Meeting the Moment

The findings in this report suggest a straightforward agenda for the family planning community to rally around: 

Invest to ensure that funding levels match the size of the current and projected user base. The number of women of reproductive age has grown by 20% since 2012 and is continuing to rise. Countries and their donor partners need to develop long-range resource plans to ensure that family planning programs are appropriately funded for the foreseeable future. What level of expenditure is needed to serve a growing population, both today and in years to come? What additional expenditures are needed to expand and strengthen services in accordance with country goals? These projections should guide resource planning for countries, donors, and the global family planning sector.  

Invest to support and expand implant access throughout the world. Implants have proven hugely popular in Africa and may be one of the keys to achieving long-term improvements in contraceptive prevalence. But they remain expensive and must be subsidized by the international community. We need to maintain implant access where it already exists and expand access to regions and demographic groups that have been left behind.   

Invest in postpartum family planning (and other high impact practices). Postpartum family planning is a key intervention that has been proven to save the lives of mothers and newborns and increase the uptake of contraception. We need to close the gaps in the continuum of care and ensure that every mother receives prompt postnatal care with counseling on family planning that is tailored to her needs. Young or unmarried women should not be denied services, and the quality of care should be at the same level regardless of facility.  

Invest in gender-transformative approaches to family planning to shift norms and advance gender equality. This is long-range work and requires real commitment to social change, but it is essential if we are to achieve lasting progress in rights-based family planning. Gender-transformative programs and interventions are designed to actively challenge gender norms, address power inequities between men and women, and promote women’s empowerment — in everything from making decisions about their own reproductive lives to exercising political leadership in their communities.   

Adopting a gender-transformative lens also has implications for family planning metrics. Measurements of success must go beyond modern contraceptive prevalence to capture degrees of reproductive empowerment: the ability of individuals to make informed decisions about their reproductive lives and achieve their reproductive goals. From a technical standpoint this is a complex measurement challenge, but one on which FP2030 and other family planning data partners are already embarked (see Areas of Future Work).  

As the global push for gender equality gains strength, FP2030 affirms the central importance of rights-based, gender-transformative family planning. Contraception is fundamentally about bodily autonomy, and the movement to make modern contraceptive available to all people is part and parcel of the movement for human rights, dignity, and equality. FP2030 is committed to advocating, supporting, and implementing that agenda, and to developing better data tools that truly reflect the lived experiences of women and girls. 

The language throughout this report refers to women or women and girls, which should be understood to include women and girls of reproductive age (15-49). But not all individuals who become pregnant are women and girls; transgender men and nonbinary people can and do become pregnant. However, the data used in this report overwhelmingly come from surveys and studies that identify participants as women or girls, and to extend the conclusions from those data to include gender-diverse people could result in inaccuracies or even the erasure of concerns specific to sexual minorities (UNFPA, State of World Population 2022). Therefore, we calculate contraceptive use and measure contraceptive prevalence based on women and girls using these methods, while acknowledging that some users may identify as transgender men or nonbinary people. 

We also acknowledge that the data used in this report may not represent certain marginalized groups, such as people with disabilities, migrants, refugees, and ethnic minorities for whom data is not collected systematically through household surveys or other regular data systems. 

In addition, the data from countries with on-going crises may not reflect the impact of the crises on family planning services and contraceptive use.  

Data systems may not capture data for all groups nor for rapidly changing situations, but FP2030 is committed to advancing SRHR for all and looks for insights on challenges to access beyond just the data featured in this report.    

This year’s Measurement Report covers 85 countries: the 82 countries classified as low- or lower-middle income in 2020; new commitment makers Botswana and Namibia, both middle-income countries; and Jordan, which moved down into the lower-middle income category on the World Bank’s updated country list released in July 2023.³ We recognize that our current criteria for inclusion in the Measurement Report excludes a large number of countries in Asia and Latin America and the Caribbean, and we will continue to assess the geographic scope of the report over the coming years of the partnership.

