Getting Ahead of the Global Urbanization Curve in Reproductive Health

Getting Ahead of the Global Urbanization Curve in Reproductive Health


According to the United Nations, around 66 percent of the world’s population will live in urban areas by 2050. If those projections hold, that means an additional 2.5 billion people will be living in cities, with 90 percent of them in Asia and Africa. With this predicted expansion of human populations toward cities, funders are feeling the pressure to get ahead in all manner of global health and development challenges.

The Gates Foundation has its eye on meeting the growing need for urban reproductive health programs—a matter in which the foundation and its partners have been looking into since 2009 with its Urban Reproductive Health Initiative (URHI).

Armed with funding from Gates, the URHI pilot program was launched in 2009 in Kenya, Nigeria, Senegal, and India. The overarching principle of the program was to increase women’s access to modern contraception. Implementing partners in each country then expanded on that basic principle. For example, URHI in Senegal worked with project partners to develop cost effective family planning programs, increase awareness for family planning in local communities, and inform policy making related to family planning. The pilot ran from 2009 to 2015.

Now, the Bill & Melinda Gates Institute for Population and Reproductive Health, which is based at the Johns Hopkins Bloomberg School of Public Health, is launching a new urban reproductive health program, called The Challenge Initiative, or TCI.

The Gates Foundation has made a $42 million grant to support TCI which aims to scale the “tools and approaches developed and lessons learned in URHI to more cities and geographies.” TCI will focus its work on cities that demonstrate a high need for modern contraceptives, family planning information, and sexual and reproductive health services.

Given that TCI is taking a demand-driven approach, it asking participating cities to “self-select” and work with in-country partners to develop full proposals that include family planning and reproductive health interventions that are cost effective and accessible. From there, chosen cities will have access to a chunk of Gates’ $42 million.

Family planning and sexual and reproductive health isn’t just about women having increased control over their own sexual and reproductive health choices. Expanding choices, education, and accessibility here can have a significant impact on a variety of global health and development challenges such as economic security, education, poverty alleviation, and women’s empowerment.

The Gates Foundation is a key funder in the global family planning space—last year, it committed nearly $300 million to related programs—but there are a few other big names here, like the Hewlett and Children’s Investment Fund foundations. Of course, also, the Susan Thompson Buffett Foundation is a major player here.

Hewlett is a heavy funder of projects related to reproductive health rights advocacy and research to inform policymaking, rather than those focused on health care delivery services. This funder has been committed to helping women gain autonomy over their bodies, and their sexual and reproductive health choices for decades.

Hewlett’s International Women’s Reproductive Health program aims to decrease unwanted pregnancies, increase access to basic reproductive health services, and ensure that no woman or girl dies from unsafe abortions. Recent grants coming out of Hewlett include a $1.25 million give to Pathfinder International for its work which includes providing sexual and reproductive health services including maternal health, HIV prevention, and safe abortion provision. Pathfinder is also committed to strengthening national and international health systems, advocating for increased policy making in the sexual and reproductive health arena.

Hewlett, like most funders in this space, connects family planning and reproductive health into broader global health and development goals.

The Children’s Investment Fund Foundation (CIFF) takes a bit of a different funding tack than Hewlett and Gates, focusing squarely on adolescent reproductive health. To date, the UK-based funder has invested $75 million in projects related to HPV vaccinations for adolescent girls in sub-Saharan Africa. HPV is currently the leading cause of cancer-related deaths for women in the region. Other major grant include a $13.5 million to prevent unwanted teen pregnancy in Kenya, and $14.2 million to scale and increase access to the contraceptive, Sayana Press.

Incidentally, earlier this year, CIFF and partnered with the Gates Foundation earlier this year to launch Adolescents 360. The program which was funded by a multi-year, $16.5 million grant from the CIFF and matched by Gates for a total give of $33 million aims to “reinvent sexual and reproductive health services,” with a focus on girls at the center of the program’s development and design.

Upon making the $42 million announcement, Christopher Elias, president of the global development program at the Gates Foundation. “Meeting the growing demand for voluntary family planning, particularly among the urban poor, will allow more women and couples to plan their futures and break the cycle of poverty.” And he’s not wrong.

Multiple reports have found that when women have fewer children or wait longer before having more children, their families are able to invest more in their education, nutrition, and healthcare. Also, women who wait longer to get married or at least have babies, are more likely to continue their educations, which then leads to not only increased economic security, but improved gender equality.

In other words, there’s a lot at stake here.

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