Sexual and reproductive health and rights, or SRHR, are fundamental to achieving gender equality, reducing poverty, and promoting sustainable development and economic prosperity. Even with this understanding, however, nearly half of the Organization for Economic Cooperation and Development’s Development Assistance Committee — a group of top donor countries that sets standards and tracks global aid — spent less than 2% of their official development assistance, or ODA, on SRHR in 2023, often despite support for progressive policies and commitments.
As SRHR services contend with cascading donor cuts and an increasingly fragile global political climate, the message from global health leaders at a recent virtual conference hosted by Devex in partnership with DSW was clear: The world is at risk of backsliding on decades of hard-won progress — unless action is taken now.
According to DSW’s latest Donors Delivering for SRHR report, donor investments in SRHR had already dropped by 27% between 2022 and 2023 — a $4 billion cut, largely from the U.S. and the EU. Although at least part of this decrease might be linked to the timing and spacing of larger contributions rather than actual, intentional cuts, it has since been exacerbated by recent, drastic reductions in funding. “No one anticipated the amount of disruption that we have seen since January,” said Carole Sekimpi, senior Africa director at MSI Reproductive Choices. “The times we’re facing are unprecedented.”
This is more than a budget issue; it’s a direct threat to access and lives. In countries such as Ethiopia and Zambia, national systems reliant on U.S. support were destabilized almost instantly, leaving massive service gaps. Speakers described front-line consequences, from shuttered clinics and laid-off health workers to surging stockouts of contraceptives and halted maternal health services. In video remarks, Natalia Kanem, executive director of the United Nations Population Fund, or UNFPA, warned listeners that the repercussions aren’t theoretical: “Gaps in funding mean that a displaced woman seeking contraception will find, after walking hours to a clinic, that the door is closed. Cuts mean that women will give birth alone without any skilled hands, putting their own life and the life of the newborn at risk. Cuts mean that survivors of gender-based violence who are seeking refuge are going to be turned away.”
To make matters worse, over the past few years, countries have been reporting less in terms of health data to the World Health Organization, creating a knowledge gap for funders and policymakers. In the words of Agnès Soucat, director of health and social protection at the French Development Agency: “We are in the dark — and we may not even be able to demonstrate this disruption of services with real data.”
For decades, SRHR programs in many low-income countries have been propped up by foreign assistance, particularly from the U.S. But Washington’s sudden aid pullback has underscored the fragility of that model. According to Almut Knop, head of the SRHR/social protection division at Germany’s Federal Ministry for Economic Cooperation and Development, “Donor money will never be enough to cover all the needs.”
While speakers agreed ODA is still critical to achieving development objectives, they emphasized a longer-term shift toward domestic ownership and financial sovereignty. “That investment case has been there for a long time,” said Samukeliso Dube, executive director at FP2030. “If you don't invest in reproductive health and rights, you will slow down [the] economic growth that you wanted for your country.”
But leaders also acknowledged that filling the funding gap requires more than national budgets. From philanthropy and social impact bonds to public-private partnerships and diaspora contributions, SRHR financing must diversify. In her closing remarks, Lisa Goerlitz, head of DSW’s Brussels office, said: “We need to face the reality that ODA is decreasing and perceived as a transactional tool, and we need to not only talk about alternative financing mechanisms… but also speed up the implementation.”
Across geographies, the SRHR agenda is facing not just budget cuts, but an orchestrated backlash. “We know there's going to be a lot of misinformation. We have experienced media attacks that have become more brutal, more sophisticated… We have seen a retrogression in the progress of reproductive health policies,” warned MSI’s Sekimpi. Countries are increasingly moving toward regressive SRHR frameworks — “sandwiched in language around family protection and preservation of the family,” Sekimpi noted — which makes coordination, solidarity, and effective communication more critical than ever.
Speakers also called for greater alignment among donors, stronger cross-regional alliances, and pragmatic language that resonates in challenging contexts — even if that means calling it “maternal health” in public and delivering full SRHR in practice. And, according to Jonathan Wittenberg, co-president and co-CEO of the Guttmacher Institute, there’s an opportunity to embed SRHR within broader universal health coverage frameworks: “There’s been a push for expanded access to primary health care, and some of the services that are most frequently sought by communities are SRHR care, such as family planning.”
Overall, speakers emphasized that the global community must act with urgency, unity, and creativity. “In this challenging environment of shifting aid, the landscape tells us we can’t abandon the world’s women and girls,” UNFPA’s Kanem remarked. “They need us now more than they ever have.”