Child, maternal deaths rise in Nepal

Gates Foundation predicts 2025 will be first year this century where global child mortality rates increase

GAUR, Nepal -- The young mother's breath had grown ragged. Inside her mud home in rural Nepal, she hunched over in agony, pain pummeling her pregnant belly, her swollen legs scarcely able to support her.

Kabita Mukhiya was in the midst of an emergency, but didn't know it. For weeks, she'd suffered at home, because there was nobody around to tell her to rush to a hospital. The aid workers who once regularly visited her village to help pregnant women had stopped coming, after foreign aid cuts by the United States shuttered a program aimed at saving mothers' and babies' lives.

Kabita was uneducated and impoverished, and she did not know what was happening to her body. In desperation, she turned at last to her aunt for help, who hauled her off to the hospital, where both women wept as the doctors said things neither could understand.

Which is why Kabita -- confused and confined to her hospital bed -- turned to something she could understand: prayer.

"Please save the baby," she begged God through her tears. "Please save me."

Then, through the chaos, came the words that Kabita finally grasped, but could not bear: It was too late. Her baby was dead.

And her own life was now hanging by a thread.

One baby at a time, the world is marching toward a grim milestone: Because of global cuts to foreign aid, the Gates Foundation has predicted that 2025 will be the first year this century where child deaths will increase.

For many experts, the health of a country is measured by the health of its smallest: Children under the age of 5. And while global child mortality data for 2025 won't be available for several months, health officials are already bracing for a surge in deaths among the world's youngest and most vulnerable.

The decision by U.S. President Donald Trump's administration to dissolve the United States Agency for International Development -- once the world's largest humanitarian donor -- gutted maternal and neonatal care, decimated nutrition programs for millions of pregnant women and children and left scores of birthing centers devoid of equipment, medicine and staff. The U.S. cuts, followed by foreign aid cuts from several other countries, forced 60% of women's organizations to reduce their services, according to the World Health Organization.

The U.S. government has repeatedly insisted that no one -- and, particularly, no children -- have died because of its funding cuts. But the AP has documented the deaths of women and children from Myanmar to Nigeria.

A study published in The Lancet journal, meanwhile, said the U.S. cuts could lead to more than 14 million deaths, including more than 4.5 million children under age 5, by 2030.

"It's heartbreaking to see what's happening. It's decades of progress being washed away," said Rajat Khosla, executive director of WHO's Partnership for Maternal, Newborn and Child Health.

In a statement to The Associated Press, the U.S. State Department said the Trump administration had reinvigorated its assistance programs to focus on efficiency, effectiveness and partnership. The department also said the U.S. spends more on health and humanitarian assistance than any other country, and still supports programs in Nepal aimed at improving maternal and child health.

In Nepal, cuts to nutrition and reproductive outreach programs have already increased pregnancy complications and deaths, according to health workers, government officials, aid workers and families interviewed by the AP.

"The number of deaths of mothers, young mothers, during delivery has really increased," said Mona Sherpa, country director for the aid group CARE Nepal, which lost more than half its funding from the U.S. cuts. "The expected number within a year is happening within four to six months."

Maternal and child health programs are perhaps the clearest foreign aid example of small, relatively cheap interventions leading to the greatest good. Packets of fortified peanut paste that cost less than a dollar each can bring a malnourished child back from the brink of death within weeks. Clean birth kits that cost a few dollars slash the risk of mothers and newborns dying from infections.

In Nepal, a five-year, $35 million program canceled by the U.S. cuts reached more than 100,000 women and girls in its first three years. The program equipped birthing centers and trained nurses, midwives and outreach workers known as female community health volunteers. These workers regularly visited pregnant women's homes, explained the warning signs of complications and urged them to attend prenatal appointments, often escorting them there.

When the program was canceled, many pregnant women were left to navigate a medical system they struggle to trust or understand, Sherpa says.

The consequences can be found in the dusty, sun-scorched villages of Nepal's Rautahat district, home to Kabita's family and one of the poorest and least-literate parts of the country. At a birthing center in Rautahat's municipality of Dewahi Gonahi, the number of women coming for prenatal checks has halved since the funding cuts, says the officer in charge, Kishori Shah. Because of that, women aren't identifying complications fast enough, leading to emergencies.

"There would have been a decrease in complications if the USAID program was still running," he said.

In the village of Prempur Gonahi, it took just 10 months for newborns to begin dying again after the U.S. cuts, said the officer in charge, Sadho Baitha.