Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.


Underfunded and fragmented — a storm is brewing for sexual and reproductive health services

The Guttmacher–Lancet Commission’s report on Sexual and Reproductive Health and Rights for All coincides with raised awareness of this topic as a result of global movements such as #metoo. However, weak political leadership, increasing fragmentation of services, and sustained underfunding pose a threat to sexual and reproductive health globally.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Fragmentation of SRH funding in England mapped to the seven domains of sexual and reproductive health care outlined by the Guttmacher–Lancet commission.


  1. 1.

    Starrs, A. M. et al. Accelerate progress — sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. Lancet (2018).

    Article  Google Scholar 

  2. 2.

    Festin, M. P. et al. Moving towards the goals of FP2020 — classifying contraceptives. Contraception 94, 289–294 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Antiretroviral Therapy Cohort Collaboration. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV 4, e349–e356 (2017).

    Article  Google Scholar 

  4. 4.

    Prevention Access Campaign. Risk of sexual transmission of HIV from a person living with HIV who has an undetectable viral load: message primer and consensus statement. Prevention Access Campaign (2018).

  5. 5.

    Canning, D. & Schultz, T. P. The economic consequences of reproductive health and family planning. Lancet. 380, 165–171 (2012).

    Article  PubMed  Google Scholar 

  6. 6.

    Stenberg, K. et al. Advancing social and economic development by investing in women’s and children’s health: a new Global Investment Framework. Lancet. 383, 1333–1354 (2014).

    Article  PubMed  Google Scholar 

  7. 7.

    World Association for Sexual Health. Declaration of sexual rights. WAS (2014).

  8. 8.

    British Medical Association. Feeling the squeeze: the local impact of cuts to public health budgets. BMA (2018).

  9. 9.

    Family Planning Association. Unprotected Nation 2015. FPA (2015).

  10. 10.

    Public Health England. Multi-drug resistant gonorrhoea in England: 2018. GOV.UK (2018).

Download references

Author information



Corresponding author

Correspondence to Shema Tariq.

Ethics declarations

Competing interests

S.T. has previously received a travel bursary funded by Janssen-Cilag through the British HIV Association, speaker honoraria and funding for preparation of educational materials from Gilead Sciences, and is a member of the steering group of SWIFT, a networking group for people involved in research in HIV and women, funded by Bristol Myers Squibb. N.P. has previously received WHO funding to attend and present at WHO training on gender-based violence and family planning.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pathak, N., Tariq, S. Underfunded and fragmented — a storm is brewing for sexual and reproductive health services. Nat Rev Urol 15, 472–473 (2018).

Download citation

Further reading


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing