Evaluation of Global Affairs Canada's Sexual and Reproductive Health and Rights Programming

Evaluation report

Prepared by the Evaluation Division
Global Affairs Canada
March 2026

Table of contents

• Acronyms and abbreviations
• Executive summary
• Program background
• Evaluation purpose, scope and objective
• Evaluation approach and methodology
• Evaluation limitations and mitigation measures
• Evaluation findings: Relevance and external coherence
• Evaluation findings: Effectiveness
• Evaluation findings: Efficiency and internal coherence
• Conclusions, considerations and recommendations
• Annexes

Acronyms and abbreviations

10YC

10-Year Commitment to Global Health and Rights

ADM

Assistant Deputy Minister

APP

Authorized programming process

CEFM

Child early and forced marriage

CfP

Call for proposal(s)

CSO

Civil society organization

CSE

Comprehensive sexuality education

DG

Director General

DG GHC

DG Global Health Committee

DI

Department-initiated

FIAP

Feminist International Assistance Policy

FGM/C

Female genital mutilation/cutting

FPI

Future planning initiative

FRET

Fiduciary risk evaluation tool

FTE

Full-time equivalent

GAC

Global Affairs Canada

GBA Plus

Gender based Analysis Plus

GBV

Gender-based violence

GE

Gender equality

GFF

Global Financing Facility for Women, Children and Adolescents

GoC

Government of Canada

HVHC

Her Voice Her Choice

IA

International assistance

IDRC

International Development Research Centre

KPI

Key Performance Indicator

LLD

Locally led development

LM

Logic Model

LGBTQI+

Lesbian, gay, bisexual, transgender, intersex, plus

MEL

Monitoring, evaluation, and learning

MLO

Multilateral organization

MNCH

Maternal newborn and child health

NGO

Non-governmental organization

ODA

Official development assistance

OECD-DAC

Organisation for Economic Co-operation and Development - Development Assistance Committee

OGD

Other government department

PTL

Project team lead

PWDs

Persons with disabilities

RBM

Results-Based Management

SGBV

Sexual and gender-based violence

SRHR

Sexual and reproductive health and rights

UN

United Nations

UNFPA

United Nations Population Fund

WHO

World Health Organization

YEE

Education and Ending Violence Division

YFM

International Assistance Partnerships and Programming Branch

YSD

Global Health and Food Systems Bureau

Executive summary

The evaluation of Global Affairs Canada's (GAC’s) Sexual and Reproductive Health and Rights (SRHR) programming covered the period from 2017-18 to 2024-25 and focused on two international assistance commitments: the Her Voice Her Choice (HVHC) initiative (2017–20) and the 10-Year Commitment to Global Health and Rights (10YC) (2020-30). The evaluation aimed to inform the planning and delivery of SRHR programming for the remainder of the 10YC and beyond.

Throughout the evaluation, evidence highlighted an SRHR ecosystem where acute global crises, geopolitical shifts, opposing socio-political movements and donor funding withdrawals posed challenges to program delivery, the achievement of SRHR results and their sustainability. Within this dynamic and complex global context, the evaluation found clear evidence of both successes and challenges for GAC’s portfolio of SRHR programming.

The department’s SRHR investments consistently aligned with its policy priorities under the Feminist International Assistance Policy (FIAP) as well as its financial and advocacy objectives. Within case study countries, programming was also relevant to national and regional SRHR priorities and broadly aligned with the core needs identified by rights holders and their wider communities, including for marginalized groups.

SRHR programming led to positive change for women and girls in several key areas. While progress varied across contexts, case study evidence demonstrated that GAC-funded programming contributed to increasing access to sexual and reproductive health services, improving healthy SRHR-related behaviours; and strengthening the capacity of governments and civil society to promote and protect SRHR. However, host country SRHR readiness, local laws, customs and cultures, partners’ capacity and expertise as well as the degree of local ownership and leadership in delivering SRHR initiatives all affected programming effectiveness and its ability to fully align with rights holders’ needs.

Within the global SRHR ecosystem, Canada demonstrated strong leadership, earning recognition as both a reliable donor and influential advocate for SRHR through its global, regional and national-level engagements. Canada made consistent efforts to collaborate, build synergies and minimize duplication with other actors.

