Adding It Up 2024: Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries in Asia

Adding It Up 2024: Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries in Asia The Adding It Up study examines the need for, impact of and cost of fully investing in sexual and reproductive health (SRH) care—services that ensure people can decide whether and when to have children, experience safe pregnancy and delivery, have healthy newborns, and have a safe and satisfying sexual life. Access to comprehensive sexual and reproductive health services is recognized as a fundamental human right, essential for achieving gender equality and enabling individuals to make autonomous decisions about their own bodies, health and futures. Realizing this right for all women, especially those facing systemic barriers, upholds human dignity and advances equity across communities. WHO IS AFFECTED: Women of reproductive age (15–49) in 36 low- and middle-income countries (LMICs) in Asia in 2024 WHAT IT COVERS: Contraceptive services, maternal care, newborn care, abortion services and treatment for the major curable STIs WHAT’S NEW IN 2024: The latest edition of Adding It Up offers a more person-centered approach to contraceptive need than previous studies by providing estimates of women who would like to avoid a pregnancy, are not currently using a contraceptive method, and intend to use contraception in the future or are open to future use. This definition, called “unmet demand,” offers the most strategic starting point for prioritizing limited resources and focuses on women’s own expressed preferences for contraceptive use. All cost estimates and savings are calculated in 2024 US dollars. Current Use of Contraception and Pregnancy Outcomes in Asia Contraceptive use In LMICs in Asia, 648 million women of reproductive age want to avoid a pregnancy. Out of this total, 519 million women are using modern contraception and 57 million rely on traditional methods. The types of modern contraceptive methods currently used range widely: 42% of modern method users rely on short-acting methods 22% on long-acting reversible methods 36% on sterilization Approximately 36 million women have an unmet demand for contraception, meaning they want to avoid pregnancy and have expressed interest in using modern contraception, but are not currently doing so. Table 1. Contraceptive need by subregion Subregion Women wanting to avoid pregnancy Women with unmet demand for contraception Traditional method users Modern method users Eastern Asia 228.6 million 5.9 million 7.2 million 209.9 million Central Asia 10 million 1.3 million 431,000 7.6 million Southern Asia 296.3 million 18.6 million 34.7 million 222 million Southeast Asia 85.5 million 7.7 million 7.7 million 63.5 million Western Asia 27.6 million 2.3 million 6.7 million 16.1 million Unintended pregnancies Each year, 57 million unintended pregnancies occur in LMICs in Asia, accounting for 47% of all pregnancies in the region. Among this total: 72% end in abortions 17% end in unplanned births 11% end in stillbirths and miscarriages Needs for Sexual and Reproductive Health Services In addition to unmet need for contraception, women in LMICs in Asia have a range of other sexual and reproductive health needs that are not being fully met. Insufficient access to maternal and newborn health care puts women and infants at risk. Each year, 63 million women in Asia give birth, and many do not receive recommended care in accordance with World Health Organization guidelines: 22 million make fewer than four antenatal care visits 9.6 million do not give birth in a health facility 5.5 million do not receive necessary care after a major obstetric complication Furthermore, each year in Asia: 2.1 million newborns do not receive necessary care for infections and other neonatal health problems 21.3 million women have unsafe abortions 58,300 women die from causes related to pregnancy, abortion and childbirth 70.2 million women do not receive the treatment they need for chlamydia, gonorrhea, syphilis and trichomoniasis Table 2. Gaps in SRH care by subregion Eastern Asia Central Asia Southern Asia Southeast Asia Western Asia Women having unsafe abortions 1.1 million 369,000 16 million 2.1 million 1.6 million Women who die from maternal causes 1,700 392,000 42,200 11,200 2,800 Women who do not receive STI treatment 25.7 million 928 million 28.7 million 11.2 million 3.6 million Impact of Expanded and Improved SRH Services Meeting contraceptive need yields enormous benefits for women’s health. Those benefits are multiplied when combined with meeting their needs for care during pregnancy and childbirth, as well as the needs of their newborns. Unintended pregnancies in Asia would drop by 26% and unsafe abortions by 25% if all