In addition to reporting on more countries than ever before, this year’s Measurement Report — along with a new dashboard and data resources — provides more insights on contraceptive use, adolescent and youth sexual and reproductive health, and finance trends than any previous FP2030 Measurement Report. Based directly on feedback from FP2030 focal points, country monitoring and evaluation officers, and civil society and youth advocates, FP2030 continues to develop new resources and provide additional visibility into data. Specific changes in this year’s dataset include new detail on country governments’ domestic expenditures, including spend on staff, commodities, and other components of the family planning program. In addition, FP2030 is now publishing trend data on domestic expenditures starting with 2020. Each of these advancements is due to the work of Avenir Health’s Track20 Project on annual Family Planning Spending Assessments (FPSAs), which have used a consistent methodology and process to support governments to track their FP expenditures over the last several years.

Also new to this year’s report is a renewed focus on improving the reporting of family planning decision-making, which contributes to reporting for the SDG indicator 5.3.1 on gender and decision–making. This indicator is meant to capture the extent to which women are engaged in the decision to use or not use contraception. This year’s report reflects a change decided upon by FP2030’s PME Working Group, and moves from reporting on whether women made a decision alone or jointly with their husband, to separating out those women who report that they do in fact make the decision alone.

^{3. FP2030 reports progress for all countries that have ever been categorized as low-income or lower-middle income since 2020, based on the World Bank’s GNI per capita classification, as well as any upper-middle income country that makes an FP2030 commitment.}

Data and measurement advancement remain a critical aspect of FP2030’s strategy. In addition to improving data availability, we are also working to advance an FP2030 Measurement Agenda to address ongoing challenges: measuring quality of care (including clients’ experience of care), assessing autonomy and empowerment, capturing the influence of gender norms on family planning, and monitoring the scale-up of high impact practices.  

In 2024, in collaboration with partners such as the PME Working Group, the Momentum Knowledge Accelerator Project, Performance Monitoring for Action (PMA), Track20, and the Post-Partum and Post-Abortion Family Planning Steering Committee, we are embarking on a Measurement Advancement Convening Series. This series of consultations is designed to foster more inclusive participation in the global family planning measurement agenda, drawing particularly on country experts and stakeholders across Africa, Asia, and Latin America and the Caribbean. The goal is to develop a locally-driven program of action to identify priorities, resolve longstanding challenges, improve existing measures, and create new indicators.   

This year’s data also suggest that continued progress over the next several years is far from guaranteed. Warning signs are emerging that the road ahead will require more resources, sharper strategies, and deeper commitments:  

Population of contraceptive users outstripping funding. As we saw above, the population of women of reproductive age has increased by 20% since 2012, and the number of contraceptive users has grown by 92 million. Yet donor government financing is trending downward, and is now at its lowest level since 2015 (see Finance). Donor financing is an essential component of the total resource package for family planning, alongside domestic government expenditures and consumer spending. If donor aid continues to shrink, it could become difficult in some countries to maintain the existing base of contraceptive users and almost impossible to expand it.  

The stagnation in funding is especially problematic when it comes to donor-dependent methods like contraceptive implants. Implants are an important addition to the method mix, and should be made available to all potential users in every geographic region. But they are a relatively expensive method and donor subsidies are essential.  

Countries plateauing in their progress. During the COVID-19 pandemic national demographic and health surveys were postponed, but after the pandemic many of these surveys were resumed. Since 2021 we have had 12 new country surveys to analyze, revealing that progress in some countries appears to have  stalled. Honduras, Nigeria, Pakistan, and Tanzania are all examples of countries where MCP has plateaued or grown much more slowly than previously estimated. The reasons for this are different for each country, and may include a variety of factors: political challenges, funding issues, service or commodity problems, and entrenched gender norms that interfere with demand. (In some cases the reasons may be completely outside the purview of the family planning program; in Nepal, for example, MCP has barely budged since 2012, but Nepal is also experiencing significant male out-migration, so women have less need for contraception.) In any event, progress in expanding family planning is not assured without attention to the factors that may be constraining growth. 

Impending slow-downs in formerly low prevalence countries. The fast-growing countries that have moved from the bottom of the S-curve to the middle are beginning to approach levels where further gains may not be possible without a change in strategy. Most of these countries will need to invest in social behavior change and communication projects to address existing gender norms and limitations on women’s decision-making power. They will also need to scale up high impact practices such as post-pregnancy family planning (postpartum and post-abortion family planning), which have the potential to reach women and girls at some of the most critical points in their lives.  

East and Southern Africa (ESA) has the fastest-growing population in the world. The number of WRA (women of reproductive age) rose by 35% between 2012 and 2023 — from 102 million to 139 million. Almost four million women reached reproductive age just in the past year (from 2022 to 2023).

