The publication of a new Lancet study, which reports $5 billion less in funding for reproductive health than commonly accepted, has raised questions among family planning advocates. With more than 222 million women in the developing world with unmet need for modern contraception, mobilizing funding for reproductive health, including family planning, is critical. What do these new numbers tell us about those efforts, and how do they compare with the existing data? We crunched the numbers to get the bottom of what the buzz is all about.
Resource Tracking 101
For decades researchers and advocates monitoring funding flows for international RH have relied on data produced by the United Nations Population Fund (UNFPA). PAI has been one of the organizations using UNFPA’s data to mobilize funding by comparing donor funding to their commitments or ability to pay (so-called “naming and shaming”). Civil society materials “shadow” official UN reports monitoring implementation of the International Conference on Population and Development (ICPD) Programme of Action (PoA).
UNFPA gathers data on funding for the costed population package from the ICPD PoA, or population assistance, which includes basic reproductive health, family planning, HIV/AIDS and other sexually transmitted infections (STIs), and basic research. They collect the aid data from the OECD’s Creditor Reporting System (CRS), verified by a questionnaire filled out by donors and UNFPA country offices. The current incarnation of this work is the Resource Flows Project implemented by the Netherlands Interdisciplinary Demographic Institute (NIDI), but the data collection goes as far back as population assistance itself. Just last week in PAI’s library (yes, we still have a physical library!) we discovered a Global Population Assistance Report published by UNFPA in 1992, and it has data on population assistance dating back to the 1950s.
The UNFPA/NIDI data is sometimes criticized for the long time lag and the difficulty in capturing pooled funding that goes to reproductive health. But it remains the best source of data on funding. So how do these new numbers compare?
A New Kid on the Block
The authors of the Lancet study—Justine Hsu, Peter Berman and Anne Mills—pored through hundreds of thousands of projects in the OECD CRS database to calculate the amount of funding for projects and components of projects dedicated to female reproductive health. They define reproductive health as maternal and newborn health, family planning, sexual health and STIs, including HIV/AIDS. They find that a vast majority of aid goes to prevent and treat HIV infection in women — with less than 16 percent of funding going towards reproductive health generally and just 8 percent reserved for family planning. This marks an important contribution in a landscape sparse with aid data specifically on women and girls’ RH.
Squaring the Numbers
At face value, Hsu, Berman and Mills’ total for reproductive health is $5 billion below UNFPA/NIDI, and their funding categories are not readily comparable. We dug into the annexes of Hsu et al. to disentangle the funding for reproductive health into the categories of family planning, basic reproductive health/maternal and newborn health and STIs to make a comparison. We were not able to separate out Hsu et al.’s sexual health, which is included in the family planning category.
Table 1: Comparison of RH Funding Data by Category of Activity 2009 (2010 Constant $US)
|Hsu, Berman and Mills||Resource Flows Project|
|Total Reproductive Health||$5,579,000,000||$10,611,000,000|
|ODA for Basic Reproductive Health/Maternal and Newborn Health||$2,117,000,000||$2,485,000,000|
|ODA for Family Planning, Sexual Health and STIs, including HIV*||$3,461,000,000||Not Applicable|
|ODA for Family Planning||$750,000,000||$760,000,000|
|ODA for STIs/HIV/AIDS**||$2,711,000,000||$7,511,000,000|
|*Hsu, Berman and Mills use this category, which includes ODA for family planning (and sexual health), as well as ODA for STIs/HIV/AIDS
**Hsu, Berman and Mills isolate funding for HIV positive women of reproductive age only, while UNFPA/NIDI track total funding for STIs/HIV/AIDS, regardless of age and gender.
As you can see from Table 1, the $5 billion difference comes from Hsu et al.’s lower estimate for HIV/AIDS, which can be explained because they only included the proportion of funding for women only (versus UNFPA/NIDI’s women and men). The data for family planning and reproductive health/maternal health funding is roughly similar, and the difference can likely be explained by the varying methodologies. This makes sense, since most of the data that UNFPA/NIDI collect for reproductive health and family planning go to women and girls, so should include in Hsu et al.’s numbers.
The Bottom Line
The Hsu, Berman and Mills study validates the UNFPA/NIDI Resource Flows approach. It confirms that UNFPA and NIDI’s still have the best data we have for holding donors accountable for implementing the ICPD PoA given their alignment with resource needs. This is especially important as we approach the 20th anniversary of the ICPD, the achievement of which will depend on our ability to mobilize funding.