Finance
Introduction
To meet the ever-growing demand for modern contraception and reach their development goals, countries need to develop reliable, resilient financing for their family planning programs. The focus for the next eight years must be on achieving sustainability, with a combination of country-led domestic resource mobilization, broadly supported universal health schemes, greater private sector involvement, co-financing development opportunities, cross-sectoral partnerships, and donor funding for the neediest countries and programs.
FP2030 builds on the work of the FP2020 partnership in tracking resource flows across the sector, including donor disbursements, domestic expenditures, and total spending on family planning. This year’s report presents the most recent findings from these efforts:
- Bilateral donor funding in 2021 totaled US$1.39 billion, essentially the same amount as in 2020. An additional estimated US$402 million from foundations and nongovernmental organizations (NGOs) brings the international donor total to US$1.79 billion in 2021.
- Domestic government expenditures are estimated at US$1.57 billion for the 59 countries that report expenditures, accounting for 91% of modern method users in low- and lower-middle-income countries. Adjusting this estimate upward to encompass all 82 countries results in an estimated total domestic government expenditure of US$1.73 billion in 2021.
- Total expenditures on family planning in 2021 are estimated at US$4.2 billion across all low- and lower-middle-income countries. International donors contributed an estimated 42%, domestic governments 41%, and consumers 17%.
On the donor side, the most significant movement is the reduction in funding from the U.K., which has historically been the world’s second largest donor. The U.K. is implementing its decision to temporarily reduce foreign aid from .7% to .5% of its gross national income. This translated into a US$100 million drop in funding for family planning from 2020 to 2021. But because several other donor governments posted significant increases in funding in 2021—Australia, Denmark, Germany, Norway, and Sweden—the overall bilateral total held steady at the 2020 level. This figure is, however, well below the peak achieved in 2019 (US$1.52 billion).
Bilateral funding in 2021 does not seem to have been affected by the COVID-19 pandemic. Nevertheless, the ongoing economic pressures resulting from the pandemic as well as the war in Ukraine could have an impact on future year disbursements.
The estimates for domestic expenditures, consumer spending, and total expenditures are compiled from a range of data covering the years 2019, 2020, and 2021. As a result, any impacts from the COVID-19 pandemic may not yet be reflected in these figures.
Donor Government Funding for Family Planning in 2021: KFF Summary Analysis
Donor governments account for about 33% of total funding to address family planning in low- and lower-middle-income countries (see Total Expenditures). To track their role, the Kaiser Family Foundation (KFF) has been collecting and analyzing donor government funding for family planning on an annual basis since the London Summit on Family Planning in 2012. This year’s analysis assesses funding in 2021 as well as trends over time. It includes both bilateral funding and multilateral contributions to the United Nations Population Fund (UNFPA) and is based on analysis of data from the 30 donor government members of the OECD’s Development Assistance Committee (DAC) in 2021 that had reported official development assistance (ODA) to the DAC. Data were collected directly for 10 of these governments, which account for 99% of all bilateral donor government funding for family planning (data for the remaining donors were obtained from the OECD Credit Reporting System, or CRS). Key findings are as follows:
Bilateral Funding:
- Bilateral family planning funding from donor governments was essentially flat in 2021: US$1.39 billion compared with the 2020 level of US$1.41 billion (Figure 11).1,2
- While the overall amount remained steady in 2021, there were significant variations among several donors.
- Funding from five donor governments (Australia, Denmark, Germany, Norway, and Sweden) rose in 2021, with Sweden having the largest overall increase (rising by more than $50 million from US$129.3 million in 2020 to US$180.4 million in 2021); funding from Australia and Germany both doubled in 2021 (Australia increased from US$23.9 million in 2020 to US$49.0 million in 2021; Germany went from US$32.9 million in 2020 to US$66.2 million in 2021).3
- These increases offset a significant decline of more than US$100 million by the UK, a decrease that was not unexpected given the UK government’s decision to reduce overall ODA.4
- Funding from the Netherlands also declined slightly, while funding from Canada and the U.S. remained flat.
- These trends were the same after adjusting for inflation and exchange rate fluctuations.
- More broadly, while bilateral funding from donor governments for family planning has fluctuated over the past decade, it has generally risen since the London Summit in 2012. Funding in 2021 was approximately US$200 million higher than in 2012 (US$1.19 billion), though this was below the peak level reached over the period (US$1.52 billion in 2019).
