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Funding for sexual and reproductive health and rights in low- and middle-income countries: threats, outlook and opportunities

©UNICEF Ethiopia/2014/Nesbitt

This report, commissioned by PMNCH, takes stock of current and potential future investments in sexual and reproductive health and rights (SRHR), to inform discussions on how to ensure adequate support for SRHR. It provides analysis of SRHR funding by donors and low- and middle-income country governments, which is crucial as much of the needed growth in SRHR funding will have to come from domestic sources.

Sexual and reproductive health and rights are essential for reaching the Sustainable Development Goals (SDGs) for health. The Guttmacher-Lancet Commission found in 2017 that meeting the unmet need for contraception for 214 million women in developing regions would avert an additional 67 million unintended pregnancies annually. Although there are substantial benefits to investing in SRHR, SRHR is a politicized topic in many countries.

While all countries should include SRHR in their path towards universal health coverage (UHC), and many countries are including common elements of SRHR (primarily family planning, maternal, and newborn health) in their UHC packages and plans, inclusion of a full package of SRHR interventions is rare, and by no means guaranteed. Moreover, despite official development assistance (ODA) for SRHR and funding provided by the Bill & Melinda Gates Foundation amounting to US$11.3 billion in 2017, an all-time high, donors invested a lower share of their overall health funding in SRHR compared to previous years.

The evidence presented and recommendations made in this report support countries to prioritize health, including SRHR in their domestic budgets as well as encourage donors to include SRHR as an integral part of UHC efforts and to protect health investments from other emerging priorities. Nevertheless, a new global movement to mobilize political and financial support for SRHR is needed to sustain investments.