Countries in East and Southern Africa have been largely successful in adopting laws and policies to support family planning and SRHR. The Maputo Protocol has played a vital role in spurring domestic development of legal frameworks. Constitutions commonly include rights on accessing health, and both Rwanda and Zambia have adopted gender integration laws to shape government policies and programs.

Gender norms in the region are enforced by strong sanctions and influenced by religion, culture, and traditions. Most ESA countries face issues revolving around adolescent girls’ sexuality: child marriage, teen pregnancy, and female genital mutilation. Norms that regard men as “head of the household” limit women’s autonomy and contribute to restrictions on SRHR for unmarried women and adolescents, while economic discrimination and exclusion perpetuate the lack of access to healthcare. Notable progress in political representation has been made in some countries, but discrimination still stifles women’s leadership in government and health workforces.

Countries reviewed: Angola, Burundi, Comoros, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe

In 11 of the 14 countries we reviewed (all except Lesotho, Namibia, and Zimbabwe), MCP is low in the early postpartum period, which in this study we define as within 1 month of delivery. The risk of a pregnancy is low in this period because most women are postpartum insusceptible, meaning that they are either abstaining from sex or amenorrheic (not menstruating). Postpartum insusceptibility declines over time, but most women in ESA are still not at risk of a pregnancy at 6 months postpartum. But by 12 months postpartum, women in all countries except Angola, Burundi, Ethiopia, Malawi, and Rwanda have become susceptible to a pregnancy.

In all countries, MCP starts to increase as time since delivery increases. MCP at 1 month postpartum is highest in Zimbabwe at 48.3%, followed by Lesotho at 34.1% and Namibia at 22.1%. These are also countries with high MCP overall.

The World Health Organization recommends that births be spaced at least 24 months apart. In all 14 countries we reviewed, more than 10% of births are too closely spaced, falling within two years of a previous birth. And in five countries (Angola, Comoros, Ethiopia, Madagascar, and Uganda), more than 20% of births are too closely spaced. Closely spaced births are particularly high in Comoros, where nearly a third (30%) of pregnancies occur within a two-year interval. Very short birth intervals of 7-17 months — which are the riskiest — are not common in the region, although around 1 in 10 births in Angola, Comoros, and Madagascar do fall within this very close interval.

Facility Type: In all countries, women who delivered at home have the lowest MCP at all timepoints in the postpartum period. In some countries (Ethiopia, Kenya, Namibia, Rwanda, and Zimbabwe), the gap in MCP between women who delivered at home versus a facility (either private or public) is particularly wide and continues to widen until 12 months postpartum. By 12 months postpartum, the gap in use is at least 20 percentage points. This highlights the need for community-based distribution of contraceptives, with health workers who are trained in postpartum family planning and prepared to provide prompt, appropriate counseling and services.

Age of Mother at Most Recent Birth: In most of the countries we reviewed, postpartum MCP was lowest among the oldest mothers (those aged 35-49). Modern contraceptive use was broadly similar for mothers in the <20 age group and the 20-34 age group. In three countries — Burundi, Ethiopia, and Madagascar — MCP at 6 months postpartum was highest among the youngest mothers (those under age 20).

Marital Status of Mother at First Birth: In 7 of the 14 countries we reviewed (Comoros, Ethiopia, Kenya, Lesotho, Madagascar, Namibia, and Zambia) there is no real difference in postpartum contraceptive use among women who had their first child within marriage or outside of marriage. In Angola, Burundi, Rwanda, Tanzania, and Uganda, women whose first births were outside of marriage had higher modern contraceptive use at 6 months postpartum. Conversely, in Malawi and Zimbabwe, women whose first births were within marriage had higher modern contraceptive use at 6 months postpartum.

Ensure all mothers receive timely postnatal care. A significant percentage of women in every country we analyzed received their one and only postpartum check either 41+ days after delivery or not at all. This includes more than 80% of postpartum women in Ethiopia; more than 60% of postpartum women in Angola and Tanzania; more than 40% of women in Malawi, Burundi, Uganda, and Madagascar; and more than 20% of women in Zimbabwe, Rwanda, Zambia, and Kenya. Only in three countries — Kenya, Rwanda, and Zambia — do the majority of women receive their postnatal checks within 4 hours of delivery.

