The future of RMNCH-N funding: A sector at risk

In 2023, more than half (51%) of all development assistance to health for RMNCH-N came from just ten sovereign donors. Alarmingly, six of these top donors (US, Germany, UK, France, Netherlands, and Sweden) have now announced cuts to their ODA budgets, casting a shadow over the future of global RMNCH-N funding. This threat comes at a critical juncture—since 2000, under-five and maternal mortality rates have more than halved. The hard-won gains in health outcomes are now at risk of stalling or even reversing.

In this piece, we explore how global funding trends, donor decisions, and shifting political dynamics are reshaping the future of RMNCH-N support.

A disrupted growth trajectory

From 2005 to 2019, development assistance for RMNCH-N grew steadily alongside overall funding to global health. However, this progress was disrupted by the COVID-19 pandemic, which saw resources disproportionately reallocated away from RMNCH-N. While funding levels began to recover post-pandemic, the looming wave of announced donor cuts now threatens to derail that recovery.

How will ODA budget cuts affect global RMNCH-N funding?

Funding forecasts for RMNCH-N are alarming: in 2026, development assistance from the top 10 sovereign donors is expected to fall by at least 34%—from US$8.4 billion in 2023 to an estimated US$5.5 billion. The United States, the largest donor by far, is driving most of this decline. The impact is exacerbated by additional expected reductions from Germany, the UK, and France.

While some countries like Canada and the Netherlands maintain public commitments to SRHR and MNCH through policies like Canada’s "10-Year Commitment" and the Netherlands’ recent Policy Memorandum, these pledges are unlikely to fully offset the global downward trend.

US Cuts: A sector-wide shockwave

The United States has historically played an outsized role in funding RMNCH-N, providing 46% of bilateral assistance for reproductive and maternal health systems and 45% for family planning in 2023.

The Center for Global Development's analysis of USAID award terminations suggests a 94% cut to family planning, 92% to MNCH, and 39% to nutrition programs. The funding freeze and subsequent cuts have already started to disrupt programs on the ground, from contraceptive supply chains and service delivery to core data systems like DHS and LMIS.

Funding is expected to sharply decline in upcoming years as the Trump administration's 2026 budget request seeks to eliminate funding to family planning and reproductive health. In additional to bilateral assistance, the US' withdrawal from key multilateral institutions such as WHO and Gavi will significantly impact global RMNCH-N outcomes.

A push towards self-reliance?

Amid ODA decline, some have called for philanthropic actors to step up. Several recent announcements signal continued interest and support:

• The Beginnings Fund, backed by a coalition of donors, has pledged nearly US$500 million toward MNCH.
• The Bezos family committed another US$500 million to UNICEF’s Child Nutrition Fund.
• A consortium including CIFF, ECF, the Gates Foundation, and Kirk Humanitarian pledged more than US$250 million to expand access to multiple micronutrient supplements for pregnant women.

However, no single funder—or even group of philanthropies—can match the scale of ODA. Some see this funding gap as an opportunity for low- and middle-income-country ownership and decolonization of aid. LMIC governments are facing increasing political pressure at home to step up domestic health funding, including calls to "dismantle the current system", "re-build the sector", and for "self-reliance".

The calls to actions are leading to early movements:

• In February 2025, Nigeria approved an additional US$200 million in domestic health financing to help offset the US funding shortfall
• As a result of PEPFAR losses, health ministries in Botswana, Cameroon, and Kenya pledged to mobilize domestic resources to finance HIV care

The outlook for RMNCH-N funding is undoubtedly challenging, but there are opportunities to adapt and respond. While reductions in ODA from key donors will create funding gaps, growing domestic financing in LMICs signal a shift towards more diversified and sustainable support. To maintain progress in maternal and child health, the global health community must focus on fostering partnerships, strengthening health systems, and encouraging innovative funding approaches.