FREETOWN, Sierra Leone—Sonita Kamara is in obstructed labor, a life-threatening complication where the baby cannot pass through the birth canal despite strong contractions. She is rushed to Princess Christian Maternity Hospital in Freetown, the busiest maternity and newborn hospital in Sierra Leone.

Her baby is in distress. “If we don’t operate within 30 minutes, the baby might die,” says Rosetta Cole, a senior obstetrician-gynecologist, as she prepares to perform an emergency cesarean section.

But the operation cannot begin. The hospital has run out of basic surgical supplies: sutures, anesthetic, and IV fluids. Kamara’s family is sent into the city to search for them in pharmacies. More than two hours later, they return, and the operation can finally start.

After an agonizing wait, Kamara’s newborn is safely delivered but is in need of oxygen. Baby Kelvin is transferred to the special care baby unit just down the street at Ola During Children’s Hospital. A few days later, he and Kamara are discharged.

Not every mother in Sierra Leone is so lucky.

A small nation of close to 9 million people on the west coast of Africa, Sierra Leone is one of the world’s poorest countries and depends heavily on foreign aid to fund essential services, including in health care. In 2023, it received about $500 million in official development assistance, and total aid flows have, at times, exceeded 10 percent of the country’s total economic output.

Sierra Leone once had the highest maternal mortality rate in the world, but since 2000, maternal deaths have fallen by nearly 80 percent. Foreign aid has been credited with helping more Sierra Leonean women and children survive birth.

The special care baby unit at Ola During Children’s Hospital, to which Kamara’s baby was sent, was built—and gets money for supplies—through the Saving Lives in Sierra Leone program.

Started in 2016 with funding entirely provided by the United Kingdom, the work of Saving Lives (which has included training for midwives, the provision of contraceptives, and the establishment of special care baby units) had previously been a source of pride for British politicians. In 2023, it was renewed for a third five-year phase and allocated a budget of 35 million pounds ($47.3 million).

Then, without warning, the entire system was thrown into turmoil. At the end of January 2025, the Trump administration issued a sweeping stop-work order, abruptly freezing projects funded by the U.S. Agency for International Development around the world. By March, 83 percent of the programs had been canceled. And in February of that year, British Prime Minister Keir Starmer delivered a further shock: U.K. aid would be cut from 0.5 percent to 0.3 percent of gross national income.

Despite the prime minister saying that funding would fall from 2027, by late 2025, it was reported by the Independent that Saving Lives had been axed “quietly behind the scenes.” Its remaining funding of approximately 17 million pounds ($22.9 million) was reduced to just 1 million pounds ($1.3 million). Sources close to the program confirmed this, telling the Fuller Project that they thought activities could be wound down as soon as March 2026.

A U.K. Foreign Office spokesperson would neither confirm nor deny the cuts, telling Fuller: “Allocations of the official development assistance budget for next year haven’t been set out yet and we will not speculate on them in advance.”

The impact of the loss of U.S. funding has been harder to show clearly because “when U.S. funding is cut, it affects our health institutions … not only in maternal and child health but also in other critical areas,” said Mustapha Kabba, a physician and deputy chief medical officer for clinical services at the Ministry of Health and Sanitation in Sierra Leone.

The ministry told Human Rights Watch in July 2025 that cuts in U.S. foreign aid represented at least a $45 million reduction in health projects focused on maternal, child, and adolescent health. And in 2024, the United States provided $3.2 million to Sierra Leone’s reproductive health services, comprising about 14 percent of the country’s overall reproductive health funding.

Despite lively debate on the effectiveness and ethics of aid, the consensus has been that its abrupt termination was irresponsible, would disproportionately affect women and girls around the world, and invariably lead to more deaths.

“The sudden nature of these cuts is a huge blow,” said Nellie Bell, a physician and the head of pediatrics at Ola During Children’s Hospital. “We are already stretched … but we are going to see an increase in mortality in all those [special care baby] units.”

One source, who had worked on previous phases of the Saving Lives program and agreed to speak to Fuller on condition of anonymity, said the U.K. government had been warned about the impact that an abrupt termination of funding would have.

“Despite evidence and sustained warnings that these cuts would put women and girls at risk, we were ignored. Today, the consequences are unfolding in real time. The suffering is not inevitable. It is the foreseeable result of deliberate policy choices,” they said, before adding: “It is not too late to change course.”