Within the department, the structures, systems and processes that supported SRHR programming affected internal efficiencies and the overall cost-effectiveness of SRHR investments. The Global Health and Food Systems Bureau (YSD) was the SRHR policy lead, and its support improved the department’s capacity to deliver on its SRHR programming. However, the lack of systematic global health and SRHR specialist engagement in the programming cycle led to challenges, including measuring and reporting SRHR results and the inconsistent use of evidence to inform SRHR project and partner selection. Finally, YSD did not have an official programmatic mandate and there was a lack of global health operational guidance that connected policy priorities with programming and advocacy objectives, resulting in coordination challenges and instances of fragmented SRHR programming.

Program background

Canada’s SRHR commitments

Figure 0.1

Canada’s support for sexual and reproductive health and rights (SRHR) was embedded within its broader commitment to global health. Over the past decade, this commitment has been reflected in sustained investments aimed at improving the health and rights of women and girls in developing countries, with a particular focus on integrated and comprehensive approaches to reproductive health.

Canada’s engagement in SRHR can be traced as far back as 2010 when it took a leadership role championing maternal, newborn and child health (MNCH) through the Muskoka 1.0 (2010–2015) and Muskoka 2.0 (2015–2020) initiatives. While both included SRHR programming, their primary focus was on reducing maternal, newborn, and child mortality. Since Muskoka, Canada adopted a more targeted approach to SRHR through two major commitments (see Annex 1 for the timeline):

Her Voice Her Choice Initiative (2017-2020, $650 million)

In line with the Feminist International Assistance Policy (FIAP)^{Footnote 1} (Figure 0.1), in 2017 Canada announced the Her Voice Her Choice (HVHC) initiative to address gaps identified in Muskoka 1.0 and 2.0 and to better align with global health policy calls for an expanded focus on reproductive, maternal, newborn, child and adolescent health and nutrition. Through this commitment, Canada pledged to:

1. Strengthen access for women and adolescent girls to the full range of sexual and reproductive health services; and
2. Enhance focus on adolescent health and SRHR advocacy.

10-year commitment to global health and rights (2020-2030, $1.4 billion)

Announced in 2019 as the Muskoka and HVHC initiatives were winding down, Canada launched the 10-Year Commitment to Global Health and Rights (10YC) in response to calls from Canadian civil society for a renewed, long-term global health investment. The 10YC committed $1.4 billion annually to global health, including $700M specifically for comprehensive SRHR programming (beginning in 2023). At the time of the evaluation, the 10YC represented Canada’s largest global health commitment to date. It also responded to growing international demands to advance a comprehensive, rights-based global health agenda, prioritizing under-funded and under-served areas of SRHR, commonly referred to as the neglected areas of SRHR (Figure 0.2).

Figure 0.2: Neglected areas of SRHR

Resources

Between 2017-18 and 2023-24, GAC disbursed nearly $3 billion for SRHR programming across both HVHC and the 10YC. This included $672 million disbursed under the HVHC commitment and approximately $2.3 billion under the 10YC (see sidebar for details). Across both commitments, GAC’s SRHR investments supported 568 initiatives, 60% of which were funded through the geographic programs (particularly the Africa Branch). Of these, GAC funded 435 individual projects, totaling $1.4 billion. See Annex 2 for more details.

While GAC was the lead for Canada’s SRHR investments under the 10YC and HVHC, it coordinated with other government departments (OGDs), e.g. the International Development Research Centre (IDRC) and Finance Canada, to meet commitment targets and ensure policy coherence, evidence-based programming and alignment with Canada’s global health priorities (see Figure 0.3). SRHR funding disbursed by OGDs was not included as part of this evaluation.

Figure 0.3: In 2022-23, the primary sources of 10YC funding included

Source: 2022-23 10YC annual report

GAC’s HVHC and 10YC SRHR disbursements, 2017-18 to 2023-24

GAC’s HVHC and 10YC SRHR disbursements by branch, 2017-18 to 2023-24^{Footnote 2.1}

GAC’s HVHC and 10YC SRHR disbursements by region, 2017-18 to 2023-24

SRHR sector areas

SRHR encompassed a broad spectrum of thematic areas. Between 2017-28 and 2023-24, the bulk of GAC’s funding was directed toward initiatives focused on sexually transmitted disease (STD) prevention and control; reproductive health care; and ending violence against women and girls (sexual and gender-based violence).