Strive to provide postnatal checks as soon after delivery as possible. In all countries, current MCP is higher for women who received their postnatal checks within 4 hours of delivery compared to women who received their postnatal checks at 41+days or never. The contrast is most pronounced for women in Angola (19.8% vs. 5.2%) and Ethiopia (45.5% vs. 25%). In some public health facilities women are discharged 12-24 hours after delivery, and they may not return for early postnatal checks unless there is a problem. Hence the importance of providing immediate postpartum care, including family planning counseling and options, while women are still in the facility.11

Ensure that postnatal checks include counseling on family planning that is tailored to the woman’s specific needs by age and marital status; young or unmarried women should not be denied services. While detailed information on the content of postnatal checks is scarce, the data we do have suggest that counseling on family planning may be missing in many encounters. In the latest household survey from Kenya (DHS 2022), which included questions on postnatal care, only 29% of postpartum women reported being counseled on family planning. In the most recent Service Provision Assessment from Tanzania (SPA 2014-2015), only 35% of antenatal care check-ups included information about postpartum family planning, while in Malawi’s most recent survey (SPA 2013-2014), only 12% of antenatal checks included this information.12

11. Oona M. R. Campbell et al., “Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys,” PLoS Medicine 13, no. 3 (March 2016): e1001972, doi:10.1371/journal.pmed.1001972.

12. See Tanzania SPA, 2014-15 and Malawi SPA, 2013-14 on the DHS website.

Central and West Africa have the highest fertility rates in the world, and Central Africa has the world’s youngest population, with half of its inhabitants aged 16 or under. Across the North, West, and Central Africa (NWCA) region as a whole, the population of WRA grew by 31% between 2012 and 2023: from 164 million to 216 million. Around 5.5 million women reached reproductive age just in the past year (from 2022 to 2023). 

The GESI Assessment in this region focused on five countries: Benin, Burkina Faso, Côte d’Ivoire, Liberia, and Nigeria. The Maputo Protocol has been ratified in each country, and SRHR is guaranteed by law in every country except Côte d’Ivoire. The three Francophone countries are members of the Ouagadougou Partnership, which has galvanized the movement for family planning in West Africa. Liberia and Nigeria have also made political progress: Liberia has been a leader in inter-ministerial cooperation on gender and family planning, and in Nigeria the participation of civil society has led to an exceptionally strong national gender policy. But political battles over costs mean that family planning is not included in every country’s Universal Health Coverage plan.  

Countries reviewed: Benin, Burkina Faso, Côte d’Ivoire, Egypt, Gambia, Ghana, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone

Throughout the region, postpartum use of modern contraception is extremely low in the early postpartum period; in most countries MCP at 1 month postpartum is 10% or lower. Postpartum insusceptibility is correspondingly high: 85% or higher at 3 months postpartum in every country except Egypt, where it’s 57%. At that point insusceptibility begins to decline steeply, and by 9 months postpartum, at least a third or more women are susceptible to a pregnancy. And by 12 months, a majority of postpartum women in all countries (except Guinea, Niger, Senegal, and Sierra Leone) are susceptible.

In all 14 countries of our study, more than 10% of births occurred within 24 months of a previous birth — closer than the WHO recommended spacing. In five countries (Cameroon, Mali, Mauritania, Niger, and Nigeria) the figure rises to 20%: one in five births are too closely spaced.

Facility Type: Women who deliver at home have the lowest modern contraceptive uptake in the postpartum period. The gap is widest in Senegal, where more than 1 in 4 women who deliver in a facility (public or private) are using a modern method at 3 months postpartum, while only around 1 in 10 women who delivered at home are using a modern method at that point. In six countries (Gambia, Mali, Mauritania, Niger, Nigeria, and Senegal) there is also a notable difference based on the type of facility, with MCP higher among women who delivered in a private facility rather than public. The difference is largest in Senegal: at 6 months postpartum, 55.1% of women who delivered in a private facility are using a modern method, compared to 35.2% of women who delivered in a public facility. The difference between public and private facilities in modern contraceptive uptake is more variable in NWCA than in ESA or Asia, with especially sharp differentials in Niger and Senegal.

