Partial progress in sexual and reproductive health and rights: the influence of sociocultural, behavioural, structural, and technological changes on epidemiological trends.
Grulich A, Mercer C, et al. • Lancet (London, England) • 2025
Progress on the sexual and reproductive health and rights agenda has been inconsistent since 2018, with advances in some areas but considerable gaps in others due to inadequacies in funding, policy, and implementation, compounded by sociocultural, political, and technological changes.
Key Findings
Background
The concept of sexual and reproductive health and rights has evolved from narrower conceptualizations, with the 2018 Guttmacher-Lancet Commission proposing a broader and integrated defining framework together with a package of essential health service elements.
The broader framework was proposed in 2018 by the Guttmacher-Lancet Commission.
Despite this framework, progress on the sexual and reproductive health agenda has been 'inconsistent, with progress in some areas and considerable gaps in others.'
Progress has been partial even in areas that have seen breakthroughs in biomedicine and technology, owing to inadequacies in funding, policy, and implementation.
Background
Initial executive orders of the Trump administration in early 2025 presented a major challenge to sexual and reproductive health and rights in the USA and threatened devastating impacts on recipient low-income and middle-income countries through restrictions on US foreign aid.
Executive orders were issued in early 2025.
Orders on US foreign aid were described as threatening 'devastating impacts on sexual and reproductive health and rights in recipient low-income and middle-income countries.'
The paper identifies this as a significant geopolitical challenge to the global sexual and reproductive health agenda.
Background
Discussions of sexual and reproductive health and rights are often perceived as sensitive or controversial even at senior government levels, requiring consideration of complex interplay between social, cultural, political, legal, and technological factors when assessing epidemiological trends.
The perceived sensitivity of sexual and reproductive health affects the provision of adequate education on sex, sexuality, and relationships.
Such education is 'often resisted by religion or traditionalist sentiments.'
Technological change means many young people receive sexuality education online, which has 'both positive and negative effects.'
Background
Fluidity in gender and sexual identity is identified as a key driving factor behind global epidemiological trends in sexual and reproductive health.
Gender and sexual identity fluidity is listed among the major sociocultural and behavioural factors shaping sexual and reproductive health outcomes.
The paper considers this alongside biomedical innovations, gender-based violence, abortion access, fertility needs, and comprehensive sexuality education.
These factors are described as crucial to understanding progress on the sexual and reproductive health and rights agenda.
Background
Biomedical innovations in contraception and in the treatment and prevention of HIV and other sexually transmitted infections are identified as significant technological drivers of trends in sexual and reproductive health outcomes since 2018.
Innovations span both contraception and infectious disease prevention and treatment.
Despite biomedical breakthroughs, progress remains partial due to inadequacies in funding, policy, and implementation.
The paper reviews trends in these outcomes specifically since 2018.
Background
Gender-based violence and access to safe abortion are identified as ongoing structural and policy challenges within the sexual and reproductive health and rights agenda.
Gender-based violence is listed as a key epidemiological and structural factor shaping sexual and reproductive health trends.
Access to safe abortion is highlighted as an area where progress has been partial.
These are included among the factors for which the paper provides an overview of trends since 2018.
Background
Comprehensive sexuality education is identified as a crucial component of the sexual and reproductive health and rights framework, with online delivery presenting both opportunities and risks for young people.
The paper notes that 'providing adequate education on sex, sexuality, and relationships is crucial.'
Religious and traditionalist sentiments frequently resist such education.
Technological change means many young people now receive this education online, with effects described as having 'both positive and negative' dimensions.
What This Means
This research paper, part of a Lancet Series, reviews progress on sexual and reproductive health and rights (SRHR) since 2018, when the Guttmacher-Lancet Commission established a broad framework for what this concept should include. The authors found that progress has been uneven: while there have been real advances in areas like contraception technology and HIV prevention and treatment, these gains have not translated fully into better health outcomes for everyone due to shortfalls in funding, weak policies, and poor implementation. Political developments — particularly executive orders from the Trump administration in early 2025 and cuts to US foreign aid — are identified as serious threats to SRHR both within the United States and in lower-income countries that depend on US support.
The paper highlights that sexual and reproductive health topics are often treated as politically or culturally sensitive, which makes it harder to deliver good sex education, design effective policies, or track health trends honestly. Religious and traditionalist opposition frequently limits access to sexuality education, while the internet has become a major — and double-edged — source of information for young people. Factors like changing understandings of gender and sexual identity, gender-based violence, and restrictions on safe abortion are all identified as important influences on health outcomes that need to be understood together, not in isolation.
This research suggests that technological and biomedical progress alone is not enough to improve sexual and reproductive health for all populations. Achieving better outcomes requires addressing the social, cultural, structural, and political barriers that prevent people from accessing the services and information they need. The paper frames the current moment as one of partial progress with significant ongoing challenges, particularly for people in low- and middle-income countries who may be acutely affected by reductions in international health funding.
Grulich A, Mercer C, Sturrock B, Baral S, Turpin N, Phanuphak N, et al.. (2025). Partial progress in sexual and reproductive health and rights: the influence of sociocultural, behavioural, structural, and technological changes on epidemiological trends.. Lancet (London, England). https://doi.org/10.1016/S0140-6736(25)01188-2