Summary

• MSI Reproductive Choices is one of the largest providers of reproductive health services globally. Last year we served more than 23.8 million people and are on track to exceed that in 2025.

• We work in 36 countries and are highly cost-effective. On average, we can provide a woman with a year of protection from unintended pregnancy for $6.50.

• You can read more about our cost-effectiveness here.

• USAID was by far the largest global donor to family planning, and its dissolution has put the lives and futures of millions of girls at risk.

• We are seeing more than a 20% increase in demand for our services as other organizations have had to close. 

• We are seeking to raise an additional $25m for 2026 to support our country programs that have significant gaps next year and those that are expecting further foreign aid cuts in Q1 2026. 

What is MSI Reproductive Choices? Why Support Reproductive Health?

According to the Guttmacher Institute, an estimated 214 million women in low- and middle-income countries want to avoid pregnancy but aren’t using contraception.^[1] This unmet need leads to unintended pregnancies, unsafe abortions, and maternal deaths, issues that disproportionately affect women in fragile health systems. It also undermines broader socioeconomic outcomes by limiting women’s educational and employment opportunities, constraining their economic autonomy, and perpetuating intergenerational cycles of poverty.

MSI is one of the world’s leading nonprofit organizations focused on sexual and reproductive health and rights (SRHR). We work in 36 countries to ensure women and girls can access high-quality, affordable family planning. Our approach combines clinical services, community outreach, and advocacy, empowering individuals to make informed choices about their bodies and futures.

In 2024, MSI supported more than 23.8 million women and girls with reproductive health services and delivered 46 million years of protection from unintended pregnancy (commonly called a couple year of protection). 

Through our 2030 strategy (2021-2030), we aim to reach 120 million women, preventing millions of unintended pregnancies and maternal deaths.

Read more about MSI’s approach, impact and cost-effectiveness in our 2024 EA Forum blog post here. 

Why MSI? Why Now?

We are evidence-based and data-driven 

At MSI, data is not just numbers; it's a powerful tool that drives our mission to provide high-quality, accessible healthcare to those who need it most. We collect 300+ million client data points from across 50,000 communities every year through both routine data collection, client surveys and research. Since 2011, we have spoken with more than 200,000 clients across 29 countries through annual client exit interviews and use their feedback to improve programs.

Equity is at the heart of everything we do

We are focused on reaching underserved groups and our goal is that 80% of our clients from the most marginalized and underserved communities including:

• adolescents

• people living in poverty

• people with no other option for services

• people who haven’t used contraception previously

We have comprehensive metrics to measure how successful we are in reaching those at risk of being left behind without access to services. In 2024, 82% of our clients were from the communities listed above.

Cost-effectiveness is part of our DNA; we know that every dollar could be spent improving or saving lives. 

MSI has always focused on cost-effectiveness, and we’ve honed our service delivery models around the world to drive economies of scale. For just $6.50 we provide a year of protection from unintended pregnancy.

MSI’s average costs* across our last-mile clients are:

• Cost per client reached: $10.26

• Cost per CYP: $4.88

• Cost per DALY averted: $4.70

• Cost per unintended pregnancy averted: $8.16

• Cost per maternal death averted: $3,353

*Note, these are the costs to a donor. In our service delivery models reaching the underserved such as mobile outreach, we usually use some donated commodities. Here is a comparison of costs to the donor for mobile outreach for two country programs with the value of donated commodities and without (i.e. cost to a donor):

We have diversified funding streams, making us more resilient 

MSI is a social business. Nearly half of our income is self-generated through fee-for service clinics and product sales enabling us to remain more resilient to external shocks and stressors. Our clinic networks are financially sustainable, meaning we can keep our doors open despite donor shifts. It also means that we focus donor funding on reaching the most underserved through our last mile service models. 

Key Areas for Impact

We are seeking funding specifically to scale our service delivery models reaching the most underserved communities including mobile outreach, our support to scale access in the public sector, and our community-based midwives which we call MS Ladies. 

