Financing SRHR beyond ODA: What a country perspective reveals

Introduction

International advocacy on SRHR financing has long focused on donor contributions. The focus remains essential, but donor support is now facing an unprecedented contraction. The US administration has frozen and cancelled most global family planning projects and proposed eliminating its family planning budget in 2026, and ODA for RMNCH-N from the top 10 sovereign donors, including the UK, France, and Germany, is expected to fall by at least 34% between 2023 and 2026. In countries where USAID and FCDO have historically anchored SRHR programming, the contraction represents a structural shock. However, external assistance is not usually the largest source of health financing overall. In many LMICs, domestic government spending and household out-of-pocket expenditure account for most health expenditure. External funding can nevertheless be disproportionately important for SRHR commodities, services, and technical support that domestic budgets do not consistently protect.

The consequences of donor cuts will therefore depend on how SRHR is financed across the wider health system, and on the extent to which other financing sources can sustain services and systems when external support declines.

In support of vital SRHR efforts, SEEK Development has partnered with Ipas to analyze the country financing landscapes of five countries - Nigeria, Ethiopia, Bangladesh, Nepal, and Mexico - mapping domestic government spending, external finance, private and innovative finance, and the legal, policy, and normative environment that shapes all of them. This publication shares what that analysis reveals through a deep dive into Nigeria and Ethiopia, as well as what it makes possible for organizations working to protect and strengthen SRHR financing at country level.

Why is the country perspective crucial?

The global development discourse is shifting in parallel. Frameworks like the Accra Reset Agenda place domestic resource sovereignty and country-led financing at the center of a growing reform agenda. Without a clear picture of the entire financing landscape of a country — not just the donor funding — it is difficult for advocates and policymakers to support that transition.

Taking a country financing lens adds value in several ways. First, it grounds donor analysis in the systems that receive and use external funds, showing where they complement, duplicate, or crowd out domestic spending. Second, it brings into view the policy and institutional entry points that may matter most for SRHR, such as health reforms, subnational budget cycles, and insurance benefit packages under review, as well as the actors who can influence them. Third, during acute ODA contraction, it broadens the strategic question. Rather than asking only how to mobilize more donor funding, it asks how money moves through the system and where leverage lies to protect or strengthen SRHR financing.

Country snapshots: Nigeria and Ethiopia

Nigeria and Ethiopia, two countries with a different legal and policy environment related to abortion and broader SRHR issues, illustrate how the same financing challenge plays out on the ground in different contexts and why a country-specific lens is relevant.

Nigeria: Large economy with challenging legal and fiscal environment for financing SRHR

Ethiopia: Government supports SRHR, but funding still dependent on households and donors

What do the findings reveal?

Finding 1: SRHR framing in budgets and donor programs shapes both durability and visibility

Across all five countries, SRHR funding proves most durable when embedded within maternal and newborn health, primary health care, or UHC frameworks, whether the financing source is domestic government, external donors, or multilateral platforms.

On the domestic side, Ethiopia's essential health package includes abortion under RMNCH-N, Bangladesh's Menstrual Regulation program has been financed within the national family planning program for nearly five decades, and Mexico's P029 budget program bundles maternal, sexual, and reproductive health into a single line. On the donor side, the pattern holds as well: Nigeria's MAMII initiative funds the maternal health infrastructure on which SRHR depends. The GFF doubled its Nigeria grant to US$50 million, complementing US$500 million in IDA financing based on the Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition investment case.

Embedding within broader health frameworks provides political cover and access to larger, more stable financing pools, and in restrictive legal environments it is often the only viable channel. However, it also buries SRHR within aggregate budget lines with no dedicated tracking, no SRHR-specific execution data, and limited accountability. The question is not only whether SRHR survives the political moment, but whether it remains visible enough to be monitored, advocated for, and protected by governments, donors, and civil society alike.

Finding 2: Countries commit, but often do not follow through with spending

SRHR is frequently endorsed in national health plans and global frameworks. Bangladesh, Ethiopia, Nigeria, and Nepal have made commitments to FP2030. Nigeria and Ethiopia have committed to the Abuja Declaration target of 15% of the national budget to health, but both countries are not regularly achieving the benchmark. Nigeria's FP2030 commitment of 1% of the health budget to family planning has not been achieved. While the government of Nepal has set out the goal of spending 8% of its national budget on health, spending in 2026/2027 stands at only 5%.

