloves.
Delays in medical staff training and the non-payment of community health workers have compounded these issues.
Moses K. Banyan, head of CB Dunbar Hospital, referred to the U.S. aid cuts as “beyond a shock,” expressing concern over the future as Bong County is starting to see cases of mpox emerging from neighboring Sierra Leone.
Banyan pointed out that advance warnings could have enabled better preparation.
The withdrawal of U.S. support has left an opening for other nations, particularly China, as experts note the growing presence of Chinese companies in Liberia’s gold mining, road construction, and training of aid workers.
With Chinese brands proliferating, including beer alongside local beers, many Liberians are now considering education opportunities in China rather than the U.S.
Recently, China inaugurated a cardiology wing in the capital’s main hospital, which, despite being named after John F. Kennedy, has struggled with resources and endured misnomers like “Just For Killing” due to its inadequacies even before the cuts.
“We are open door to the rest of the world, including the United States,” stated Deputy Finance Minister Zuo.
In Sarworlor, community health worker Alice Togbah clings to her USAID vest even as she has not been compensated for months.
Her supply of malaria medications for children has run dry, and she is quickly exhausting her limited cough and diarrhea treatments.
The desperation of the community is palpable as local resident Grace Morris described her 4-year-old daughter Promise’s recent battle with malaria.
Limited access to malaria tablets left her child feeling poorly, paralleling the tragedy of a neighbor who lost a son due to delayed medication last year.
Women in the area, including Morris, echo the growing demand for access to contraceptives in a country that had previously made significant progress in reducing teen pregnancy and maternal mortality rates.
“For women in traditional, conservative communities, access to contraceptives meant reclaiming some control over their lives,” reflected Phay.
Expressing the critical extent of her predicament, Phay stated, “If … my man touches me, I cannot say no because I need to satisfy him.
But if I have no medicine, I will get pregnant.”
Concerned for her 9-year-old daughter, also named Promise, who lives with an aunt in the capital city Monrovia, Phay yearns for her child to complete her education and lead a different life.
“I am begging, if you people have the medicine, you people need to help us,” she pleaded.
“I don’t want her to suffer like me.”
image source from：nbcnews