- The U.S. continued to be the largest bilateral donor to family planning in 2021, accounting for 42% (US$576.7 million) of bilateral funding from governments (Figure 12). The Netherlands was the second-largest donor (US$190.5 million, or 14%), followed by Sweden (US$180.4 million, 13%), the UK (US$157.8 million, 11%), and Canada (US$98.9 million, 7%).
- Bilateral funding in 2021 from most donors does not seem to have been affected by the COVID-19 pandemic. Nevertheless, the ongoing economic pressures resulting from the pandemic as well as the war in Ukraine could have an impact on future year disbursements.
1 For purposes of this analysis, family planning bilateral funding represents amounts specifically designated by donor governments for family planning as defined by the OECD DAC (see Methodology Note), and includes standalone family planning projects, family planning–specific contributions to multilateral organizations (e.g., contributions to UNFPA Supplies), and, in some cases, projects that include family planning within broader reproductive health activities.
2 Some of the figures for previous years are different from the data reported last year due to updates after the 2021 report was published. Donor amounts do not exactly sum to total amounts due to rounding.
3 At the time of publication, data from France were not available. France’s prior year amount was used as a temporary estimate to calculate the overall donor government total in 2021.
4 UK Foreign Commonwealth & Development Office (FCDO), “Statistics on International Development: Provisional UK Aid Spend 2021,” April 2022.
FIGURE 12
International Family Planning Assistance: Donor Governments as a Share of Bilateral Disbursements, 2021
Note: figures based on Kaiser Family Foundation analysis of donor government funding for family planning
Donor Contributions to UNFPA:
- In addition to bilateral funding for family planning—which may include non-core contributions to UNFPA for specific family planning programs, such as UNFPA Supplies—donors contribute to UNFPA’s general or core resources, which are meant to be used for both programmatic activities (family planning, population and development, HIV/AIDS, gender, and sexual and reproductive health and rights) and operational support.
- In 2021, core contributions from profiled donor governments totaled US$405.3 million, similar to 2020 levels (US$411.7 million).
- Seven of the 10 donors profiled (Australia, Canada, Denmark, France, the Netherlands, Norway, and Sweden) provided level funding to UNFPA in 2021. Funding from Germany and the UK fell.5 The U.S., under the Biden Administration, resumed funding in 2021 after the Trump Administration had invoked the Kemp-Kasten Amendment, a provision of U.S. law, to withhold funding—both core and non-core contributions—from UNFPA for the prior four years.6
- Sweden provided the largest core contribution to UNFPA in 2021 (US$64.1 million), followed by Norway (US$54.3 million), Germany (US$47.8 million), and the Netherlands (US$40.5 million).
- In 2021, UNFPA spent approximately US$488.7 million (45% of UNFPA’s total program expenses) on family planning activities. This includes US$278.8 million for activities specifically related to family planning (such as enabling environments for family planning, contraceptives and related supplies, provision of services, and family planning systems strengthening) and US$209.9 million for activities with an impact on family planning results in other areas of work under UNFPA’s mandate.7
5 Germany’s decline in 2021 was a return to prior year levels following a significant increase in 2020 that was aimed at supporting UNFPA’s efforts to address the impacts of COVID-19.
