The U.S. Department of Health and Human Services (HHS) said on Wednesday that the country’s specialized treatment network remains ready to respond to the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC), where the World Health Organization has reported 344 confirmed cases and 60 deaths.

The issue has gained prominence after the U.S. State Department said American citizens exposed to Ebola but not showing symptoms would be quarantined at a facility under construction at Kenya’s Laikipia Air Base. The department has also pledged to prevent travelers infected with Ebola from entering the United States.

Public health specialists have increasingly urged the U.S. government to bring infected Americans back to the United States for treatment rather than relying on overseas facilities. Opposition to the Kenyan quarantine center has intensified following protests that resulted in at least two deaths, while a Kenyan court has ordered construction work halted.

The United States invested heavily in Ebola preparedness after the 2014 West African outbreak, spending hundreds of millions of dollars to strengthen treatment capacity and establish a national network of specialized facilities capable of handling highly contagious pathogens.

Reuters contacted the 13 hospitals and universities participating in the National Emerging Special Pathogens Training and Education Center network. Nine confirmed they are currently prepared to receive and treat patients exposed to Ebola.

The network includes institutions such as the University of Nebraska Medical Center, Emory University in Atlanta, Bellevue Hospital in New York and Cedars-Sinai Medical Center in Los Angeles. Four institutions, including Emory, did not respond to requests for comment.

“The United States’ investment in preparedness remains a critical component of national health security,” HHS spokesperson Emily Hilliard said, adding that participating hospitals are equipped to evaluate, isolate and treat patients with high-consequence infectious diseases while supporting broader outbreak response efforts.

Under federal requirements, designated treatment centers must be capable of caring for at least two patients exposed to contagious viral hemorrhagic fevers such as Ebola. Facilities are required to conduct quarterly training exercises, maintain laboratory testing capabilities and stock protective equipment.

The U.S. Centers for Disease Control and Prevention has dozens of personnel deployed in the DRC and has said members of the U.S. Public Health Service Corps could be sent to support operations at the proposed Kenyan facility. American healthcare workers and aid personnel also continue to serve in the region through international relief organizations.

Several healthcare officials, including former CDC leaders, argued in an open letter this week that medical evacuation to established U.S. treatment centers would pose fewer risks than housing exposed Americans at a newly constructed overseas quarantine site.

A former CDC official familiar with the response effort said concerns surrounding the Kenya plan could complicate efforts to recruit American personnel for outbreak response missions.

The official said some prospective volunteers fear they could be left overseas if exposed to the virus, potentially undermining confidence in government support for public health workers deployed to epidemic zones.

practice of medically repatriating citizens exposed to or infected with dangerous infectious diseases abroad.The administration announced last week that it was establishing a quarantine facility in Kenya for U.S. citizens exposed to Ebola during the ongoing outbreak affecting eastern Democratic Republic of Congo and Uganda. Under the plan, Americans who develop symptoms would not be returned to the United States but instead transferred to a third country for treatment as Washington seeks to prevent Ebola cases from entering U.S. territory.

The health officials said the proposal raises “profound clinical, ethical, operational, and legal concerns,” warning that it could discourage healthcare workers and emergency responders from participating in outbreak-control missions in affected regions.They also expressed concern that resources would be diverted toward creating temporary quarantine, isolation and treatment infrastructure overseas rather than supporting efforts to contain the disease at its source.

According to the letter, such a shift could weaken already strained outbreak response operations and complicate international public health coordination.The administration’s plan has also generated opposition in Kenya, where concerns have been raised about the potential public health implications of hosting a quarantine center for foreign nationals exposed to Ebola.

A Kenyan court has temporarily suspended plans to establish the facility following a legal challenge arguing that the project could pose risks to public health. The ruling places the future of the proposed site in doubt as legal proceedings continue.The dispute highlights growing tensions between domestic disease-control priorities and international public health practices as governments seek to manage cross-border infectious disease threats while balancing political, logistical and medical considerations.

When Craig Sinclair told his wife he did not want to die in a hospital, the couple faced a challenge that extended beyond his advanced cancer diagnosis. Fulfilling his wish to spend his final days at home required navigating a complex healthcare system and securing tens of thousands of dollars in care that was not fully covered by insurance or public programs.

Sinclair, a British-born academic who moved to the United States in his twenties to pursue doctoral studies in comparative literature, died from bladder cancer on March 10, 2025, in the Brooklyn apartment he shared with his wife, Shannon Carroll. He was 49. Carroll was 37.His death came after more than two years of cancer treatment and several hospitalizations. It also followed a frantic effort by family and friends to raise more than $65,000 to cover private nursing care and medical supplies needed to support home hospice services.

