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Review
. 2025 Nov 1;406(10515):2100-2118.
doi: 10.1016/S0140-6736(25)01188-2.

Partial progress in sexual and reproductive health and rights: the influence of sociocultural, behavioural, structural, and technological changes on epidemiological trends

Andrew E Grulich  1 , Catherine H Mercer  2 , Beattie Sturrock  3 , Stefan Baral  4 , Nguissali Turpin  5 , Nittaya Phanuphak  6 , Jane Rowley  7 , Teodora Wi  7 , Kristina Gemzell-Danielsson  8 , Claudia García-Moreno  9 , Bela Ganatra  9 , James Kiarie  9 , Gitau Mburu  9 , Deborah Bateson  10 , Karen Canfell  11 , Peter Aggleton  12 , Jennifer M Head  13 , Kenneth H Mayer  14
Affiliations
Review

Partial progress in sexual and reproductive health and rights: the influence of sociocultural, behavioural, structural, and technological changes on epidemiological trends

Andrew E Grulich et al. Lancet. .

Abstract

The concept of sexual and reproductive health and rights has evolved in the 21st century from previous narrower conceptualisations. In 2018, the Guttmacher-Lancet Commission proposed a broader and integrated defining framework, together with a package of essential health service elements. Despite this, progress on the sexual and reproductive health agenda has been inconsistent, with progress in some areas and considerable gaps in others. Even in areas that have seen breakthroughs in biomedicine and technology, progress has been partial owing to inadequacies in funding, policy, and implementation. Additionally, 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 orders on US foreign aid threaten devastating impacts on sexual and reproductive health and rights in recipient low-income and middle-income countries. As discussions of sexual and reproductive health and rights are often seen to be sensitive or controversial, even when had at a senior government level, any consideration of time trends in sexual and reproductive health outcomes need to consider the complex interplay between trends in social and cultural factors, politics and legal frameworks, and technology and biomedicine. The perceived sensitivity of sexual and reproductive health means that providing adequate education on sex, sexuality, and relationships is crucial, and this education is often resisted by religion or traditionalist sentiments. Furthermore, technological change means that many young people receive this education online, which has both positive and negative effects. A thorough understanding of the driving factors behind global epidemiological trends in sexual and reproductive health-such as fluidity in gender and sexual identity, biomedical innovations in contraception and the treatment and prevention of HIV and other sexually transmitted infections, gender-based violence, access to safe abortion, fertility needs, and comprehensive sexuality education-is crucial in assessing progress on the sexual and reproductive health and rights agenda. To this end, this Series paper provides an overview of trends in sexual and reproductive health and rights outcomes since 2018.

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Conflict of interest statement

Declaration of interests AEG has received financial research support from GSK and Viiv Healthcare; has received an honorarium from Clinical Care Options; and is a member of the governing council of the International AIDS Society. CHM has received financial research support from the Wellcome Trust, the Economic and Social Research Council, the National Institute for Health and Care Research, the British Association for Sexual Health and HIV, and the International Union Against Sexually Transmitted Infections. BS has received financial research support from the National Institute for Health Research, Gilead Sciences, and ViiV Healthcare; is employed by the Royal Free London NHS Foundation Trust; and works as a public health specialty registrar at the UK Health Security Agency. SB has received financial research support from the United States National Institutes of Health and WHO; and holds a position on the External Advisory Board of the University of California San Francisco Centre for AIDS Prevention Studies. NP has received financial research support from Gilead Sciences, USAID, ViiV Healthcare, the Global Fund to fight AIDS, TB and Malaria, Cepheid, and the United States National Institutes of Health; has received consulting fees from ViiV Healthcare and Gilead Sciences; and has received honoraria from Gilead Sciences and Abbott. KG-D has received honoraria from Bayer, Organon, Gedeon Richter, Natural Cycles, Exelgyn, Exeltis, Cirqle, RemovAid, and Obseva; and has held a position at the International Federation of Abortion and Contraception Professionals (FIAPAC), the International Federation of Gynecology and Obstetrics (FIGO), the Faculty of Sexual and Reproductive Healthcare, UK, the Royal College of Obstetricians and Gynaecologists (RCOG) UK, and the Swedish Association of Obstetrics and Gynecology (SFOG). CG-M has received consulting fees from WHO; has received financial research support from the University of Bristol; holds a position on advisory boards for What Works to prevent violence against women and girls and the UK Foreign, Commonwealth, and Development Office; has held a position on the research advisory board for FCDO and estimating the prevalence of child sexual abuse (Together for Girls); and is on the Leadership Council of the Sexual Violence Research Initiative. BG has received financial support from UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health, WHO. DB has received financial research support from the National Health and Medical Research Council of Australia, the Commonwealth Department of Health (Australia), and the Australian Centre for Prevention of Cervical Cancer (ACPCC), the Australian Government, the Minderoo Foundation, and equipment donations from Roche Molecular Diagnostics, Cepheid, and Microbix; and holds positions as Chair of the National Cervical Screening Program Clinical Advisory Group (Australian Government) and on the COMPASS trial Scientific Advisory Committee. KC has received financial research support from the National Health and Medical Research Council of Australia, the Commonwealth Department of Health, Australia, and ACPCC, the Minderoo Foundation, and equipment donations from Roche Molecular Diagnostics, Cepheid, and Microbix; and held a position as Chair for the Expert Advisory Group to the Elimination Response (Australian Government) and for Cancer Screening and Immunization Committee for Cancer Council Australia, and for the Australian Government Public Health and Health Services Research Committee. PA has received financial research support from the UNFPA Eastern Europe and Central Asia Regional Office; has held a role as principal consultant on Social Norms and Comprehensive Sexuality Education; is Editor-in-Chief of Culture Health and Sexuality, Sex Education Journal and the Health Education Journal; and holds a position as an executive member of the Australasian Sexual and Reproductive Health Alliance. JMH reports support for being a technical writer and editor for this Lancet Series from the Fenway Institute. KHM has received financial research support from Gilead, Merck, GSK, Moderna, and ViiV Healthcare; and has served as an advisory board member for Gilead Science and Merck. All other authors declare no competing interests.