Figures 0.4: GAC’s HVHC and 10YC SRHR disbursements by sector, 2017-18 to 2023-24^{Footnote 3}

SRHR implementing partners

SRHR programming was delivered globally through a variety of partnerships (see Finding 16). Since the beginning of the 10YC, an average of 62% of annual spending was directed to multilateral organizations (MLOs). Civil society largely made up the rest, with Canadian civil society organizations (CSOs), including Canadian-based international non-governmental organizations (INGOs), taking in an annual average of 25% of 10YC investments and the remainder going to foreign CSOs (e.g., INGOs). 

Figures 0.5: GAC’s HVHC and 10YC SRHR disbursements by partner type, 2017-18 to 2023-24^{Footnote 5}

HVHC disbursements by Partner Type, % of Total, 2017-18 to 2023-24^{Footnote 6}

10YC disbursements by Partner Type, % of Total, 2017-18 to 2023-24^{Footnote 7}

SRHR roles and responsibilities 

Figure 0.6: Additional SRHR responsibility centres within the department.

Within the International Assistance Partnerships and Programming Branch (YFM), the Global Health and Food Systems Bureau (YSD) served as the policy lead for both the FIAP Action Area on Health and Nutrition and the 10YC and was responsible for managing SRHR investments and engagement with both multilateral and Canadian partners. YSD also played a central coordination role within the department for the 10YC and was responsible for reporting on progress towards meeting commitment targets and objectives (see sidebar below). 

The department’s SRHR investments and funded programming under both HVHC and the 10YC were managed and delivered by a wide range of internal stakeholders. In addition to YSD’s pivotal mandate, other branches, bureau and teams within the department played important roles in SRHR planning and delivery (Figure 0.4).

SRHR governance  

Figure 0.7: 10YC Global Health Governance Structure

GAC’s global health governance bodies functioned separately but complementary to the International Assistance Operations Committee (IA Ops) and its subsidiary bodies, which were responsible for providing guidance on the implementation of IA commitments, including the 10YC, to ensure coherence and alignment of resources with departmental priorities. The foundational governance architecture and committee tiers dated back to the Muskoka Initiative and therefore existed before both HVHC and the 10YC were launched but have evolved over time (see Finding 14).

Within this overarching structure, 10YC global health governance provided operational and financial oversight for GAC’s global health investments and related policy commitments under the 10YC. Outside of IA Ops, it comprised 4 distinct committees: ADM Global Health Committee (dissolved in 2019), DG/Director Global Health Committee, Global Health Focal Points, and the Health and Nutrition Community of Practice (see Figure 0.5 and Annex 3). Global health governance aimed to support the alignment of departmental resources with global health commitments by ensuring corporate reporting and audit requirements were met, as well as by providing “strategic direction” for the delivery of the 10YC.

Evaluation purpose, scope and objectives

Evaluation focus

The evaluation focused on GAC-funded SRHR programming and was not designed to make comparisons between HVHC and the 10YC across all evaluation questions. The evaluation team made strategic choices to identify the appropriate depth at which various elements within the scope were covered for different questions. For example, multiple findings under relevance and effectiveness were based heavily on case study evidence, which did not include the full range of GAC’s SRHR programming, partnerships, contexts, sectors and funding modalities.  

Evaluation purpose and objectives

The evaluation purpose was to generate findings, conclusions, recommendations and lessons to:

• inform the planning and delivery of SRHR programming for the remainder of the 10YC;
• inform future SRHR programming and approaches beyond the 10YC.

The objectives of this evaluation were to: 

• examine the efficiency, coherence, relevance and effectiveness of GAC-funded SRHR programming;
• take stock of and identify best practices related to GAC’s approach to SRHR programming to better understand what worked well, the key challenges, and the results achieved;
• assess Canada's value and positioning within the global SRHR ecosystem;
• identify lessons learned related to managing international assistance commitments more broadly.