The experience highlights broader questions about access to end-of-life care in the United States, where patients and families often face significant financial and logistical barriers when seeking alternatives to hospital-based care.By December 2024, Sinclair and Carroll had become familiar with New York City’s hospital system after multiple emergency admissions during the year.

During what would become Sinclair’s final hospitalization at NYU Langone Hospital in Manhattan, his condition had deteriorated significantly.According to Carroll, Sinclair became distressed after being transferred from intensive care to a shared room. The environment contrasted sharply with the comfort and familiarity of home, where he hoped to spend his remaining time.

Medical staff informed the couple that further treatment options had been exhausted and recommended hospice care. However, returning home required arrangements that extended beyond standard hospice services.

The hospital would only approve Sinclair’s discharge if adequate care could be provided in the apartment. While hospice services were available, they included limited nursing visits and were insufficient to address the complexity of Sinclair’s medical needs.A private nursing service was required to provide specialized wound care and daily medical support.

The service cost between $5,000 and $7,000 per week and included several hours of care each day from a registered nurse. The expenses quickly exceeded the couple’s financial resources.Carroll said she spent hours coordinating between healthcare providers, hospice representatives and private nursing companies while seeking approval for Sinclair’s discharge.

Eventually, medical staff agreed to allow him to return home after Carroll committed to providing around-the-clock support and securing funding for the additional care.Once back in Brooklyn, Sinclair’s condition appeared to improve emotionally. Carroll said the change in environment was immediate.

Surrounded by familiar possessions, preferred lighting and music, he was able to engage in longer conversations and spend meaningful time with family and friends.The experience reinforced the couple’s determination to maintain home-based care despite mounting costs.

To cover expenses, Carroll and her support network launched a fundraising effort. The money raised ultimately paid for private nursing services and medical equipment, but financial pressures persisted throughout Sinclair’s final months.The burden was compounded by limitations in existing caregiving support programs.

Carroll discovered that under New York law, spouses are not eligible to receive compensation through the state’s consumer-directed Medicaid caregiving program, even though other family members and non-relatives may qualify under certain circumstances.

As a result, Carroll spent months providing extensive care while also managing medical appointments, medications and administrative responsibilities without compensation.The financial strain extended beyond direct caregiving costs. Medical bills from previous hospital visits continued to arrive during and after Sinclair’s final illness.

Carroll said she received repeated notices regarding disputed charges, including a hospital bill of nearly $6,000 and a separate laboratory charge dating back more than a year.The couple also explored whether medical aid in dying could provide another option for Sinclair as his condition worsened.

During a chemotherapy appointment in 2024, Sinclair discussed the possibility with his oncologist. According to Carroll, the physician expressed support and noted that another patient had previously used medical aid in dying laws in a neighboring state.

At the time, however, Sinclair was unable to pursue that option. New Jersey’s residency requirements prevented him from qualifying there, while traveling to Vermont would have required a lengthy journey that his deteriorating health made impractical.The issue took on added significance after his death.In 2025, New York became the 13th U.S. state to approve medical aid in dying legislation.

The law is scheduled to take effect on August 5, 2026, allowing eligible terminally ill adults to request medication to end their lives under specific legal and medical conditions.According to Carroll, Sinclair would likely have qualified had the law been available during his final months.

For the family, however, the primary objective remained ensuring that Sinclair could spend his final days where he felt most comfortable.Even as his physical condition declined, Carroll recalled moments that reflected his personality and resilience. Friends, nurses and doctors frequently remarked on his humor.

During one hospital stay, despite significant weakness, he continued joking with staff members and expressing gratitude for those caring for him.At home, he remained engaged with news, music and conversations with loved ones for as long as his health allowed.

Carroll improvised practical solutions to help him maintain independence, including building a simple phone support stand so he could continue reading and communicating despite severe physical limitations.Following Sinclair’s death, Carroll remained in the apartment for several months before eventually moving out.

Among the final items she packed was a stair-assist cane used during his illness.For Carroll, the object served as a reminder not only of Sinclair’s final journey but also of the challenges many families face when attempting to honor a loved one’s wishes at the end of life.His death at home fulfilled a goal the couple had fought to achieve for months.

Achieving it, however, required substantial fundraising, unpaid caregiving and extensive coordination within a healthcare system where end-of-life choices often carry significant financial consequences.

