(Illustration by Peter Thomas Ryan)
Contraceptives are vital for reproductive health, empowering women to prevent unintended pregnancies with potential threats to their well-being. Access to contraceptives, despite their well-documented health benefits, remains limited in low- and middle-income countries (LMICs). For instance, in sub-Saharan Africa, up to 40 percent of women who wish to delay or prevent a pregnancy lack access to contraceptives, compared with only about 6 percent in North America and Western Europe. Limited access to contraceptives poses a significant obstacle to achieving the United Nations Sustainable Development Goals (UN SDGs)—the 17 goals that United Nations member states committed to achieving by 2030—specifically concerning poverty elimination (UN SDG 1), good health and well-being for all (UN SDG 3), and gender equality (UN SDG 5).
A significant proportion of contraceptive demand in LMICs is satisfied through funding by global health agencies such as the United States Agency for International Development (USAID) and the United Nations Population Fund (UNFPA). However, recent policy decisions by the administration of US President Donald Trump threaten to undermine decades of progress in reproductive health initiatives worldwide, reversing critical gains in maternal and newborn health and women’s empowerment.
An analysis by the Guttmacher Institute, a research and policy organization focused on sexual and reproductive health, estimates that if USAID’s abrupt funding freeze stays in place, it will lead to 4.2 million unintended pregnancies and more than 8,000 maternal deaths worldwide—over a period of just three months.
Given these looming risks, how can reproductive health in the world’s impoverished regions be safeguarded? While the funding freeze will create significant short-term challenges, the long-term sustainability of reproductive health initiatives requires shifting away from donor dependence and fostering locally driven political commitment.
Specifically, the crisis presents a strategic opportunity for national governments and nongovernmental organizations (NGOs) aiming to promote reproductive health in LMICs to invest in greater female representation in political leadership. The success of various initiatives critical to reproductive health, such as supply chain strengthening, public awareness campaigns, and mobile health solutions for women, hinges on the commitment and dedication of political leaders. By leveraging the influence and dedication of female political leaders, these organizations can enhance the effectiveness and long-term sustainability of reproductive health programs in LMICs.
The Influence of Female Leaders
Despite making up nearly half of the global population and 80 percent of the frontline health workforce, women hold only 25 percent of senior leadership positions in the health-care sector and remain underrepresented in national governments across LMICs. This underrepresentation excludes women from influencing critical policy decisions that directly affect their health and well-being, including access to contraceptives. As Amina Mohammed, the UN deputy secretary-general, aptly stated, “[We women] are half the population. And what we bring to the table is incredibly important and it’s missing.”
We have recently conducted and published research that demonstrates the critical role that female political leaders in LMICs can play in strengthening support for contraceptive access, ensuring continued advancement of reproductive health despite funding uncertainties. We analyzed contraceptive procurement data for 101 LMICs over the period of 2000 through 2015. The appointment of a female (vis-à-vis male) health minister leads to an average 66 percent increase in the volume of contraceptives procured by these countries. Further, this effect becomes even stronger with an increase in the proportion of female parliamentarians.
Our conversations with public-health supply-chain experts and political leaders in LMICs reinforced these findings. Specifically, female political leaders not only demonstrate greater awareness of gender disparities in health outcomes but also exhibit the political will necessary to advocate for solutions, such as improved contraceptive access.
“The biggest challenge was the insensitivity of the executive about reproductive health,” says former Ugandan Member of Parliament Beatrice Rwakimari. “Most male ministers were not as passionate about reproductive health as we women were. They would say, ‘That’s not our priority.’ Their focus was on roads or production of electricity.”
Having a greater number of influential female political leaders can specifically boost two critical goals. First, it can help to promote financial self-sufficiency for contraceptive procurement. In most LMICs, contraceptive procurement is primarily reliant on donor funding. This dependency poses long-term challenges to securing contraceptive supplies in LMICs, as demonstrated by the recent USAID funding freeze. Female leaders are uniquely positioned to address this issue by utilizing their authority to mobilize domestic resources for contraceptive procurement. Through their advocacy, they can push for larger budget allocations and ensure that reproductive health remains a priority on government spending agendas.