The intended evaluation users were:

• branches, bureaus and divisions responsible for planning, managing and delivering SRHR programming;
• GAC senior management and strategic policy stakeholders (RFM);
• a broader range of external stakeholders, including:
• SRHR implementing partners, including multilateral organizations, Canadian CSOs, INGOs, local NGOs, among others;
• SRHR duty bearers, rights-holders and their communities;
• bilateral donors.

Evaluation scope 

The evaluation's scope included the full range of GAC’s SRHR programming, partnerships, contexts, sectors, funding modalities and underlying departmental “SRHR architecture” for two commitments with a specific focus on SRHR: HVHC (2017-2020) and the 10YC (2020-2030). The evaluation covered the period from 2017-18 to 2024-25.

Evaluation questions

The key evaluation questions focused on three main issues:

1. relevance/external coherence,
2. effectiveness and
3. efficiency/internal coherence.

For each issue, evaluation questions and sub-questions were developed through a participatory design process, involving representatives from the various GAC branches involved in the planning and delivery of SRHR programming as well as external stakeholders. From these key questions, an evaluation matrix was developed to serve as the guiding framework for the evaluation. Below is a simplified version of the matrix, which details the evaluation issues, evaluation questions and sub-questions.

Evaluation approach and methodology

Evaluation approach

The evaluation was grounded in several complementary approaches to meet its purpose and objectives:

Formative evaluation

Given that the evaluation took place during the midpoint of the 10YC (2020-2030), a formative evaluation approach was applied. A formative evaluation is intended to improve performance and inform course corrections to implementation and delivery while activities are still in progress.

Utilization-focused evaluation

The primary principle of a utilization-focused evaluation is that the evaluation is designed and implemented to meet the information needs of the intended evaluation users. The SRHR evaluation design was based on an extensive document review and consultations with key internal and external stakeholders to ensure that it would facilitate evidence-based decision-making.

Participatory evaluation approach

The SRHR evaluation applied a participatory evaluation approach, guided by six simplified feminist evaluation principles. The approach was sensitive to context (e.g. culture and values) and was guided by the SRHR feminist evaluation framework^{Footnote 8} developed by the evaluation team. The evaluation process and its products aimed to support positive change, reflection and learning both internally and externally to the organization.

GBA Plus lens

The evaluation applied a Gender-based Analysis Plus (GBA Plus) lens throughout data collection and analysis to assess how diverse groups of people experienced SRHR programming and results. GBA Plus also informed the development of evaluation tools and protocols as well as the sampling strategy for all stakeholder groups.

Case study approach

The evaluation team used a case study approach to cover certain elements within the full SRHR evaluation scope in more depth. The evaluation purposively sampled five country case studies: three deep dives (Colombia, Tanzania and Côte d’Ivoire) and two desk dives (Bangladesh and Mozambique). Case selection considered SRHR funding materiality, partnership diversity, and programming breadth, including the five neglected SRHR areas under the 10YC. The three deep dive case studies were co-led by local evaluators with in-country data collection. One drew on prior GAC evaluation data (Mozambique), and another used remote methods (Bangladesh). Case studies generated an in-depth and nuanced understanding of certain key SRHR elements, however the evidence generated was not representative of all GAC-funded SRHR programming. Case studies allowed the evaluation team to collect rich data on what worked and what didn’t for different stakeholder groups in different operating contexts. Evaluation evidence from deep dive case studies is presented in Annex 4.

Methodology

The evaluation used a mixed-methods approach to collect and analyze both qualitative and quantitative data from a range of sources. For the evaluation’s findings presented in this report, the evaluation team used a variety of triangulation methods to ensure consistency and accuracy across multiple lines of evidence, data collection instruments and a diversity of contexts and sources. The following methods were used:

Document review

Over 600 documents and databases from Global Affairs Canada, global partners, research institutions, implementing partners and partner countries were analyzed to gain insights into the SRHR policy context, internal and external priorities, internal structures, systems and processes as well as SRHR results. Document review included a standalone partner and project selection process analysis.

Rapid evidence synthesis

A rapid evidence synthesis (RES) was conducted to identify key trends, best practices, and limitations to SRHR programming through the review of global evidence on SRHR, drawing on peer-reviewed literature and existing evidence syntheses on SRHR. A sample of GAC-funded SRHR projects were reviewed to assess the degree to which they aligned with the identified best practices.

