This paper was originally published by The Lancet on 1 October 2026. Staying the course, shaping the future: WHO's commitment to sexual health and reproductive rights – The Lancet Obstetrics, Gynaecology, & Women’s Health
Advances in sexual and reproductive health and rights (SRHR) have been among the great public health successes of the past half-century. In particular, the past decade has delivered some of its most decisive gains. Success has never rested on a single metric. It is measured in the millions of women who have gained increased control over their health, education, and economic futures through application of SRHR.
Contraception remains among the most cost-effective and life-saving interventions in health. An analysis across 172 countries estimated that contraceptive use prevents 272 000 maternal deaths in a single year, reducing maternal mortality by 44%.
Access to safe abortion has followed a similar trajectory. The evidence is unambiguous that legal restrictions do not reduce the incidence of abortion; it does, however, reduce its safety. WHO's 2022 Abortion Care Guideline, updated in 2025, outlines findings that medical abortion and post-abortion contraception can be delivered safely through primary care services and that early medical abortion can often be self-managed without direct provider supervision. Reflecting that evidence base, mifepristone and misoprostol are now listed as essential medicines for the medical management of abortion, free of the political caveats that once accompanied the listing.
Progress against cervical cancer is one of the clearest global health success stories of the past decade. Since the WHO Cervical Cancer Elimination Initiative was adopted in 2020, it has helped transform a disease once dependent on specialist oncology services into one that can be prevented detected and managed through primary health care.
Other major causes of maternal death have seen equally significant gains. WHO's postpartum haemorrhage response bundle validated in a trial of more than 200 000 women has been shown to reduce severe bleeding, emergency surgery, or death by roughly 60% once adopted into practice. WHO's global estimates on infertility and violence against women have also illuminated health burdens that had long gone uncounted. What is not measured is rarely funded, and what is not funded cannot be delivered. The past decade has done more to close that measurement gap than the previous 40 years combined.
Beyond health, reproductive autonomy has also contributed significantly to economic development. Claudia Golden's Nobel prize-winning research showed how access to oral contraception enabled women's participation in higher education and professional careers. Access to oral contraception enabled this participation by allowing childbearing to be aligned with education employment and personal choice. WHO has consistently approached SRHR as a matter of evidence, epidemiology, and public health. The 2018 Declaration of Astana reaffirmed that SRHR is an integral component of primary health care and universal health coverage, not a discretionary add-on. The question was how best to ensure delivery in health systems.
Therefore, SRHR remaining contested in some quarters is a major concern, with challenges evident across multiple global health and geopolitical forums. The development assistance for health has contracted sharply, and UN agencies have warned that two decades of gains in maternal survival are increasingly vulnerable, particularly in fragile humanitarian settings.
At the same time, the multilateral system is undergoing significant reform, and sexual and reproductive health is not always named explicitly within the architecture that is emerging. Increasingly, opposition to SRHR is advancing through mechanisms that make implementation hard regardless of what the evidence shows. Funding conditionality is attached to existing regional and international commitments, and proposals are asserting cultural and religious issues over reproductive health policy and rejecting access to services such as abortion. These initiatives make established commitments hard to finance, administer, or sustain.
All this matters, particularly for WHO. WHO's mandate and its constitution recognises the enjoyment of the highest attainable standard of health as a fundamental right for every human being. Sexual and reproductive health cannot be separated from that principle without weakening the right's universality. As an organisation with this mandate, WHO cannot afford to let decades of hard-won evidence-based progress become the casualty of processes it does not shape nor of funding it does not control.
The same convergence that creates this risk also creates opportunities. Shifting care towards self-managed contraception, medical abortion, and self-sampling are already supported by WHO's own self-care guidelines. This shift moves essential services out of the health facilities and supply chains most exposed to financial and political pressure. Diversifying and financing beyond the small number of bilateral donors through domestic budget allocation and regional risk pooling would convert SRHR from a donor line item into a domestically owned commitment. Engaging finance and planning ministries alongside health ministries places the strongest evidence for reproductive autonomy before the institutions with the greatest influence over policy and resource allocation. This engagement can maximise the opportunity to safeguard these gains during the current period of reform and transition.
50 years of evidence and a decade of accelerating progress have already proven that SRHR is not only integral to the right to health but also among the most effective investments in human development. However, the danger today is not an absence of evidence, it is the silence of voice. If governments and institutions do not defend these gains at this moment of great change, silence will become policy by default and the cost will be measured in rights curtailed, opportunities lost, and lives affected.