Earlier this year we launched The Choice Emergency Fund for donors wanting to contribute rapid response funding for MSI to maintain access to reproductive health services in light of USAID cuts. This fund has enabled MSI:

• maintain service delivery teams that directly lost funding from USAID

• buy contraceptive commodities (i.e. IUDs, implants, injectables etc.) because the commodity supply chain has been devastated by the USAID cuts (see: As Belgium Races to Save U.S.A.I.D. Contraception, Some Supplies Are Reported Ruined - The New York Times).

MSI’s Choice Emergency Fund has raised $5.6M so far this year and we have already allocated that funding for spending. We are aiming to raise an additional $10M for the fund over the next 6 months as additional aid cuts impact access. 

Specific programs that need more funding

If you are interested in funding a specific program, below are three specific high- impact funding opportunities, providing direct support where it can make an immediate difference. Our finance systems enable us to direct a donation to a specific country if they are $1,000 or above, and for a specific project or channel if they are $10,000 or above. 

1. Contribute to Randomized Control Trial research in Sierra Leone ($200,000/year for 5 years)

This five-year randomized controlled trial (RCT) will rigorously evaluate an integrated model that combines Sierra Leone’s national Child and Adolescent Health and Life Skills (CAHLS) curriculum with direct access to youth-friendly contraceptive services in schools. This RCT will enable us to test these combined interventions in a way that measures health outcomes, behavioral change, and cost-effectiveness. 

The intervention will operate in three high-need districts where unmet need for contraception among adolescents is among the highest in the country. Up to 120 schools will participate, ensuring continuity from primary through junior secondary levels. The model embeds teacher training to deliver the CAHLS curriculum effectively, community engagement to build parental and societal support, and quarterly mobile outreach visits that bring a full range of contraceptive methods, counseling, STI screening, and referrals directly to students. This approach addresses both demand-side barriers, such as knowledge gaps and harmful norms, and supply-side constraints, including stockouts and provider bias, within a rights-based framework.

The projected impact is substantial. Over the course of the trial, MSI Sierra Leone will deliver more than 535,000 services, generating approximately 592,733 couple-years of protection. This translates into an estimated 291,000 unintended pregnancies averted, 151,000 unsafe abortions prevented, and 326 maternal deaths prevented (using MSI’s Impact 2 tool). 

For donors focused on impact per dollar, this is a high-leverage opportunity: every contribution not only delivers measurable health outcomes but also creates knowledge that multiplies benefits far beyond Sierra Leone.

The total implementation cost is $4 million. We have secured $3 million, leaving a gap of approximately $1 million for implementation of the outreach teams. Even $50,000 accelerates this landmark study, ensuring we answer critical questions about how to deliver adolescent SRHR most effectively and at scale. 

2. Support 16 MSI Ladies delivering life-saving services in remote areas of Afghanistan ($196,000 over 1 year)

Afghanistan is one of the hardest places in the world to be a woman. Over the last 4 years gender equality has worsened, and access to family planning and SRH services remains challenging due to restrictions on women and girls’ education, movement, limited non-governmental organization operations, and varying acceptance by local Taliban authorities. In 2021 and 2022, the Taliban-led administration ordered severe restrictions on women and girls’ ability to attend school beyond a primary education and work outside the home. This continues to significantly impact their futures and the future of the health system and economy. 

While women are unable to work, a critical exception has been made for female staff providing health services – which means that at MSI Afghanistan and our team of local women nurses and midwives can continue to deliver the reproductive care that women and girls want and need.

Access to these services was always challenging in Afghanistan, but when USAID withdrew over $1.8 billion in aid, leading to the termination of all major family planning/SRH programs and the closure of over 400 health facilities, access to health services was cut off for millions across 28 of 34 provinces. 

Maternal mortality remains high at 620 deaths per 100,000 live births.^[2] The modern contraceptive prevalence rate remains low at 19% and ~27% of married women have an unmet need for modern contraception. The most common barriers for FP uptake are limited availability of contraceptives, cultural and religious opposition, lack of female healthcare workers, lack of awareness, and restricted mobility of women.^[3] The requirement for a mahram, a male guardian, to accompany women in public severely limits their mobility and ability to seek SRH information and services independently. 

