President Trump's FY 18 budget request to Congress includes unprecedented cuts to global health. If enacted, they would total approximately $2.5 billion and bring funding below FY 08 levels. Still, the President's budget is just the first step in a longer process where Congress now takes center stage. We developed "budget impact models" to assess the impact of funding cuts. We modeled three budget scenarios--the Administration's proposed cuts as well as two more modest decreases--in countries that receive U.S. global health assistance for HIV, TB, family planning, and maternal, newborn, and child health. Based on our models, the potential health impacts of these one-year cuts is significant across all three budget scenarios. For example, depending on the size of the cut, we estimate that starting next year: (1) Additional new HIV infections would range from 49,100 to 198,700; the number of people on antiretrovirals could decline by more than 830,000 in the steepest budget cut scenario; (2) Additional new TB cases would range from 7,600 to 31,100; (3) The number of women and couples receiving contraceptives would decline, ranging from 6.2 million to almost 24 million; the increase in the number of abortions would range between 778,000 to almost 3 million; and (4) Additional maternal, newborn, and child deaths would range between 7,000 and 31,300. While the fate of this year's global health budget remains uncertain, these models illustrate the relationship between such decisions and health outcomes in low- and middle-income countries and provide one important tool for assessing future budget choices.
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