When the women come to him, they are desperate.
They meet the traditional healer in a sparsely furnished room, a half-hour’s bumpy ride outside Blantyre, in southern Malawi.
“I mix these secret herbs with hot water,” he says, gesturing to a concoction in a plastic container. “They all want a shortcut to terminate their pregnancy.”
“Once a woman drinks the mixture, she starts bleeding in less than an hour,” he says, adding that the whole process takes only a few hours.
The healer, who asked CNN not to be identified because abortion is illegal in Malawi, shows us where the women wait after he administers his mixture — a crumbling redbrick structure with a bamboo mat on a dirt floor.
In this wretched place, the herbs begin to work and the women start to bleed, often uncontrollably.
He dismisses the very real danger the women are in, saying that they wanted a shortcut and he can provide it.
“I tell them if they start bleeding too heavily, they should go to the hospital to seek post-abortion care,” he says.
New research suggests that there were as many as 141,000 abortions in Malawi in 2015 – most of them in clandestine situations like this. The rate of maternal deaths in Malawi is among the highest globally and illegal abortions are a significant reason.
Now public health officials, aid professionals and doctors in Malawi fear it could get even worse. The impoverished East African nation could be one of the hardest hit in Africa by proposed cuts to US foreign aid.
Earlier this year, US President Donald Trump made public a budget proposing zeroing out global family-planning assistance administered chiefly through USAID.
The proposal shocked many in the global health and foreign aid world.
“There is a lot at stake. The US is the largest provider of family planning in the world and has been a real leader in providing support for many low- and middle-income countries,” said Jennifer Kates, vice president and director of global health and HIV/AIDS at the Kaiser Family Foundation.
The White House said that the proposed cuts to family planning – and foreign aid more broadly – were a way to save money for other budget areas like defense and to help realize Trump’s “America First Policy.”
And the family-planning cuts are just part of the story.
Like previous Republican presidents, Trump has reintroduced and now expanded the reach of the so-called Mexico City policy, also known as the “global gag rule,” which mandates US funding withdrawals from any international non-governmental group that gives advice or helps women access abortions.
The US has also pulled all funding from the United Nations Population Fund (UNFPA) – a UN agency that promotes family planning – for allegedly supporting coercive abortion in China.
The UNFPA calls the allegation “erroneous.”
Politics versus real people?
In low-income countries like Malawi, family-planning cuts could be devastating.
“They are giving a death sentence to our women in this part of the world,” says Chisale Mhango, an obstetrician at Blantyre’s main referral hospital.
“It is a matter of women’s lives. And with women’s lives, they don’t know what the issues are in Washington.”
Mhango, a staunch advocate of women’s reproductive rights, treats between 10 and 15 post-abortion cases every day at the hospital.
Though abortion is illegal – except to save the mother’s life – it is up to the public system to treat women who suffer complications.
He says that family-planning assistance, significantly funded by USAID in the country, has helped Malawian couples and women make big strides in avoiding unplanned pregnancies – adding that condom use is on the rise and fertility rates have dropped as a result of the educational programs.
“There are a lot of associated economic and development indicators that go hand in hand with family planning. It has a direct impact on people’s lives but also has a significant impact for the country’s development,” Kates, from the Kaiser Family Foundation says.
But Mhango puts it more bluntly.
“If USAID says we can not provide this service, then it is almost like saying, ‘Well, our women are going to die and we know they are going to die but we are not going to help you because our president says there is no more money for you’.”
A USAID official noted the agency is currently the largest overall global health donor.
“While the United States will continue significant funding for global health programs, even while refocusing foreign assistance, other stakeholders must do more to contribute their fair share to global health initiatives,” the official said.
Living through hell
Flora, whose real name has been changed for her protection from possible prosecution, remembers the day she visited the traditional healer – April 5, 2005.
“I lived through hell. After I started taking the medicine I started bleeding heavily. Then things got worse. I couldn’t work. They had to fetch me in an ox cart to take me to hospital and when I was in hospital they removed my uterus,” she says.
Flora’s unwanted pregnancy came before the current level of family-planning education and assistance was available in Malawi. She felt her only option was to get an illegal abortion.
“I had an unexpected and unplanned pregnancy. I fell pregnant when I had a very little baby. And there was no way that I could have two little babies at the same time,” she says. Flora says their meager earnings as subsistence farmers would make it impossible to care for two children in quick succession.
Flora says that if the help now offered by USAID and others in Malawi were available to her in 2005, she would never have gotten pregnant again, sought out an illegal abortion or lost her uterus.
It’s up to Congress
Advocates of foreign aid are still hoping to avoid the cuts because the White House doesn’t set the budget – Congress does.
But the House Appropriations Committee’s latest proposal cuts 24% of family-planning aid, supports the expanded Mexico City policy, and continues to withhold all UNFPA funding.
It could come down to the US Senate to preserve funding for global family planning. Policy experts hope that the Senate will remain true to recent bipartisan calls for the importance of foreign aid.
“A lot of negotiation still has to happen. We don’t know what the final picture will be. This White House has taken a very different direction from previous ones. It is a direction that appears to withdraw American Leadership from the world,” said Ian Koski of the One Campaign, an international non-partisan advocacy organization.
The Kaiser Family Foundation estimates that the proposed bilateral House cuts could mean more than 591,000 more abortions globally per year – and a spike in maternal deaths.
In Malawi, they are nervous that any cuts could reverse the progress they have made.
Flora has a simple message.
“Funding for family-planning services should continue so that Malawian women can benefit.”
Otherwise, she says, more women could live through the hell that she did.