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The global funding landscape for family planning is in a state of flux. The Mexico City Policy, reduced funding to UNFPA, and policy changes in the US have created an uncertain environment for family planning programs around the world. Many partners are scaling back their programs in response to the loss of US funding; donors and countries are shifting to accommodate the situation by reprioritizing and reallocating their resources. The question of who funds what, and how reliable that funding is, remains unsettled.

The annual analysis from the Kaiser Family Foundation indicates that bilateral funding for family planning declined in 2016 for the second year in a row, essentially retreating to 2013 levels. At the same time, the Summit generated a groundswell of new funding commitments from donor governments (refer here), which KFF intends to track going forward. The extent to which new commitments are able to offset funding reductions from other quarters will become clearer next year.

DONOR GOVERNMENT FUNDING FOR FAMILY PLANNING IN 2016: KAISER FAMILY FOUNDATION ANALYSIS

OVERVIEW

Donor government funding for bilateral family planning decreased in 2016 compared to the prior yearc (see Figure 2). This marked the second year of declines in a row, after an initial increase following the London Summit in 2012. These decreases are largely due to currency fluctuations and the timing of donor disbursements. Still, after accounting for these factors, funding has declined to 2013 levels.

These findings are based on analysis of data from 30 governments which were members of the Organisation for Economic Co-operation and Development (OECD) Development Assistance Committee (DAC) in 2016 and had reported Official Development Assistance (ODA) to the DAC. Data for 10 of these governments, which account for 99% of all donor government funding for family planning, were collected directly; data for the remaining donors were obtained from the OECD Creditor Reporting System (CRS). Key findings from 2016 are as follows:

BILATERAL FUNDING:

• After the 2012 London Summit on Family Planning, bilateral funding from donor governments began to rise, reaching a peak in 2014. Since then, funding has declined to 2013 levels, even after accounting for currency fluctuations and timing of donor disbursements.
• In 2016, donor governments provided US$1.19 billion in bilateral funding compared to US$1.34 billion in 2015 (a decrease of more than US$150 million or 12%, as measured in current terms).
• Funding increased from five donors (Australia, Denmark, Germany, the Netherlands, and Sweden), remained flat for one (Canada), and decreased for four (France, Norway, the UK, and the US).
• The decline in funding from the US (from US$638.0 million in 2015 to US$532.7 million in 2016) appears to reflect the timing of disbursements, as overall funding commitments by the US have remained flat for several years.d
• Even with the decrease in funding by the US, it remained the largest bilateral donor to family planning in 2016, accounting for 45% of total bilateral funding.

The UK was the second largest donor (US$203.4 million, 17%), followed by the Netherlands (US$183.1 million, 15%), Sweden (US$92.5 million, 8%), and Canada (US$43.8 million, 4%).

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DONOR CONTRIBUTIONS TO UNFPA:

• In addition to bilateral disbursements for family planning—which include non-core contributions to UNFPA for family planning projects as specified by the donor—donors also contribute to UNFPA’s 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 2016, donor government core contributions totaled US$347.0 million, compared to US$392.6 million in 2015 (a decline of US$45.6 million or 12%). Among the donors profiled, two increased funding (Germany and Sweden), four remained flat (Canada, France, Netherlands, and the US), and four declined (Australia, Denmark, Norway and the UK).e When measured in currency of origin, UK contributions remained flat.
• Sweden provided the largest core contribution to UNFPA in 2016 (US$59.0 million), followed by Norway (US$46.8 million), the Netherlands (US$39.1 million), and the US (US$30.7).
• In 2016, UNFPA reports that it spent an estimated US$319 million (or 40% of its resources) on family planning. Of this, an estimated US$76 million came from core resources (resources meant to be used by UNFPA for both programmatic activities and operational support) and an estimated US$243 million came from non-core resources (resources earmarked for specific programmatic activities).6

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METHODOLOGICAL NOTE

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. Constant US$ amounts were calculated using the OECD’s “Deflators for Resource Flows from DAC Donors” and adjusting non-US$ funding amounts accordingly. In order to take into account the global rise in the US dollar, 2014 was used as the base year.

In some cases it is difficult to disaggregate bilateral family planning funding from broader reproductive and maternal health totals, and the two are sometimes represented as integrated totals (Canada, France, the Netherlands, Sweden, and the US do not disaggregate family planning funding from broader reproductive and/or maternal health totals). In addition, family planning-related activities 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 family planning-specific funding where possible (see Figure 2 notes ). Going forward, it will be increasingly important to efforts to track donor government support for family planning to have such funding identified within other activity categories by primary financial systems.

For data in the currency of the donor country, please contact the researchers.