6 See KFF, “UNFPA Funding & Kemp-Kasten: An Explainer,” 2022.
7 Direct communication, UNFPA, October 2022.
COUNTRY
TOTAL
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
$26.6
$12.4
$24.9
$25.6
$22.2
$24.7
$23.9
$49.0
$41.5
$45.6
$48.3
$43.0
$43.8
$69.0
$81.8
$89.4
$94
$98.9
$13.0
$20.3
$28.8
$28.1
$30.7
$33.1
$38.5
$25.6
$18.8
$23.5
$49.6
$37.2
$69.8
$68.6
$39.9
$19.2
$17.0
$11.1
$19.8
**
$47.6
$38.2
$31.3
$34.0
$37.8
$36.8
$51.3
$44.1
$32.9
$66.3
$105.4
$153.7
$163.6
$165.8
$183.1
$197.0
$215.6
$203.3
$202.3
$190.5
$3.3
$20.4
$20.8
$8.1
$5.7
$2.2
$12.9
$15.6
$10.8
$15.4
$41.2
$50.4
$70.2
$66.0
$92.5
$109.2
$107.0
$113.1
$129.3
$180.4
$252.8
$305.2
$327.6
$269.9
$204.8
$280.0
$284.5
$383.3
$270.9
$157.8
$579.8
$579.4
$579.3
$579.2
$576.8
$600.5
$592.5
$592.5
$592.5
$576.7
$11.0
$29.5
$9.0
$10.1
$3.3
$9.6
$29.6
$14.4
$12.6
$7.5
$1,188.4
$1,319.4
$1,375.4
$1,285.2
$1,243.3
$1,382.1
$1,452.9
$1,517.1
$1,407.8
$1,386.5
*For purposes of this analysis, family planning bilateral expenditures represent funding specifically designated by donor governments for family planning as defined by the OECD DAC (see methodology), and include: stand-alone family planning projects; family planning-specific contributions to multilateral organizations (e.g. contributions to UNFPA Supplies); and, in some cases, projects that include family planning within broader reproductive health activities. During the FP2020 Summit, donors agreed to a revised Muskoka methodology to determine their FP disbursements totals. This methodology includes some funding designated for other health sectors including, HIV, reproductive health (RH), maternal health, and other areas, as well as a percentage of a donor’s core contributions to several multilateral organizations including UNFPA, the World Bank, WHO, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Among the donors profiled, Australia and the U.K. reported FP funding using this revised methodology.
**Austria, Belgium, Czech Republic, European Union, Finland, Greece, Hungary Iceland, Ireland, Italy, Japan, Korea, Luxembourg, New Zealand, Poland, Portugal, the Slovak Republic, Slovenia, Spain, and Switzerland.
**At the time of publication, data from France were not available. France’s prior year amount was used as a temporary estimate to calculate the overall donor government total in 2021.
Methodological Note:
With some exceptions, the financial data presented in this analysis represent “disbursements,” which are defined as the actual release of funds to, or the purchase of goods or services for, a recipient. They were obtained through direct communication with donor governments, analysis of raw primary data, and the OECD CRS. UNFPA core contributions were obtained from Executive Board documents.
For the U.S., funding represents final congressional appropriations (firm commitments that will be spent), rather than disbursements, which can fluctuate from year to year due to the unique nature of the U.S. budget process (unlike most other donors, U.S. foreign assistance funding may be disbursed over a multiyear period). All prior year amounts have been changed from disbursements to appropriations. This change in methodology does not alter the overall trend over time.
In some cases, it is difficult to disaggregate bilateral family planning funding from broader population, reproductive, and maternal health totals, and the two are sometimes represented as integrated totals. In addition, activities related to family planning that are funded in the context of other official development assistance sectors (e.g., education, civil society) have remained largely unidentified. For purposes of this analysis, we worked closely with the largest donors to family planning to identify such cross-sectoral funding specifically related to family planning where possible (see Table 2 Notes). Going forward, efforts to track donor government support for family planning will be strengthened if such funding is identified within other activity categories by primary financial systems.
For data in the currency of the donor country, please contact the researchers.
1 For purposes of this analysis, family planning bilateral funding represents amounts specifically designated by donor governments for family planning as defined by the OECD DAC (see Methodology Note), and includes standalone family planning projects, family planning–specific contributions to multilateral organizations (e.g., contributions to UNFPA Supplies), and, in some cases, projects that include family planning within broader reproductive health activities.
2 Some of the figures for previous years are different from the data reported last year due to updates after the 2021 report was published. Donor amounts do not exactly sum to total amounts due to rounding.
3 At the time of publication, data from France were not available. France’s prior year amount was used as a temporary estimate to calculate the overall donor government total in 2021.
4 UK Foreign Commonwealth & Development Office (FCDO), “Statistics on International Development: Provisional UK Aid Spend 2021,” April 2022.
Domestic Government Expenditures
Domestic government expenditures reflect a government’s commitment to its family planning program and indicate the prospects for its long-term financial sustainability. Domestic expenditures are defined as all government expenditures that support family planning, including commodity purchases, demand creation campaigns, investments in training and research, and service delivery.
