Life is already tough for pregnant women anywhere in Nigeria, where one in every 100 women dies giving birth, and at least 75,000 annually, the highest in the world according to the World Health Organization.

Aisha Muhammed was in the third trimester of her pregnancy when she had the convulsions and high blood pressure of eclampsia, a leading cause of maternal death.

Her village's only health clinic had no doctor, and the only medical help was 40 kilometers (25 miles) away in one of the world's most dangerous places.

More women die giving birth in Nigeria than anywhere else in the world, according to the World Health Organization. But Muhammed managed to reach the city of Maiduguri and have a cesarean section the next day, delivering twins in April.

The odds are stacked against pregnant women in Nigeria's northeast like never before.

The deadly Boko Haram militant group is making a resurgence. And hundreds of millions of dollars in foreign aid from the United States, once Nigeria's biggest donor, have disappeared under the Trump administration this year.

Roads are closed by fighting. Many doctors and other health workers, as well as aid organizations, have fled. In an attempt to make up for the lack of U.S. funding, Nigeria has released an emergency $200 million for its health budget.

Even before these developments, Nigeria had over a quarter of the world's maternal deaths in 2023 — 75,000 — according to the WHO.

At least one in every 100 women dies giving birth in Africa's most populous country, which faces chronic underfunding for health systems that cater to 220 million people.

The Associated Press visited Borno state, one of the areas most threatened by the Boko Haram insurgency. Its militants have fought a 14-year conflict seeking to impose Islamic law and are best known for its mass kidnappings of schoolchildren.

Now, despite the efforts of Nigeria's military, Boko Haram has been carrying out more assaults, attacking almost daily in the region.

Health workers say it is increasingly difficult to recruit doctors and others, especially outside of the relatively safe state capital, Maiduguri.

Doctors in Borno can expect to make about $99 to $156 a month.

Aid workers described local mothers dying because they could not reach care. Once relatively peaceful communities have again turned into garrison towns for the military, and some healthcare systems have collapsed.

The Borno government acknowledged the problem and cited the insecurity.

Falmata Muhammed went into labor suddenly in 2021. With no hospitals in her village of Bulabilin Ngaura, she and her husband set off to Maiduguri, 57 kilometers (35 miles) away. But she started bleeding and delivered the child en route, stillborn.

She said the mental anguish still weighs heavily. Now the 30-year-old is pregnant again. She has since moved to Magumeri, a larger town whose major hospital was burned in a Boko Haram attack in 2020. Now it has only a mobile clinic, which is not equipped to assist with childbirth.

The prospects of more health resources have dwindled in the region.

U.S. foreign aid data shows that Nigeria received almost $4 billion in aid from the now-dismantled U.S. Agency for International Development between 2020 and 2025, with $423 million going to maternal health and family planning.

Now that is gone. The U.S. Embassy did not respond to questions.

And the world's other crises, including Ukraine, Gaza and Sudan have led other donors to shift funding priorities.

With funding aid gone and Nigeria's government cutting the budget for family planning by almost 97% in 2025, even women with no intention of having more children face little choice.