A growing number of women, healthcare professionals and advocates are calling for greater awareness and research into Premenstrual Dysphoric Disorder (PMDD), a severe hormone-related condition that can have profound effects on mental health, family relationships and quality of life but remains widely underdiagnosed and poorly understood.

Current research indicates that PMDD affects up to one in 20 women of reproductive age. Despite its prevalence, only about 1.6% of affected individuals receive a formal diagnosis. The consequences can be severe. Research cited in the source material indicates that approximately one-third of those diagnosed with PMDD have attempted suicide, underscoring the condition’s significant mental health burden.

PMDD is characterized by severe emotional, psychological and physical symptoms that occur during the luteal phase of the menstrual cycle, typically in the days before menstruation. However, many patients report years of confusion, misdiagnosis and ineffective treatment before receiving appropriate care.

Limited awareness within the medical community has contributed to delayed diagnosis and treatment, according to patients and healthcare professionals interviewed about their experiences. The condition remains unfamiliar to many clinicians despite its potentially debilitating effects.

The lack of understanding extends beyond clinical diagnosis. Relatively little is known about how PMDD affects family dynamics, particularly relationships between mothers and their children. In response to these gaps, the United Kingdom has recently seen the establishment of its first charity dedicated exclusively to supporting individuals with PMDD and their families.

For families living with the condition, the impact can extend far beyond the individual experiencing symptoms.Daly, now 37, recalls growing up in a household affected by her mother’s undiagnosed PMDD. She remembers frequent and intense arguments between her parents before treatment became available.

“I’d feel sad because she’d be crying – I hated seeing her so upset,” Daly said.Reflecting on her childhood, Daly described periods when her mother’s behavior was difficult to understand.“Mum was hard work at points. I’d sometimes overhear her shouting at Dad and think, this is unfair,” she said.

For many women diagnosed later in life, understanding the source of recurring emotional distress can bring both relief and regret. Barker, another woman living with PMDD, described years of struggling with symptoms that affected her relationships and self-perception.“I’d say nasty things, and felt unable to stop, then afterwards think: that was awful,” Barker said.

She described a recurring cycle in which episodes of anger and emotional instability were followed by periods of remorse, depression and repeated apologies.“Then the tears and depression came, I’d spend a week apologising – then it’d start all over,” she said.

Barker’s experience also highlights the connection between PMDD and serious mental health challenges. Visible reminders of that period remain part of her daily life.

Tattoos now cover self-harm scars from some of the most difficult years of her illness.A significant turning point came when consultant gynecologist Professor John Studd introduced her to treatment involving oestrogen implants. According to Barker, the results were immediate and transformative.“It was the only thing that worked – my symptoms disappeared,” she said.

However, access to treatment proved challenging. Barker said the National Health Service declined to fund the therapy because PMDD was classified as a syndrome rather than a disease, affecting eligibility for coverage.Determined to continue treatment, she contacted physicians, elected officials and healthcare providers while relocating from Hampshire to Edinburgh.

The process ultimately required substantial personal financial investment.“I ended up paying £600 every six months to travel to London and get a new implant fitted at my own expense,” Barker said.Despite the costs, she described the treatment as indispensable.“Life on the oestrogen implant was heaven,” she said.

At one point, Barker said her daughter loaned her £1,000 to help finance continued treatment after her own financial resources became strained.Even after finding an effective medical intervention, Barker said she remained concerned about the effect PMDD had already had on her children.

“I worried I’d ruined my relationship with my kids,” she said.She believes receiving treatment before her children reached adolescence helped prevent further difficulties, but she remains conscious of the years lost to managing symptoms.“I was lucky to get treatment before their teens.

But as younger kids, they grew up around me, not with me,” she said. “I was on the outside looking in, trying to manage and hide my symptoms. They bore the brunt.”According to Barker, successful treatment allowed her to reconnect emotionally with her family in ways that had previously been difficult.She said it enabled her “to feel the love and joy from spending time with the kids which PMDD had stolen.”The lack of awareness surrounding PMDD is not limited to patients.

Healthcare professionals themselves can experience the condition without recognizing it.Dr. Milli Raizada, a general practitioner and specialist in women’s health, said she had never heard of PMDD before being diagnosed with it six years ago, despite years of medical training and clinical experience.Now 40, Raizada said the diagnosis exposed significant shortcomings in professional education regarding women’s health conditions.

She described feeling disappointed that a condition affecting so many women remained largely absent from medical training.“Too many doctors, myself included, don’t have the knowledge to help women who suffer in silence,” she said.Raizada argues that improvements in medical education and research are essential if diagnosis and treatment rates are to improve.“Better training. More research.

