FINANCING
Inadequate sustainable financing and strategic prioritization alongside barriers to on-the-ground implementation undermine universal access to family planning and reproductive health, especially in LMICs
MARCH 2025
Despite significant need, shortfalls in reproductive health and family planning financing are not being adequately met by governments at the national and sub-national levels, leaving bilateral donors and philanthropies with an outsized funding burden. The financing ecosystem for family planning and reproductive health spans national governments, multilateral institutions, philanthropies, and the private sector, many of which are also responsible for implementation and supply needs. UNFPA is the primary global coordinator and convener of family planning and reproductive health interventions, channeling funds from a wide range of donors, including national governments such as the U.S., the U.K., and the Netherlands, into its distinctive programs and toward technical assistance projects. In 2022, UNFPA had a total budget of over USD 1.4 billion, which was distributed across regional and global activities including the Supplies Partnership, in which UNFPA matches funding contributed by donor governments, philanthropies, and the private sector. UNFPA is responsible for around 40 percent of global contraceptive supply via the Supplies Partnership, making it a critical actor in the family planning supply chain. However, the combination of decreasing official development assistance (ODA) from traditional sources, and several years in which emergency humanitarian response needs have skyrocketed, has caused UNFPA to report funding shortfalls. In late 2023, the agency reported needing a further USD 1.2 billion for urgent humanitarian response, not including the additional funds necessary for its longer-term work.
Multilateral development banks represent another critical channel for family planning and reproductive health financing, including through lending and distribution to emerging economies. The World Bank reportedly approved over USD 3.5 billion in new lending for reproductive, maternal, newborn, child, and adolescent health between 2018 and 2023, primarily focused in Africa, where maternal and neonatal mortality rates remain high. Much of that funding will be funneled via the Global Financing Facility (GFF), which facilitates investments in making health systems fit-for-purpose to serve maternal, newborn, childhood, and adolescent health (MNCA-H) needs. Currently working with 36 countries, in 2023 the GFF reportedly supported 130 million women to access safe birth services by catalyzing a combination of funding from the World Bank, recipient governments, bilateral donors, philanthropies, and the private sector. However, it is unclear how much of this lending will be dedicated to family planning and reproductive health, including commodities such as contraceptives. While comprehensive MNCA-H and family planning interventions are closely linked, and can be mutually reinforcing, greater transparency about how funding is targeted for different priorities—and by whom—is needed to enable monitoring and evaluation of progress toward various reproductive health goals.
Philanthropic, private-sector, and non-governmental actors represent the rest of the funding landscape for family planning and reproductive health. Major foundations such as the Bill and Melinda Gates Foundation and CIFF deploy financing directly and indirectly via multilateral funding mechanisms such as the GFF, recognizing that family planning underpins their overall strategic aim of “achieving a more prosperous and equal world.” Meanwhile, FP2030 acts as a global convener for funding, strategic prioritization, and implementation on the ground, working with multistakeholder partners around the world to improve access to rights-based family planning services. Interviewees informing FP Analytics’ research from across different sectors repeatedly emphasized the critical role that FP2030 plays in galvanizing action and maintaining a shared vision for collaborative action. Anne Pfitzer, Director of Family Planning and Reproductive Health for the MOMENUTM Country and Global Leadership project, led by Jhpiego, for example, shared, “The alignment of partners around family planning commitments like FP2030 can be super challenging, but I think it holds a lot of promise . . . it shifts the locus of control and power away from organizations like ours and the donors, and more to the target countries.” Enshrining a country-led approach is key to the long-term sustainability of family planning and reproductive health interventions, particularly as bilateral funding priorities shift. One critical step to ensure that adequate funds are available is budget and funding transparency. This will enable advocates and stakeholders in family planning and reproductive health from all sectors to accurately track and assess the amount of financing that is available, mobilized, and distributed to different aspects of family planning—including, but not limited to, contraceptives, diagnostics and therapeutics for reproductive diseases, and maternal health care—and hold funders accountable for closing gaps.