SPOTLIGHT ON EUROPE: ANALYSIS FROM COUNTDOWN 2030 EUROPE

TRENDS AND DEVELOPMENTS FROM SELECT EUROPEAN DONORS

In the past year European donors have maintained a solid and committed policy stance on sexual and reproductive health and family planning (SRH/FP). Several countries further increased their commitments to SRH/FP in 2017, either as part of the SheDecides initiative (launched this year in response to the reinstatement of the Global Gag Rule), and/or at the Family Planning Summit held in London in July 2017.

Since the Sustainable Development Goals were launched in 2015, European countries have played a key role in keeping SRH/FP at the forefront of the global agenda and protecting SRH/FP in global accountability mechanisms for the 2030 Agenda. So far, donor commitments to SRH/FP have been maintained at the same level or increased, but there remains uncertainty in some countries about the future of SRH/FP funding in light of political shifts, new government formations, or overall cuts to ODA. Nevertheless, countries remain confident as SRH/FP financial commitments are so far being upheld.

This analysis focuses on overall trends and developments in SRH/FP funding from Countdown 2030 European countries, including policy updates from FP2020 commitment makers as well as other countries.

Update on policy context for European FP2020 Commitment makers

Belgium: Belgium became an FP2020 commitment maker this year, announcing at the Summit that it would contribute €36 million over the next four years to core funding for UNFPA. Belgium also hosted the SheDecides pledging conference in March 2017, and pledged €10 million to SRH/FP as part of that initiative. This follows an increase in spending on SRH/FP in 2016. As part of its bilateral cooperation, Belgium supported UNFPA’s programs on SRH/FP in Burkina Faso (€2.5 million) and Guinea (€1.2 million). The proportion of Belgium’s health expenditures contributing to reproductive, maternal, newborn, and child health (RMNCH) rose from 50 to 70% in 2016.

Denmark: As one of the driving forces of the SheDecides initiative, Denmark has reaffirmed its national commitment to SRH/FP, co-hosting the pledging conference and follow-up events and pledging 75 million DKK (€10.1 million). In January 2017 a broad majority of the Danish parliament adopted a new strategy to guide implementation of the SDGs: The World 2030: Denmark's strategy for development cooperation and humanitarian action, which identifies SRH/FP as one of four strategic priorities. In August 2017 the government published a proposed state budget for 2018, which includes a substantial increase in multilateral funding for SRH/FP. The budget will be negotiated in Parliament in late 2017.

European Institutions: In August 2017, the European Commission launched a call for proposals for a new €32 million fund for “Promoting Gender Equality and Women and Girls’ Empowerment in Developing Countries,” which includes SRH/FP as one of its two key priorities. In September 2017, the European Union and the United Nations launched the EU–UN Spotlight Initiative to eliminate violence against women and girls. The EU is investing €500 million in the initiative, which will deploy large-scale investments to support gender equality and women’s empowerment in Asia, Africa, Latin America, the Pacific, and the Caribbean. The European Institutions’ commitment to SRH/FP has also been clearly presented in the new European Consensus on Development, the guiding document that will set the budget for international development by the European Union for the coming years.

France: The Ministry of Foreign Affairs has published a strategy on “Population and SRHR: 2016–2020,” but the strategy lacks detailed financial commitments to SRH/FP. A new “Gender and Development” strategy is underway for release in 2018, with SRH/FP expected to feature as a key component. France continues to politically support the Ouagadougou Partnership, and the new president has pledged to prioritize women’s rights during his presidency and increase ODA to 0.55% of gross national income (from 0.38%) by 2022.

Germany: Germany renewed its FP2020 commitment in May 2016, with a pledge to provide a minimum of €514 million until 2019 for SRH/FP. The government indicated that spending on family planning was expected to comprise approximately 25% of bilateral funding, including RMNCAH-relevant contributions to the Global Fund to fight AIDS, Tuberculosis and Malaria and financial support to UNFPA and the International Planned Parenthood Federation. Since then, no further commitments have been made.

Netherlands: The Netherlands maintains its position as a longstanding supporter of SRH/FP in its policies, with €424 million of its ODA budget going to SRH/FP in 2016 and €417 million projected for 2017. The Netherlands pledged €25 million as part of the SheDecides initiative, of which €10 million has already been allocated. Formation of a new coalition government is ongoing, with uncertainty as to what this new government’s impact will be on the ODA budget. If the ODA budget is further reduced, it is unclear how the SRH/FP budget will be affected.

Norway: Norway is historically a strong supporter of SRH/FP, being one of the main donors to UNFPA. In 2017 Norway increased its support for SRH/FP through the SheDecides initiative and FP2020, with an additional US$85 million (approximately €74 million) pledged at the Summit for SRH/FP between 2017 and 2020. This is on top of existing commitments to SRH/FP via the Global Financing Facility, and includes an increase of funds to UNFPA and SRH/FP organizations. Norway will also re-launch its support of UNFPA Supplies in 2018 (the most recent funding having been provided in 2014).