Investing in domestic financing for contraceptive procurement is not only impactful but also cost-efficient. For every $1 spent on enhancing contraceptive access, the long-term costs associated with unintended pregnancies can be reduced by $3—a return on investment of 200 percent. These savings can in turn be invested in other key areas such as education, job opportunities, and health infrastructure.
Given these considerations, female political leaders can strengthen the case for greater and sustained domestic funding by emphasizing the socioeconomic benefits of enhanced contraceptive access. These benefits include lower maternal mortality rates, reduced health-care expenditures, and increased workforce participation among women. By framing reproductive health as an issue that intersects public health, gender equality, and economic growth, female leaders can advocate for greater government ownership of reproductive health programs, thereby reducing reliance on external funding.
With USAID’s funding freeze, national governments and NGOs must assume greater responsibility for reproductive health.
Second, having more female political representation can help strengthen the local manufacturing capacity for contraceptives. Beyond achieving financial self-sufficiency, strengthening the local contraceptive manufacturing capacity in LMICs is crucial for safeguarding reproductive health in the long run. For example, the COVID-19 pandemic exposed vulnerabilities in contraceptive supply chains, particularly in sub-Saharan Africa, where heavy reliance on international suppliers led to significant disruptions in contraceptive availability. A robust local manufacturing base could have mitigated the impact of this shock by reducing dependency on international suppliers. However, establishing local manufacturing capacity presents significant hurdles, including limited access to investment capital, restricted availability of manufacturing technology and know-how, long product registration timelines, and high import duties on raw materials.
Female political leaders in LMICs are well-positioned to advocate for policy reforms that support the local manufacturing of contraceptives. For instance, they can promote financial incentives (e.g., government-backed subsidies and loans) to encourage local players to establish and scale up contraceptive manufacturing capacity. They can also sponsor legislation that reduces or eliminates import duties on active pharmaceutical ingredients and equipment necessary for contraceptive production, as well as push for faster product registration processes to bring locally manufactured contraceptives to the market more quickly.
Further, female leaders can spearhead initiatives to ensure sustained demand for locally manufactured contraceptives. For example, by launching public-awareness campaigns that promote contraceptive use and by prioritizing the purchase of locally manufactured contraceptives over imported ones, governments can create a sustainable market for contraceptives that are produced locally.
Promoting Female Leadership
As for national governments and NGOs, they can take several steps to advance female political representation in LMICs. National governments can first establish gender quotas in parliaments and cabinets. Gender quotas are designed to ensure that women hold a “critical minority” of at least 20 percent of leadership positions. Governments can leverage data-driven initiatives of organizations like the Inter-Parliamentary Union and the International Institute for Democracy and Electoral Assistance to build a strong, evidence-based case for gender quotas in parliaments and cabinets.
Second, governments can promote the formation of women’s parliamentary committees. These committees mentor aspiring female politicians, helping them overcome self-doubt and other reservations that may deter women from entering politics.
As for NGOs, they can collaborate with political parties and election commissions to reduce entry barriers for women in politics. For example, financial constraints and a lack of political patronage often hinder female political participation in LMICs. NGOs can advocate for gender-focused public funding to overcome these barriers.
NGOs can also invest in leadership training to groom future female political leaders. Tunisian NGO Aswat Nissa, for example, trains aspiring female parliamentarians to “become actors of change and advocates for gender equality.” Since health care remains a sector that is “delivered by women, led by men,” fostering female leadership at an early stage is crucial, and NGOs are well-positioned to facilitate this.
With USAID’s funding freeze, national governments and NGOs must assume greater responsibility for prioritizing reproductive health in LMICs. As Heba Aly, former CEO of nonprofit news agency The New Humanitarian, says, “If this is the beginning of the end of the aid, we should focus on structural transformation.” Advancing female representation in political leadership is critical to this transformation, ensuring sustainable progress in reproductive health and advancing the UN SDG themes of people, planet, and prosperity.
Read more stories by Dwaipayan Roy, Amir Karimi & Sydney Block.