Country Ownership Without Accountability: How New Financing Models Sideline Women’s Health

Drastic shifts in bilateral and multilateral funding are reshaping global health and development. New financing compacts that promise “country ownership” and more efficient delivery are emerging. Amidst this, a critical question is being overlooked: what do these changes mean for women and girls, whose health, rights, and economic futures are already routinely treated as expendable?

For governments seeking to stimulate sustainable economic growth while safeguarding rights, the evidence points to a powerful truth: investing in sexual and reproductive health and rights (SRHR) is not separate from economic development—it’s fundamental to it. When countries integrate SRHR into their economic strategies, they see measurable returns in productivity, workforce participation, and long-term prosperity. Yet, despite this proof, SRHR remains underfunded, narrowly defined, and chronically siloed. Where investments do occur, they focus almost exclusively on women of reproductive age, ignoring the full range of SRHR needs across the life course.

This is happening at a moment when development assistance for gender equality is declining, and global funding for SRHR has fallen to its lowest point since 2012. Meanwhile, official development assistance fell by 9% in 2024, and is projected to fall an additional 9-17% in 2025, further complicating governments’ abilities to sustain investments and growth. Amidst these cuts in funding, new global health financing models are emerging that claim to localize decision-making but these often reinforce the same power imbalances that have long shaped the system. Negotiations remain opaque, civil society voices are rarely included, and there is little clarity on how these models will address the SRHR needs of women, girls, and marginalized communities.

The fourth International Conference on Financing for Development, which produced the Compromiso de Sevilla, is one such example. The agreement missed an opportunity to elevate the need for increased financing in global health, specifically in sexual and reproductive health. And now, with the current U.S. administration’s plans to use compact models to expand the reach of the Global Gag Rule, other global partners must step up to protect and advance SRHR within these rapidly shifting systems.

If the goal is to build stronger economies, the evidence is clear: investing in family planning yields significant benefits. Every dollar spent can generate between $60 and $100 in long-term economic growth. Meeting the unmet demand for contraception and maternal, newborn, and child health could save as much as $6.9 billion—far more than investing in maternal health alone.

The assumption that economic growth, in the absence of a comprehensive social development policy framework, will naturally trickle down to improve community well-being simply doesn’t match reality. In Gujarat, India, for example, economic gains have not translated into better outcomes for women’s health or SRHR services. Instead, women and families are forced to rely on costly private care for their reproductive health needs. This reveals a deeper problem: exclusionary norms that devalue women’s bodies and health are still built into the very systems that determine where public money goes. Until we confront that reality, we will continue to lose out on both health and economic progress.

ICRW has long worked to illuminate these linkages—and to show why progress on women’s economic empowerment, without equal attention to reproductive rights, will never truly deliver transformative change for women, girls, and their communities.

A Call for Comprehensive Policy

Governments, policymakers, and partners committed to rights, equality, and sustainable economic growth must recognize how global financing trends shape—and often limit—access to SRHR and act accordingly.

Proven strategies for integrating SRHR into economic development include:

• Design financing and investment strategies with explicit budget lines for comprehensive SRHR—from sexuality education for young people to contraception for adults and reproductive healthcare for older women. Universal access to reproductive health and services strengthens workforce participation, boosts educational attainment, and lowers long-term health expenditures.
• Increase allocation of public investments in SRHR and family planning through sustainable domestic financing mechanisms.
• Expand social protections for women employed in informal sectors, closing gaps in reproductive service access while strengthening economic security and market stability.

The path forward is clear. We must stop treating SRHR as an afterthought in economic development and start recognizing it for what it is–the foundation of equitable economic systems. Without accountability and inclusive power-sharing in emerging financing models, we risk building economies that grow on paper while leaving the health and rights of women and girls behind. The time for half-measures and siloed thinking is over.