Sweden: SRH/FP remains a priority area within development cooperation and feminist foreign policy, with a special focus area included in 2017 to intensify SRH/FP efforts. Sweden continues to advocate for a stronger commitment to SRH/FP in the UN and EU. Budget allocation for SRH/FP within the ODA remains stable and is likely to increase in the 2018 budget. Sweden was instrumental in launching SheDecides, and pledged an additional 200 million SEK (€21 million) to SRH/FP as part of that initiative.

UK: The UK continues to place a high priority on FP in the context of wider support for comprehensive SRHR. In July 2017 the UK co-hosted the global Family Planning Summit, aimed at keeping FP at the forefront of the global agenda. The UK announced at the Summit that it was increasing its existing commitment by 25% to an average of £225 million (€254 million) a year, and extending its commitment by a further two years.

Updates on policy context for other European donors

In addition to the above-mentioned European donors who made an FP2020 pledge, other European donors are contributing to a supportive SHR/FP policy environment in Europe to address the global unmet need for FP:

Finland: Finland maintains its commitment to SRH/FP as a priority area for ODA. Although Finland’s overall ODA budget has not increased, it pledged €20 million as part of the SheDecides initiative and an additional €21.3 million to SRH/FP at the Summit, of which €18 million will be directed to UNFPA Core Funding.

Ireland: A cabinet reshuffle and the election of a new prime minister have seen Ireland’s ODA commitments reaffirmed and existing SRH/FP commitments for the coming years upheld. Positive engagement with SR/FP, including country representation at the SheDecides conference and appointment of a gender champion as the SRH/FP focal point, is a tangible reflection of these commitments.

Spain: In 2016 the government earmarked €1.5 million for SRH/FP, split across UNFPA Supplies (€200,000), SRH/FP for people living with disabilities (€300,000), and the Joint Global Program on Essential Services for Women and Girls Subject to Violence (€1 million).The ODA budget in Spain increased by 2% in 2017 (an additional €54 million), with commitments to UNFPA core funding expected but yet to be confirmed. Representatives from Spain participated in the SheDecides conference and the Summit, but no pledges have been made to date.

Switzerland: SRH/FP falls under one of six strategic focal areas in Switzerland’s new Gender Equality and Women’s Rights Strategy, which is guided by the 2030 Agenda for Sustainable Development. Despite recent cuts in international cooperation, Switzerland has steadily increased its overall funding for SRH/FP in recent years, from around €33m in 2011 to €60m in 2017.

ESTIMATING EXPENDITURES

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Family planning expenditures are not comprehensively tracked by current information systems. However, some information is available which we can use to estimate expenditures in the FP2020 focus countries. In addition to the bilateral donor disbursements discussed above, expenditures are also made from domestic government budgets and by non-governmental organizations (NGOs), corporations, and consumers. Estimates of domestic government expenditures are available from the FP Resource Flows Project implemented by UNPFA and the Netherlands Interdisciplinary Demographic Institute (NIDI), which uses national consultants to collect information from various government offices on domestic government expenditures as well as NGOs and corporations.

Another source of expenditure is out-of-pocket payments (OOP) by consumers who purchase family planning services from private sector providers. The number of users relying on the private sector can be estimated from the total number of modern method users presented in this report together with DHS data on method mix and the proportion of users of each method who rely on the private sector. Information on the amount paid by each consumer is available for 14 countries from DHS and PMA2020 surveys and PSI studies on the prices charged by social marketing programs. These 14 countries represent about three-quarters of all modern method users. Countries without surveys are based on proxy countries from the 14 for which we do have data.

The results indicate that total family planning expenditures in 2015 in the 69 FP2020 countries stood at approximately US$2.7 billion. About half of the resources came from international donors, just under one-third were from domestic government expenditures, and most of the remaining were out-of-pocket payments by consumers. This is equivalent to about US$9 per modern method user.

The new estimate of OOP spending is considerably lower than last year’s, largely due to new information from PMA2020 facility surveys in nine countries and the addition of a new data source, PSI FPWatch market studies, in five countries. These studies provide more up-to-date data, especially for the short term methods (condoms, injectables, and pills) that represent almost three-quarters of OOP payments. The methodology for estimating international donor expenditures has been revised since last year, and is now aligned with the Kaiser Family Foundation’s analysis.

The estimates of domestic government and OOP expenditures are not yet refined enough to detect trends over time, but we should see significant increases in the coming years if recent pledges are fulfilled. Additional details are available in the Track20 report “Family Planning Expenditures in 69 Low- and Middle-Income Countries in 2015.”