Investing in Sexual and Reproductive Health in Middle Africa

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The Adding It Up study examines the need for, impact of and cost of fully investing in sexual and reproductive health care—services that together 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.

WHO: Women of reproductive age (15–49) in nine low- and middle-income countries (LMICs)* in Middle Africa in 2019
WHAT: Contraceptive services, maternal care, newborn care, abortion services and treatment for the major curable STIs

Unmet needs for services in Middle Africa

  • Among women who want to avoid a pregnancy, unmet need is slightly lower for adolescents aged 15–19 than for all women aged 15–49 (65% versus 67%).
  • Each year, 6.8 million women in Middle Africa give birth, and many do not receive needed care
    • 3.4 million make fewer than four antenatal care visits
    • 2.3 million do not deliver in a health facility
    • 1.3 million do not receive the care they need following a major obstetric complication
    • 960,000 have newborns who do not receive needed care for complications
  • Lack of high-quality sexual and reproductive health care puts women at risk.
    • 1.1 million have abortions in unsafe conditions
    • 35,000 die from causes related to pregnancy and childbirth
    • 5.7 million do not receive the treatment they need for chlamydia, gonorrhea, syphilis and trichomoniasis

Cost of meeting all service needs in Middle Africa

  • Every $1 spent on contraceptive services beyond the current level would save $3.66 in maternal, newborn and abortion care because contraception reduces the number of unintended pregnancies.

Impacts of expanding and improving services

Investing for the future

  • The interventions that make up the recommended care have proven feasible to implement in diverse settings around the world.
  • Investing in them provides national and local governments, the private sector and international development partners with good value for money.
  • By saving lives and improving women’s health and well-being, sexual and reproductive health care benefits individuals and families and contributes to countries’ social and economic development. Such care would also enable people to exercise their sexual and reproductive rights.


The information in this fact sheet can be found in Sully EA et al., Adding It Up: Investing in Sexual and Reproductive Health 2019, New York: Guttmacher Institute, 2020,


This fact sheet was made possible by UK Aid from the UK Government and grants from the Bill & Melinda Gates Foundation, The Children’s Investment Fund Foundation and the Dutch Ministry of Foreign Affairs. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the donors.