WASHINGTON — A major US-funded global health initiative is under scrutiny following revelations that healthcare workers in Mozambique violated program guidelines by performing abortions, sparking concerns about the future of the multibillion-dollar effort credited with saving millions of lives worldwide.

The President's Emergency Plan for AIDS Relief (PEPFAR), which provides critical support to combat HIV/AIDS across developing nations, prohibits service providers from offering abortion services using US funds. However, a recent review uncovered four nurses in Mozambique had performed 21 abortions since 2021 while working at PEPFAR-supported facilities.

"This represents the first confirmed violation of PEPFAR's abortion policy in the program's two-decade history," explained a senior State Department official involved in administering the initiative. "We immediately notified Congress and have taken corrective actions to strengthen compliance measures."

The discovery comes at a sensitive time for PEPFAR, which has faced increasing political opposition from some Republican lawmakers who claim - without presenting evidence - that the Biden administration has used the program to promote abortion access internationally.

In Mozambique, where abortion is legal under national law, PEPFAR-funded nurses routinely receive training on pregnancy termination procedures as part of their general medical education. Program administrators emphasize they implement additional safeguards to ensure US funds aren't used for these services.

The violations were detected during routine compliance checks last October when officials discovered some of Mozambique's 2,751 PEPFAR-supported nurses hadn't completed required training about restrictions on abortion services. Subsequent investigation identified just four practitioners who had performed terminations.

"We froze funding to those providers immediately upon discovery and are implementing new verification procedures," assured another US official familiar with the matter. "All staff will now be required to certify they understand and will comply with abortion restrictions."

The revelation has intensified political debate about PEPFAR's future after Congress only approved a one-year funding extension last March instead of its traditional five-year reauthorization due to Republican objections led by Senator Jim Risch (R-ID), who chairs the Senate Foreign Relations Committee overseeing foreign aid programs.

"American taxpayers' money must never fund abortions anywhere in world," Risch declared in response to news of violations. "This breach puts entire PEPFAR program at risk unless we guarantee such abuses won't recur."

Democratic leaders pushed back against suggestions that isolated incidents should jeopardize what public health experts consider one most successful global health initiatives ever launched by United States since its creation under President George W Bush 2003.