Did U.S. Foreign Aid Actually Reduce Maternal and Child Deaths in Developing Countries?
Yes. In 25 priority countries where USAID concentrated its maternal and child health efforts, 4.6 million children and 200,000 women were saved since 2008. Maternal mortality in those countries decreased at a rate of 5% per year. Across all recipient countries, the Lancet analysis estimates that USAID programs prevented 30 million child deaths over two decades.
Maternal and child mortality remain among the most sensitive indicators of a country’s health infrastructure. In many low-income nations, a woman’s risk of dying during childbirth is hundreds of times higher than in the United States. Children under five die from preventable causes like diarrhea, pneumonia, and malnutrition at rates that have been virtually eliminated in wealthy nations. USAID was the single largest funder of programs targeting these deaths. This article examines what the evidence shows about whether that investment worked.
This article accompanies Episode 40 of The Dr Kumar Discovery, where Dr. Kumar and Keith Hourihan explore the inside story of USAID, including Keith’s firsthand accounts of programs providing mobile gynecological exams, childhood nutrition, and maternal care in some of the most challenging environments on earth.
Dr. Kumar’s Take
What struck me most in my conversation with Keith was hearing about the mobile health units, essentially small trailers outfitted with medical equipment and staffed by midwives, that traveled to rural areas to provide gynecological exams and prenatal care to women who had no other access. That is the kind of program that does not make headlines, but it is the difference between a mother who survives childbirth and one who does not. The Lancet data showing 30 million children saved is extraordinary, but it is the individual stories behind those numbers that tell the real story. A woman in rural Afghanistan who can get prenatal care. A child in sub-Saharan Africa who receives oral rehydration therapy for diarrhea instead of dying from it. These programs worked. The evidence is overwhelming.
The Lancet Evidence: 30 Million Children Saved
The most comprehensive analysis of USAID’s impact on mortality was published in The Lancet in 2025 by Cavalcanti, Rasella, and colleagues. Their retrospective analysis of 133 low- and middle-income countries from 2001 to 2021 found that USAID-supported programs prevented an estimated 91 million deaths overall, with 30 million of those being children.
In countries receiving the highest levels of USAID funding, substantial decreases were documented in mortality from conditions that disproportionately kill mothers and children: diarrheal diseases, lower respiratory infections, nutritional deficiencies, and maternal and perinatal conditions. The study found that high levels of USAID funding were associated with a 15% reduction in all-age, all-cause mortality.
These findings align with USAID’s own performance data, which documented that in 24 countries where the agency focused its maternal and child health efforts, maternal mortality decreased at a rate of approximately 5% per year. In 25 priority countries, USAID programs saved 4.6 million children and 200,000 women since 2008.
How the Programs Worked
USAID’s approach to maternal and child health was not a single intervention but a suite of programs targeting the leading causes of death at every stage from pregnancy through early childhood.
Prenatal and Maternal Care: Programs funded skilled birth attendants, prenatal check-ups, and emergency obstetric care. In countries like Afghanistan, where only 3% of women could read at the time of intervention, USAID-funded programs provided mobile health units that brought gynecological exams and midwifery services to rural areas that had no permanent health facilities.
Childhood Vaccination: USAID was a major funder of routine immunization programs, supporting the delivery of vaccines against measles, polio, rotavirus, and pneumococcal disease in dozens of countries. These vaccines address some of the leading killers of children under five.
Nutrition Programs: Malnutrition is an underlying cause in nearly half of all deaths among children under five globally. USAID funded therapeutic feeding programs, micronutrient supplementation, and community-based management of acute malnutrition.
Oral Rehydration Therapy and Diarrheal Disease: Diarrhea remains one of the top killers of young children in low-income countries. USAID programs distributed oral rehydration salts and zinc supplements, simple interventions that cost pennies but save hundreds of thousands of lives annually.
Water, Sanitation, and Hygiene (WASH): Clean water and basic sanitation are fundamental to preventing childhood diarrhea and other waterborne diseases. USAID funded well construction, latrine building, and hygiene education programs across dozens of countries.
Keith Hourihan described the breadth of these programs during the podcast, noting that food security, nutrition, public health, and women’s empowerment initiatives were operating across the countries where he worked. He emphasized that in many of these areas, there was simply no other available access to these services.
The Projected Impact of Cutting These Programs
The Lancet study projected that if current USAID funding cuts continue through 2030, the result could be more than 14 million additional deaths, with 4.5 million of those being children under five. That represents approximately 700,000 additional child deaths per year, or roughly 1,900 additional children dying every single day from preventable causes.