Stop sidelining women’s health,” she said.Her own symptoms emerged after discontinuing oral contraceptive medication. According to Raizada, changes became apparent during the luteal phase of her menstrual cycle, when emotional and psychological symptoms intensified.“In the luteal phase, I’d be arguing lots with him and he said, ‘This isn’t normal’,” she said, referring to observations made by her husband.

Raizada described a sharp contrast between her usual personality and the symptoms she experienced during affected periods.“I’m usually resilient and a multitasker but I suddenly had impostor syndrome, felt overwhelmed and worthless, and was hypersensitive and apathetic for two weeks of the month,” she said.

The turning point came after an unusually intense reaction to a routine family interaction.“After flying off the handle at my mother-in-law over a throwaway comment, I knew it was time to act,” Raizada said.For advocates and patients, such experiences illustrate the urgent need for greater recognition of PMDD within healthcare systems.

Despite affecting millions of women globally, the condition continues to be characterized by delayed diagnoses, inconsistent treatment access and limited research, leaving many patients to navigate years of symptoms before obtaining effective care.

The planned changes would affect workers across the Department of Health and Human Services, including staff involved in shaping public health policy, regulation and research oversight, the sources said. The move follows Trump’s campaign pledge to reclassify certain federal employees viewed by his advisers as exercising significant influence over government policy.

The proposal is tied to a revived version of “Schedule F,” a federal employment category first introduced during Trump’s first term that would allow agencies to remove some career civil servants from traditional job protections. Critics said the measure could expose career officials to politically motivated dismissals, while supporters argued it would increase accountability within the federal bureaucracy.

Employees at agencies overseen by HHS, including the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health, could be affected depending on how individual positions are classified, the sources said.

The administration has not publicly disclosed how many employees may lose protections or which roles would be targeted first. HHS did not immediately respond to requests for comment.

Trump and allies have argued that career officials across federal agencies have obstructed presidential priorities and insulated policy decisions from elected leadership. During the 2024 election campaign, Trump repeatedly pledged to reshape the federal workforce and remove what he described as entrenched bureaucratic resistance within government institutions.

Federal employee unions and governance watchdog groups have opposed the effort, warning it could weaken the independence of scientific and regulatory agencies responsible for public health oversight, drug approvals and medical research funding.

The issue is expected to draw legal and political scrutiny as the administration moves to implement broader changes across the federal workforce.

Terminally ill campaigners and British photographer Rankin have launched a renewed push for assisted dying legislation in England and Wales, urging lawmakers to revive a stalled bill that supporters say would give dying people greater control over end-of-life decisions.

The campaign, organised with advocacy group Dignity in Dying, comes ahead of Thursday’s private member’s bill ballot in parliament and follows mounting frustration among supporters after legislation introduced by Labour MP Kim Leadbeater cleared the House of Commons but became delayed in the House of Lords amid a large number of amendments.

Rankin, one of Britain’s best-known photographers and directors, said his involvement in the campaign stemmed from an encounter in late 2023 with Paola Marra, a terminally ill woman who later travelled to the Swiss assisted dying clinic Dignitas.

During a RankinLIVE portrait event in London’s Carnaby Street shortly before Christmas that year, Marra asked the photographer to take what would become her final public image before travelling to Switzerland.“I asked what the occasion was, and she said: ‘I’m going to Dignitas,’” Rankin recalled.

Marra, a former music industry and charity worker, had terminal bowel cancer. The portrait later gained widespread attention after it was released alongside a farewell video following her death at the Swiss clinic in March 2024.

In the image, the 53-year-old gestures defiantly toward the camera while referencing her illness.Rankin said the encounter had a profound impact on him and helped shape his support for assisted dying reform.“It was like a punch to the stomach,” he said.

The latest campaign includes a series of short films featuring terminally ill individuals discussing fears surrounding the end of life and arguing for legal changes that would allow medically assisted dying under regulated circumstances.One of the videos, titled “Time to Back the Bill Again,” features eight participants aged between 19 and 77.

The film opens with one participant saying: “Yep. I’m terminal.”The campaign’s central message urges MPs to resume legislative efforts after the bill’s progress slowed in the Lords. Supporters of the legislation argue that parliament has not completed the democratic process after MPs previously voted in favour of moving the proposal forward.

Rankin said participants in the campaign came from very different backgrounds but shared frustration over the bill’s delay.“They have all got one thing in common: they don’t understand why this bill hasn’t been passed,” he said. “They don’t understand why it’s been stopped.”He added that he believed the proposed law would have allowed people facing terminal illness to make decisions “in a responsible and dignified way.”

