Re-Costing Cairo: Revised Estimate of the Resource Requirements to Achieve the ICPD Goals

by Suzanna Dennis, March 2009

Importance of Family Planning and Reproductive Health 

Achieving universal access to reproductive health, including family planning services and supplies, is essential to ensuring the health and well-being of women and their families. Poor reproductive health is the leading cause of death and disability among women in their childbearing years.1 An estimated 201 million women in developing countries want to delay or stop childbearing, but lack effective contraceptives. Satisfying their unmet need for family planning would avert 52 million unintended pregnancies each year, saving more than 1.5 million lives and preventing 505,000 children from losing their mothers.2

In 2005 the World Summit—a follow-up to the meetings that launched the Millennium Development Goals (MDGs)—reaffirmed the importance of sexual and reproductive health and rights by adding Target 5.B.: Achieve universal access to reproductive health by 2015 as part of MDG 5: Improving Maternal Health. Contraceptive prevalence rate and unmet need for family planning are indicators for monitoring progress towards this target.


Original ICPD Cost Estimates 

In 1994 the International Conference on Population and Development (ICPD) in Cairo produced estimates of the resource requirements to achieve universal access to a range of population-related programs: Family planning services; Basic reproductive health services; Sexually transmitted infection/HIV/AIDS prevention (treatment for HIV/AIDS was subsequently added); and Basic research, data and population and development policy analysis. It was estimated that by the year 2010, it would cost US$29.2 billion annually in current dollars (or US$20.5 billion in 1994 dollars) to achieve the costed interventions of the ICPD by 2015. The international community committed to share the costs, with donor nations pledging to provide one-third or US$9.7 billion per year (adjusted for inflation), and domestic resource mobilization—funding from developing country governments, non-governmental organizations and consumer spending—making up the remaining two-thirds. Global financial flows toward meeting the ICPD goals are tracked by the Resource Flows Project, a joint collaboration between the United Nations Population Fund (UNFPA) and the Netherlands Interdisciplinary Demographic Institute.

Estimates of resource requirements are essential to ensure that governments and donors fulfill their commitments, and to track progress towards achieving the ICPD goals. Collectively, donors have never fulfilled their one-third share of the inflation-adjusted population assistance. In 2006 donor funding came within US$2 billion of the original ICPD estimate, primarily due to a strong funding for HIV/AIDS. Due to data collection limitations, it is not clear whether developing country governments are meeting their share of funding. However, there is strong evidence that many governments are failing to adequately prioritize sexual and reproductive rights and health in development planning.3


The Need for New Numbers 

By 2008 a consensus developed that the 1994 ICPD cost estimates were out of date. Escalating need, rising drug and supply costs, and the scale of the resources needed to address the HIV/AIDS pandemic undermined the relevance of the original estimates. There was also a need to integrate post-1994 information regarding the set of interventions that made up a complete package of reproductive health services, the status of this care in developing countries, and also its cost and current needs.4


  1. UNFPA. ND. Improving Reproductive Health. New York: UNPFA.
  2. Singh, S, JE Darroch, M Vlassoff, J Nadeau. 2004. Adding it Up: The Benefits of Investing In Sexual and Reproductive Health Care. New York: The Alan Guttmacher Institute.
  3. Bhuyan, A, M Borda and W Winfrey. 2007. Making Family Planning Part of the PRSP Process: A Guide for Incorporating Family Planning into Poverty Reduction Strategy Papers. Washington, DC: USAID Health Policy Initiative; Sundaram, S, J Epp, N Oomman and JE Rosen. 2004. A Review of Population, Reproductive Health, and Adolescent Health & Development in Poverty Reduction Strategies. The Washington, DC: World Bank.
  4. Bernstein, S, E Weissman, M Vlassoff, H Friedman and C Juul Hansen. 2007. Resource Requirements for Sexual and Reproductive Health Care in Developing Countries. [unpublished paper]. Presented at UNFPA/HQ Costing Expert Group Meeting, 17 November 2008.