Age of Mother at Most Recent Birth: In Benin, Gambia, Niger, Nigeria, and Senegal, the youngest mothers (those under age 20) are the least likely to be using modern methods at 6 and 12 months postpartum. The largest gaps in use between younger and older mothers are in Senegal and Nigeria. In Nigeria, only 5% of mothers in the <20 age group are using modern contraception at 6 months postpartum, compared to 11% of mothers aged 20-34. In Senegal, 21% of mothers in the <20 age group are using modern contraception at 6 months, compared to 34% of mothers aged 20-34. These gaps persist throughout the postpartum period. A different pattern obtains in Burkina Faso, Guinea, Liberia, Mali, Mauritania, and Sierra Leone, where the oldest mothers (those aged 35-49) have the lowest postpartum use of modern contraception.

Marital Status of Mother at First Birth: In all countries except Niger and Egypt, modern contraceptive use is higher among women who had their first child outside of marriage. This is especially pronounced in Mali. In Niger and Egypt, on the other hand, women whose first births were outside of marriage are less likely to use modern contraceptive methods in the postpartum period.

Identify and reach those women and girls who are not receiving postnatal care. Unlike the ESA region, in NWCA at least one-third of all postpartum women in all countries receive a postnatal check within 4 hours of delivery. This rises to more than 50% of women in Benin, Burkina Faso, Cote d’Ivoire, Gambia, Mali, Liberia, Senegal, and Sierra Leone. Conversely, more than half of postpartum women in Nigeria and Mauritania do not receive a postnatal check until 41+ days after delivery or never. Countries in the region should capitalize on their already-strong postnatal programs to identify why some women and girls are being left behind and develop tailored strategies to ensure they receive postnatal care.

Strive to provide postnatal checks as soon after delivery as possible. In all countries, current MCP is higher for women who received their postnatal checks within 4 hours of delivery compared to women who received their postnatal checks at 41+days or never. The contrast is most pronounced for women in Burkina Faso (35.8% vs. 27.8%) and Senegal (29.7% vs. 12.8%). Senegal also had the widest gaps between modern contraceptive use uptake between women who delivered at home versus in a facility.

Ensure that postnatal checks include counseling on birth spacing and family planning. Young or unmarried women should not be denied services. In the most recent Service Provision Assessment from the Democratic Republic of Congo (SPA 2017-2018), only 11% of antenatal consultations included information about postpartum family planning.¹³ This is the only relatively recent survey from the region.

13. See Congo Democratic Republic SPA, 2017-18.

The Asia and Pacific (AP) region has the largest population in the world, but it is not growing as fast as the population of Sub-Saharan Africa. Nevertheless, the sheer size of the region’s population means that small percentage increases translate into very large absolute numbers. Between 2012 and 2023, AP added 40,000,000 million women of reproductive age. The fertility rate for the region as a whole is 1.9  —which is below replacement level.  

Countries reviewed: Afghanistan, Bangladesh, Cambodia, India, Indonesia, Jordan, Kyrgyz Republic, Myanmar, Nepal, Philippines, Pakistan, Tajikistan, Timor-Leste, Yemen

In most of the countries we reviewed, MCP is low in the early postpartum period (within 1 month of delivery); this is also when women’s risk of pregnancy is low due to postpartum insusceptibility. MCP increases in all countries as time since delivery increases. MCP use at 1 month postpartum was above 20% in Indonesia, Jordan, Philippines, and Yemen. MCP at 1 month is highest in Jordan at 33.7%, which could indicate immediate postpartum use since IUDS are the most common method in that country.

Close birth spacing is an issue in the region, particularly in eight countries: in India, Jordan, Kyrgyz Republic, and Timor-Leste, more than 20% of women give birth within two years of a previous birth, and in Afghanistan, Pakistan, Tajikistan, and Yemen, the figure is 30% or higher. In fact, 1 in 10 women in these eight countries give birth in very short birth intervals: only 7 to 17 months since the previous birth.

14. There is no data from Yemen on postpartum insusceptibility; the survey only asked about postpartum amenorrhea and not postpartum abstaining.

Facility Type: In all countries, women who deliver at home rather than in a facility (public or private) have the lowest MCP, although the gaps are not wide as they are in the ESA or NWCA regions. Furthermore, in all countries we reviewed (except Afghanistan), by 12 months postpartum there is no significant difference in MCP among women who delivered in a public facility versus a private facility. In Afghanistan there is about a 10 percentage point difference between women who delivered in a private facility versus a public facility (42.3% vs. 31.2%, respectively).

