The effects of development assistance on sexual and reproductive health services in low- and lower-middle-income countries: a cross-country panel data analysis

Using data on 119 low- and lower-middle-income countries from 2002 to 2020, we fit fixed-effects (FE) models to evaluate the impacts of three types of official development assistance (ODA) on access to three types of sexual and reproductive health (SRH) services: access to skilled birth attendance, access to modern contraceptives and coverage of antiretroviral therapies against HIV/AIDS. The results show that aid has had a small, but positive effect on these outcomes over this period. While effects vary by type of ODA and outcome, SRH aid has generally increased service coverage rates by between 0.190 and 0.628 percentage points. The results also indicate that the effect of aid has improved across the period and is larger in low-income countries compared with lower-middle-income countries. Additionally, the findings suggest that bilateral aid may be somewhat more effective than other types of aid. Importantly, the impact of development assistance appears to be larger if it reaches a certain share of overall health spending. The results of the study lend support to the continued allocation of aid to low-income countries to support the provision of sexual and reproductive health services while also identifying ways to improve the effectiveness of development assistance in this area.