The gap between commitment and spending is driven by several factors: fiscal space constraints compress capital budgets disproportionately; decentralized systems in which federal commitments must be re-translated at state or provincial level with no guarantee of follow-through; procurement failures and weak supply chain management that leave allocated funds unspent; and the political vulnerability of SRHR-specific lines in conservative contexts. Identifying which factor is operative in a specific country is the starting point for any meaningful advocacy or technical assistance strategy.

Finding 3: Private and innovative finance are marginal, and unlikely to change soon

Across the five countries, impact investment is concentrated in sectors such as fintech, infrastructure, private clinics, and health technology, rather than SRHR. Nigeria illustrates the gap: although around US$3 billion was deployed across 404 private equity and venture capital deals between 2020 and 2024, no SRHR-specific investment was identified. Blended finance faces similar constraints. Nigeria ranked among Africa's largest blended finance markets in 2024, with 13 deals worth US$2.02 billion, yet focused mainly on infrastructure and financial services.

SRHR and abortion are difficult to finance through private capital. Legal and political sensitivities create regulatory and reputational risks, while publicly provided and subsidized services offer limited predictable revenue or exit opportunities for investors. The constraints are particularly strong for abortion, even where services are legally permitted.

However, adjacent examples show potential. The World Bank and GFF-supported Nigeria State Health Investment Project used results-based financing for maternal and child health, and informed the design of the BHCPF. In Ethiopia, an AFD-funded Development Impact Bond mobilized private capital for menstrual health and hygiene, with repayment linked to verified results. The examples suggest that the most realistic route is to embed SRHR indicators and services within broader MNCH, PHC, and health financing mechanisms, rather than expect standalone SRHR investments to emerge.

How is SRHR financing reshaped?

The standard framing of SRHR financing as a donor funding problem obscures a more fundamental fact: in most countries, the domestic financing architecture, politics, and legal environment are a larger lever than donor funding alone. For organizations working to protect and strengthen SRHR financing at country level, the strategic implications are direct. The entry points that matter most — an ongoing health reform, a subnational budget cycle, an insurance benefit package under redesign — are invisible from a donor-only vantage point, and so are the actors who control them.

As ODA comes under sustained pressure, the shift in analytical lens becomes strategically necessary: for donors trying to understand how their funding lands; for NGOs navigating an increasingly constrained external environment; and for governments being asked to do more with domestic resources. SEEK's country financing landscape analysis maps all of this — the legal and normative environment, the domestic budget architecture, the external financing picture, and the private and innovative finance market — to identify, specifically, where the real points of leverage are.

About Ipas

Since 1973, Ipas has worked to ensure that all people - no matter who, no matter where - can access the sexual and reproductive health care they need, including abortion. We believe everyone has the right to control their own body, health and future. These basic human rights are necessary to achieve gender equity, and to support the health and wellbeing of women and girls everywhere.

Today, Ipas works on five continents with a comprehensive approach that centers the needs of those who seek legal abortion care. We build sustainable abortion ecosystems that address all factors impacting a person’s ability to access abortion - from individual health knowledge, to social and community support, to a trained health workforce, to political leadership and supportive laws. We train providers and work with health systems to ensure accessible, high-quality legal abortion services - including the right and ability to self-manage an abortion with pills. We conduct research with the goal of turning policy into practice. We also partner with local organizations to educate communities on reproductive health and rights, to advocate for legal abortion, and to support local champions for reproductive justice.

Annex: Methodology note

• Countries: Nigeria, Ethiopia, Bangladesh, Nepal, Mexico;
• Financing dimensions mapped: domestic government health spending, development finance (bilateral, multilateral, private), domestic private sector and philanthropy, out-of-pocket expenditure, innovative finance (impact investing, blended finance, RBF); and
• Policy and normative layer: legal status of abortion, national strategies and global commitments, CSO and political landscape.

Data sources: OECD CRS, WHO GHED, IMF and World Bank economic indicators, desk research, expert interviews.