Despite gains made in access to sexual and reproductive health care over the last several decades, widespread unmet need for services remains across low- and middle-income countries (LMICs). If these needs were met, there would be transformative change in the health and well-being of millions of individuals and families across the globe. And such investment would not be costly to make. Just a few additional dollars spent per person in LMICs annually would go a long way toward fulfilling current needs and would result in cost savings over time. Policymakers, including those in the United States, have the tools to make this all possible, if only they seize the moment to act.

Unmet and Inequitable Need

Today, too many people in LMICs lack the sexual and reproductive health care they want, need and deserve. The Guttmacher Institute's Adding It Up project documents that as of 2019, there were approximately 1.6 billion women of reproductive age living in 132 LMICs around the world and 923 million of them wanted to avoid a pregnancy. Unfortunately, 218 million of these women have an unmet need for contraception; that is, they are not using a modern contraceptive method (e.g., implants, IUDs, condoms, hormonal pills, sterilization).

As a result, about half (49%) of pregnancies in LMICs—111 million annually—are unintended. The situation is especially concerning for women in the lowest income countries, where nearly half (46%) of women who do not want to become pregnant are not using any method of contraception or are using a traditional method (e.g., periodic abstinence, withdrawal)—leaving these women at the very real risk of having a pregnancy they do not want.

Beyond contraception, massive gaps exist in access to essential clinical care in many countries. Among the 127 million women who give birth each year in LMICs, 50 million make fewer than the recommended four antenatal care visits and more than 31 million do not deliver in a health facility. Tragically, 16 million women and 13 million newborns do not receive care for major complications in pregnancy and childbirth, and every year there are 299,000 pregnancy-related deaths and 2.5 million newborn deaths.

In most cases, this loss of life is preventable, which makes it even more heartbreaking. Currently, more than two million women do not receive the care they need after a miscarriage, 35 million have abortions in unsafe conditions and nine million do not receive necessary care for complications from an unsafe abortion. In addition, an estimated 133 million women of reproductive age in LMICs need but do not receive treatment for one of the four major curable STIs—chlamydia, gonorrhea, syphilis or trichomoniasis.

The situation is even worse for adolescents. More than 43% of sexually active adolescents want to avoid a pregnancy but are not using a modern form of contraception, which results in 21 million pregnancies each year, half of which are unintended. The barriers adolescents face in accessing care are myriad: judgmental providers, lack of confidentiality, inadequate financial resources, and legal or social constraints. This makes them less likely than adult women to get the contraceptive services they require, as well as less likely to get safe, confidential and high-quality clinical care should they become pregnant.

A Few Dollars, a Huge Impact

The situation is dire, but it does not need to remain that way. Evidence shows that even a small investment in family planning can have a radical impact on people’s health and well-being. The total package of services would cost $68.8 billion per year, which translates to just $10.60 per person in LMICs annually, or $4.80 more than current spending. With these resources, the full package of essential sexual and reproductive health care could be provided to all women in LMICs. This package of care includes: voluntary access to high-quality modern contraception; pregnancy and newborn care, including antenatal care, delivery and postnatal care, newborn care, and HIV care for pregnant women and newborns; abortion and postabortion care; and treatment for the four most common STIs.

These services would dramatically improve health and enable people to truly control their reproductive destiny. If the full package of recommended services were to be provided to all those in need:

  • Unintended pregnancies would drop by 68%
  • Unsafe abortions would drop by 72%
  • Maternal deaths would drop by 62%
  • Newborn deaths would drop by 69%
  • HIV infections among babies up to six weeks old would drop by 88%

We must make these investments to save lives and to protect the rights and bodily autonomy of people everywhere. But these investments also ultimately save money. Every additional dollar invested in increasing access to voluntary contraception results in $3 saved on pregnancy-related and newborn care. Globally, investing in both contraceptive and pregnancy-related and newborn care services would result in annual savings of $11 billion. This money could then be invested in other social priorities, including education, gender equity and environmental sustainability.

What Congress Should Do

To make this a reality, a wide range of stakeholders must act, including nongovernmental organizations, foreign governments, donors and global institutions. Given the size and scope of the United States’ influence, Congress must lead the way in charting a course toward comprehensive services for all. This starts with four key actions:

  • Pass the Global Health, Empowerment and Rights (Global HER) Act to permanently repeal the global gag rule. This would allow health care providers around the world to talk to their patients about the full range of reproductive health services available, including abortion, as well as to be eligible to apply for U.S. foreign assistance funding.
  • Repeal the Helms Amendment and end the ban on U.S. funding for safe abortion. Making abortion accessible saves lives and prevents the need for postabortion care resulting from unsafe services.
  • Appropriate the full U.S. fair share of funding for international family planning and reproductive health programs, $1.66 billion per year. Living up to global commitments and contributing what it should, relative to other countries and stakeholders, would demonstrate U.S. leadership, accountability and true partnership at a time when they are sorely needed.
  • Pass the UNFPA Funding Act to reinstate funding for the United Nation’s family planning programs. Reengaging with global institutions and providing them with sufficient funding would help ensure the sustainability of programs into the future.  

People are complex and live multifaceted lives, with changing sexual and reproductive health needs. The global community, including the United States, must contribute financially to the full range of services that support those needs and address the barriers that prevent people from accessing care. Doing so is a smart investment, and also the right thing to do.