Record numbers of women use modern contraception worldwide, but experts at the world’s largest family planning conference warned aid cuts could reverse gains in reproductive health and restrict access to birth control in low and middle-income countries.
Family Planning 2030, a global partnership for advancing access to reproductive health services, said in a report this week that a decade of hard-won gains in reproductive health could be undone after the United States, which once covered 41 per cent of global family planning budgets, largely stopped its funding.
“We are at the precipice of progress and rollback,” Samukeliso Dube, executive director of FP2030, told a news conference at the International Conference on Family Planning (ICFP) in the Colombian capital Bogota.
Dube said more than 80 per cent of government funding for family planning came from countries that have either announced or proposed significant cuts to their international aid budgets. In addition to the United States, these include the Netherlands, Britain, Germany and Sweden.
Some 101 million more people from low and lower-middle-income countries were able to access modern contraceptives, including implants and injectables compared to 2012, the FP2030 report said. It said nearly 400 million women out of 1.1 billion of reproductive age in these countries are using contraception.
FP2030 said the use of modern contraception in 2024 alone had averted 148 million unintended pregnancies, 30 million unsafe abortions and 128,000 maternal deaths around the world.
But US funding cuts and the ripple effect they had have on other funders have meant sexual and reproductive health groups have had to look for new sources of money.
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This is not business as usual. This is not just the way things have always been. These are new challenges that confront our field and force us to rethink how we approach the work that we do.
Dr Phil Anglewicz, director, William H. Gates Institute for Population and Reproductive Health
US-based research and policy group Guttmacher Institute said in a report that US$104 billion was needed annually, or almost double the amount currently spent, to meet all sexual and reproductive health needs in low and middle-income countries.
The extra cost is only US$8.05 per recipient, Dr Elizabeth Sully, director for international research of Guttmacher Institute, told Context. “The price of a cappuccino in many wealthy countries,” she said.
But Sully said this would be money well spent as every US$1 invested in contraceptive services could save US$2.48 in maternal, newborn and abortion care costs.
“Financing to fill the funding gap in sexual and reproductive health and rights needs to be a shared responsibility between national governments, donor governments, philanthropies and the private sector,” she said.
Funding setbacks
Some experts said shrinking aid donations showed the vulnerabilities of donor-dependent health systems and the need for alternative and domestic funds.
“We need to acknowledge that the US government wasn’t always the best donor. There were a lot of strings attached,” said Dr Anu Kumar, the head of Ipas, an international reproductive health and rights organisation that focuses on access to contraception and abortion.
Between 2020 and 2024, donor government funding for family planning in low and middle-income countries averaged more than US$1.4 billion per year, according to FP2030.
The United States accounted for around US$500 million annually in global health and family planning donor funding, followed by the Netherlands, Britain, Sweden and Canada.
But to make up for the withdrawal of US funding, the FP2030 said other donor governments would need to nearly double their spending on international assistance in 2025.
In the Asia-Pacific region, home to the largest population of women of reproductive age and the largest number of contraceptive users globally, FP2030 said USAID cuts had hit adolescent and youth health programs, such as NGOs providing contraceptives to millions of young women in India and Nepal.
In Malawi, Kumar said that 4,000 health professionals, or nearly half of the country’s total health workforce, were laid off after the US funding cuts.
While the speed at which USAID was dismantled was “shocking”, Kumar said she was seeing pushback from people in low and middle-income countries against their governments’ dependency on foreign aid for basic social services.
People “are also grappling with the fact that their countries … had actually outsourced health and education, some very basic elements of life, frankly,” Kumar told Context.
Rethinking aid
At the ICFP, experts from more than 800 organisations from some 120 countries are looking for local solutions to address shortfalls in global financing and the shifting political climate around sexual reproductive health and rights.
“This is not business as usual. This is not just the way things have always been. These are new challenges that confront our field and force us to rethink how we approach the work that we do,” Dr Phil Anglewicz, director of the William H. Gates Institute for Population and Reproductive Health, told reporters.
Kumar said foreign funding cuts had sparked conversations on how nations and organisations could build sustainable healthcare and had prompted governments to rethink budget priorities.
“I think it’s going to require a new way of thinking about how to rebuild the global health architecture,” she said.
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