Age of Mother at Most Recent Birth: In seven countries — Afghanistan, India, Jordan, Kyrgyz Republic, Nepal, Pakistan, and Tajikistan — modern contraceptive uptake is lowest among the youngest mothers (under age 20). In two countries, Kyrgyz Republic and Tajikistan, the MCP gap between the youngest mothers and those aged 20-34 or 35-49 actually widens over time. The situation is reversed in Cambodia and Indonesia, where postpartum contraceptive uptake is lowest among the oldest mothers (those aged 35-49) and highest among the youngest (those under age 20).

Marital Status of Mother at First Birth: In five of nine countries¹⁵ analyzed — Afghanistan, Cambodia, Jordan, Philippines, and Yemen — postpartum uptake of modern contraceptives is higher among women who had their first child outside of marriage. The difference is largest in Cambodia, where the gap is more than 10 percentage points at 12 months postpartum. Conversely, Indonesia and Myanmar are two countries where modern contraceptive use uptake is higher among women who had their first birth within marriage.

^{15. Only nine countries had sufficient sample births outside of marriage for this analysis: Afghanistan, Cambodia, India, Indonesia, Jordan, Myanmar, Philippines, Timor-Leste, and Yemen.}

Shore up any gaps in timely postnatal care. In stark contrast to ESA and NWCA, the AP region has a strong record on prompt postnatal care. In eight of the 11 countries with data on timing (Bangladesh, Cambodia, India, Indonesia, Jordan, Nepal, Pakistan, and Tajikistan), more than half of mothers receive a postnatal check within 4 hours of delivery.¹⁶ The chief outlier is Timor-Leste, where the majority of women do not receive a postnatal check until 41+ days after delivery or never. This is also the case for more than 20% of women in Myanmar, Nepal, and Pakistan.

Take advantage of the immediate postpartum window to offer contraception. In 10 of the 11 countries with data on timing (except Cambodia), current modern contraceptive use is higher for women who received their postnatal checks within 4 hours of delivery compared to women who received their postnatal checks at 41+ days or never. The contrast is most pronounced for women in Myanmar (63% vs. 46.4%) and the Philippines (51.7% vs. 36.3%). There is no difference in Cambodia.

Ensure that postnatal checks include counseling on birth spacing and family planning. Young or unmarried women should not be denied services. The latest DHS surveys in Cambodia, Nepal, and the Philippines include questions about the content of postnatal checks. The majority of women in Cambodia and the Philippines received information on family planning during their postnatal checks, but only about a quarter of women (25.4%) in Nepal received this information. The most recent Service Provision Assessment from Nepal (SPA 2021) shows a similar percentage, with 23.6% of postpartum women being counseled on family planning and 3.6% adopting a method. The youngest mothers in Nepal (those under age 20) are less likely to be counseled on family planning than older mothers (aged 20-49). Very few consultations (1% or less) included discussion of newborn care, breastfeeding practices, infant vaccinations, or family planning.¹⁷

^{16. Afghanistan, Kyrgyz Republic, and Yemen did not have data on the timing of postnatal checks.}

^{17. See Nepal SPA, 2021.}

Modern contraceptive use in the LAC region is high — higher than in most regions in Africa or Asia and Pacific. Estimates suggest that more than 70% of married women and more than 55% of all women were using modern contraception in 2023. Little recent data on sexual and reproductive health, however, are available for the region. Only five LAC countries have conducted a household survey with women of reproductive age since 2014 (Belize, Bolivia, El Salvador, Haiti, and Honduras), so few in-depth insights on the last decade of progress are available at national and subnational levels or with historically marginalized populations such as indigenous peoples and Afro-descendants. Some indicators do however suggest remaining SRHR challenges in the region.

While in much of the world the availability of newer contraceptive methods has resulted in shifts to long-acting reversible contraceptives, most LAC countries reported little use of these methods in their last reproductive health surveys.¹⁸ In three of the five LAC countries with surveys since 2015 — Belize, El Salvador, and Honduras — female sterilization was the most common method. Injectables were the most common method in Bolivia and Haiti, and the second-most common method in Belize, El Salvador, and Honduras. Implants and IUDs, which are widely used throughout Africa and Asia, have not emerged as commonly used methods in the LAC region. Usage of long-acting reversible contraceptives is low among the entire population, but appears to be lowest among poor, rural, uneducated, young, and indigenous women.