The areas most affected include childhood infectious diseases (diarrhea, pneumonia, malaria), neonatal conditions (birth asphyxia, prematurity, neonatal sepsis), and maternal complications (hemorrhage, eclampsia, obstructed labor). These are conditions for which effective, low-cost interventions exist but require organized delivery systems, trained health workers, and reliable supply chains, all of which USAID programs provided.
A related concern is the disruption to routine childhood vaccination programs. When health infrastructure breaks down, vaccination rates decline, creating vulnerability to outbreaks of measles, polio, and other vaccine-preventable diseases that can kill thousands of children in a single epidemic.
Comparing the Investment to the Return
USAID’s entire annual budget of approximately $23 billion represented less than 1% of federal spending. The maternal and child health portfolio was a fraction of that total. Yet the return in lives saved was extraordinary. The Lancet analysis estimated that high levels of USAID funding were associated with mortality reductions that, when scaled across 133 countries over two decades, prevented 30 million child deaths.
To put this in perspective, USAID’s child survival programs cost a fraction of what the United States spends domestically on a single weapons system, yet they produced measurable, documented reductions in mortality across dozens of countries and multiple disease categories.
Practical Takeaways
- USAID maternal and child health programs saved 4.6 million children and 200,000 women in 25 priority countries since 2008, with maternal mortality declining at 5% per year.
- The Lancet’s comprehensive analysis of 133 countries estimated 30 million child deaths were prevented by USAID-supported programs over two decades, with significant reductions in deaths from diarrhea, pneumonia, malnutrition, and maternal complications.
- Projections indicate that continued funding cuts could result in 4.5 million additional child deaths by 2030, roughly 1,900 children per day, from conditions for which effective, inexpensive treatments already exist.
Related Studies and Research
- PEPFAR put 20 million people on HIV treatment and prevented nearly 8 million infected births examines the clinical outcomes of USAID’s flagship health program.
- Lancet study projects 14 million preventable deaths by 2030 from U.S. foreign aid cuts provides the broader mortality projections from the comprehensive Lancet analysis.
- How foreign aid builds soft power: the evidence for health diplomacy explores the strategic value of the health programs that maternal and child health efforts exemplified.
FAQs
What were the leading causes of child death that USAID programs addressed?
The primary targets were pneumonia, diarrheal diseases, malaria, neonatal conditions (prematurity, birth asphyxia, sepsis), and malnutrition. Malnutrition alone is an underlying factor in nearly half of all deaths among children under five. USAID programs distributed oral rehydration salts, supported childhood vaccination, funded nutrition programs, and trained community health workers to identify and treat sick children in rural areas where hospital access was limited or nonexistent.
Why is maternal mortality so high in developing countries?
Maternal mortality in low-income countries is driven by a combination of factors: limited access to skilled birth attendants, lack of emergency obstetric care, inadequate prenatal screening, high rates of anemia and malnutrition during pregnancy, and geographic barriers that prevent women from reaching health facilities in time. In countries like Afghanistan, female literacy rates were as low as 3% at the time USAID began its programs, reflecting the broader systemic challenges that contribute to poor maternal health outcomes.
Can these deaths really be prevented with existing interventions?
Yes. The vast majority of maternal and child deaths in developing countries are caused by conditions for which effective, low-cost interventions already exist. Oral rehydration therapy costs pennies per dose and can prevent death from childhood diarrhea. Childhood vaccines cost a few dollars per course. Skilled birth attendance and access to emergency obstetric care can prevent the majority of maternal deaths during childbirth. The challenge has never been a lack of medical knowledge but rather the logistics and funding required to deliver these interventions at scale, which is precisely what USAID programs provided.
Bottom Line
The peer-reviewed evidence consistently shows that USAID’s maternal and child health investments produced measurable, large-scale reductions in mortality across the developing world. The Lancet analysis of 133 countries estimates 30 million child deaths prevented. USAID’s own data documents 4.6 million children and 200,000 women saved in 25 priority countries since 2008. The programs worked by delivering proven, low-cost interventions, vaccines, oral rehydration therapy, skilled birth attendance, and nutrition support, to populations that had no other access. The projected loss of 4.5 million additional child deaths by 2030 represents the reversal of two decades of progress.
Listen to the full conversation on Episode 40 of The Dr Kumar Discovery.
Sources:
- Cavalcanti DM, Rasella D, et al. “Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030." The Lancet. 2025.
- USAID. “Preventing Child and Maternal Deaths: Reports to Congress." 2024.
- KFF. “The U.S. Government and Global Maternal and Child Health Efforts." Fact Sheet, 2025.
