Paying for reproductive health care: What is needed, and what is available?

Context: The 1994 international Conference on Population and Development (I CPD) established goals for the expansion of reproductive health services an d estimated the funding that would be required from the international commu nity and national governments to meet those objectives. Methods: Available data are examined to determine the extent to which fundi ng has met the ICPD estimates of resources needed. Results: Annual global spending on family planning as of the mid-1990s was less than half the $17 billion that the ICPD estimated will be required in the year 2000 international lending has grown, but support from internation al donors has not increased to fill the gap; when adjusted for inflation do mestic spending in many countries has fallen. Funding for the prevention of sexually transmitted diseases also falls far short of the projected need. Some 4-17% of government health expenditures in developing countries are co mmitted to maternal health. However, since many women lack even the most ba sic reproductive health services, the ICPD projections likely underestimate the resource requirements. Conclusions: Funding for reproductive health services falls substantially b elow ICPD goals. Consumer spending may be able to fill part of the shortfal l, but other strategies for meeting the goals will be needed that do not ad versely affect demand or social justice. Priorities will have to be careful ly set if available resources are to be used as cost-effectively and equita bly as possible.