Putting rights, choices and investment at the heart of bodily autonomy and sexual health

Shobha Shukla *

Bodily autonomy and sexual health are often framed as matters of individual health, personal choice and human rights. But the latest evidence from the Adding It Up 2024 report by Guttmacher Institute shows that meeting sexual and reproductive health needs is not merely a health expenditure—it is a smart investment that can save lives, reduce unintended pregnancies and generate significant economic returns.

Main findings of this report that were presented by Dr Elizabeth A Sully, Guttmacher Institute’s Director of International Research, during a SHE & Rights session organised ahead of World Contraception Day and International Safe Abortion Day, examine the need, impact, and cost of investing in sexual and reproductive healthcare across 128 low- and middle-income countries: 36 countries from Asia, 53 countries from Africa, 23 countries from Latin America and Caribbean and 8 countries each from Europe and Oceania regions.

In low- and middle-income countries across Asian and African regions, millions of women face significant unmet demands for modern contraception, leading to high rates of unintended pregnancies and maternal mortality. Fully funding comprehensive sexual and reproductive health care would dramatically reduce maternal deaths and unsafe abortions. SHE & Rights was organised by the Global Center for Health Diplomacy and Inclusion (CeHDI), Guttmacher Institute, Asian Pacific Resource and Research Centre for Women (ARROW), International Planned Parenthood Federation (IPPF), CNS and partners.

From unmet need to unmet demand

One of the report's notable features is to rethink how contraceptive need is measured.

In Asia, approximately 129 million women of reproductive age are classified as having an unmet need for modern contraception. But this number includes women using traditional methods who may be satisfied with them and may not want to switch.

Guttmacher Institute therefore uses the term unmet demand to identify women who want to avoid pregnancy, are not currently using contraception and express an openness to using family planning in the future.

A rights-based approach to family planning should not be about persuading people to adopt particular methods. Rather it should be about ensuring that people who want to prevent pregnancy can exercise that choice and access services they need.

By this measure, an estimated 36 million women in low- and middle-income countries in Asia have an unmet demand for contraceptive care.

Almost half of all pregnancies in Asia were unintended

Every year, the region experiences approximately 57 million unintended pregnancies, representing 47% of all pregnancies. Guttmacher Institute's analysis reports that 72% of them end in abortions, 17% in unplanned births and 11% in stillbirths and miscarriages.

Meeting all the sexual and reproductive health needs of women could reduce unintended pregnancies in Asia by 26% and unsafe abortions by 25%. Also maternal deaths would decrease by 65% and newborn deaths by 62%, while new HIV infections among babies could fall by 93%.

US$ 12.4 billion gap in Asia

The report estimates that the annual cost of meeting all sexual and reproductive health needs in low- and middle-income countries in Asia is US$ 38.8 billion. So an additional annual investment of US$ 12.4 billion is required to fully fund contraception, maternal and newborn care, abortion services and treatment for 4 major curable sexually transmitted infections (STIs). This means increasing annual spending from an estimated US$ 5.87 to US$ 8.61 per person. That is an additional US$ 2.74 per person a year.

At first glance, the additional investment may appear substantial. But every additional US$ 1 spent on family planning and contraceptive care could save US$ 1.97 in pregnancy-related and newborn care costs by reducing unintended pregnancies.

Africa: another powerful investment case

In low- and middle-income countries in Africa an estimated 29 million unintended pregnancies occur every year, representing 43% of all pregnancies. Meeting all sexual and reproductive health needs could reduce maternal deaths by 67% and newborn deaths by 70%, while new HIV infections among babies six weeks and younger could fall by 87%.

The required comprehensive package needs an additional annual investment of US$ 40.1 billion, equivalent to US$ 26.83 per person each year.

But then again, estimated savings are significant - every additional dollar invested in contraceptive services could save US$ 2.49 in maternal, newborn and abortion care costs.

While the scale and nature of unmet reproductive health needs differ between Asia and Africa, yet the potential health gains by meeting all of them are substantial in both regions- every additional US$ 1 spent is estimated to save US$ 1.97 in Asia and US$ 2.49 in Africa in maternal, newborn and abortion care.

In other words, contraception is not simply another line item in a health budget. It can reduce pressure on several other parts of the health system and reduce the need for expensive interventions later.

From statistics to action

Guttmacher Institute has turned its research into two online interactive tools that can help policymakers, advocates and journalists translate global evidence into country-specific scenarios.

The Family Planning Investment Impact Calculator is a tool that is available online to see what the impacts would be from investments made in family planning in different low- and middle-income countries. It allows users to select a country, investment amount and currency and estimate how many unintended pregnancies could be prevented, unsafe abortions averted and lives saved.

I have tried this tool online myself: if a US$1 million investment in contraceptive care is made in the Philippines, it could provide modern contraceptive methods to approximately 84,000 women and couples, prevent more than 18,000 unintended pregnancies and avert nearly 4,000 unsafe abortions. It also estimated a saving of US$ 2.51 in pregnancy-related and newborn care for US$ 1 invested.

The Safe Abortion Calculator focuses on the economics and health benefits of expanding access to safe abortion (provided within healthcare facility) care. It shows how investing in safe abortion care is a cost-savings investment.

When I tried this tool online, I found that by increasing the provision of safe abortion to 100% (from the current 26%) in Bangladesh, it could substantially reduce overall costs by an estimated 57.5%, resulting in a saving of US$ 27 million. Because when we invest in safe abortion care, we see a massive reduction in post-abortion care needs and costs.

Thus, by using these tools one can better understand some of the concrete impacts of investments made in family planning. The tools are particularly relevant when health budgets and development assistance are under pressure. They allow the conversation to move from broad appeals for investment to concrete questions: What would additional financial resources achieve in a particular country? How many unintended pregnancies could be prevented? How many lives could be saved?

Riju Dhakal, Programme Officer, Asian-Pacific Resource and Research Centre for Women (ARROW) asks whether international commitments and pledges are actually reflected in approved national budgets for sexual and reproductive health and rights. ARROW is working with partners in 12 countries, including India, Nepal, Bangladesh, Pakistan, Sri Lanka, Indonesia and the Maldives, to examine financing for sexual and reproductive health and rights, and engage governments on investment and impact.

Amid concerns over falling development assistance for sexual and reproductive health and rights (46% decline in official development assistance for it between 2024 and 2026), Dhakal called for the Guttmacher Institute’s tools (Family Planning Investment Impact Calculator and Safe Abortion Calculator) to be used to localise the numbers, track government commitments and check whether financing pledges are actually reflected in approved national budgets.

She highlighted the importance of tracking not only what governments pledge, but also whether the money is budgeted, released and ultimately reaches services and communities.

Contraception is not a woman's responsibility alone

The investment debate also exposes a persistent gender imbalance.

The theme for World Contraception Day 2026 "No Barriers, Just Choices: Access to Options, Freedom to Decide!," highlights the importance of ensuring genuine reproductive choice. Yet contraceptive responsibility continues to fall disproportionately on women. Female sterilisation accounts for 24% of contraceptive use worldwide, compared with appallingly low 2% for male sterilisation.

The focus of International Safe Abortion Day 2026 is on “Solidarity in Action: Advance Reproductive Justice and Urgently Strengthen Health Systems for Comprehensive Abortion Care." And rightly so, as safe abortion is an essential component of sexual and reproductive healthcare and links it to reproductive freedom, gender equality and the right to health.

The question facing health systems is not only "how much will reproductive healthcare cost?" It is also about "what will it cost if these needs remain unmet?"

Ultimately, investing in contraception, safe abortion, maternal healthcare and newborn care is about ensuring that people can prevent pregnancies they do not want, have children when they do want them, receive safe care when they are pregnant, and survive childbirth and its complications.

The price of reproductive healthcare can be measured in dollars. The cost of not providing it is measured in unintended pregnancies, preventable illness, lives lost and opportunities denied to women.

It is high time we do away with patriarchal expectations that have often treated family planning and domestic care as women's responsibilities. A more equitable approach requires recognising contraception as a shared responsibility between sexual partners while protecting women's autonomy over decisions concerning their bodies.