women with an unmet demand used modern contraception and all pregnant women received care that meets international standards. By meeting all SRH care needs, maternal deaths would drop by 65%. If all mothers and their newborns received recommended care, newborn deaths would drop by 62% and new HIV infections among babies six weeks and younger would drop by 93%. Cases of infertility-causing pelvic inflammatory disease from untreated chlamydia or gonorrhea would be eliminated if all women infected with these two STIs were given effective and timely treatment. Table 3. Impact of expanding SRH care by subregion Eastern Asia Central Asia Southern Asia Southeast Asia Western Asia Unintended pregnancies ↓20% ↓49% ↓25% ↓32% ↓28% Unsafe abortions ↓20% ↓48% ↓23% ↓31% ↓28% Maternal deaths ↓44% ↓38% ↓66% ↓66% ↓64% Newborn deaths ↓49% ↓58% ↓62% ↓61% ↓64% HIV infections among babies ↓94% ↓89% ↓93% ↓93% ↓93% The Investment Case for Meeting All SRH Needs in Asia A package of SRH care that would meet all needs for women in Asia—unmet demand for contraception, all maternal and newborn care, abortion services and treatment for the four major curable STIs—would cost $39 billion annually. This includes $6 billion for all contraceptive care, $31.7 billion for pregnancy-related and newborn care, and $1.2 billion for STI care. This $38.8 billion total represents a $12.4 billion annual increase. It is equivalent to a $2.74 increase per capita annually. Table 4. Investment to meet all SRH needs by subregion Eastern Asia Central Asia Southern Asia Southeast Asia Western Asia Total cost $7.5 billion $979 million $21.2 billion $4.2 billion $5 billion Contraceptive services $2.3 billion $89 million $2.2 billion $884 million $474 million Maternal and newborn care $4.7 billion $874 million $18.5 billion $3.2 billion $4.4 billion STI treatment $446 million $17 million $444 million $128 million $115 million Total increase needed ↑ $1.5 billion ↑ $214 million ↑ $7.7 billion ↑ $1.2 billion ↑ $1.7 billion Per capita increase needed ↑ $1.05 ↑ $2.63 ↑ $3.74 ↑ $1.77 ↑ $7.31 With an investment in a comprehensive package of SRH services: all women of reproductive age would receive the pregnancy-related and STI care that they need; all newborns would receive essential care just after birth; and all women would receive the contraceptive services they need to decide whether and when to have children. These gains would reduce the substantial health system costs in LMICs and provide a high return on investment. In addition, the interventions in this package of services have proven to be feasible to implement in different settings around the world. The total cost of SRH care decreases when more women who want to use contraception are able to do so. The decrease in unintended pregnancies that would result from an increase in contraceptive use means large reductions in the need for services such as abortion and postabortion care, antenatal and delivery care, and neonatal care. Achieving this vision requires addressing a critical funding challenge for contraceptive care needs. It currently costs $5 billion to provide contraceptive care in LMICs across Asia, including $2.6 billion in direct costs. To meet all unmet demand for contraceptive care in these countries, an additional $932 million investment is needed. Table 5. Costs to meet demand for contraceptive care by subregion (in millions) Eastern Asia Central Asia Southern Asia Southeast Asia Western Asia Current costs – Total $2,034.7 $69.7 $1,839.2 $714.4 $399.7 Health worker salaries $725.3 $27.2 $628 $189.5 $142 Commodities, drugs and supplies $322.3 $8.6 $318.8 $178.3 $35.8 Programs and systems costs $987.1 $33.8 $892.3 $346.6 $222 Costs to meet all unmet demand – Total $2,302.3 $88.6 $2,241.3 $883.7 $473.9 Health worker salaries $744.9 $31.3 $694.4 $212.4 $159 Commodities, drugs and supplies $331.4 $10.2 $353.3 $200.7 $41 Programs and systems costs $1,226 $47.2 $1,193.6 $470.6 $274 Savings from Investing in Contraceptive Services Every dollar spent on contraceptive services beyond the current level would save $1.97 in the cost of maternal, newborn and abortion care in LMICs in Asia because use of contraceptives reduces the number of unintended pregnancies. Savings vary across the region: Each dollar invested would save $0.75 in LMICs in Eastern Asia, $2.23 in Central Asia, $2.51 in Southern Asia, $1.44 in Southeast Asia and $3.16 in Western Asia. Enabling women to have children when they want them and to deliver healthy newborns safely also boosts national economies as women gain greater access to education and participate more fully in the workforce. sramashwar January 9, 2026 Policy Resources Global Exclude from search No Facebook Image aiu asia social@4x.png Twitter Image aiu asia social@4x.png