Watch this 110 second video about our work in Afghanistan:

MSI Afghanistan is resilient, and the only provider left for any healthcare, including reproductive healthcare, in most of the places where we work. In 2024 MSI Afghanistan served 970,000 clients, averting an estimated 206,000 unintended pregnancies and saving more than $10 million in healthcare costs (MSI’s Impact 2).

One of our key service delivery models in Afghanistan is our MSI Ladies model. MSI Ladies are nurses and midwives who work in their own communities, often located in peri-urban and rural areas where they are well-known and trusted. They deliver services from their homes, which removes the need for a mahram and is culturally acceptable, convenient, and enhances client privacy and confidentiality. MSI Ladies provide family planning counselling, short-term contraceptives, and longer-acting methods like IUDs and implants.

In 2026, these MS Ladies are unfunded due to foreign aid cuts.  Through your support, over one year these 16 MS Ladies would reach 68,000 women and girls, which we estimate will prevent 114,000 people and children from falling further into poverty. An investment of just $12,000 means a midwife remains in her post for 12 months and more than 4,000 woman and girls will receive the care that protect their lives and futures.

3. A Market-Based Approach to Scaling Family Planning Access in Pakistan ($3.57M over 1 year)

Marie Stopes Society (MSS) has been MSI’s trusted partner in Pakistan since 1990, delivering high-quality, client-centered reproductive health services through a market-based model that leverages private sector capacity. At the heart of this approach is the Suraj Network, a nationwide system of 350 accredited primary healthcare clinics, supported by 17 mobile outreach teams and 17 pharmacies, reaching underserved communities across Punjab, Sindh, and Khyber Pakhtunkhwa. These clinics provide modern contraception, counseling, and integrated SRH services to women who often have no other access to care.

The Suraj model is proven and highly cost-effective: just $5.22 per couple-year of protection. It also builds long-term sustainability by strengthening clinical and business capacity of private providers, ensuring resilience beyond donor co-funding. MSS complements this with digital innovations like Pakistan’s first bilingual SRH information portal, a toll-free helpline, and a Youth App to reach adolescents and newlyweds.

MSS has remarkable impact. In 2024 the Suraj network delivered:

• 560,000 CYPs 

• 1.3 million people using a family planning method provided by MSS

• $32M in direct healthcare costs saved

• 485,000 unintended pregnancies averted

• 199,000 unsafe abortions prevented

• 310 maternal deaths averted

Notably MSS’s equity focus is clear: 78.5% of outreach clients live in multidimensional poverty, and over 91% report no other provider. Outreach teams operate in rural areas where public health infrastructure is weak, ensuring no one is left behind. 

The Suraj Network is not just about health; it drives socio-economic progress. Access to contraception enables girls to stay in school, women to join the workforce, and families to escape cycles of poverty. Every CYP delivered reduces healthcare costs, prevents catastrophic health expenditures, and contributes to gender equity and economic resilience.

Because of forthcoming foreign aid cuts, we are anticipating a  $3.5M gap that risks dismantling this network. Even $10,000 can keep clinics operating and sustain services for the poorest women while we secure larger commitments. Every dollar here delivers measurable impact, saving lives, reducing poverty, and protecting futures at one of the most cost-effective rates in global health.

If you are interested in supporting any of the programs above, please email: 

meghan.blake@msichoices.org

1. ^{^}

    Guttmacher Institute. Adding It Up 2024: Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries, 2024.

2. ^{^}

   World Bank: Afghanistan Country Data, 2020. The true figures are likely higher today given worsening healthcare conditions since the Taliban’s return, particularly for women and girls. Historical evidence shows that during the Taliban’s first period of rule, morbidity and mortality among women, infants, and children increased (Faiz A., Health care under the Taliban, Lancet, 1997). More recent work documents persistent barriers to healthcare for Afghan women (Ezadi S. et al., Afghan women and access to health care in the past 25 years, eClinicalMedicine, 2022).

3. ^{^}

   Track20 Project: Afghanistan Country Profile, 2024.