Bodily autonomy and sexual health are often framed as
matters of individual health, personal choice and human
rights. But the latest evidence from the Adding It Up 2024
report by Guttmacher Institute shows that meeting sexual and
reproductive health needs is not merely a health
expenditure—it is a smart investment that can save lives,
reduce unintended pregnancies and generate significant
economic returns.
Main findings of this report that
were presented by Dr Elizabeth A Sully, Guttmacher
Institute’s Director of International Research, during a
SHE & Rights session organised ahead of World
Contraception Day and International Safe Abortion Day,
examine the need, impact, and cost of investing in sexual
and reproductive healthcare across 128 low- and
middle-income countries: 36 countries from Asia, 53
countries from Africa, 23 countries from Latin America and
Caribbean and 8 countries each from Europe and Oceania
regions.
In low- and middle-income countries across
Asian and African regions, millions of women face
significant unmet demands for modern contraception, leading
to high rates of unintended pregnancies and maternal
mortality. Fully funding comprehensive sexual and
reproductive health care would dramatically reduce maternal
deaths and unsafe abortions. SHE & Rights was organised
by the Global Center for Health Diplomacy and Inclusion
(CeHDI), Guttmacher Institute, Asian Pacific Resource and
Research Centre for Women (ARROW), International Planned
Parenthood Federation (IPPF), CNS and partners.
From
unmet need to unmet demand
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One of the report’s
notable features is to rethink how contraceptive need is
measured.
In Asia, approximately 129 million women of
reproductive age are classified as having an unmet need for
modern contraception. But this number includes women using
traditional methods who may be satisfied with them and may
not want to switch.
Guttmacher Institute therefore
uses the term unmet demand to identify women who want to
avoid pregnancy, are not currently using contraception and
express an openness to using family planning in the
future.
A rights-based approach to family planning
should not be about persuading people to adopt particular
methods. Rather it should be about ensuring that people who
want to prevent pregnancy can exercise that choice and
access services they need.
By this measure, an
estimated 36 million women in low- and middle-income
countries in Asia have an unmet demand for contraceptive
care.
Almost half of all pregnancies in Asia were
unintended
Every year, the region experiences
approximately 57 million unintended pregnancies,
representing 47% of all pregnancies. Guttmacher Institute’s
analysis reports that 72% of them end in abortions, 17% in
unplanned births and 11% in stillbirths and
miscarriages.
Meeting all the sexual and reproductive
health needs of women could reduce unintended pregnancies in
Asia by 26% and unsafe abortions by 25%. Also maternal
deaths would decrease by 65% and newborn deaths by 62%,
while new HIV infections among babies could fall by
93%.
US$ 12.4 billion gap in Asia
The report
estimates that the annual cost of meeting all sexual and
reproductive health needs in low- and middle-income
countries in Asia is US$ 38.8 billion. So an additional
annual investment of US$ 12.4 billion is required to fully
fund contraception, maternal and newborn care, abortion
services and treatment for 4 major curable sexually
transmitted infections (STIs). This means increasing annual
spending from an estimated US$ 5.87 to US$ 8.61 per person.
That is an additional US$ 2.74 per person a year.
At
first glance, the additional investment may appear
substantial. But every additional US$ 1 spent on family
planning and contraceptive care could save US$ 1.97 in
pregnancy-related and newborn care costs by reducing
unintended pregnancies.
Africa: another powerful
investment case
In low- and middle-income countries
in Africa an estimated 29 million unintended pregnancies
occur every year, representing 43% of all pregnancies.
Meeting all sexual and reproductive health needs could
reduce maternal deaths by 67% and newborn deaths by 70%,
while new HIV infections among babies six weeks and younger
could fall by 87%.
The required comprehensive package
needs an additional annual investment of US$ 40.1 billion,
equivalent to US$ 26.83 per person each year.
But then
again, estimated savings are significant – every additional
dollar invested in contraceptive services could save US$
2.49 in maternal, newborn and abortion care
costs.
While the scale and nature of unmet
reproductive health needs differ between Asia and Africa,
yet the potential health gains by meeting all of them are
substantial in both regions- every additional US$ 1 spent is
estimated to save US$ 1.97 in Asia and US$ 2.49 in Africa in
maternal, newborn and abortion care.
In other words,
contraception is not simply another line item in a health
budget. It can reduce pressure on several other parts of the
health system and reduce the need for expensive
interventions later.
From statistics to
action
Guttmacher Institute has turned its research
into two online interactive tools that can help
policymakers, advocates and journalists translate global
evidence into country-specific scenarios.
The Family
Planning Investment Impact Calculator is a tool that is
available online to see what the impacts would be from
investments made in family planning in different low- and
middle-income countries. It allows users to select a
country, investment amount and currency and estimate how
many unintended pregnancies could be prevented, unsafe
abortions averted and lives saved.