This is our fifth year of reporting domestic expenditures at the country level, and the number of countries for which estimates are available have increased each year. This year’s table includes estimates for 59 countries, amounting to US$1.57 billion in spending (Table 3). These 59 countries account for 91% of modern method users in all low- and lower-middle-income countries. The largest amounts are reported by populous countries in Asia that fund much of their own programs. Indonesia, India, the Philippines, Bangladesh, and Pakistan together account for about 80% of the total. Government expenditure per modern method user ranges from nearly zero to over US$100, with an average of about US$5 per user.
Each country estimate in the table is for the most recent available fiscal year, in most cases 2019, 2020 or 2021. The expenditures reported come from three sources:
WHO/SHA. WHO has been implementing data collection on health expenditures under the System of Health Accounts (SHA) 2011 for several years as part of a joint effort with the OECD and Eurostat. Government-approved estimates are published on the WHO Global Health Expenditure Database. These data include directly measured expenditures, when available for 2019, or estimates based on trends from measurements in previous years. New estimates are released each December, so information for 2020 may be available for some countries at that time.
FPSA (Family Planning Spending Assessment). Track20 collects data on family planning expenditures in low- and lower-middle-income countries using a modified version of health accounts that focuses strictly on family planning. These analyses collect information from the main funders and implementing organizations to describe sources and uses of funds. Results are disseminated to governments and other stakeholders. The FPSA methods were first tested in Kenya with 2017 data and have since been extended to 38 countries.
UNFPA. UNFPA and NIDI (Netherlands Interdisciplinary Demographic Institute) tracked domestic government expenditures for family planning from 2014 to 2019. NIDI worked with national UNFPA offices to engage local consultants to review records and interview government officials. Results were checked for completeness and quality by NIDI. Final results were approved for release by the organizations contributing data and, in most cases, by appropriate government agencies.
COUNTRY
Afghanistan
$995,876
2019
NIDI/UNFPA
$230,300,000
2020
FPSA
Benin
$3,443,101
2021
FPSA
$1,143,369
2019
2019
UNFPA
$1,756,825
2021
FPSA
$2,502,913
2020
FPSA
$135,702
2020
Central African Republic
$219,219
2019
WHO/SHA
Chad
$5,814,595
2021
FPSA
$4,050,174
2019
WHO/SHA
$3,938,979
2019
$35,711,413
2021
FPSA
Djibouti
$89,456
2021
FPSA
$11,451,878
2021
FPSA
2018
NIDI/UNFPA
$6,441,333
2020
FPSA
$525,126
2021
FPSA
2018
$2,939,094
2021
FPSA
2016
$100,755
2019
$2,469,404
2016
$314,163,648
2019
Government
$355,471,125
2020
FPSA
$34,450,000
2020
$6,191,640
2020
FPSA
$754,082
2021
FPSA
$1,707,490
2020
FPSA
$5,498,935
2019
$3,405,906
2021
FPSA
$3,281,256
2020
FPSA
$10,148,634
2021
FPSA
$2,372,718
2019
$3,492,581
2020
$6,277,150
2020
$5,068,272
2020
FPSA
2018
NIDI/UNFPA
$6,456,017
2021
FPSA
$8,916,146
2019
$130,971,130
2020
FPSA
Papua New Guinea
$156,754
2018
UNFPA
$260,171,718
2021
FPSA
Rwanda
$3,650,132
2020
FPSA
$288,210
2021
FPSA
$7,644,776
2021
$1,305,108
2020
FPSA
Somalia
$12,000
2018
NIDI/UNFPA
$305,037
2020
FPSA
$14,229,196
2021
FPSA
$3,675,606
2019
$466,642
2020
FPSA
$1,134,160
2020
FPSA
$4,454,808
2021
FPSA
$419,158
2019
$4,459,734
2021
FPSA
$18,965,068
2020
FPSA
$5,054,228
2019
$17,928,498
2021
Note: FPSA: Family Planning Spending Assessment; NCM: National Consensus Meeting; NIDI/UNFPA: Netherlands Interdisciplinary Demographic Institute/United Nations Population Fund; WHO/SHA: World Health Organization System of Health Accounts; * Federal government only
Assessing Trends in Domestic Expenditures: Mali, Madagascar, and Côte d'Ivoire
Estimates of government expenditures are sensitive to the approaches used, especially for allocating shared expenditures such as human resources. As a result, estimates for individual countries may vary from year to year without necessarily indicating real changes. As these efforts have become more mature, the approaches have become more consistent, allowing comparisons of changes over time.
