The Aid cuts: A gendered health catastrophe

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OPINION

By Beatrice Were

The suspension of foreign aid to Uganda represents not only a geopolitical or fiscal catastrophe but also a gendered health crisis, jeopardizing decades of progress against HIV, TB, and malaria—diseases that disproportionately impact women.

Uganda’s health system, heavily reliant on donor funding, has left women vulnerable due to the government’s persistent neglect of their health and well-being. While celebrating Women’s Day, accountability is essential, not only for the immediate effects of these cuts but also for the systemic failure to prioritize women’s health rights over decades.

The aid cuts will disproportionately impact women, exacerbating existing disparities within the patriarchal system. Women in Uganda already bear the greatest burden of HIV, TB, and malaria, while navigating a health system weakened by chronic underfunding and mismanagement. The suspension of aid will push this fragile system toward collapse, further deteriorating inadequate maternal healthcare and leaving pregnant women without critical services.

Rising societal tensions will likely increase sexual violence, while eroded coping mechanisms will deepen the vulnerability of women and girls. Without urgent intervention, the consequences will be catastrophic, disproportionately harming women and girls the most.

As societal tensions rise, households will become hotspots for gender-based violence. Financial strain will drive harmful coping mechanisms like early marriages and sexual violence, further violating women's sexual reproductive health rights. Uganda Bureau of Statistics data shows women-led households now comprise 55% of the population, up from 30% in 2019. These households, already vulnerable, will be pushed to the brink.

The climate crisis exacerbates these challenges, intensifying food insecurity, water scarcity, and malnutrition, leaving women too weakened to breastfeed, care for their families, or advocate for themselves. As the backbone of Uganda’s unpaid labor force, women will face increased burdens, such as longer distances to collect firewood and water, more grueling agricultural work, and greater difficulty securing food.

This backbreaking labour will severely impact their physical health, leading to starvation, exhaustion, and heightened mental stress, further eroding their ability to provide for households and perpetuating cycles of poverty and inequality that disproportionately affect women and girls.

For decades, the government has used tokenism—such as International Women’s Day celebrations, symbolic appointments of women, and empowerment rhetoric—as a substitute for genuine progress. These performative gestures commodify women’s rights, diverting attention from enduring systemic inequities rather than addressing them.

Token representation is not merely ineffective—it is harmful, serving as a tool of control to legitimize the neglect of women’s rights. Women in power are often rewarded for defanging women’s movements, diluting their impact to preserve the status quo. As Amina Mama critiques in her analysis of the “First Lady Syndrome,” such figures perpetuate a system that values optics over substantive action.

Tokenism offers no solution. As aid cuts reduce resources, pre-existing gender disparities will deepen, forcing women and girls to shoulder more domestic labor at the cost of their health and education. Pregnant and breastfeeding women, needing higher caloric intake, will face malnutrition and stress, jeopardizing their lives and those of their children.

Malaria, Uganda’s leading cause of death, disproportionately affects pregnant women due to physiological changes that heighten susceptibility to severe malaria, risking foetal and maternal mortality. Aid cuts will disrupt the distribution of insecticide-treated bed nets and intermittent preventive treatment for pregnant women (IPTp), critical measures that mitigate these risks, especially in rural and underserved areas.

The aid cuts not only endanger health outcomes but also intensify the caregiving burden on women, who are already overburdened as primary caregivers. This exacerbates their physical labour, mental stress, and financial strain while disrupting employment and education opportunities. The aid freeze thus represents both a public health failure and a socioeconomic setback, disproportionately impacting women and their communities.

Uganda has made significant progress in addressing HIV/AIDS, largely due to foreign aid, yet women, especially young women and girls, remain disproportionately affected, accounting for over half of new infections. Gender-based violence, limited education, economic dependence, and power imbalances heighten their vulnerability, as many cannot negotiate safer sex or protect themselves from sexual violence.

The suspension of aid threatens critical interventions like Prevention of Mother-to-Child Transmission (PMTCT) programs and access to antiretroviral therapy (ART), endangering women’s health and their ability to care for families. These cuts will destabilize households and communities, further entrenching gender inequalities.

Women of reproductive age, particularly those living with HIV, face heightened susceptibility to TB. Stigma, discrimination, and financial dependency often delay diagnoses, leading to poorer health outcomes. Caregiving responsibilities further increase their vulnerability, as prolonged exposure to biomass smoke from cooking raises TB risks. Donor-funded programs have been crucial in providing TB screening, treatment, diagnostics, and education, with a focus on reaching vulnerable populations, especially women.

The aid freeze risks disrupting essential TB diagnostics and treatment, disproportionately affecting women of reproductive age, for whom TB is a leading cause of mortality. This will likely exacerbate maternal mortality rates, impacting families and communities reliant on women as caregivers and economic contributors.

The suspension highlights the urgent need for Uganda to reduce dependence on external funding. While reinstating aid is desirable, the government must address structural inequities by increasing domestic health investment, prioritizing gender-responsive healthcare, and tackling social determinants of health that perpetuate women’s vulnerability to malaria, HIV, and TB.

We call on the government to:

Increase domestic funding for health: Allocate sustained, proportionate health investments to address systemic gaps and build a resilient, comprehensive health system tailored to the unique needs of women and girls.

Strengthen Gender-Responsive health system: Invest in women-centered clinics and comprehensive sexual and reproductive health services, ensuring the continuity of critical programs like PMTCT, IPTp, and TB screening to protect women’s health and well-being.

Empower women economically: Invest in education, skills training, and viable income-generating opportunities to reduce women’s dependence and enhance health outcomes.

Advocate for Gender Equality: Challenge harmful cultural norms, combat gender-based violence, and ensure women’s meaningful participation in health-related decision-making processes.

The government must act urgently to prioritize women’s health as a national imperative, moving beyond tokenism and performative empowerment. It must address systemic gender disparities by increasing health financing and implementing tangible measures to reduce maternal mortality, close the education gap, meaningful economic empowerment and combat gender-based violence. International Women’s Day celebrations should be anchored in accountability, measuring progress against critical goals.

The writer is a human rights, policy analyst, HIV and AIDS advocate