Just the Math

EXPLAINING THE METHODOLOGY

At the 1994 International Conference on Population and Development (ICPD) in Cairo, 179 U.N. member states agreed by consensus — purportedly for the first time during an international conference — on a costed implementation plan designed to achieve the goal of significantly expanding access to reproductive health care, including family planning, through 2015.[i] The ICPD Programme of Action called for two-thirds of the annual cost to be borne by recipient countries and the remaining one-third by donor nations like the United States. Using the agreed-upon ICPD burden-sharing rationale, donor nations would be expected to contribute one-third of the $14.0 billion total current cost — or $4.67 billion.

The most equitable formula for allocating the relative shares of the $4.67 billion contribution to meet the $14.0 billion annual cost among donor countries should be based on each nation’s wealth relative to each other. The membership of the Development Assistance Committee (DAC) of the Organisation for Economic Co-operation and Development (OECD) is composed of all the major industrial nations that provide official development assistance to LMICs, amounting to nearly $212 billion in 2024.[ii] Gross national income (GNI) is the internationally accepted indicator for measuring national wealth. Under this measurement, the U.S. economy represented just over 45% of total donor nation GNI — U.S. GNI of $27.0 trillion divided by total OECD DAC GNI of $59.9 trillion — in 2023, the latest year available.[iii]

The final computation produces a recommendation of $2.106 billion for fiscal year (FY) 2027 as the appropriate U.S. share of the total annual funding from all sources required to continue care for 714 million people currently using modern contraception and meet the current unmet demand for contraception of 78 million women in LMICs — 45.1% of $4.67 billion. Embedded within the $2.106 billion target is an allocation of $145 million for a U.S. contribution to the United Nations Population Fund, the only intergovernmental institution with an explicit mandate to address the reproductive health needs of women and men worldwide.

U.S. SHARE OF THE COST

International family planning and reproductive health (FP/RH) advocates in Washington, D.C., can furnish to legislators and executive branch policymakers a defensible, evidence-based estimate of the appropriate U.S. government share of the cost.

To put the size of the recommendation in perspective, if $2.106 billion were to be appropriated by Congress for FY 2027, that level of spending would require an appropriation of an amount three-and-a-half times the current FY 2026 enacted level of $607.5 million. Appropriated levels for international FP/RH programs have plateaued at just over $600 million for the last 16 fiscal years since FY 2011.

But flat funding is a cut in reality because of the pernicious effects of inflation. Adjusting for inflation, the purchasing power of the funds appropriated has decreased by $201 million — or a third (33%) — in constant FY 2011 dollars.[iv] The FY 2011 appropriated amount would have the purchasing power of $919 million today (though this would vary across the countries in which this funding is being spent). From a historical perspective, the high-water mark for overseas FP/RH funding in constant dollars ($595 million in FY 1995), enacted by Congress just prior to ICPD in 1994, would have the equivalent purchasing power today of $1.3 billion when adjusted for inflation.[v]

Stagnant funding also fails to keep pace with the growth in the number of women of reproductive age in countries previously assisted by the U.S. Agency for International Development, which has increased dramatically since 2011, from roughly 470 million to over 800 million today.[vi]

BENEFITS OF A U.S. INVESTMENT OF $2.11 BILLION

Based on the methodology used in “Just the Numbers,” a comprehensive analysis by the Guttmacher Institute in February 2025 of the costs and impacts of family planning in more than 30 LMICs receiving U.S. international FP/RH assistance in FY 2023,[vii] with additional investments —bringing the total U.S. funding to $2.11 billion — the following would result:

• 95.3 million women and couples with contraceptive services and supplies;
• 32.7 million fewer unintended pregnancies, including 12.7 million fewer unplanned births;
• 10.6 million fewer unsafe abortions; and
• 50,000 fewer maternal deaths.

Strategic investments in sexual and reproductive health save lives. The Guttmacher Institute’s analysis found that meeting the current unmet demand for modern contraception in LMICs would result in a decline of about one-third in unintended pregnancies (from the current 96 million to 64 million per year), unplanned births (from 28 million to 17 million per year), and unsafe abortions (from 34 million to 23 million per year). Furthermore, for every additional $1 spent on contraceptive care, $2.48 is saved on maternal, newborn, and abortion care because of declines in the number of unintended pregnancies.[viii]

A calculation of the appropriate U.S. share of the global investment required to satisfy the current unmet need for modern contraception of women in LMICs—while continuing to meet the needs of hundreds of millions of existing contraceptive users—derived from a methodologically sound estimate of the total annual cost to achieve that goal and based on a reasonable burden-sharing rationale for contributions to the effort by donor and recipient countries, helps inform policymakers’ priority setting and decision-making by providing a solid, evidence-based estimate of what the U.S. government should be investing in contraceptive availability and use.

SOURCES

[i] United Nations Population Fund. (2004). Programme of Action: Adopted at the International Conference on Population and Development, Cairo, 5-13 September 1994. https://www.unfpa.org/sites/default/files/event-pdf/PoA_en.pdf

[ii] Organisation for Economic Co-operation and Development (2026, March 25). Development Finance Statistics:  Data on Flows to Developing Countries. Comparison of DAC members’ ODA (grant equivalent basis) from 2023 to 2024, table 1A.

[iii] Organisation for Economic Co-operation and Development (2026, March 25). Development Finance Statistics:  Data on Flows to Developing Countries. Gross national income and population, by DAC country, 2023, table 38.

[iv] U.S. Bureau of Labor Statistics. (2026, March 25). CPI Inflation Calculator. https://www.bls.gov/data/inflation_calculator.htm

[v] PAI. (n.d.). Cents and Sensibility: U.S. International Family Planning Assistance from 1965 to Present. https://pai.org/cents-and-sensibility

[vi] Center for Global Development. (2023, February). USAID’s Family Planning and Reproductive Health Program: A Look Back and Ahead, 14. https://www.cgdev.org/sites/default/files/usaids-family-planning-and-reproductive-health-program-look-back-and-ahead.pdf

[vii] Guttmacher Institute. (2025, February). Just the Numbers: The Impact of US International Family Planning Assistance, 2024. https://www.guttmacher.org/2025/02/just-numbers-impact-us-international-family-planning-assistance-2024

[viii] Guttmacher Institute. (2025, October). Adding It Up 2024: Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries. https://www.guttmacher.org/report/adding-it-up-2024-investing-sexual-and-reproductive-health-low-and-middle-income-countries