Bilateral funding for reproductive health and family planning services is driven by a small number of champions but is not growing at the same pace as overall ODA
Funding by key donor governments remains a critical source of financing for family planning and reproductive health, through direct bilateral partnerships, core and specified contributions to multilateral institutions, and donations to major NGOs such as MSI and Planned Parenthood. However, the combination of austerity measures, rapidly emerging crises and conflicts, and the politicization of SRHR issues is leading to a reduction in aid spending on gender equality, family planning, and reproductive health. As Kathleen Mogelgaard, President and CEO of the Population Institute, shared, “It’s an increasingly complex picture for financing . . . within the polycrisis moment we’re in, sometimes the issue of this foundational investment in family planning and reproductive health is forgotten.” As a result, financing, implementation, and strategic policy prioritization of family planning and reproductive health services and rights have suffered, with short- and long-term negative impacts on population health and well-being. Funding from donor governments for family planning increased in 2023 to USD 1.47 billion from USD 1.37 billion in 2022, but it remained below the pre-pandemic peak of USD 1.58 billion in 2019. Similarly, in 2024, the OECD noted that the share of ODA specifically targeting gender equality had dropped for the first time in a decade, having previously remained steady around 4 percent. Decreasing commitments by these traditional funders of family planning and reproductive health services leaves gaps that will require innovative new pathways to financing, including through increased domestic funding by governments themselves.
Securing the necessary funds to close gaps in unmet need will require catalyzing creative partnerships, and increasing domestic financing commitments, rather than solely relying on traditional donor sources
United States of America
The U.S. has historically been a champion of SRHR financing and technical assistance, with most of its support funneled via USAID, the government’s international development agency. USAID’s work is guided by the FP/RH Program, which outlines the bilateral and multilateral aid and financing strategy through 2030. The Program highlights three underlying and interconnected principles: Individual rights (“every person has the fundamental right to decide whether and when to have children, and how many children to have”); Health benefits for all (“Exercising this right enhances the health and well-being of women, adolescents, and children”); and Development impact (“The positive social and economic repercussions of enacting this right extend far beyond the individual, enriching families, communities, and countries”). These three principles make a strong case for investing in reproductive health and family planning, and are enacted via partnerships with recipient governments and multilateral partners such as UNFPA. In FY2023, the Program reached an estimated 24.2 million women, contributing to the prevention of 14,000 maternal deaths and 8.1 million unintended pregnancies. Reflective of USAID’s overall strategy, the FP/RH Program has worked to transition responsibility for financing and implementation over to domestic governments to support the long-term sustainability of activities.
Interviewees for this research consistently highlighted USAID as a critical partner for extending family planning and reproductive health services but raised concerns over the sustainability of its work. USAID had the same static budget between 2010 and 2024, of around USD 575 million—this share declines every year the agency continues its work, while the global population of women of reproductive age continues to grow, gradually decreasing its potential impact. In addition, as administrations change, policy priorities and constraints can shift, including the re-introduction of the Mexico City Policy, which curtails U.S. official development assistance to any organization providing abortion counselling, services, or advice, and was in effect from 1985 to 1993, 2001 to 2009, and 2017 to 2021. The Trump administration’s re-introduction of the Policy in January 2025 will have a significant impact on global funding for family planning and reproductive health, particularly as it impacts financing to UNFPA, UNAIDS, and others, while the restrictions imposed have additionally been shown to produce cascading impacts on health and well-being more generally. Similarly, the administration’s blanket suspension of foreign aid in January 2025 and intention to withdraw from multilateral institutions such as the WHO will drastically reduce the resources available for family planning, reproductive health, gender equality, and broader development outcomes. As a result of the U.S.’ suspension of foreign aid, an estimated 11.7 million women and girls are at risk of being denied essential care, which in turn could lead to millions of unintended pregnancies and thousands of preventable deaths during pregnancy and childbirth.
A woman sits by her stall offering contraceptives and family planning counseling services in a market in Monrovia, Liberia. Photo credit: Marco Longari/via Getty Images
United Kingdom
The U.K. has traditionally played a significant role in global SRHR funding and intervention, as part of a broader development focus on gender equality. Under its 2023–2030 International Women and Girls Strategy, family planning and reproductive health services are funded and supported by the Foreign and Commonwealth Development Office (FCDO) under the priority theme of “Empowering” women and girls. In particular, FCDO funding has focused on expanding access to modern contraceptive methods and improving contraceptive choice, including through the introduction and scaling-up of DMPA-SC, a self-injectable contraceptive that reduces the need to travel to health clinics, and increases the privacy of its users. As part of its expansion program, FCDO has supported the introduction of DMPA-SC to 42 countries, reached six million users, and trained 800,000 health care workers to educate their patients about the method. In addition to specific work on SRHR, FCDO made a commitment in 2023 that 80 percent of all bilateral aid programs would include a focus on gender equity by 2030, including in climate finance and health care.