I have tried this
tool online myself: if a US$1 million investment in
contraceptive care is made in the Philippines, it could
provide modern contraceptive methods to approximately 84,000
women and couples, prevent more than 18,000 unintended
pregnancies and avert nearly 4,000 unsafe abortions. It also
estimated a saving of US$ 2.51 in pregnancy-related and
newborn care for US$ 1 invested.
The Safe Abortion
Calculator focuses on the economics and health benefits of
expanding access to safe abortion (provided within
healthcare facility) care. It shows how investing in safe
abortion care is a cost-savings investment.
When I
tried this tool online, I found that by increasing the
provision of safe abortion to 100% (from the current 26%) in
Bangladesh, it could substantially reduce overall costs by
an estimated 57.5%, resulting in a saving of US$ 27 million.
Because when we invest in safe abortion care, we see a
massive reduction in post-abortion care needs and
costs.
Thus, by using these tools one can better
understand some of the concrete impacts of investments made
in family planning. The tools are particularly relevant when
health budgets and development assistance are under
pressure. They allow the conversation to move from broad
appeals for investment to concrete questions: What would
additional financial resources achieve in a particular
country? How many unintended pregnancies could be prevented?
How many lives could be saved?
Riju Dhakal, Programme
Officer, Asian-Pacific Resource and Research Centre for
Women (ARROW) asks whether international commitments and
pledges are actually reflected in approved national budgets
for sexual and reproductive health and rights. ARROW is
working with partners in 12 countries, including India,
Nepal, Bangladesh, Pakistan, Sri Lanka, Indonesia and the
Maldives, to examine financing for sexual and reproductive
health and rights, and engage governments on investment and
impact.
Amid concerns over falling development
assistance for sexual and reproductive health and rights
(46% decline in official development assistance for it
between 2024 and 2026), Dhakal called for the Guttmacher
Institute’s tools (Family Planning Investment Impact
Calculator and Safe Abortion Calculator) to be used to
localise the numbers, track government commitments and check
whether financing pledges are actually reflected in approved
national budgets.
She highlighted the importance of
tracking not only what governments pledge, but also whether
the money is budgeted, released and ultimately reaches
services and communities.
Contraception is not a
woman’s responsibility alone
The investment debate
also exposes a persistent gender imbalance.
The theme
for World Contraception Day 2026 “No Barriers, Just Choices:
Access to Options, Freedom to Decide!,” highlights the
importance of ensuring genuine reproductive choice. Yet
contraceptive responsibility continues to fall
disproportionately on women. Female sterilisation accounts
for 24% of contraceptive use worldwide, compared with
appallingly low 2% for male sterilisation.
The focus
of International Safe Abortion Day 2026 is on “Solidarity
in Action: Advance Reproductive Justice and Urgently
Strengthen Health Systems for Comprehensive Abortion Care.”
And rightly so, as safe abortion is an essential component
of sexual and reproductive healthcare and links it to
reproductive freedom, gender equality and the right to
health.
The question facing health systems is not only
“how much will reproductive healthcare cost?” It is also
about “what will it cost if these needs remain
unmet?”
Ultimately, investing in contraception, safe
abortion, maternal healthcare and newborn care is about
ensuring that people can prevent pregnancies they do not
want, have children when they do want them, receive safe
care when they are pregnant, and survive childbirth and its
complications.
The price of reproductive healthcare
can be measured in dollars. The cost of not providing it is
measured in unintended pregnancies, preventable illness,
lives lost and opportunities denied to women.
It is
high time we do away with patriarchal expectations that have
often treated family planning and domestic care as women’s
responsibilities. A more equitable approach requires
recognising contraception as a shared responsibility between
sexual partners while protecting women’s autonomy over
decisions concerning their bodies.
Shobha Shukla
– CNS (Citizen News Service)
(Shobha Shukla is a
feminist, health and development justice advocate, and an
award-winning founding Managing Editor and Executive
Director of CNS (Citizen News Service). She serves as
Chairperson of Global AMR Media Alliance (GAMA), Host and
Coordinator of SHE & Rights (Sexual Health with Equity
& Rights), President of Asia Pacific Media Alliance for
Health, Gender and Development Justice (APCAT Media), and
founder leader of DJOP (Development Justice for Older
Persons) initiative. She is the author of 2026 book “Justice
Unbound: Feminist Voices on Gender Equality, Health Rights,
and Inclusive Futures” and was also the Lead Discussant for
SDG-3 at United Nations inter-governmental High Level
Political Forum 2025. GAMA, led by her, received the AMR One
Health Emerging Leaders and Outstanding Talents Award at UN
High Level Ministerial Conference on AMR 2024. Follow her on
X @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)
–
Shared under Creative Commons
(CC)
