Budget Document Signals Trump Administration Intent to Withhold Congressional Family Planning Appropriations and Siphon Funding Away From Low- and Middle-income Countries and into U.S. Companies

Following the decimation of U.S. global health assistance in 2025, the Trump administration is restructuring health funding through rapid rampdowns in U.S. assistance via three- to five-year bilateral health funding agreements (MOUs) in some countries and shorter term funding in others. In 2026, Congress rejected the administration’s proposed 60% cuts to global health funding. But it is still unclear how the Trump administration will spend Congressionally-mandated health funds. The preliminary fiscal year (FY) 2026 653(a) allocation report, a budget planning document sent by the Department of State to Congress in May 2026, shows the Trump administration’s near-term plans to spend global health funds across the full breadth of countries receiving U.S. support.

Key findings:

• The administration plans to withhold or divert effectively all international family planning and reproductive health (FP/RH) funds that Congress appropriated for this purpose. Across three FP/RH funding streams, the administration plans to set aside or repurpose: 1) nearly $524 million appropriated for bilateral global health programs, 2) $48.5 million for bilateral programs in strategically important countries “to support exigent energy security needs” and 3) $32.5 million originally appropriated for UNFPA and then further diverted from bilateral FP/RH spending requirements. This amounts to nearly $605 million out of $607.5 million in international family planning and reproductive health funds appropriated;
• The FY 2026 653(a) report shows dramatic increases in newer funding streams, including $888 million in an “innovation fund.” This is nearly 15 times as much as it planned to spend on the new fund in the prior year. At the same time, the administration cuts country-level funding by $1.66 billion compared to pre-Trump funding amounts, meaning the administration is moving nearly a billion dollars from low- and middle-income countries to a fund benefiting U.S. corporations;
• Of 79 countries listed in the FY 2024 or FY 2026 report, 69 have their funding reduced compared to pre-Trump (FY 2024) spending plans. Among these 69 countries, eight countries’ funding has been cut to zero.¹ In absolute dollars, the countries with the largest reductions compared to FY 2024 allocation plans are: South Africa ($437.1 million decrease), Tanzania ($137.4M), Zimbabwe ($126.1M), Zambia ($65.9M), Mozambique ($65.6M), Bangladesh ($54.1M), and Malawi ($51.9M).