Another challenge in the LAC region is the high adolescent birth rate. The adolescent birth rate in the region is 53 births/1000 women aged 15-19, and is particularly high across most countries in Central and South America. What stands out in the LAC region is that the adolescent birth rate is higher than in comparable upper-middle income countries in other regions, and higher than in countries and regions with similarly high levels of contraceptive use. These differences may suggest barriers to young people’s SRHR, but again little in-depth data is available from recent surveys.

In order to better understand possible barriers to expanded method availability and meet the needs of young people and other populations, FP2020 will work with data partners to shine a light on the issues that hamper data collection and analysis. More broadly, FP2030’s work in the region will focus on calling attention to the remaining challenges, strengthening our engagement with civil society organizations and youth-led organizations, and gaining commitments from governments, donors, and technical partners to this unfinished agenda.

^{18. Rodolfo Gomez Ponce de Leon et al., “Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries,” The Lancet Global Health 7, no. 2 (2019): e227-e235, doi:10.1016/S2214-109X(18)30481-9.}

Domestic governments spent an estimated US$1.68 billion on family planning in 2022. Domestic expenditures are defined as all government expenditures that support family planning, including commodity purchases, demand creation campaigns, investments in training and research, and service delivery.

This is our sixth year of reporting domestic expenditures at the country level, with the number of countries for which estimates are available increasing each year. This year’s table includes estimates for 61 low- and lower-middle income countries, amounting to US$1.6 billion in spending. The largest amounts are reported by populous countries in Asia that fund much of their own program. India, the Philippines, Indonesia, Bangladesh and Pakistan together account for about 76% of the total. Government expenditure per modern method user ranges from nearly zero to US$50, with an average of US$5 per user. Reporting countries account for 95% of modern method users in all low-income and lower middle-income countries. Adjusting for the missing countries raises the estimated domestic government expenditures to US$1.68 billion.

The latest estimate of expenditures is 3% lower than reported last year. This should not be interpreted as a trend, however, since the data set has changed each year and there are large fluctuations in country spending. The new estimate adds four countries (Cambodia, Eswatini, Palestine, and Tunisia) totaling nearly US$39 million, but there were large declines in spending in Bangladesh (from US$230 million to US$187 million) and Indonesia (from US$355 million to US$251 million) that were only partially offset by increases in Pakistan (US$130 million to US$171 million) and the Philippines (US$260 million to US$294 million).

In many countries government spending on family planning is decentralized, with some amounts coming from national budgets and some from sub-national government bodies. Thus there is interest in understanding how decentralized government entities—such as provinces, states, local government administrations/units and municipal governments, districts, and even facilities—might increase their funding for health programs and for family planning. Since 2017, Track20 has attempted to estimate the contribution of decentralized funding to total domestic funding as part of its Family Planning Spending Assessments (FPSAs). In that year Kenya reported decentralized funding from its 47 counties for 2014-2015.

Table 8 lists the most recent data (from 2021 and 2022) for countries whose FPSA showed decentralized funding. The results indicate various levels of decentralized funding compared to central government funding. In Pakistan the ratio of decentralized funding is very high, with 98% of total FP expenditures coming from the provinces. In Kenya, the counties accounted for 85% of total family planning expenditures. The Philippines data show that decentralized funding amounted to 68% of total family planning expenditures, with the majority coming from Local Government Entities.

While the number of countries showing decentralized funding is relatively small (compared to the yearly average of 42 countries for which FPSAs were conducted in 2021 and 2022), there are at least three factors at work:

The funding amounts are often small and hard to capture.
In some countries, such as India, we know that significant funding is provided by subnational governments, but it is difficult to separate family planning from other health expenditures.
In many countries, potential sources of decentralized funding are not invested in health/FP and contribute to other government sectors instead.
Discussions in Francophone West Africa by Track20 staff revealed that many managers did not know if decentralized funding existed in their countries. Track20 is currently working with Nigeria to include the expenditures financed by the 37 Nigerian States.

See the Technical Appendix for methodologies.

