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Countries with limited budgets typically choose to pay for what are considered more essential health services, such as vaccines, rather than reproductive health, said Dr Ayman Abdelmohsen, head of the family planning division of UNFPA’s technical division, because they produce more immediate results.

But a recent UNFPA initiative to get low-income countries to shoulder a greater share of the costs has prompted 44 governments to sign up to a new financing model that commits them to increasing their contributions to reproductive health each year.

Despite this, last year saw a significant global shortfall of around $95 million in commodity purchases. Donors now pay for the majority of commodities, but their funding for 2022 was nearly 15% lower than in 2019, as the climate crisis, war in Ukraine and other new priorities squeezed global health budgets. Program support from African governments also stagnated as countries struggled with rising food and energy prices.

The good news is that prices for new contraceptives have fallen dramatically over the past 15 years, thanks in part to promises of large bulk orders brokered by the Gates Foundation, which is betting big on the idea that long-acting methods will appeal to many women in sub-Saharan Africa. Hormone implants made by Bayer and Merck, for example, fell to $8.62 in 2022 from $18 each in 2010, and sales rose to 10.8 million units from 1.7 million over the same period.

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