Gaps in sexual and reproductive health and rights (SRHR) take an enormous toll on individuals, communities and economies around the world. Closing these gaps requires a holistic approach that encompasses the right of all individuals to make decisions about their bodies—free of stigma, discrimination and coercion—and to have access to essential sexual and reproductive health services. The Guttmacher-Lancet Commission’s vision of universal access to SRHR is affordable, attainable and essential to the achievement of health, equitable development and human rights for all.

Sexual and reproductive health and rights are fundamental to people’s health and survival, to gender equality and to the well-being of humanity. Several decades of research have shown—and continue to show—the profound and measurable benefits of investing in sexual and reproductive health. And, through numerous international agreements, governments have committed to such investment. Yet weak political commitment, inadequate resources, persistent discrimination against women and girls, and an unwillingness to openly and comprehensively address issues related to sexuality have repeatedly stalled progress. Each year in developing countries:

• more than 200 million women want to avoid pregnancy but are not using modern methods of contraception
• more than 45 million women have inadequate or no antenatal care
• more than 30 million women do not deliver their babies in a health facility

Worldwide, each year:

• 25 million unsafe abortions take place
• over 350 million women and men need treatment for one of the four curable STIs
• there are nearly two million new HIV infections
• approximately 266,000 women die from cervical cancer

And at some point in their lives, nearly one in three women worldwide experience gender-based violence in the form of intimate partner violence or non-partner sexual violence.

Ultimately, almost everyone of reproductive age—some 4.3 billion people—will lack at least one essential sexual or reproductive health service over the course of their reproductive years.

The global community cannot continue to ignore or tolerate these gaps and failures—and we don’t have to. The rapid pace of technological change; momentum from the health, education, and economic gains of the last 20 years; and new, ambitious global development goals make progress in achieving sexual and reproductive health and rights—that is, health and human rights—possible for all.

We have the means and the knowledge to achieve universal SRHR. It is time to make SRHR a reality in people’s lives.

Meeting all needs for these services is affordable for most countries. For example, in developing regions, an estimated US$9 per capita annually would cover the total cost of fully meeting women’s needs for modern contraception and providing health services recommended by the World Health Organization to all pregnant women (including those who have miscarriages, stillbirths or abortions as well as live births) and to newborns.

And the investments would yield enormous returns. Evidence shows that access to sexual and reproductive health services saves lives, improves health and well-being, promotes gender equality, increases productivity and household income, and has multigenerational benefits by also improving children’s health and well-being. The most recent data show that fully meeting the need for modern contraception in developing regions and ensuring that pregnant women and their newborns receive essential care would result in the following declines from 2017 levels: 67 million fewer unintended pregnancies (75% decline), 2.2 million fewer newborn deaths (80% decline) and 224,000 fewer maternal deaths (73% decline). These benefits would pay dividends over many years and facilitate the achievement of other development goals.

Finally, the Commission recommends high-priority actions to be undertaken by national, regional and global policymakers, health practitioners, educators, and health and rights advocates. These recommendations are based on evidence and rooted in human rights, and address gaps in health services as well as social, cultural and economic barriers—including those that are gender-specific—that prevent people from fully achieving SRHR.

• Adopt and apply the report’s comprehensive definition of SRHR, with specific attention to sexual and reproductive rights
• Support changes in laws, policies, and social norms and structures that enable all people to understand, protect and fulfill their SRHR and to respect the rights of others
• Progressively expand access to the essential, integrated package of sexual and reproductive health interventions, ensuring that the needs of vulnerable and marginalized populations are addressed
• Secure sustainable domestic and international financing to achieve full access to the essential sexual and reproductive health package
• Take action on components of SRHR often neglected in program implementation, but which impact large numbers of people, including:
  • Provide access to safe abortion services and liberalize abortion laws where necessary
  • Ensure adolescents have access to sexual and reproductive health information and services without discrimination
  • Address sexual and gender-based violence through policies, services and prevention programs
  • Engage men to support women’s health, rights and autonomy and address the SRHR needs of men
• Provide additional support to groups often marginalized, disadvantaged and subject to discrimination:
  • Protect the SRHR of displaced and refugee populations and strengthen services in humanitarian settings
  • Acknowledge and address the SRHR needs of people of diverse sexual orientations, gender identities and expression, and sex characteristics
• Address evidence gaps and prioritize SRHR research needed for policy and program decision making
• Strengthen and use accountability processes at all levels to ensure that SRHR goals and commitments are realized

We have the knowledge and tools we need—in the form of global guidelines, protocols, technology and evidence of best practices—to ensure that all people receive confidential, respectful and high-quality sexual and reproductive health services. Many successful interventions have been piloted in low- and middle-income countries. Too often, however, these effective approaches are not implemented on a wide scale, are not integrated as part of a comprehensive approach to SRHR, or fail to reach vulnerable or marginalized groups.

To accelerate progress, governments and donors must adopt and advance a comprehensive SRHR agenda that benefits all people. Civil society groups and others who recognize the essential benefits of advancing SRHR must work across sectors and hold governments accountable to their commitments. A shared commitment to evidence-driven SRHR policy and programming—that improves health and upholds human rights—is essential to support the ability of all individuals to live secure, fulfilling lives and to achieve global development goals.