Consumers spent an estimated US$710 million on family planning in 2022. This figure is based on the Landscape & Projection of Reproductive Health Supply Needs (LEAP) Report, produced by the Reproductive Health Supplies Coalition and Avenir Health. The LEAP Report estimates out-of-pocket expenditures on contraceptives based on the number of modern method users (from Track20 and the UN Population Division), method mix, price points, and the percentage of users obtaining services from the private sector (from DHS, MICS, and other national surveys).

Family planning totals include bilateral funding as well as an FP-adjusted share of donor government contributions to UNFPA’s core resources. Bilateral funding represents amounts specifically designated by donor governments for family planning as defined by the OECD DAC and includes standalone family planning projects, family planning-specific contributions to multilateral organizations (e.g., contributions to UNFPA Supplies), and, in some cases, projects that include family planning within broader reproductive health activities.

UNFPA’s core resources are meant to be used for both programmatic activities (family planning, population and development, HIV/AIDS, gender, and sexual and reproductive health and rights) as well as operational support. Donor government contributions to UNFPA’s core resources were adjusted to reflect the share of core resources supporting FP activities in a given year based on information from UNFPA. For instance, in 2022 UNFPA reported expenditures totaling US$532 million from core resources, including US$63 million for family planning activities, which results in an estimated 12% of a donor government’s core contribution in 2022 being included in its total funding for FP.²³

With some exceptions, data represent “disbursements,” which are defined as the actual release of funds to, or the purchase of goods or services for, a recipient. They were obtained through direct communication with donor governments, analysis of raw primary data, and the OECD CRS. UNFPA funding data were obtained from Executive Board documents and direct communications.

For the US, funding represents final, Congressional appropriations (firm commitments that will be spent), rather than disbursements, which can fluctuate from year-to-year due to the unique nature of the US budget process (unlike most other donors, US foreign assistance funding may be disbursed over a multi-year period).

In some cases it is difficult to disaggregate bilateral family planning funding from broader population, reproductive and maternal health totals, and the two are sometimes represented as integrated totals. In addition, family-planning-related activities funded in the context of other official development assistance sectors (e.g., humanitarian assistance, education, civil society) have remained largely unidentified. For the purpose of this analysis, we worked closely with the largest donors to family planning to identify such cross-sectoral family-planning-specific funding where possible (see table notes).

Funding data are collected from donor governments in their currency of origin and converted to US dollars using exchange rate data from the OECD DAC and US Federal Reserve. Exchange rates for 2022 were applied to 2021 totals to assess the effect of currency fluctuations on overall funding levels between 2021-2022. Totals have not been adjusted for inflation. For data in the currency of the donor country, please contact the researchers.

^{23. In 2022, UNFPA spent approximately US$342 million (28% of UNFPA’s total programme expenses) on family planning activities (US$63 million from core resources and US$279 million from non-core resources). The total amount provided by UNFPA in 2022 includes funding exclusively designated for family-planning-specific activities, including enabling environments, provision of contraceptives and related supplies, and family planning systems strengthening. In contrast to previous years, this total excludes funding allocated to activities with an indirect impact on family planning outcomes.}

WHO/SHA. WHO has been implementing data collection on health expenditures under the System of Health Accounts (SHA) 2011 for several years as part of a joint effort with the Organization for Economic Co-operation and Development (OECD) and Eurostat. Government approved estimates are published on the WHO Global Health Expenditure Database. These data include directly measured expenditures by year, when available, or estimates based on trends from measurements in previous years.

FPSA (Family Planning Spending Assessment). Track20 collects data on FP expenditures in low- and middle-income countries using a modified version of the National HIV/AIDS Spending Assessment (NASA) that focuses strictly on family planning. These analyses collect information from the main funders and implementing organizations to describe sources and uses of funds. Results are disseminated to governments and other stakeholders. The FPSA methods were first tested in Kenya with 2017 data and have now been extended to 48 countries with estimates of FP expenditures from government.

UNFPA. UNFPA and NIDI (Netherlands Interdisciplinary Demographic Institute) tracked domestic government expenditures for family planning from 2014 to 2019. NIDI worked with national UNFPA offices to engage local consultants to review records and interview government officials. Results were checked for completeness and quality by NIDI. Final results were approved for release by the organizations contributing data and, in most cases, by appropriate government agencies.