The issue of assisted dying remains one of the most divisive ethical debates in British politics. Supporters argue that terminally ill people should have the right to choose the timing and manner of their deaths under strict safeguards, while opponents warn of potential risks involving coercion, vulnerable patients and pressure on medical systems.

Dignity in Dying said polling conducted by Opinium showed continued public support for parliament completing debate on the legislation.

According to the organisation, 69% of respondents said parliament should continue considering the bill until a final decision is reached, while 61% said the government should ensure sufficient parliamentary time for MPs and peers to complete the legislative process.

Barbara Shooter, 69, who appears in the campaign films, said she supported assisted dying after accompanying her late husband Adrian Shooter to Dignitas in 2022. Adrian Shooter, the former chair of Chiltern Railways, had motor neurone disease, which progressively affected his mobility, speech, swallowing and breathing.“It was getting control back,” she said.

“Once he knew he had a day, it was very powerful. He cheered up no end. And he had a calm, peaceful death.”In what she described as a cruel development, Shooter herself was later diagnosed with motor neurone disease.

She said her condition is currently progressing slowly and that she continues to maintain a good quality of life.“I do have my own lines in the sand, but I’m nowhere near those,” she said.

Shooter criticised peers who opposed the legislation and warned that delays risked pushing the issue out of public attention.“Who wants to face horror and pain and awfulness at the end of their life when you know you’re not going to get better?” she said.

“Some might be perfectly content to let nature take its course. It’s their choice. And I want my choice.”Another participant in the campaign, London charity worker Maddie Cowey, 28, was diagnosed at 18 with alveolar soft part sarcoma, a rare and incurable cancer.

She now has more than 30 sarcoma nodules across both lungs and remains dependent on treatment to manage the disease.“Without treatment I would die, basically, and it’s not going to be cured,” Cowey said.She said the unpredictable progression of the illness created ongoing uncertainty about the future.

“It could become aggressive at any time and become uncontrollable and it could happen really quickly,” she said. “Or I could have decades more if they manage to keep it at bay.”Cowey said she had come to terms with the possibility of dying younger than most people but remained fearful about suffering during the final stages of illness.

“Not having an alternative option is really scary,” she said. “Having the alternative of being able to choose how and when it happens would give me a lot of peace and hope.”She said the delay to the legislation had replaced earlier optimism with anxiety.

“I try not to dwell on it day to day because I just want to live my life, but if I let myself think about it, it’s terrifying,” she said. “It feels really unfair and unjust.”Sarah Wootton, chief executive of Dignity in Dying, said the organisation believed terminally ill people continued to face limited and distressing options under current laws.

“Every week, dying people are left with the same cruel options: suffer, travel abroad to die, or act alone,” Wootton said.She accused opponents in the House of Lords of obstructing legislation that had already secured backing in the Commons.

“This is bigger than assisted dying,” she said. “Parliament has unfinished business, and it’s time for MPs to return the bill to Westminster and finish what they started.”

Mental health specialists are calling for expanded psychiatric support within maternity services, warning that perinatal mental illness remains one of the most widespread yet under-recognized complications associated with pregnancy and childbirth.

The concerns come amid growing attention to gaps in screening, specialist access and treatment pathways for women experiencing psychiatric symptoms during pregnancy and the postnatal period.

Experts in the field say many women continue to face delayed diagnosis and inconsistent care despite national guidelines recommending routine psychosocial screening during pregnancy.Edna Lekgabe, a perinatal psychiatrist and co-founder of WARM Health Collective⁠, said the scale of the issue remains poorly understood relative to other pregnancy-related complications.

“Mental illness is the number one complication of pregnancy and the postnatal period,” Lekgabe wrote in an analysis examining failures within current maternity mental healthcare systems.Perinatal mental illness refers to psychiatric conditions occurring during pregnancy or within the first year following childbirth. According to specialists and public health agencies, up to one in five women experience a diagnosable mental health condition during that period.

Conditions can include depression, anxiety disorders, post-traumatic stress disorder related to traumatic births, obsessive-compulsive symptoms involving intrusive fears about infant harm, and, in rare cases, postpartum psychosis.Medical experts classify postpartum psychosis as a psychiatric emergency because of the heightened risk of self-harm, suicide or harm to the infant if untreated.

Lekgabe described a recurring clinical pattern in which women initially report symptoms during routine antenatal care but are reassured that emotional distress, insomnia or anxiety are normal features of pregnancy.

