Investments in sexual and reproductive health and rights have profound and measurable benefits. Such investments not only promote health and well-being throughout people’s lives but also lead to improvements in gender equity, political stability, economic development and environmental sustainability.1
U.S. support for international family planning
Family planning is a fundamental component of comprehensive sexual and reproductive health care. The United States, through the U.S. Agency for International Development (USAID), plays a critical role in increasing access to voluntary family planning information, services and supplies in more than 30 countries where the need is greatest. USAID’s reproductive health portfolio includes efforts to end child marriage and gender-based violence and to integrate family planning with maternal and child health interventions and HIV programming. It also addresses other crosscutting factors that shape the sexual and reproductive health and rights of individuals, families and communities.
To complement its bilateral work, USAID collaborates closely with the United Nations Population Fund (UNFPA), a multilateral organization that focuses specifically on the delivery of family planning services and maternal and child health care in more than 150 countries and territories. The Trump-Pence administration withheld congressionally appropriated funds from UNFPA; the Biden-Harris administration restored funding to the organization, enabling it to continue its important work, including with marginalized populations and in humanitarian settings.
Benefits of current and increased investment
In federal fiscal year (FY) 2021, Congress appropriated $607.5 million in U.S. assistance for family planning and reproductive health programs overseas, including $32.5 million for UNFPA. The graphic below shows the benefits of this investment in terms of the estimated number of unintended pregnancies, unplanned births, unsafe abortions and maternal deaths currently being averted. It also shows the estimated benefits expected to accrue for every additional $10 million increase in funding.
If the United States were to increase its investment to $1.17 billion in FY 2022, the benefits would be notable. Compared with the current investment, the estimated number of unintended pregnancies averted would increase from 12 million to 22.5 million, and the number of maternal deaths prevented would increase from 19,000 to 36,000. This level of investment, recommended by the International Family Planning Coalition and other groups, represents the annual sum needed for the United States to move toward contributing its fair share to addressing family planning needs worldwide.2
Methodology and sources
Estimates of the impacts of current and increased investment were calculated by dividing family planning allocations to countries and regional offices for FY 2020 by estimated 2019 country-level per-user impacts, which come from the most recent comprehensive analysis of costs and impacts of family planning in low- and middle-income countries.3–5 Impacts per user were estimated as the difference between the annual number of events that would occur if all women wanting to avoid pregnancy used modern methods and the number that would occur if they relied on traditional or no methods.4
Country-level per-user costs were updated to 2020. Funding allocated to regional offices, rather than countries, was assigned cost and impact estimates based on the countries covered by that family planning funding. Estimates for UNFPA funding were based on information from USAID about how USAID’s Bureau for Global Health intended to distribute the $32.5 million appropriated for UNFPA in FY 2018.6
Just the Numbers estimates for 2021 are not directly comparable to prior iterations of this analysis. The estimates do not account for the impact that the Trump-Pence administration’s so-called global gag rule7 or the COVID-19 pandemic may have had on access to and provision of family planning services.
1. Starrs AM et al., Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission, Lancet, 2018, 39(110140):2642–2692, https://doi.org/10.1016/S0140-6736(18)30293-9.
2. PAI, Just the math: methodology for calculating the U.S. share of the cost of addressing the unmet need for contraception in developing countries, Washington Memo, 2018, https://pai.org/resources/just-math-methodology-calculating-u-s-share-co....
3. ForeignAssistance.gov, Download, budget and performance, budget planning data—all reporting agencies data set, Apr. 16, 2021, https://foreignassistance.gov.
4. Sully EA et al., Adding It Up: Investing in Sexual and Reproductive Health 2019, New York: Guttmacher Institute, 2020, https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-repro....
5. Riley T et al., Adding It Up: Investing in Sexual and Reproductive Health 2019—Methodology Report, New York: Guttmacher Institute, 2020, https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-repro....
6. U.S. Agency for International Development, personal communication, 2020.
7. Giorgio M et al., Investigating the early impact of the Trump Administration’s Global Gag Rule on sexual and reproductive health service delivery in Uganda, 2020, PLOS ONE, 15(4):e0231960, https://doi.org/10.1371/journal.pone.0231960.