by Eastern and Southern Africa Regional Directors, Ms. Anne Githuku-Shongwe, UNAIDS and Ms. Lydia Zigomo, UNFPA, and Acting Regional Director, Dr. Chikwe Ihekweazu, WHO Africa Region 

Princess Chitsuro has transformed her life. Born with HIV, she only learned her status as a young adult. Overcome with shock and fear, she initially distanced herself from everyone – friends, community, even her own future. 

But denial only lasts so long. When she became pregnant, Princess was unaware that she could prevent transmitting HIV to her unborn child. She learned that she could, after joining a mentorship programme for young mothers. There, she found peers – women who had walked the same path, who offered her guidance, compassion, and care. 

Thankfully, her baby does not have HIV. 

There are thousands of stories like Princess’s in East and Southern Africa, thanks to family planning, reproductive health and HIV funding in the region. 

In 2024 alone, these services and commodities helped avert some 9.49 million unintended pregnancies, 3.38 million abortions, 19,150 maternal deaths (UNFPA supplies data) and 2.6 million HIV infections in children across the region. Namibia and Botswana, for example, recently received ‘Bronze’ and ‘Silver’ tier certifications for being on the path to eliminating vertical transmission of HIV from a mother to her child. 

But the endings to these stories are under threat with the funding shortfall crisis following reductions in foreign development and humanitarian assistance across the African continent – and it is women and girls who will suffer the most. 

When funding falters, women suffer 

Analysis from 2gether 4 SRHR, the joint United Nations Regional Programme, indicates that funding cuts will have a significant impact on health equity; increase the barriers for vulnerable populations to access services; reverse the progress made in the HIV response; impact on early and unintended pregnancies; weaken health systems; and challenge the collection of data that enables stakeholders to monitor impact, improve programming, identify gaps, and hold governments accountable. 

According to UNAIDS projections, if funding is not available to fill the gap left by PEPFAR funding cuts we can expect to see, globally, a 400% increase in AIDS-related deaths, 8.7 million new HIV adult infections, an additional 3.4 million orphans made vulnerable by HIV and 350,000 new HIV infections in children by 2029. Our region will bear witness to 75% of these deaths and new infections. 

Put simply, funding cuts will roll back the hard-earned health and development gains in East and Southern Africa, and put governments at risk of achieving the targets of the 2030 Sustainable Development Goals. 

Invest in Sexual and Reproductive Health and Rights (SRHR)

Despite shifting priorities and shrinking budgets, investing in SRHR is the right thing to do – benefiting the individual, community, and society as a whole. 

New data indicates that in South Africa, the lifetime cost of failing to invest in SRHR is $33.7 billion, equating to 8% of the nation’s annual GDP — exceeding the country’s annual health and education budgets combined. 

Conversely, universal access to contraception is cited as having one of the highest returns on investment among the targets of the Sustainable Development Goals. In Kenya, every shilling invested in scaling up family planning services yields a return of 22 shillings in productivity returns in a five-year time frame. 

At the heart of the matter, investing in SRHR transforms a woman’s life: through improved maternal health, increased access to contraception and HIV services, and reduced gender-based violence, women can meaningfully participate in the workforce and in society, representing an investment for the future. 

For example, Princess is now paying it forward as a young mentor mother, helping other women who are pregnant or breastfeeding to access the support she once received. 

This holistic approach is key. 

‘Healthy beginnings, hopeful futures’ 

Now is the time to increase new investments in sexual and reproductive health, and work strategically with national governments to do so. 

2gether 4 SRHR is working across the region to support governments to unlock investments and financial opportunities for SRHR, determining alternative options for sustainable financing. 

The programme is working with regional economic communities such as the Southern African Development Community and East African Community to convene national dialogues with governments to increase domestic financing for health. 

It’s time to scale up our partnerships and collaborations with governments, donors, civil society and others, so every woman in our region, like Princess and her baby, can survive and thrive.

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The views and opinions expressed in this opinion piece are those of the author, who is not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.