The 1994 International Conference on Population and Development estimated the cost of meeting the world population's basic reproductive health needs at US$17 billion per year by 2000 and $22 billion by 2015. But at the moment overall resources are insufficient and resources for supplies actually declining.

Financial need is rising steadily as both population and contraceptive use increase. There are three basic sources that support reproductive health supplies for the developing world: government budgets, donors, and individual users.

Many developing countries are moving to become self-sufficient in reproductive health essentials, but most will continue to rely on commodities supplied by donors far into the future, especially the poorest countries and those in sub-Saharan Africa.

The financial situation:

The cost of quality contraceptives and condoms alone (a small part of reproductive health needs) is projected to rise in the next 15 years from $810 million per year to $1.8 billion, of which two-thirds is expected to be borne by developing countries. ¹ Rather than increasing to meet rising need, donor support for contraceptive essentials declined between 1996 and 2000.

• Between 1992 and 1996, donor support averaged 41 percent (of overall estimated requirements) for contraception and condoms for STI/HIV prevention. In 1999 it fell to under 25 percent, the lowest level in five years.

• Contributions peaked in 1996 at $172.2 million. In 1999 they were $130.8 million and in 2000 $154 million.²

• Governments of the Netherlands, the United Kingdom and Canada donated an emergency $80 million in 2000 for contraceptive essentials, especially condoms, in order to help cover shortages.

• Every $1 million shortfall in contraceptive supplies results in about 360,000 unwanted pregnancies, 150,000 abortions, and the deaths of more than 800 women, and 25,000 children under 5 years of age.¹

• Donor support has broadened. In 1991, the U.S. Agency for International Development supplied more than two-thirds of all donor support, and the three other major donors were UNFPA, the World Health Organization and the International Planned Parenthood Federation. By 1999, 14 agencies were regular donors, and USAID support was 37 percent of the total.

Cost estimates do not include the costs of distribution or of ensuring that the product reaches those who need it or that they use it correctly.

Infrastructural issues:

• Resupply actions typically take several years to complete. Funding sources may need advance notice of a year or more to budget and provide the funds to pay for future deliveries, and suppliers need six months or more to plan production and delivery capacity.

• Distribution systems need weeks or months of demand data to predict loadcarrying needs and may not be able to meet that need.

• Delivery, storage and transport systems, refrigeration capacity, import procedures, regulatory systems and accounting techniques require long-term planning and policy support in order to get a continuous stream of commodities to the right places in the needed amounts at the right times.

Cultural and other issues:

• Language barriers, religious restrictions and cultural taboos, especially on women's ability to make choices about their reproductive lives, hamper contraceptive understanding and use in many places.

• Corruption, social unrest and emergency situations may disrupt or divert the supply flow of reproductive health commodities.

• Technical assistance programmes have sometimes involved contracts with narrowly defined goals that were not coordinated with the work of other groups. Lack of cooperation among agencies has created unnecessary supply gaps or surpluses in some countries. Integrated approaches involving consensus planning and management can solve these problems.

• UNFPA's management experience can provide leadership among partners to ensure success.