According to her account, many patients eventually reach specialist psychiatric care only after symptoms have significantly worsened.One illustrative example described a pregnant woman experiencing severe insomnia, hopelessness and suicidal thinking during the third trimester after earlier concerns were dismissed as routine pregnancy-related stress. The psychiatrist noted the case was fictionalized but based on recurring patterns observed across hundreds of patients.

The issue has gained increasing attention internationally as healthcare systems attempt to integrate mental health more fully into maternal care frameworks. Public health researchers have repeatedly linked untreated perinatal psychiatric illness to poorer outcomes for both mothers and infants, including impaired maternal functioning, disrupted bonding and elevated long-term developmental risks for children.

Despite those risks, specialists say mental healthcare remains inconsistently integrated into maternity services.In Australia, national guidelines recommend routine psychosocial screening during pregnancy and after childbirth, with many providers using the Edinburgh Postnatal Depression Scale, a standardized questionnaire designed to identify women at risk of depression and anxiety.

Lekgabe argued, however, that screening tools alone are insufficient without accessible treatment systems behind them.

“A screening tool is only as good as the pathway behind it,” she wrote.Mental health advocates and clinicians have raised concerns that women identified as high-risk frequently encounter lengthy delays for psychiatric assessment or psychological treatment. In Australia’s public healthcare system, wait times for mental health services can extend for months, particularly outside major metropolitan areas.

The psychiatrist pointed to disparities between urban and regional care availability, noting that specialist mother-baby psychiatric units and dedicated perinatal mental health services remain concentrated in larger cities. Women dependent on public healthcare or unable to afford private treatment often face more limited access.

Organizations including PANDA (Perinatal Anxiety & Depression Australia)⁠ and Centre of Perinatal Excellence (COPE)⁠ have sought to increase public awareness and improve access to support services across Australia.

Lekgabe also identified cultural expectations surrounding motherhood as a barrier to early intervention. According to her analysis, social narratives that idealize pregnancy and early parenthood can lead women to interpret severe psychological distress as personal inadequacy rather than a treatable medical condition.

The psychiatrist referenced the growing use of the term “matrescence,” which describes the emotional and identity transition associated with becoming a mother. While acknowledging the concept’s value in normalizing emotional adjustment, Lekgabe warned against conflating ordinary stress or disorientation with clinically significant psychiatric illness.

“There is a vast difference between the disorientation of new parenthood and a major depressive episode,” she wrote.Specialists in maternal mental health have increasingly emphasized that early symptoms are often minimized both by patients themselves and by healthcare systems focused primarily on physical outcomes such as blood pressure, fetal development and obstetric complications.

Lekgabe said many women internalize the belief that struggling emotionally reflects failure as a parent rather than evidence of illness requiring treatment.“I thought I was just a bad mother,” she said patients frequently tell her.The psychiatrist argued that statement reflects systemic diagnostic failure, particularly when women interact repeatedly with healthcare providers without receiving meaningful psychiatric evaluation or referral.

Mental health professionals have advocated for a more integrated care model in which psychiatric services are embedded directly within maternity clinics and obstetric care settings. Under such systems, psychiatrists, psychologists and mental health nurses would work alongside obstetricians and midwives rather than operating through separate referral systems.

Lekgabe identified three priorities for reform: integrating mental healthcare into maternity services, expanding the number of trained perinatal psychiatrists and improving public understanding of perinatal psychiatric illness.Australia currently has relatively few psychiatrists specializing in perinatal and reproductive mental health compared with overall demand, according to clinicians in the field.

Training opportunities within the subspecialty also remain limited.The psychiatrist stressed that perinatal mental illness is highly treatable when recognized early and managed appropriately. Treatment options can include psychotherapy, medication considered safe during pregnancy, supported birth planning and coordinated postpartum care.

The fictionalized patient example described in Lekgabe’s analysis ultimately improved after receiving psychiatric medication, psychological treatment and coordinated maternity support tailored to her mental health needs.However, the psychiatrist argued that many women never receive that level of coordinated intervention.

“Not every woman who walks the path Mia walked finds that team,” Lekgabe wrote.

Mental health organizations globally have increasingly highlighted maternal suicide and severe psychiatric illness as major public health concerns linked to inadequate perinatal care systems. Several countries, including the United Kingdom and Australia, have expanded investment in specialized maternal mental health programs over the past decade, though advocates argue access remains uneven.

Lekgabe said greater public literacy around perinatal psychiatric illness could help reduce stigma and encourage earlier intervention among expectant parents and their families.

“We need expectant parents and their families to understand that perinatal mental illness is common, treatable and not a reflection of character,” she wrote.

