Donald Trump has reduced his nation's foreign aid spending by billions of dollars, but cuts to health services across the US are also having a major impact. In rural Wisconsin, a woman pregnant with twins drove four hours to a hospital only to find she was not in labour, after the closure of her local birth centre. Dr Cara Syth, the obstetrician on call, says such closures force women to travel hours for care.
Rural Maternity Wards Closing Across the US
The family birth centre in Menomonie, Wisconsin closed in January 2023, leaving patients with only four months' notice. Within five years, seven labour and delivery units closed across western Wisconsin, five of them rural. Dr Syth lists the closures: River Falls, Barron, Menomonie, Rice Lake, Cumberland, and then a large healthcare organisation pulled out of Eau Claire and Chippewa Falls.
These closures come amid the fallout from the Supreme Court's 2022 Dobbs decision, which overturned Roe v. Wade and allowed states to ban abortion. In Wisconsin, abortion services halted for 15 months as courts debated an 1849 law. Dr Syth says Dobbs pushes doctors away from states like Wisconsin, where the law criminalises their judgment.
Impact on Women and Families
A survey found 40 per cent of medical professionals in states with abortion bans felt constrained in treating miscarriages. In West Virginia, women described travelling over an hour to deliver, waiting hours for beds, or struggling to afford gas for appointments. One woman drove two hours for a VBAC, waited three hours, and then checked into a hotel for two nights because no beds were available.
Dr Syth attributes closures to three factors: healthcare organisations deciding birth units aren't cost-effective, political decisions like Dobbs, and chronic underfunding of rural obstetric care. Medicaid, covering 41 per cent of US births in 2022, has never paid enough to make rural obstetrics viable.
The One Big Beautiful Bill Act
Trump's One Big Beautiful Bill Act, signed on 4 July 2025, cuts $911 billion from Medicaid and the Children's Health Insurance Programme over a decade. Although coverage losses don't hit until 2027, hospitals are already closing. Carrie Cochran-McClain of the National Rural Health Association expects accelerated closures as hospitals feel greater strain. Leslie Dach of Protect Our Care says the cuts have pushed over 800 hospitals, clinics, and nursing homes to the brink of collapse, with nearly 30 maternity wards shut since the bill passed.
The US maternal mortality rate was 22.3 deaths per 100,000 live births in 2022, 55 per cent higher than the next highest high-income nation. For Black women, the rate was nearly 50 per 100,000. Dr Syth says: 'I don't know how you choose to vote for those cuts if you understand what people are going through.'
Global Impact of USAID Cuts
Trump's decision to effectively close USAID has devastated maternal healthcare worldwide. In South Sudan, one state has only five midwives. One midwife, speaking anonymously, describes six patients with one in labour, one recovering from a miscarriage, and one with sepsis. Two midwives cover the delivery room, neonatal ward, and postnatal side. The midwife says: 'USAID cuts have impacted us in a very bad way. From January to now we have had five maternal deaths. That is so alarming.'
One woman died of sepsis after arriving ten days postpartum, going into shock within 30 minutes. A functioning blood bank could have saved her, but without consistent funding, staff must find donors in the community. Last month a woman died of haemorrhage after a caesarean for the same reason. Staff have not been paid in seven months but continue working, often without food.
South Sudan saw USAID spending cuts exceeding 40 per cent in 2025, with future commitments falling by over 60 per cent. A 2026 study projected maternal deaths could increase by 45 per cent across six vulnerable countries. The Guttmacher Institute estimates that if 11.7 million women are denied contraceptive care in 2025, around 8,340 maternal deaths could result.
The midwife says: 'We are a growing country. We are trying hard. Our mothers need a lot of support.'
The Connection Between Rural Wisconsin and South Sudan
The US is simultaneously cutting maternity care from its own communities and withdrawing funding that kept services alive in some of the world's most under-resourced settings. Dr Syth thinks about the women she can no longer reach. 'When you move to a university town you don't expect that you're not going to be able to deliver your baby there,' she says.
