Kelly Nhedega had mapped out a different future: finish school, train as a nurse, and then start a family. But the 18-year-old Zimbabwean's plans unraveled when she became pregnant at 16 and dropped out of school.

When Nhedega became sexually active, contraception felt out of reach. The stigma of a young girl queuing for condoms, pills, or a birth control implant at a crowded local clinic — where other patients or even health workers might judge her or tell her parents — kept her away. Now caring for an 18-month-old child, she recently obtained contraception discreetly as she works toward returning to the classroom.

"That's a mission I have to complete first. More babies will mean less or no time for school," she said, her toddler fidgeting on her lap.

Nhedega's experience highlights a broader challenge confronting girls across Africa as aid cuts and global shipping disruptions threaten access to contraception. The obstacles extend beyond whether contraceptives are bought or stocked: parental opposition, restrictive policies, stigma, and the fear of being seen at a clinic can all stand between girls and birth control, even as governments try to compensate for shrinking foreign aid.

Experts say contraception is critical to helping adolescent girls avoid unintended pregnancies and the risks of childbirth, particularly given Africa's high maternal mortality rates.

A widening funding gap

This report is part of a series on maternal mortality in sub-Saharan Africa, the region with the world's fastest-growing population, which accounts for 70% of global maternal deaths. Around 180,000 pregnancy deaths are recorded every year across the continent.

The United Nations Population Fund (UNFPA) estimates that aid cuts will leave a $185 million shortfall in contraceptive funding globally this year. According to the International Planned Parenthood Federation, nearly 1,400 reproductive health service facilities had closed worldwide by December, including 1,175 in Africa, leaving an estimated 5.9 million women without services.

A discreet lifeline in Epworth

Girls like Nhedega often depend on low-profile services to obtain contraception without being scrutinized or exposed. For her, that place was an aging blue-and-white caravan tucked into a discreet corner of a hospital in Epworth, a densely populated settlement on the outskirts of Harare. The converted family travel trailer operates as a mobile clinic, giving adolescents a private place to access contraception away from relatives, neighbors, church colleagues, or other patients.

"No one will know, it becomes your own secret," Nhedega said, adding that even after agreeing with her husband to use contraceptives, the community stigma can feel daunting.

Since 2021, the caravan alone has provided more than 100,000 adolescents in Epworth and nearby farming communities and informal settlements with contraceptives, treatment for sexually transmitted infections, counseling, and sexual and reproductive health information, according to Pester Siraha, director of Population Services Zimbabwe, which operates the caravan and other mobile clinics.

But the service is under mounting pressure as international aid shrinks.

Grants pulled midstream

Population Services Zimbabwe, an affiliate of MSI Reproductive Choices — which provides abortion and contraceptive services in 36 countries, mostly in Africa and Asia — lost a five-year, $9 million grant awarded in 2023 after the Trump administration dismantled many aid programs in 2025. More than $6 million of the money was unspent, according to the organization.

It turned to Swedish funding to fill part of the gap, but that support ended in August after the Swedish government phased out development assistance to Zimbabwe Tanzania, Mozambique, Liberia, and Bolivia in order to prioritize Ukraine.

"We were quite excited when Sweden came in," Siraha said. "Then, suddenly, boom, Sweden said they were leaving." She warned of increased unplanned pregnancies and unsafe abortions that could lead to death.

The funding cuts could force the four-decades-old organization to close its outreach activities. "Or even the entire country program," Siraha said.

Zimbabwe's government has moved to fill part of the void domestically. Health Minister Douglas Mombeshora said the country has spent $6.3 million buying contraceptives since 2022 and has pledged a further $2.25 million a year on contraceptives in 2026 and 2027.

Barriers beyond supply

Across Africa, contraceptive availability does not always translate into adolescent access. In Zambia, Inonge Wina Chinyama, director at MSI Zambia, said uncertainty over parental consent rules creates an additional obstacle.

"How many young people can go and say, 'Mommy, I want to have sex tonight. Can you allow me to go and get a contraceptive method?'" she said. "It doesn't happen in Africa."

Even girls who navigate those hurdles may find their preferred contraceptive unavailable at the clinic, Chinyama said. She added that the loss of U.S. support for distribution in Zambia is particularly affecting what she called the "last mile" — getting contraceptives from central warehouses and provincial hubs to rural health centers. Contraceptives sitting in storage are of little use to a girl living far from the warehouse where they are kept, she said.

Shipping disruptions and the Iran war

Global shipping disruptions have compounded the uncertainty. In March, UNFPA said carriers had rerouted shipments to avoid conflict-affected waterways. In Zambia, a contraceptive shipment ordered in November arrived more than three months late.

"At first, we thought Zambia was a low-risk country with the Iran war, because it felt like it was very far out there," Chinyama said. "But we are only just receiving the products this week."

Girls 'racing toward us'

In Zimbabwe's remote communities, the consequences of losing mobile outreach are especially visible, sometimes dramatic. In Binga, a poor and isolated district in northwestern Zimbabwe, funding cuts forced Population Services Zimbabwe to slow down its mobile clinics. When they briefly returned in August after a six-month absence, girls came running, said Engeline Mawere, the organization's operations director.

"Sixteen, 17-year-olds, some with children on their backs, were racing toward us when they saw our vehicle," Mawere said. "Sometimes we park in the bush so that both married and unmarried young girls can feel safe."

The rush, she said, underscores the importance of outreach services for girls and young mothers.

For girls like Nhedega in Epworth, access is not just about what is on the shelf, but whether they can get contraception without being seen, shamed, or stopped.

"So here, you just do it secretly and plan better," Nhedega said. "There is no child who should be attributed to a mistake. We should be able to plan and decide when to have a baby."

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Editorial note: The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP's standards for working with philanthropies at AP.org. This story was originally featured on Fortune.