Australia’s National Disability Insurance Scheme, once hailed as one of the country’s most ambitious social policy reforms, is undergoing its most significant restructuring since its creation as the Albanese government moves to curb rising costs and restore what ministers describe as long-term sustainability.

The federal government this week announced sweeping changes to the NDIS, including tighter eligibility rules and mandatory independent functional assessments for all participants, in a package projected to save the budget A$35 billion over four years.

The reforms come as annual scheme costs approach A$50 billion and concerns intensify over whether the system can remain financially viable in its current form.David Bowen, the inaugural chief executive of the National Disability Insurance Agency, said the scale the scheme has reached would likely have prevented it from being approved had governments anticipated its current size.

“Had any government, of any political persuasion, known it was going to be this size, by this time, it would have never been funded in the first place,” Bowen said.The NDIS was introduced following a landmark 2011 Productivity Commission report, which described Australia’s previous disability support framework as underfunded, fragmented and inefficient.

The commission proposed a national insurance model that would provide individualised support for people with permanent and significant disabilities, replacing the inconsistent state-based systems that had long drawn criticism.At full implementation, the scheme was expected to support around 410,000 Australians and cost approximately A$13.5 billion annually. Alongside it, a second level of support—known as tier two was intended to provide broader community-based assistance for the roughly four million Australians living with disability who would not qualify for individualised packages under the NDIS.The commission argued that while the upfront costs would be substantial, the long-term economic and social benefits would significantly outweigh the expenditure.

Over time, however, participation and costs expanded far beyond original projections. Health Minister Mark Butler said the growth was driven by both structural design flaws and implementation failures, including poor market regulation and an eligibility system that allowed broader entry than originally intended.

Butler said the NDIS had become vulnerable to what he described as a “free-for-all” environment in parts of the support market, allowing some providers to exploit weak oversight while costs accelerated.He also said the eligibility framework had shifted away from assessing functional impairment toward diagnosis-based access, allowing significantly more people to enter the scheme than policymakers initially expected.

The largest area of growth has been autism-related participation. According to government figures, people with autism now account for 324,200 participants, representing 43% of all people currently enrolled in the NDIS.Bowen said that during the trial years of the scheme, an autism diagnosis alone was not sufficient for entry and eligibility was based more strictly on the level of functional impairment.

He said that changed after his retirement from the NDIA in 2017 and described the policy shift as one that broadened the scheme “incalculably.”In response to this expansion, Butler last year announced a jointly funded A$4 billion federal-state initiative known as Thriving Kids, aimed at supporting children under nine with mild developmental delays and autism outside the NDIS and reducing pressure on the scheme.

The government now plans to legislate a system under which every participant will undergo evidence-based independent assessments to determine both eligibility and the level of support required. The proposal mirrors, in part, reforms previously attempted by the Coalition government under Scott Morrison.

In 2021, the Coalition proposed mandatory independent assessments requiring participants to complete a three-hour interview with a government-contracted health professional. The plan was met with strong opposition from disability advocates, state governments and Labor, which accused the government at the time of undermining the scheme.

Labor campaigned in the 2022 election on protecting the NDIS and criticised the Coalition over attempts to reduce access. After winning government, however, the fiscal reality of the scheme’s rapid expansion prompted a policy shift.Bill Shorten, appointed as NDIS minister, took charge of reforms to a system he had helped establish during the Gillard government.

He commissioned a major review led by Bruce Bonyhady, another key architect of the NDIS, which recommended creating a stronger system of foundational disability supports outside the scheme—effectively implementing the second-tier support model originally proposed by the Productivity Commission.

At the same time, Prime Minister Anthony Albanese secured agreement from national cabinet for the first formal annual growth target for NDIS costs, initially set at 8%.“We know that the trajectory of NDIS expenditure is just not sustainable into the future,” Albanese said after the April 2023 meeting, warning that without intervention the scheme could reach A$97 billion within a decade.Following another A$13 billion cost blowout, that target has now been revised further, with the government aiming to reduce annual growth to 2% until 2030.

The changes have triggered significant concern across the disability community, particularly among participants uncertain about how new eligibility rules and reassessments may affect their access to support.

Australian Disability Network chief executive El Gibbs and other advocates have warned that while reform is necessary, the political language surrounding cost containment risks framing disabled Australians as a financial burden rather than citizens entitled to support.

Disability advocacy groups say many participants remain deeply anxious about what the reforms will mean in practice, especially for families who rely on the scheme for daily care, therapy and independence.

