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Overview
Access to sexual and reproductive health services allows women and girls to have autonomy and choice about their personal health and creates the foundations for healthy societies. Yet, more than 150 million women in low- and middle-income countries (LMICs) still lack access to modern contraceptives due to limited choices, unaffordability, inadequate provider access, and insufficient education. Unintended pregnancies, the deadly HIV epidemic and other infections, such as TB, are prevalent globally yet overwhelmingly affect the most vulnerable communities in the world. Creating a world where children can thrive is predicated on robust access to sexual and reproductive health.
In 2025, innovations have emerged against a backdrop of growing threats to access. While innovation is essential to increase access, it requires concerted collaboration from governments, healthcare systems, service delivery partners and the private sector.
Sustaining family planning access for those with the greatest need
Many governments recognise that SRHR is an essential part of achieving our SDGs but for some regions, the delivery gap is large and widening. This is particularly true for many countries across the Sahel and Central Africa, where donor investment in family planning has been relatively low, despite huge unmet need for family planning services and some of the highest adolescent pregnancies and deaths in motherhood. National governments and local civil society are leading efforts to do far more, and CIFF is prioritising these regions.
This is why CIFF supports the mCPR Challenge Fund platform which is designed to support government leadership, public sector performance and equity - to make faster progress towards national goals and FP2030 commitments. The platform strengthens access to high-quality family planning, supporting people within national health systems and, importantly, also those unable to access formal care. CIFF has continued to support this platform, in partnership with co-funders such as the FCDO and foundations, as well as with implementing partners such as MSI Reproductive Choices and Ministries of Health. In 2025, the partnership reached approximately 2 million women and girls, bringing the cumulative reach to 5.4 million since 2023.
Scaling SRHR innovations: self-injectable generic breakthrough
Self-injectable contraceptives are a powerful innovation that put control directly into women’s hands. By enabling women to plan pregnancies according to their own needs and circumstances, it reduces unintended pregnancies and strengthens health, autonomy, wellbeing and economic agency. Children are then likely to be healthier and grow up in households with greater stability and opportunity. Self-injection, therefore, supports families to thrive, improving long-term outcomes across generations.
One challenge to wider access for women and girls across the global market has been a reliance on a single manufacturer. Generics play a vital role as cost-effective, bio-equivalent versions – and in 2025, the first generic version of the self-injectable, DMPA-SC, developed by Incepta, was granted pre-qualification by the World Health Organization. This will strengthen supply security and capacity and open up access for 15 million women annually and reduce the costs to health-systems by more than 20%. The generic itself is on track to be registered in 40 countries by the end of 2026.
To support access with uptake and enable women to make informed choices, education, awareness and provider training are essential. Overall, CIFF has worked with partners to train 149,000 health care providers in self-injection in 19 countries and has supported 64 countries to implement their self-injection policies.
Photo Credit: The Global Fund/ Brian Otieno
Breaking the cycle of transmission: the
game-changing lenacapavir
The latest data tells us that in 2024 over 40 million people were living with HIV, around 1.3 million people acquired HIV, and approximately 630,000 people died from HIV-related causes globally (WHO, 2025). These figures were taken before the global cuts to international aid took place, which have curtailed delivery and stalled life-saving progress in reaching the most vulnerable populations around the world.
The 2025 introduction of lenacapavir represents a historic moment in HIV prevention. As a twice-yearly injectable and the most effective prevention option to date, lenacapavir offers an unprecedented opportunity to dramatically reduce new HIV infections and save lives, particularly as efforts expand to increase access and uptake across lower-income countries.
Progress has occurred because of the efforts across government, civil society, philanthropy and the private sector to secure regulatory pathways, commercial deals, and country-level implementation. Our partner, the Global Fund, played a pivotal role in this process, working hand in hand with governments and health-systems. In December 2025, the first doses of lenacapavir arrived in Eswatini and Zambia. Countries are showing leadership by integrating lenacapavir into contextualised HIV strategies, linking delivery with broader SRHR and social protection programmes across multiple countries including Mozambique, Malawi, Tanzania, Uganda, South Africa, Zambia, and Zimbabwe. CIFF, alongside partners, aims to deliver lenacapavir to at least 3 million people in LMICs by 2027, while also building sustainable pathways for low-cost generics to reach even more people.