Despite this strategic prioritization, in practice, U.K. bilateral aid to family planning and reproductive health has plummeted since 2020 and has not yet recovered to its pre-COVID-19 levels, with no clear indications that it will. A report to the parliamentary International Development Committee found that FCDO funding was reduced with little to no warning, threatening the functioning and sustainability of bilateral and multilateral projects, and undermining the work of implementing partners. ODA spending on family planning specifically dropped by almost half, to just USD 225 million, between the years of 2019 and 2021 (the latest year for which information is publicly available), while core funding to UNFPA dropped by around 60 percent between 2020 and 2021. In addition, the U.K. government has drastically reduced its financial commitments to the UNFPA Supplies Partnership, cutting the 2021 allocation by almost 85 percent, compared to 2020. As a result, UNFPA reported that it had to cut its provision of commodities, including modern contraceptives, by almost 30 percent.
A mobile clinical outreach team visits a rural Kenyan hospital to offer reproductive health services. Photo credit: Jonathan Torgovnik/via Getty Images
Japan
Japan is the largest bilateral aid donor in Asia, and the third largest globally. In recent years, the Japanese government has increased its spending on SRHR to become a key player alongside the U.S., the U.K., and Canada. Japan’s international development agency JICA treats gender mainstreaming as a cross-sectoral priority, with the aim of integrating a gender perspective into all JICA projects. Additionally, the elimination of sexual and gender-based violence is highlighted as a development priority or “cluster,” on which JICA works in partnership with other bilateral and multilateral donors, NGOs, and the private sector.
JICA’s Global Agenda for Health includes a dedicated section on Maternal, Newborn, and Child Health. Priorities for action include prevention of unwanted pregnancies, STIs, and malnutrition; preparation for safe delivery, and care in the case of complications; and building out health care workforce, infrastructure, and supply. Analysis of the 2017–2021 period found that JICA’s intervention supported the training of over 11,500 health workers globally on MNCH, and a financial commitment of JPY 7.3 billion (USD 47 million) on technical cooperation projects, and JPY 29.1 billion (USD 188.5 million) on broader ODA grants within this area.
Women and children sit during a counseling session on family planning at a village in India’s Bihar state. Photo credit: Sachin Kumar/AFP via Getty Images
Netherlands
Dutch development cooperation has included a focus on the “universal fulfilment of SRHR—including HIV/AIDS” in recent decades, taking a rights-based approach to family planning and reproductive health. Within the overall Global Health Strategy, SRHR is highlighted as part of a larger priority to strengthen health care systems through long-term partnerships. Annual reports on all of the Dutch government’s international development priority areas, of which SRHR is one, are published. In 2019, for example, reportedly over 600,000 people from vulnerable groups were able to access HIV/AIDS health services through Dutch aid, and between 2012 and 2019, Dutch aid enabled an additional 2,750,000 women and girls to access modern contraceptives in the 69 countries targeted by FP2020.
However, a review by the independent evaluation agency within the Ministry of Foreign Affairs—the IOB—found that the impacts of Dutch SRHR policy may be less than assumed, and suggested that a wide range of updates be made to the overall SRHR policy and monitoring and evaluation framework. The IOB highlighted that data collection could be strengthened, including by updating the indicators measured to be more relevant and more straightforward to track, and noted that few SRHR projects supported by the Dutch agenda continue after bilateral funding has ceased, due to a lack of political will by partner governments, which undermines the longer-term sustainability and impact of those efforts. As a result, the IOB recommended an overhaul of the SRHR policy and evaluation approach, and an increased emphasis on project transition from international aid actors to ownership by domestic actors. This challenge is not unique to the Netherlands as a bilateral donor but rather a perennial problem related to funding and operationalization, which hampers progress on family planning and reproductive health, especially in LMICs.
Members of a youth group gather during a community program to distribute condoms and perform skits related to reproductive health in Mombasa, Kenya. Photo credit: Jonathan Torgovnik/via Getty Images
Securing the necessary funds to close gaps in unmet need will require catalyzing creative partnerships, and increasing domestic financing commitments, rather than solely relying on traditional donor sources
Interviewees for this research project—from INGOs, multilateral institutions, government aid agencies, and more—consistently raised concerns over shrinking and stagnating availability of funds dedicated to reproductive health and family planning, noting that there is a gap between the available and necessary financing. Overcoming this challenge will require action across multiple pathways simultaneously. Advocating for the prioritization of financing for family planning and reproductive health will be best supported by the deployment of clear and compelling data and narratives demonstrating the outsized impact that investment in these services can yield, both immediate and long-term, including economic and global health dividends. Andrea M. Wojnar, UNFPA India representative highlighted the economic impact of targeted investments, stating, “Focusing on lowering maternal and neonatal mortality rates extends life expectancy, creates a healthier population, and boosts economic output and productivity, especially when combined with education and training. These outcomes demonstrate the value of prioritizing health and well-being in national agendas.”