Figure 13 shows estimates for 2020 and 2021 for three countries that applied a consistent approach with FPSA: Côte d’Ivoire, Madagascar, and Mali. All three showed significant increases with consistent allocation of total spending. In Mali expenditures rose from US$5.1 million in 2020 to US$10.1 million in 2021, in Madagascar from US$1.6 million in 2020 to US$3.4 million in 2021, and in Côte d’Ivoire from US$26.6 million in 2020 to US$35.8 million in 2021.
Note: The categories are those used by the Family Planning Spending Assessment (FPSA). “Salaries” refers to salary and benefit payments to health personnel who deliver family planning services. If family planning is only one of the services they provide, then only a portion of the salary is allocated to family planning. “Training” refers to family planning-specific training. “Commodities” refers to contraceptive supplies purchased by the government. “M&E” refers to monitoring and evaluation activities. “IE&C” refers to information, education, and communications programs specific to family planning. “Other services” refers to all other family-planning related services such as administration and research. “Capital” refers to expenditures on long-term assets such as equipment and facilities.
Total Expenditures on Family Planning
Total spending on family planning is composed of three main segments: domestic government expenditures, international donor contributions, and out-of-pocket spending by consumers who access services in the private sector or pay fees for public sector services.
Total expenditures in 2021 are estimated at US$4.2 billion across all low-income and lower-middle-income countries (Figure 14). This is 1% lower than last year’s estimate. International donors contributed an estimated 42%, domestic governments 41%, and consumers 17%.
Note: Figures based on analysis by Track20 and the Expert Advisory Group on International Family Planning Expenditures.
The distribution of expenditures by type varies significantly by country. Programs in some countries are very donor-dependent, while others are largely funded by national governments or consumers.
Data for each segment are collected and reviewed by the Family Planning Expenditures Expert Advisory Group, which provides guidance on combining the available information into a single estimate.
Domestic Government Expenditures
As described in the previous section, these are now available for 59 low- and lower-middle-income countries. Estimates for spending in 2021 are available for 19 countries. Estimates for other countries are from earlier years: 19 for 2020, 14 for 2019, five for 2018, and two for 2016. The total for reporting countries is US$1.57 billion. Reporting countries represent 91% of all modern contraceptive method users in low- and lower-middle-income countries. Adjusting for the missing countries raises the estimated domestic government expenditures to US$1.73 billion.
International Donor Contributions
Financial contributions from international donors are tracked by several organizations, each using different methodologies.
- The Kaiser Family Foundation tracks bilateral disbursements for family planning by interviewing each of the top 10 donor countries and using the OECD CRS database for all others (see above). For 2021 KFF reports donor funding of US$1.39 billion.
- The Institute for Health Metrics and Evaluation (IHME) collects data from a number of sources, including the OECD-DAC CRS, World Bank, regional development banks, USAID-financed NGOs, and UN agencies. Key word searches of project descriptions are used to distinguish family planning funding from other types of development assistance for health (DAH). Estimates include funding from bilateral donors as well as from foundations and NGOs. For 2020, the most recent year available, IMHE estimates donor disbursements at US$1.1 billion. This is different from the KFF estimate because of different approaches to allocated expenditures in broader reproductive health categories to family planning. The IHME estimate includes US$144 million from foundations and NGOs that is not in the KFF estimate.
- The Bill & Melinda Gates Foundation reports expenditures directly to FP2030; the amount reported in 2020, the most recent year available, was US$258 million. Combining that figure with the KFF estimate of US$1.39 billion in 2021 for bilateral donors and with the IHME estimates for other foundations, NGOs, and other organizations (US$144 million), total donor contributions for family planning come to US$1.79 billion in 2021.
Out-of-Pocket Spending
The Reproductive Health Supplies Coalition and Avenir Health estimate out-of-pocket expenditures on family planning as part of their Landscape & Projection of Reproductive Health Supply Needs (LEAP) analysis. Estimates are produced separately for married and unmarried contraceptive users, using information on the number of modern method users (from Track20 and the UN Population Division), method mix, price points, and the percentage of users obtaining their services from the private sector (from DHS, multiple indicator cluster surveys, and other national surveys). Total out-of-pocket expenditures in 2019, the most recent year available, are estimated at US$710 million in all low- and lower-middle-income countries and US$3.16 billion when upper-middle-income countries are included.
