3 questions to Floriane Borel, Senior Global Policy Associate at the Guttmacher Institute

Interview with Floriane Borel, Senior Global Policy Associate at the Guttmacher Institute

Focus 2030: The Guttmacher Institute regularly documents the persistent gaps between sexual and reproductive health needs and available funding to meet these needs in developing countries. In low- and middle-income countries, 78 million women have an unmet need for contraception. Which interventions deserve particular support? Which public policies and international organizations do you think should be committed to more?

Floriane Borel: For over two decades, the Guttmacher Institute has been documenting the need for, impact of and costs associated with providing sexual and reproductive health services in low- and middle-income countries through our Adding It Up (AIU) research program. The evidence is clear: investments in sexual and reproductive health care save lives, reduce health system costs, boost women’s empowerment, and support sustainable development.

Our latest estimates for 2024 show that out of 928 million women in low- and middle-income countries (LMICs) who want to avoid pregnancy, approximately 78 million have an unmet demand for contraception; these are women who want to avoid pregnancy and are open to using contraception in the future. In terms of investments, an additional $4.80 billion must be mobilized annually to reach the total $14 billion needed to meet all needs for contraceptive services in LMICs.

In the increasingly constrained funding environment we face, targeted investments that respond to the most pressing unmet needs have never been more urgent. Our AIU 2024 study uses a new approach for defining "need" that focuses on women’s own expressed needs and preferences for contraceptive care. The updated measure we use - "unmet demand" – differs from the traditional "unmet need" because it focuses on women who want to avoid pregnancy, are not using any method of contraception but have expressed an intention or desire to use one in the future. Women whose preferences are captured by this measure are a critical starting point for policy makers who want to prioritize limited investments as they have clearly expressed a desire to take up a contraceptive method.

However, it is important to underline that the greatest gains in terms of health, bodily autonomy, women’s empowerment and gender equality can only be achieved through fully investing in comprehensive sexual and reproductive health care and services. According to our latest estimates, a package of SRH care that would meet all needs for women in LMICs—unmet demand for contraception, all maternal and newborn care, abortion services and treatment for the four major curable STIs—would cost $104 billion annually. This total represents a $54 billion annual increase, more than double the $50.4 billion cost of current SRH care in the 128 LMICs. If we break this number down per person, this means investments would just need to increase by an additional $8.05 per capita per year. This requires governments to prioritize health in domestic budgets, but also renewed and bold political leadership at the global level that recognizes these needs can only be met through collective efforts.

Focus 2030: One year after the arrival of the new US administration and as the Global Gag Rule extends to new actors, including international organizations and US-based NGOs, what consequences have you observed on the ground and what do you think future impacts will be in terms of access to sexual and reproductive health, and on health systems, continuity of services, and the capacity of local organizations to meet population needs? What impacts do you anticipate from the US withdrawal from UN Women?

Floriane Borel: Since January 2025, the Trump administration has undertaken what can only be described as a wholesale attack on global health and human rights, with particularly grave consequences on gender equality and sexual and reproductive health and rights. At the global level, Trump’s foreign assistance freeze and subsequent dismantling of the US Agency for International Development (USAID), along with his administration’s sweeping efforts to defund and disengage from critical UN agencies, including UN Women, UNFPA, UNAIDS and the World Health Organization, have caused enormous disruptions in access to sexual and reproductive health services. Guttmacher estimated that one year of U.S. global family planning funding (based on Fiscal Year 2024 levels) allowed 47.6 million women and couples in low and middle-income countries to have access to modern contraceptives, helping prevent about 17.1 million unintended pregnancies and 34,000 pregnancy-related deaths worldwide. Without that investment in 2025, the well-being and lives of tens of thousands of people were put at risk.

One year into office, the Trump administration continues to sow uncertainty, fear and chaos into global efforts to advance SRHR and gender equality. In January 2026, the Trump administration released an extreme and far-reaching policy further restricting U.S. foreign aid that amounts to a supercharged global gag rule (GGR). The global gag rule, also known as the Mexico City Policy, prohibits NGOs based outside the United States that receive US funding from using any of their other funds to provide abortion services or engage in related activities, such as referrals to abortion care or advocacy for abortion access. The GGR is reinstated or rescinded based on who is president (Republican vs. Democrat), and under an expanded version implemented during the first Trump administration, our research documented negative consequences in reproductive health outcomes and overall bodily autonomy in impacted countries.

Now, the Administration has expanded the GGR further to apply to all non-military US foreign assistance –affecting more entities — and to restrict diversity, equity and inclusion (DEI) and gender rights programming. In doing so, the Trump administration is using foreign aid to promote a cruel anti-human rights, anti-transgender rights and anti-abortion ideology. The result is sure to be chaos, confusion and a chilling effect that leads to disruptions in health care and weakened health systems.

These efforts also echo recent hostile US diplomacy towards UN entities working to advance women’s rights and gender equality, including the Trump administration’s pressure towards UN Women to stop their work on "radical causes such as DEI, critical race theory and gender ideology." The intentions behind the policy are clear – the Trump administration is weaponizing foreign aid as it seeks to undermine global investments in health and gender equality and further strip resources from marginalized communities across the world.

Focus 2030: The 70th session of the UN Commission on the Status of Women (CSW) will be held in New York against a backdrop of global backlash against gender equality. To what extent do you think it is worth investing in this commission in the current geopolitical context?

Floriane Borel: The UN Commission on the Status of Women is one of the spaces where backlash against gender equality has been most visible, but it is important to understand that efforts by anti-rights actors to undo progress on gender equality are interconnected with broader attacks against multilateralism and the fundamental idea that governments should come together to tackle the most pressing global issues of our time.

For several years, we’ve seen global forums like CSW being instrumentalized by increasingly powerful and well-organized anti-rights actors to advance an advocacy agenda that is hostile to SRHR, LGBTQI+ rights and gender equality. These actors have simply become more emboldened in the past year by the Trump administration’s overtly hostile diplomacy in different UN settings, including in broader discussions on health, financing and sustainable development in New York and elsewhere.

Now is not the time for governments and civil society to disengage from these forums, but rather to re-commit to multilateralism as an essential avenue for addressing shared challenges that no one country can solve alone. This is a moment not only to resist backlash but also an opportunity to rethink how multilateralism can contribute to building a stronger, more inclusive global movement for SRHR and gender equality, and ensure that key UN entities are properly resourced to do so.