Safeguarding sexual and reproductive rights within the massive changes in the global health system
A new report from the Swedish Association for Sexuality Education, RFSU, in collaboration with Karolinska Institutet, outlines historic transformations currently reshaping the global health architecture. Major reforms are underway, centred on issues such as efficiency, coordination, and the shift of power from traditional donors in the Global North to countries and regions in the Global South.
"Shifting power and influence is highly welcome and necessary. However, within the rapid changes, there is a real risk that politically sensitive issues like SRHR and LGBTQI+ rights will be deprioritised and that civil society will be excluded from emerging new health models. We must prevent this from happening," says Ingela Holmertz, Secretary General of RFSU.
Weakened Institutions Amid A Funding Crises
Today, about 224 million women and girls still lack access to safe and effective contraception, while many LGBTQI+ people continue to face discrimination and barriers to health services. Meanwhile, wealthy countries have sharply reduced their international development assistance, accelerated by the US administration's drastic changes to US development policy in 2025. While funding is dwindling, structural changes in the system are also fundamentally altering global health, including SRHR. The UN as a whole and the World Health Organisation (WHO) are undergoing what may be their largest reforms in history. Within the UN reform process, there is a substantial risk that the UN agency for SRHR (the UNFPA), and UN Women, working for women's rights, could see their mandates significantly weakened or altered.
"The mandates of UNFPA and UN Women are being threatened at a time when women's rights and SRHR are under intense attack. All countries that stand up for bodily autonomy and reproductive freedom must ensure these fundamental rights are protected as the UN undergoes reform," says Sara Österlund, Policy Advisor at RFSU.
In the new report, RFSU maps the key reform processes that will affect future access to SRHR. There is a broad consensus among countries and civil society organisations that the current system is overly fragmented and driven by donor-country interests.
"Streamlining systems and changing power structures present major opportunities — but also risks for areas considered controversial, including SRHR. All of us working for bodily autonomy and sexual and reproductive rights need to closely monitor these developments," says Olivia Murpy, research assistant at Karolinska Institutet.
Four Ways to Protect SRHR as the Global Health System is Redrawn
Member states of the UN and WHO can play a vital role amid these changes, but so can also researchers, civil society, philanthropy and the business sector. The report suggests 4 areas for doing so:
- Local Ownership Beyond Governments. As power rightfully shifts away from donors in the Global North, local civil society and affected communities must also be included in new health models. Civil society participation is key to safeguarding abortion rights, comprehensive sexuality education, and LGBTQI+ rights — especially in countries where these issues face strong political backlash.
- Integrate SRHR into Primary Health Care. Several ongoing reform processes emphasise the importance of robust primary healthcare. Essential sexual and reproductive health services must be fully integrated and funded within these national frameworks. Securing SRHR within primary healthcare requires sustained political commitment, especially where these rights are contested.
- Secure Support for SRHR and Equity in the WHO Reform Process. The WHO is coordinating a joint process to reform the global health architecture. Over the coming year, critical decisions will be made that in turn determine how gender equality, human rights, equity, and SRHR are prioritised in future health systems. SRHR defenders must push hard to ensure these areas are not deprioritised.
- Ensure the UN Continues to Champion SRHR and Women's Rights. UN Women and UNFPA are currently facing a potential merger assessment. This carries a high risk of undermining the UN's dedicated work on SRHR issues, including contraceptive access and safe abortion care. SRHR defenders must continue to actively advocate to prevent this erosion of mandates.
In-Depth: US Foreign and Aid Policy
The transformations within the UN are unfolding in the shadow of a fundamentally realigned US foreign and development policy, which RFSU has analysed in two previous reports: