The end of the DHS programme: a major issue for research and sustainable developmentMarch 2025 The shutdown of USAID by the second Trump administration resulted in many existing international demographic and health data sources disappearing overnight, and interrupted ongoing survey collection efforts. The situation is particularly complicated in low-income countries, which struggle to carry out massive data collection on their own. Without these data, it will be difficult, and in some cases impossible, to design effective public policies.
The shutdown of the United States Agency for International Development (USAID) announced at the end of January has several consequences for humanitarian, food aid, HIV treatment and other international aid programs. These impacts have been widely discussed in the media.
Another consequence of the shutdown is the sudden suspension of the Demographic and Health Surveys (DHS) programme including the disappearance of all the existing data sets produced over several decades from the DHS web portal. This includes more than three hundred national surveys conducted in over ninety countries. In addition, the shutdown halted ongoing data collection efforts and terminated field staff contracts.
Although the impact on the affected populations is not as immediate as the discontinuation of humanitarian programmes, it is of great concern to the research community and policymakers who use these data in their studies and policy-making. The DHS covers areas such as fertility, child health and mortality, reproductive health, family planning, women’s empowerment, malaria, adult mortality, and disability.
With the help of USAID funding, distributed through the Inner City Fund (ICF), countries implementing these surveys received technical and financial assistance. A strength of this programme was that it used relatively standardised questionnaires with similarly formulated questions asked from one survey to another and from one country to another. Such standardisation enables comparability over time and space, and minimises the influence of national governments that might be tempted to modify the questionnaires according to their political and ideological principles.
After a period of shutdown, the DHS programme website is up again providing free resources for anyone wanting to know more about these surveys or the indicators produced using these data. All the survey reports are available, as well as publications using the DHS, methodological information, and, for non-specialists, an online tool to produce simple statistics without the need to use standalone statistical software or to download the datasets. However, the data sets can only be downloaded if a data request had been approved by the DHS before the shutdown, as no new requests can be processed. While the situation is evolving quickly, it can be assumed that the site will not be maintained or updated in the future.
Global lack of data Producing high-quality demographic and health statistics routinely on a national scale is expensive and typically only possible in high-income countries. Many poorer countries do not have vital registration systems that collect data on all births and deaths within their borders. According to the United Nations International Children's Emergency Fund (UNICEF), almost half of the children under the age of five living in Africa have not been registered. In addition, censuses are carried out at best every ten years making it impossible to monitor the population and its fertility, mortality, and quality of life in detail.
Without the DHS, there is a lack of data on the populations of low- and middle-income countries, which account for most of the world's population (84% in 2024, according to United Nations estimates) and almost all of the world's population growth. One of Africa's most populous countries, the Democratic Republic of the Congo, which is expected to become one of the ten most populous countries in the world by 2050, has only held one census in 1983, and most of its population data come from sample surveys, such as the DHS.
The DHS have been the main source of data on the general population in most low- and middle-income countries since the 1980s. Before the DHS in the 1960s and 1970s, World Fertility Surveys were collected in these countries. Both of these survey programmes are based on the principle of collecting retrospective data on events having taken place before the survey.
While fertility, infant and child mortality, and family planning are central topics in the DHS, the questionnaire is also used to gather other data on maternal and child health, such as experiences of childbirth, immunisation, nutrition, and healthcare use. If relevant in the country, questions may be asked about HIV, and malaria, and biomarkers are sometimes collected to measure conditions such as anaemia, height, weight, and HIV prevalence. More recent surveys also include GPS data to study associations between population characteristics and environment, or to link these data to other sources.
These data can influence decision-making, because by asking questions about the socio-economic conditions of the individuals, households and communities in which they live, it is possible to observe differences between population groups, identify factors that explain these observations, and develop policies. Questions are also asked about, for instance, women's empowerment and the respondents’ principal information sources.
These surveys, which are updated regularly, produce essential indicators for monitoring population trends, identifying need for action, and measuring the impact of public policies. This is the principle on which the DHS is built.
Consequences of ending the DHS programme These surveys play an essential role in understanding the demographic situation of many countries, especially their state of fertility and reproductive health. They are an essential tool for monitoring the sustainable development goals (SDGs) of the United Nations agreed in 2015. For example, the DHS are needed to measure the decline in infant mortality, adolescent fertility, unmet need for contraception, and maternal mortality.
Although the existing raw data sets have been recovered and made available centrally elsewhere , much work remains before this important source of free and open access data for researchers, academics, and students around the world is fully functional again. These data are particularly important for scholars in low- and middle-income countries. Higher education, several research projects, and other work will suffer from the disruption in data access.
Stopping all ongoing data collection activities without notice also has a direct impact on the national statistics agencies that produce these surveys. The surveys have become an integral part of official statistics. Many fieldworkers lost their main source of income overnight and their long-term wellbeing is in question, since the US government has decided not to resume this activity.
The DHSs provide a unique, freely accessible and comparable data source covering several continents and decades. Ending the programme and making it difficult for researchers to access these data compromises international research efforts both in the Global South and North.
If these surveys are replaced by national data collection efforts, we will lose comparability between countries over time. This would probably be a loss for open science as the resulting data sets would be less likely to be accessible for free to all researchers. While the DHS cannot be the only tool used to understand a country's population dynamic in detail (due to the lack of contextual nuance, which is the necessary compromise of asking the same questions everywhere), it is essential for understanding population change over time and space, for advancing science, and ultimately, for improving people's living conditions and saving lives.
Other development aid agencies will certainly be asked to step in to fund this type of data collection, but these agencies are already heavily mobilised by many other emergencies, whether or not they are linked to the freeze of USAID funding. These challenging times will very likely result in a deterioration in population health, and researchers will lack the data to measure it.
This article was written par Géraldine Duthé, Arlette Simo Fotso and Heini Väisänen (French Institute for Demographic Studies - INED) and originally published on 24 February 2025 in the French journal AOC. | 