Just the Numbers: The Impact of US International Family Planning Assistance, 2024

Foreign assistance for international family planning and reproductive health care is one of the best investments for global development: It saves and transforms lives. By helping to address people’s reproductive health needs, such investments promote positive health outcomes and well-being throughout people’s lives and also contribute to improvements in gender equity, economic development and climate resilience.¹

US Support for International Family Planning 

Family planning is a fundamental component of comprehensive sexual and reproductive health and rights, as defined by the Guttmacher-Lancet Commission.¹ The United States has distinguished itself as a global leader in—and the largest donor to—global health programs, and it has supported family planning services through financial assistance and coordination of programs across multilateral entities. The US Agency for International Development (USAID) has played a critical role in increasing access to family planning information, services and supplies in 41 countries where the need is greatest. USAID's family planning program has supported service delivery, contraceptive provision, and monitoring and evaluation, among other activities. It also has sought to integrate family planning with maternal and child health interventions, HIV programming, and efforts to end child marriage and gender-based violence.

To complement its bilateral work, USAID has collaborated closely with the United Nations Population Fund (UNFPA), a multilateral organization that focuses on the delivery of family planning services and maternal and child health care in more than 150 countries and territories. While Congress regularly appropriates funds for UNFPA, the president has the authority to withhold those funds, and Republican presidents have often chosen to do so.² For example, the Trump administration withheld funding for UNFPA from 2017 to 2020. (The Biden administration then reinstated the funding in 2021.) Each time the United States has withheld funds from UNFPA for political purposes, it has caused significant disruption to UNFPA’s critical services and programs, including gender-based violence prevention and response to humanitarian crises.

Impact of US Investment

In federal fiscal year (FY) 2024, for the ninth year in a row, Congress appropriated $607.5 million in US assistance for global family planning and reproductive health programs, including $32.5 million for UNFPA. This funding—when uninterrupted—serves 47.6 million women and couples with modern contraceptive care each year. It prevents 17.1 million unintended pregnancies, which in turn saves the lives of 34,000 women and girls who otherwise would have died from complications of pregnancy and childbirth. A decrease in—or end to—this funding would be devastating to the lives of women and girls around the world and to the public health systems that rely on this investment to provide essential contraceptive services.

The Trump administration abruptly suspended all investments in foreign aid its first week in office and has threatened to permanently eliminate foreign assistance and disband USAID. As a result, international family planning programs supported by the United States suddenly stopped providing services, and this investment is at risk of being eliminated. The administration’s actions are an overstep of presidential powers and also represent a radical shift in US foreign policy. Although some policymakers have proposed reducing funding or services in the past, investment in global family planning has for decades received bipartisan, bicameral support and recognition for the vital services it provides.  

Even small decreases in funding would increase adverse outcomes around the world. For example, every $10 million decrease in funding below the FY 2024 appropriated level would deny services to one million women and couples and lead to an additional 362,000 unintended pregnancies, 161,000 unplanned births and 110,000 unsafe abortions.  

It is vital that the US government help address the unmet needs for family planning and reproductive health services globally. Research shows that a US investment of $1.74 billion for international bilateral and multilateral family planning and reproductive health programs, including $116 million for UNFPA,³ is the annual sum needed for the United States to contribute its fair share of the cost of addressing family planning needs worldwide. This would serve an additional 31.4 million women and couples, the estimated number of unintended pregnancies prevented would increase from 17.1 million to 27.1 million, and the number of maternal deaths averted would increase from 34,000 to 42,000.

Methodology and Sources 

Estimates of the impacts of current and increased investment were calculated by dividing family planning allocations to countries and USAID regional offices for FY 2023 by estimated 2024 country-level per-user impacts, which come from the most recent comprehensive analysis of costs and impacts of family planning in low- and middle-income countries.^4–6 Impacts per user were estimated as the difference between the annual number of events that would occur if all women wanting to avoid pregnancy but not using a modern method of contraception used a modern method and the number that would occur if they relied on traditional methods or no method.⁵

To estimate the number of women and couples receiving modern contraceptive care from US investments, the analysis used the current costs of providing such care. This approach was applied to the current investment level, as well as the scenario involving a $10 million decrease in funding. To estimate the impacts if the US increased its investments to the recommended level, we accounted for the increased costs of scaling up services to meet all potential need for modern contraceptive care.    

Funding allocated to regional offices, rather than to countries, was included if some or all of the funding was allocated to countries. It was estimated that 18% of core funding to UNFPA went to family planning–specific activities.⁷ 

Just the Numbers estimates for 2024 are not directly comparable to prior iterations of this analysis. They draw on updated cost and impacts data, including new sources for commodity costs; an updated approach to estimating inflation-adjusted personnel costs; and updated data on pregnancy outcomes and maternal deaths that resulted in changes to estimated impacts per user.⁶ In addition, prior Just the Numbers analyses used the costs for providing care to all women and girls wanting to avoid a pregnancy for all funding scenarios, whereas Just the Numbers 2024 uses these costs only for the impacts of scaling up to the recommended investment level to better reflect differences in the cost necessary to provide current levels of care versus expanded levels.