“I am not a fan of aid dependency,” Freetown Mayor Yvonne Aki-Sawyerr told Fuller. “But when aid is removed in the context of weak governance, mismanagement, and corruption, you increase the population’s vulnerability.”

A year on, can Sierra Leone maintain maternal health progress and keep women from dying needlessly in childbirth?

Asked where Sierra Leone was at in its negotiations and commitments with the United States and United Kingdom, Kabba said that the Ministry of Health is still engaging with the U.K. Foreign Office and embassy but has not yet received concrete answers.

As for the United States, he pointed to a recently signed bilateral agreement. The memorandum of understanding is part of the “America First Global Health Strategy” (AFGHS), which sets out how Washington intends to engage in global health going forward. A press release from December suggests that the U.S. State Department will “front-load” more than $30 million into the country’s health systems in 2026 “while Sierra Leone steadily increases its own financial contributions,” as well as announcing hundreds of millions more in funding up until 2030.

The administration has said that AFGHS is about “reducing foreign dependence on U.S. taxpayers” and about “helping countries move toward more resilient and durable health systems”—but civil society groups disagree.

“AFGHS is being framed as health assistance, but it’s about corporate interests,” said Fadekemi Akinfaderin, the chief global advocacy officer at feminist alliance Fòs Feminista. The group published an analysis of the AFGHS document and concluded that it is “a vehicle for advancing U.S. military and commercial interests through increasingly coercive tactics.”

With little transparency, it is unclear whether the sums announced are already being spent, what they are specifically being spent on, and what Sierra Leone has offered in return for continued U.S. funding.

According to Kabba, health funding into Sierra Leone has traditionally flowed predominantly through U.N. agencies such as the World Health Organization, UNICEF, and the United Nations Population Fund, as well as international nongovernmental organizations, making it hard for even the Ministry of Health to fully quantify the extent of the country’s foreign aid dependency.

“It has been very difficult to estimate,” Kabba said. “When U.S. funding was cut, we tried to assess its impact on the health sector—not only on maternal health—but it was challenging to get accurate data and figures.”

There are other funding sources for maternal and child health efforts in Sierra Leone, including countries such as Japan, China, Sweden, Canada, Germany, Ireland as well as development banks. For instance, in 2021, the World Bank approved funding to invest $60 million in a project to deliver maternal and child health and nutrition services. This runs through 2027.

One way to compensate for lost funding would be to raise money for public services through taxation. But the latest revenue statistics from the OECD show that Sierra Leone’s tax revenue, relative to the size of its economy, is approximately 11 percent—below what the World Bank  recommends for “inclusive growth and development” (15 percent) and less than the African average, 16 percent. The 2026 government budget, however, does propose a series of new taxes, intended to “yield 1.5 percent of GDP in additional revenues by 2027.”

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Abou Bakarr Kamara, senior economist at Sierra Leone’s International Growth Centre, told Fuller: “Implementation depends on the capacity of national revenue institutions, and that can take years.”

Despite the challenges ahead, Kabba at the Ministry of Health isn’t fearing the worst. Instead, he sees the drastically changing aid landscape as an opportunity for Sierra Leone. “We are not assuming the health sector will collapse,” Kabba said. “It is a moment to realign, adjust to realities, and strengthen innovative health financing schemes. If support comes in the future, we welcome it. But we want a resilient system that depends on itself.”

At a meeting of the Africa Union in February, Sierra Leonean President Julius Maada Bio launched a 300-day campaign aimed at “ensuring continuous care throughout pregnancy, promoting safe deliveries, responding swiftly to complications, and providing thorough postnatal follow-up.” The campaign started on March 1, but at time of writing, no specifics details, targets, or projects had been made public.

For the mothers, doctors, and nurses of Princess Christian Maternity Hospital and Ola During Children’s Hospital, the decisions of two men—the U.S. president and British prime minister—are likely to have far-reaching consequences. It remains to be seen whether Sierra Leone’s president can find other ways to ensure that Kamara’s story of survival doesn’t become the exception.

Edited by Eliza Anyangwe and Charlie Brinkhurst-Cuff. Data reporting by Erica Hensley. Stills are from a Fuller video documentary, produced by On Our Radar.