Stakeholders in family planning and reproductive health need to shift conversations and strategies away from an assumed reliance on ODA and donor funding. As reflected in the USAID global health strategy, among others, sustainable long-term interventions for family planning and reproductive health require domestic governments and actors to assume responsibility for coordination, financing, and implementation, as they have the expertise and longstanding relationships to set projects up for success. Governments that rely heavily on ODA for family planning supplies and commodities, without leveraging additional domestic financing and resources, may be especially vulnerable to exogenous shocks such as the COVID-19 pandemic, or a shift in international aid priorities, which reduce the availability of donor funds. Anne Pfitzer, Director of the MOMENTUM project, led by Jhpiego, noted that INGOs and international aid funders cannot always maintain a long-term presence in-country that supports sustainable progress: “Sometimes there’s not enough time, or length of investment, to really make a project robust enough that if we withdraw funding it can sustain itself.” The answer, in her view, is to facilitate strong partnerships between domestic governments and the NGOs and CSOs active at the grassroots level, so they can “work hand in hand to achieve policy or program objectives.” Some countries with significant unmet need, including India and Indonesia, have begun to transition to a domestic-led financial model, but more must be done to close financing gaps.
FIGURE 3
Family Planning Donor Funding, 1990 to 2023
International donor funding for family planning has yet to return to its pre-pandemic spending levels.
Sources: Institute for Health Metrics and Evaluation (IHME). Financing Global Health.
Given stagnation or backsliding on several key family planning and reproductive health goals, strategic prioritization—by governments and multilateral institutions in particular—will be critical to accelerating progress
A re-commitment to achieving family planning and reproductive health goals will require the prioritization of these issues within national budget planning, investment decision making, and health care and human development strategizing. National governments and multilateral institutions, in particular, must act as drivers of this prioritization, and can positively reinforce each other, and other partners, to do the same. As conveners, financers, and implementers of international development, multilateral institutions can take a leading role in defining strategic priorities. Their toolkit for doing so includes integrating indicators for specific topics such as gender equity or climate mitigation into their project design, and—as described by Claire Charamnac, Social Development Specialist at the Asian Development Bank (ADB)—through leveraging policy-based and results-based loans in which financing is contingent on enacting policy reforms or other development milestones, such as the prioritization of SRHR. Alternatively, national governments can influence the strategic priorities of multilaterals—for example, donor governments can ringfence their donations for specific sectors and interventions, or to support specific projects such as UNFPA’s Supplies Partnerships—while governments that receive support from multilaterals can steer joint projects toward their national priorities. However, these positive feedback loops require reproductive health and family planning to be prioritized in strategy, budgeting, and more by as many stakeholders as possible.
One effective method for ensuring the prioritization of reproductive health and family planning will be to identify the numerous areas of overlap with related policies and interventions, including education, health, infrastructure, and gender equity policies. Integrating SRHR goals and monitoring into relevant socioeconomic policies and strategies enables resources to be used efficiently, while acknowledging the cross-cutting nature of reproductive health and family planning challenges. A critical opportunity for strategic integration is within national and global approaches to strengthening health care systems and the provision of universal health coverage (UHC). Family planning and primary health care strategies share multiple key needs and resources, such as increased numbers and training of health care workers, improved telehealth and mobile health facilities, and a reliable supply of diagnostics and medicines for common illnesses or contraceptives. Indeed, over half of all modern contraceptive users in LMICs get their method from public-sector sources. Adequate, sustainable funding for contraceptives and other family planning care is therefore critical to avoiding catastrophic out-of-pocket cost burdens being placed on women and girls and to securing long-term reproductive health and rights.
Relatedly, ensuring a range of affordable and accessible choices at points of care is essential to increasing uptake. As Supriya Madhavan, RMNCAH-N and Gender Lead at the World Bank’s Global Financing Facility, noted in an interview with FP Analytics, “We need to strengthen primary health care systems, and that’s where family planning should be situated, not recast as a separate thing . . . I don’t think there can any longer be a standalone family planning conversation.” The World Bank’s Gender Strategy 2024-2030 reflects this view, explicitly highlighting SRHR services as a key aspect of achieving UHC in recipient countries, while the GFF, where Madhavan works, almost exclusively finances projects in which family planning is integrated into broader aims such as improving childhood nutrition. For this reason, UNFPA recommends including SRHR services within national-level UHC benefit packages and minimum standards of essential health care, to ensure their delivery to all individuals regardless of cost. Progress has been made to that end, with UNFPA reporting a 12 percent increase in inclusion of reproductive, maternal, newborn, and child health in UHC plans between 2000 and 2019.
