Adding It Up 2024: Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries in Asia

The Adding It Up study examines the need for, impact of and cost of fully investing in sexual and reproductive health (SRH) care—services that ensure people can decide whether and when to have children, experience safe pregnancy and delivery, have healthy newborns, and have a safe and satisfying sexual life.

Access to comprehensive sexual and reproductive health services is recognized as a fundamental human right, essential for achieving gender equality and enabling individuals to make autonomous decisions about their own bodies, health and futures. Realizing this right for all women, especially those facing systemic barriers, upholds human dignity and advances equity across communities.

WHO IS AFFECTED: Women of reproductive age (15–49) in 36 low- and middle-income countries (LMICs) in Asia in 2024

WHAT IT COVERS: Contraceptive services, maternal care, newborn care, abortion services and treatment for the major curable STIs

WHAT’S NEW IN 2024: The latest edition of Adding It Up offers a more person-centered approach to contraceptive need than previous studies by providing estimates of women who would like to avoid a pregnancy, are not currently using a contraceptive method, and intend to use contraception in the future or are open to future use. This definition, called “unmet demand,” offers the most strategic starting point for prioritizing limited resources and focuses on women’s own expressed preferences for contraceptive use.

All cost estimates and savings are calculated in 2024 US dollars.

Current Use of Contraception and Pregnancy Outcomes in Asia

Contraceptive use

In LMICs in Asia, 648 million women of reproductive age want to avoid a pregnancy. Out of this total, 519 million women are using modern contraception and 57 million rely on traditional methods.

The types of modern contraceptive methods currently used range widely:

• 42% of modern method users rely on short-acting methods
• 22% on long-acting reversible methods
• 36% on sterilization

Approximately 36 million women have an unmet demand for contraception, meaning they want to avoid pregnancy and have expressed interest in using modern contraception, but are not currently doing so.

Unintended pregnancies

Each year, 57 million unintended pregnancies occur in LMICs in Asia, accounting for 47% of all pregnancies in the region. Among this total:

• 72% end in abortions
• 17% end in unplanned births
• 11% end in stillbirths and miscarriages

Needs for Sexual and Reproductive Health Services

In addition to unmet need for contraception, women in LMICs in Asia have a range of other sexual and reproductive health needs that are not being fully met. Insufficient access to maternal and newborn health care puts women and infants at risk.

Each year, 63 million women in Asia give birth, and many do not receive recommended care in accordance with World Health Organization guidelines:

• 22 million make fewer than four antenatal care visits
• 9.6 million do not give birth in a health facility
• 5.5 million do not receive necessary care after a major obstetric complication

Furthermore, each year in Asia:

• 2.1 million newborns do not receive necessary care for infections and other neonatal health problems
• 21.3 million women have unsafe abortions
• 58,300 women die from causes related to pregnancy, abortion and childbirth
• 70.2 million women do not receive the treatment they need for chlamydia, gonorrhea, syphilis and trichomoniasis

Impact of Expanded and Improved SRH Services

Meeting contraceptive need yields enormous benefits for women’s health. Those benefits are multiplied when combined with meeting their needs for care during pregnancy and childbirth, as well as the needs of their newborns.

• Unintended pregnancies in Asia would drop by 26% and unsafe abortions by 25% if all women with an unmet demand used modern contraception and all pregnant women received care that meets international standards. By meeting all SRH care needs, maternal deaths would drop by 65%.
• If all mothers and their newborns received recommended care, newborn deaths would drop by 62% and new HIV infections among babies six weeks and younger would drop by 93%.
• Cases of infertility-causing pelvic inflammatory disease from untreated chlamydia or gonorrhea would be eliminated if all women infected with these two STIs were given effective and timely treatment.

The Investment Case for Meeting All SRH Needs in Asia

A package of SRH care that would meet all needs for women in Asia—unmet demand for contraception, all maternal and newborn care, abortion services and treatment for the four major curable STIs—would cost $39 billion annually. This includes $6 billion for all contraceptive care, $31.7 billion for pregnancy-related and newborn care, and $1.2 billion for STI care.

This $38.8 billion total represents a $12.4 billion annual increase. It is equivalent to a $2.74 increase per capita annually.

With an investment in a comprehensive package of SRH services:

• all women of reproductive age would receive the pregnancy-related and STI care that they need;
• all newborns would receive essential care just after birth; and
• all women would receive the contraceptive services they need to decide whether and when to have children.

These gains would reduce the substantial health system costs in LMICs and provide a high return on investment. In addition, the interventions in this package of services have proven to be feasible to implement in different settings around the world.

The total cost of SRH care decreases when more women who want to use contraception are able to do so. The decrease in unintended pregnancies that would result from an increase in contraceptive use means large reductions in the need for services such as abortion and postabortion care, antenatal and delivery care, and neonatal care.

Achieving this vision requires addressing a critical funding challenge for contraceptive care needs. It currently costs $5 billion to provide contraceptive care in LMICs across Asia, including $2.6 billion in direct costs. To meet all unmet demand for contraceptive care in these countries, an additional $932 million investment is needed.

Savings from Investing in Contraceptive Services

Every dollar spent on contraceptive services beyond the current level would save $1.97 in the cost of maternal, newborn and abortion care in LMICs in Asia because use of contraceptives reduces the number of unintended pregnancies. Savings vary across the region: Each dollar invested would save $0.75 in LMICs in Eastern Asia, $2.23 in Central Asia, $2.51 in Southern Asia, $1.44 in Southeast Asia and $3.16 in Western Asia.

Enabling women to have children when they want them and to deliver healthy newborns safely also boosts national economies as women gain greater access to education and participate more fully in the workforce.