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

February 17, 2026

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 53 low- and middle-income countries (LMICs) in Africa 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 Africa

Contraceptive use

In LMICs in Africa, 161 million women of reproductive age want to avoid a pregnancy. Out of this total, 97 million women are using modern contraception and 11 million rely on traditional methods.

The types of modern contraceptive methods currently used range widely:

68% of modern method users rely on short-acting methods
28% on long-acting reversible methods (18% using implants and 10% using IUDs)
4% on sterilization

Approximately 32 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.

Unmet contraceptive demand represents the most urgent need among women in Africa

Subregion	Women wanting to avoid pregnancy	Women with unmet demand for contraception	Traditional method users	Modern method users
Eastern Africa	58.4 million	11.4 million	3 million	38 million
Middle Africa	20.7 million	5.7 million	3.1 million	8 million
Northern Africa	28.9 million	4.4 million	1.7 million	20.6 million
Southern Africa	12.4 million	1.3 million	76,000	10.2 million
Western Africa	40.6 million	9.2 million	3.5 million	19.7 million

Unintended pregnancies

Each year, 29 million unintended pregnancies occur in LMICs in Africa, accounting for 43% of all pregnancies in the region. Among this total:

40% end in abortions
47% end in unplanned births
13% end in stillbirths and miscarriages

Needs for Sexual and Reproductive Health Services

In addition to unmet need for contraception, women in LMICs in Africa 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, 46 million women in Africa give birth, and many do not receive recommended care in accordance with World Health Organization guidelines:

20.6 million make fewer than four antenatal care visits
15.4 million do not give birth in a health facility
7.1 million do not receive necessary care after a major obstetric complication

Furthermore, each year in Africa:

3.5 million newborns do not receive necessary care for infections and other neonatal health problems
8.5 million women have unsafe abortions
181,000 women die from causes related to pregnancy, abortion and childbirth
50.6 million women do not receive the treatment they need for chlamydia, gonorrhea, syphilis and trichomoniasis

Each year, millions of pregnant women and newborns in low- and middle-income countries in Africa do not receive recommended care

	Eastern Africa	Middle Africa	Northern Africa	Southern Africa	Western Africa
Women having unsafe abortions	2.8 million	1.3 million	1.9 million	156,000	2.4 million
Women who die from maternal causes	39,600	33,200	5,800	1,900	100,600
Women who do not receive STI treatment	18.4 million	7 million	5.7 million	2.8 million	16.7 million

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 and unsafe abortions in Africa would drop by 45% 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 67%.
If all mothers and their newborns received recommended care, newborn deaths would drop by 70% and new HIV infections among babies six weeks and younger would drop by 87%.
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.

	Eastern Africa	Middle Africa	Northern Africa	Southern Africa	Western Africa
Unintended pregnancies	↓50%	↓41%	↓47%	↓39%	↓41%
Unsafe abortions	↓48%	↓40%	↓47%	↓39%	↓42%
Maternal deaths	↓64%	↓64%	↓52%	↓48%	↓70%
Newborn deaths	↓72%	↓70%	↓65%	↓70%	↓68%
HIV infections among babies	↓85%	↓92%	↓94%	↓66%	↓91%

The Investment Case for Meeting All SRH Needs in Africa

A package of SRH care that would meet all needs for women in Africa—unmet demand for contraception, all maternal and newborn care, abortion services and treatment for the four major curable STIs—would cost $54.6 billion annually. This includes $5.1 billion for all contraceptive care, $47.6 billion for pregnancy-related and newborn care, and $1.9 million for STI care.

The additional investment needed annually for sexual and reproductive health care in Africa totals $40.1 billion for five subregions

This $54.6 billion total represents an additional total annual investment of $40.1 billion, which corresponds to $26.83 per capita per year.

An additional $26.83 per capita annually in LMICs in Africa would meet all women’s needs for essential sexual and reproductive health services

		Eastern Africa	Middle Africa	Northern Africa	Southern Africa	Western Africa
Total cost		$13.3 billion	$12.7 billion	$10.5 billion	$3.5 billion	$14.7 billion
	Contraceptive services	$1.6 billion	$616 million	$946 million	$842 million	$1.1 billion
	Maternal and newborn care	$11.2 billion	$11.7 billion	$9.3 billion	$2.4 billion	$13 billion
	STI treatment	$500 million	$379 million	$268 million	$195 million	$517 million
Total increase needed		↑ $10.7 billion	↑ $10.5 billion	↑ $4.1 billion	↑ $2.5 billion	↑ $12.4 billion
Per capita increase needed		↑ $21.66	↑ $49.93	↑ $15.26	↑ $33.72	↑ $27.56

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 $1.7 billion to provide contraceptive care in LMICs across Africa, including $950 million in direct costs. To meet all unmet demand for contraceptive care in these countries, an additional $3.4 billion investment is needed.

		Eastern Africa	Middle Africa	Northern Africa	Southern Africa	Western Africa
Current costs – Total		$389.6	$115.5	$685.7	$238.5	$247.1
	Health worker salaries	$123.9	$49.3	$249	$112.3	$88.4
	Commodities, drugs and supplies	$130	$26	$56	$43.1	$72.5
	Programs and systems costs	$135.8	$40.3	$380.8	$83.1	$86.1
Costs to meet all unmet demand – Total		$1,585.2	$615.8	$945.8	$841.8	$1,126.4
	Health worker salaries	$159.7	$83.3	$328	$126	$126.3
	Commodities, drugs and supplies	$168.8	$44.3	$71	$48.4	$107.1
	Programs and systems costs	$1,256.8	$488.2	$546.7	$667.3	$893

Savings from Investing in Contraceptive Services

Every dollar spent on contraceptive services beyond the current level would save $2.49 in the cost of maternal, newborn and abortion care in LMICs in Africa because use of contraceptives reduces the number of unintended pregnancies. Savings vary across the region: Each dollar invested would save $2.29 in LMICs in Eastern Africa, $4.27 in Middle Africa, $5.86 in Northern Africa, $1.09 in Southern Africa and $1.60 in Western Africa.

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.

Immediate return:  For every $1 invested: • $2.49 saved regionally • $2.29 in Eastern Africa • $4.27 in Middle Africa • $5.86 in Northern Africa • $1.09 in Southern Africa • $1.60 in Western Africa Long-term benefits:   • More women in education   • Increased workforce participation     • Stronger national economies

Source

The information in this fact sheet can be found in the following sources.

Sully EA et al., Adding It Up 2024: Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries, New York: Guttmacher Institute, 2025, https://www.guttmacher.org/report/adding-it-up-2024-investing-sexual-and-reproductive-health-low-and-middle-income-countries.

Rosenberg JD et al., Adding It Up 2024: Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries—Methodology Report, New York: Guttmacher Institute, 2025, https://osf.io/hrw6f/.

Acknowledgments

Elizabeth A. Sully, Ana Dilaverakis Fernandez, Meltem Odabaș and Jessica D. Rosenberg. It was edited by Chris Olah.

This fact sheet was supported by the Children’s Investment Fund Foundation, Gates Foundation, Global Affairs Canada and the Norwegian Agency for Development Cooperation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the donors.