Australian Federation of Disability Organisations chief executive Ross Joyce Bennison said uncertainty around the reforms had created widespread fear among participants.“I think people are also feeling like they’re being heralded as a burden on society,” Bennison said.“It feels really not very nice to be a disabled person in Australia at the moment.”

As parliament prepares to consider the legislation next month, the government faces the challenge of balancing fiscal restraint with preserving confidence in one of Australia’s largest and most politically sensitive social programs.

The United States is restructuring how it delivers life-saving medical supplies for HIV and malaria to low-income countries, a shift that officials and health experts warn could disrupt treatment access across parts of Africa and Asia.

The changes centre on winding down the Global Health Supply Chain Program – Procurement and Supply Management, a U.S.-funded initiative run by Chemonics, which has coordinated the delivery of critical medicines and prevention tools since 2016. According to internal communications and multiple sources familiar with the matter, U.S. officials have been instructed to begin halting implementation of the programme by May 30.

From its inception through 2024, the programme distributed more than $5 billion worth of HIV and malaria-related commodities to 90 countries, with a primary focus on sub-Saharan Africa and parts of Asia. The supplies included antiretroviral drugs, malaria treatments and insecticide-treated bed nets, forming a key component of global disease control efforts.The restructuring follows broader changes to U.S.

foreign aid policy under the administration of Donald Trump, which has prioritised reducing reliance on contractors, cutting budgets and shifting toward direct agreements with recipient governments. The overhaul also comes after the dismantling of the United States Agency for International Development, which had previously overseen much of Washington’s development assistance.

Five sources familiar with the transition said the pace of the changes risks creating supply gaps for essential medicines, particularly in countries with fragile health systems. An internal email reviewed by Reuters warned that accelerating the transition without a clear implementation plan could jeopardise continuity of services.

The communication, sent by the U.S. State Department to staff in 17 African countries and Haiti, directed country teams to prepare for the end of programme operations while outlining potential risks. It did not provide a detailed roadmap for replacement mechanisms, instead asking local offices to identify vulnerabilities and report back to Washington.

A State Department spokesperson said the agency had not issued technical instructions for Chemonics to cease operations by May 30, though the contract is set to expire on September 30 in line with other USAID awards. The official end date is listed as November.

The uncertainty has revived concerns stemming from earlier disruptions. In January last year, a freeze on international aid left millions of dollars’ worth of medical supplies stranded in ports and warehouses worldwide, including HIV drugs and malaria prevention tools. Distribution resumed only after waivers were granted for life-saving interventions.

Six sources said the United States has been in discussions with the Global Fund to Fight AIDS, Tuberculosis and Malaria about potentially using its procurement and distribution systems to replace the existing programme. The Geneva-based institution already manages approximately $2 billion in annual purchases for HIV, tuberculosis and malaria programmes through partnerships with national governments and implementing agencies.

However, two sources said earlier plans had envisaged a transition timeline extending to November 2027, allowing sufficient time for procurement cycles and logistical adjustments. Compressing this timeline into a matter of months could create operational bottlenecks, they said, noting that delivering medical supplies to remote areas can take up to a year from order to distribution.

The Global Fund declined to comment on the discussions. The State Department did not directly confirm the talks but said it would rely on pooled procurement mechanisms to secure supplies at competitive prices from private manufacturers.The policy shift is part of a broader “America First” approach to global health funding, which aims to reduce what officials describe as inefficiencies in the existing system.

A strategy document released in September argued that contractor-led programmes had contributed to waste and inflated costs, and emphasised direct funding for frontline services and national governments.

Under the new approach, Washington has signed 28 bilateral health agreements with partner countries and is increasingly channeling funds directly to national authorities. It also plans to use private logistics firms to handle distribution rather than relying on large development contractors.

Recent agreements with countries such as Kenya, Rwanda and Uganda include commitments to increase domestic health spending alongside U.S. funding. However, implementation has encountered obstacles. In Kenya, a proposed deal faces legal challenges from activists concerned about data privacy, while negotiations with Zambia have been delayed as officials seek to safeguard national interests.

Health experts and aid practitioners say the transition risks compounding existing vulnerabilities in global disease control programmes. Previous disruptions linked to funding changes have already contributed to shortages of malaria treatments for children and gaps in HIV prevention services in several countries.

The State Department defended the overhaul, describing the current system as outdated and inefficient. A spokesperson said the new model would prioritise value for American taxpayers while maintaining support for critical health interventions.

Despite those assurances, several sources involved in programme delivery said the lack of a detailed transition plan remains a central concern. They warned that without clear coordination between donors, governments and implementing partners, the shift could interrupt supply chains that millions depend on for survival.