Financial data analysis

A portfolio analysis was undertaken to better understand the evolution of funding across the two SRHR commitments, including the number and types of projects funded, partners selected, and mechanisms used. This included the review of annual SRHR disbursements between 2017-18 and 2023-24.

Key informant interviews

A total of 42 individual and group interviews were conducted with internal and external stakeholders (59 individuals in total), including GAC staff, implementing partners, and global partners. These interviews provided rich, explanatory insights across all evaluation questions, adding particular depth on issues of relevance and the architecture of SRHR programming.  

Donor scan

A donor scan was conducted to situate Canada within the global SRHR ecosystem by analyzing the priorities, practices, and funding allocations of a sample of key bilateral donors from 2017 to 2025. The sample included 10 countries: Canada, Australia, Denmark, France, Germany, Netherlands, Norway, Sweden, UK, and the US and drew on publicly available data. This analysis helped contextualize global SRHR trends and priorities, including for the neglected areas.  

Country case studies

Five country case studies (3 deep dives and 2 desk dives) focused on assessing the relevance and effectiveness of SRHR programming. Case studies included country-specific document review, 16 site visits and 236 interviews with close to 500 individuals, including GAC staff at missions, implementing partners, project participants, government officials, donors and other SRHR actors - providing rich, and context specific insights to inform evaluation findings.  

AI-enabled evaluation

The evaluation team leveraged artificial intelligence (AI) software (Co-pilot and Chat GPT) to support data analysis. AI was used to analyze large external data sets, summarize key documents and identify trends. The evaluation team ensured the process always included a “human in the loop” and validated all AI-supported analysis with the source material directly. AI was instrumental in both the RES and the partner and project selection process analysis. It was not used for potentially sensitive data, including key informant interview notes.

Evaluation limitations and mitigation measures

Evaluation findings: Relevance and external coherence*

Alignment with departmental SRHR priorities

Figure 1.1: The transition from MNCH to SRHR

Figure 1.2: Government of Canada contributions to 10YC targets

Finding 1: From 2017-18 to 2024-25, SRHR investments under the HVHC and 10YC commitments strongly aligned with the FIAP’s policy priorities and met the department’s financial and advocacy-focused objectives.

While the Government of Canada (GoC) made important investments in maternal, newborn and child health (MNCH) under the Muskoka Initiative 1.0 (2010 – 15) and 2.0 (2015-20) initiatives to reduce maternal, infant and child mortality, key elements of SRHR,  such as safe abortion and comprehensive sexuality education (CSE) - were not included (Figure 1.1).  The move from MNCH to SRHR was characterized by the transition from a service delivery model to a more rights-based and holistic approach, which enabled engagement with these and other previously underserved areas under the Muskoka Initiative and brought the spotlight firmly on the neglected areas of SRHR. In particular, the 10YC consolidated the government’s SRHR agenda through a unified funding approach, supported by the 10YC accountability framework (see Finding 17).

From 2017-18 to 2024-25, GAC’s approach to comprehensive SRHR was clearly anchored in and aligned with the FIAP’s Action Area Policy for Human Dignity - Health and Nutrition.^{Footnote 9} One of the three paths to action explicitly prioritized SRHR and highlighted the five neglected areas of SRHR (see background, slide 10). Under HVHC and the 10YC, eight out of the top 10 country recipients were in Sub-Saharan Africa, contributing to the FIAP target of directing 50% of all of Canada’s international assistance to the region (see Annex 2). The FIAP was also repeatedly referenced in relevant documentation and multiple interviews as a foundational driver that shaped GAC’s SRHR investments and strategic direction.

The FIAP also explicitly detailed the GoC’s advocacy-focused priorities related to SRHR. In line with these objectives, GAC increased its presence and voice on SRHR through its advocacy efforts in international and multilateral forums (e.g., G7, G20, UN, and Women Deliver conferences) as well as its engagement in SRHR-relevant multistakeholder platforms and global partnerships (e.g. SheDecides, Family Planning 2030, Equality Forum Action Coalitions) (see Findings 6 and 7). 

