Who pays and what pays off in sexual and reproductive health? A review of the cost and cost-effectiveness of interventions and implications for future funding and markets.

This Series paper provides a summary of what is known about the funding, cost, and cost-effectiveness of sexual and reproductive health and rights interventions, interrogates the likely impacts of increasing or reducing future sexual and reproductive health and rights funding, and provides recommendations for policy and regulatory changes from an economic perspective. Interventions that target HIV and sexually transmitted infections, contraceptive interventions, and abortion care are among the most cost-effective health interventions worldwide, but their funding is under severe duress. In 2023, approximately US$35 billion was spent on these intervention areas across low-income and middle-income countries-only two-thirds of the $52 billion needed per year. HIV treatment and prevention, as well as contraceptive commodities, rely heavily on donor funding, which has decreased since 2017. The discontinuation of the US Agency for International Development funding in early 2025, in particular, requires that the most impacted countries will have to do more with much less going forward.