The world is cutting health budgets. Women and children will pay the price

As less money is spent on healthcare, women and children bear the burden at a time when choices need to be made, and women’s, children’s and adolescents’ health protected and fought for at every budge…

By Rajat Khosla · July 26, 2026 · 6 min read

Every year, approximately260,000 women dieduring or following pregnancy and childbirth. Nearly five million childrennever reach their fifth birthday. Millions of adolescents lack access to health services that could transform their lives. These are the predictable consequences of political and fiscal choices. And right now, those choices are moving in the wrong direction. Global health financing is in crisis. Official development assistance is projected tofall by a further 5. 8%in 2026 alone, according to the Organisation for Economic Co-operation and Development (OECD), following a 23. 1% drop, the largest ever, in 2025. For health, the OECD projects a 19–33% fall. These cuts have hit low-income and fragile country health systems particularly hard, given their reliance on external aid. Total global health investment coulddrop by up to 40%, a loss of roughly $10-billion. The services cut first are those already chronically underfunded: maternal care, newborn health, sexual and reproductive health, and adolescent services. Why this matters beyond healthFinancing for maternal and child health is not only a humanitarian appeal. It is one of the highest-return investments any government can make. Healthy women are productive workers and caregivers; adolescents who survive and thrive become tomorrow’s workforce. When girls can access contraception and stay in school, fertility rates fall and economies grow. When mothers and newborns survive, families are spared the cascading costs of preventable death. Finance ministries rarely treat women’s, children’s and adolescents’ health (WCAH) as core economic policy. They should: fiscal choices on taxation, debt and budget allocation determine whether a rural midwife has supplies, or a girl can access contraception without catastrophic cost to her family. When mothers and newborns survive, families are spared the cascading costs of preventable death. (Photo: eco-business. com / Wikipedia)A broken financing systemThe current financing landscape for WCAH is fragmented, underfunded, and increasingly at risk. In many low-income and fragile settings, progress achieved over decades is now stalling. Since 2015, rates ofmaternalandneonatalmortality,preterm birth complications, andadolescent pregnancyhave barely shifted. In humanitarian settings, which now account for61% of all maternal deathsglobally, the situation is deteriorating. Several structural failures are driving this. First, health budgets overall remain too small and too poorly protected. Debt servicing is crowding out social spending in dozens of countries. Inflation erodes the real value of health allocations. Budget execution is weak, meaning even allocated funds often fail to reach frontline services. Second, external financing, while critical in low-income contexts, has historically been fragmented and donor-driven, creating programmatic dependencies that undermine sustainability. As that external funding now contracts sharply, the systems built around it are exposed. The pattern is visible across many donors. The Global Fund’s eighth replenishment closed37% shortof its target, forcing reduced country allocations that will affect maternal health alongside HIV, tuberculosis and malaria programming. Domestic responses have varied. Nigeriaadded $200-millionto its health budget within a month of losing US support, while areviewof 18 sub-Saharan African countries’ 2025 budgets found most made no comparable move, absorbing the loss through reduced services instead. New bilateral arrangements are adding further strain: under theAmerica First Global Health Strategy, dozens of countries have signed cofinancing agreements that require new domestic health spending precisely as fiscal space is shrinking, with frontline workers and commodities, the areas where maternal, newborn, and child health services are most exposed, named as shared obligations. Third, WCAH is routinely deprioritised when budgets tighten because they lack visible, organised, politically connected constituencies at the tables where financing decisions are made. The consequences of this de-prioritisation need to be made explicit and exposed to public debate around how budgets are allocated. What needs to changeThe recently launched Partnership for Maternal, Newborn and Child Health financing campaign calls for action on two connected fronts. Domestically, countries must raise and deploy more resources for health, with stronger budget advocacy, expenditure tracking, health taxes, and explicit protection of WCAH within national benefit packages and insurance schemes. Globally, donors and multilateral institutions must hold their commitments and ensure just transitions; domestic financing cannot fill the gap alone yet. Debt relief should be advanced where debt servicing is crowding out health spending, and the Global Fund, Gavi and World Bank must protect WCAH within broader health investments. For Africa specifically, the African Union has a critical role to play. The AU’s own frameworks, Agenda 2063, the Abuja Declaration, and Carmma Plus, enshrine commitments to maternal and child health and sexual and reproductive health and rights. Regional platforms can amplify country voices, enable peer learning, and build the collective political pressure that no single country can generate alone. In a promising sign that these commitments are being translated into action, the 8th Session of theAU Specialized Technical Committee on Financeadopted a Ministerial Declaration in October 2025 calling on member states to increase budget allocations to health toward the 15% Abuja Declaration target and to prioritise primary health care — commitments that must now be matched by verifiable spending on WCAH. The declaration also requested the African Union Commission to monitor member states’ progress in this area, through the African Domestic Health Financing Scorecard. The push for health sovereignty that Africa is rightly championing must explicitly include WCAH, or the most vulnerable will be left behind. Self-reliance needs to mean additional public budget allocations, not just rhetoric. Yetanalysisof 2025 budget data finds limited new domestic revenue raised to offset aid cuts in most sub-Saharan African countries. There are encouraging exceptions: in May 2026, eight countriespledged more than $175-millionin domestic investment for women’s health supplies at the World Health Assembly, showing what accountability in action can look like. A question of political choicesThere is an uncomfortable truth at the centre of this debate. The services that save women’s lives and protect children’s health — antenatal care, skilled birth attendance, postnatal care, family planning, emergency obstetric care, adolescent-responsive services — are not adequately financed anywhere simply by accident. They reflect persistent choices about how health is prioritised, whose needs are addressed first, and which rights are upheld in practice. When global health reformers talk about efficiency, coherence and sustainability, those are important goals. But efficiency achieved by cutting the services that protect women in childbirth or girls seeking contraception is not progress. It is a different kind of failure. The global health community must not allow that failure to proceed in silence. Financing for women’s, children’s and adolescents’ health must be named, protected, measured and fought for; at every budget cycle, in every ministry of finance, and at every table where the global health architecture is being reshaped. That means demanding accountability — using expenditure data, budget analysis and public debate to highlight when commitments made in ministerial declarations are not reflected in actual allocations. The question before governments and donors is simple: will you make the choices that save the lives and protect the health of women and children? The answer, ultimately, will be written in budgets. DMRajat Khosla is the executive director of the Partnership for Maternal, Newborn and Child Health (PMNCH); Dr Kalipso Chalkidou is the director of performance for financing and delivery at the World Health Organization; and Dr Patrick Ndzana Olomo is the acting director of economic development, integration and trade at the African Union Commission.

Source: news.co.za