GAC’s contributions to both HVHC and the 10YC consistently met its global health financial targets, with increased funding directed toward SRHR and the five neglected areas. Overall, the GoC exceeded its 10YC global health target in both 2022-23 and 2023-24, disbursing $1.42 billion and $1.48 billion , respectively. Since the launch of the 10YC, SRHR disbursements increased by over 30%, from $496 million in 2020-21 to $702 million in 2023-24, reaching the 10YC’s SRHR-specific financial target (see Figure 1.2).

Alignment with national priorities

Figure 2.1: National SRHR priorities across case studies

Finding 2: GAC-funded SRHR programming aligned with the health and SRHR priorities of partner countries and supported their national and regional health sector capacities.

Overall, GAC-funded programming aligned with case study country governments’ national development plans, health plans and relevant SRHR-specific strategies. Programming was not standardized, but was instead tailored to align with the diverse SRHR priorities identified by respective health ministries, including in the areas of family planning, maternal and adolescent health care, gender-based violence prevention as well as STD control and mitigation. Depending on the need, programming covered a wide range of activities, including improving access to SRH services for women, adolescents and marginalized populations; promoting youth - friendly and gender - sensitive services; as well as ensuring SRHR advocacy through community engagement (see Figure 2.1 and Annex 5). 

Strong programming alignment with national priorities was linked to a few key factors. Implementing partners across case studies supported stakeholders working within national and regional health sectors to strengthen their capacities. These project activities centred around data systems strengthening to inform decision-making, capacity strengthening to institutionalize quality care and infrastructure upgrades (see Finding 8).

In addition, evidence indicated that active Global Financing Facility for Women, Children and Adolescents (GFF) involvement in partner countries strongly supported the alignment between GAC-funded programming and country-level health priorities, identified through GFF investment cases. Investment cases were developed by national governments and were often led by respective health ministries in consultation with country-level actors, including donors and CSOs. Case study evidence from Côte d’Ivoire and Tanzania highlighted that this multi-stakeholder process helped prioritize investments and coordinate donor support (including from Canada) to improve alignment between SRHR programming and identified country-level priorities (see Finding 7).

Moreover, GAC-funded programming specifically targeted regional areas that were identified as underserved by different levels of governments (national, regional or departmental health authorities). Of the case study projects sampled for review, the majority were implemented in these high-need regions (mostly rural), further demonstrating programming alignment with country priorities. In Côte d’Ivoire for example, five of the seven sampled projects were implemented in regional priority areas identified by the Ministry of Health, Public Hygiene and Universal Health Coverage.

Despite overall alignment, partner programming in areas like safe abortion and post-abortion care proved difficult in countries with restrictive legal frameworks and challenging socio-cultural and political contexts, limiting support for the provision of safe abortion services. Depending on the context, the SRHR neglected areas sometimes did not align with the priorities of host country governments, despite their strong relevance to the needs of women and girls (see Findings 3 and 4 for more details). 

Alignment with rights holders’ needs

Figure 3.1: Right holders’ SRHR priorities

Finding 3: GAC-funded SRHR programming aligned with the needs and priorities of rights holders and their wider communities. However, in countries with restrictive legal frameworks and opposing social norms and values, programming for CSE and comprehensive abortion care proved difficult to implement. As a result, the reproductive health needs of women and girls in these areas were not adequately addressed.

Case study evidence demonstrated that GAC-funded SRHR programming across the five country case studies aligned with the needs and priorities of rights holders (primarily women and adolescent girls, aged 15 to 24) in particular in relation to improved access to quality SRH services (e.g., in the areas of reproductive health care, STD control, family planning and comprehensive abortion care) and prevention of SGBV (see Figure 3.1 and Annex 5). Local community-based organizations, youth groups, civil society and government actors played an important role in informing implementing partners of their specific SRHR needs and priorities. For example, partners in Tanzania described various levels of engagement for identifying the needs of targeted populations, including those of broader local community members. This entailed consultations with direct project participants, surveys and site visits to relevant communities, adolescent-led research, and other feedback mechanisms that helped ensure interventions were relevant and responsive to local realities.

Evidence further indicated that a number of projects were grounded in local evidence and at times, adapted based on feedback from community-level surveys. For example, the portfolio of SRHR projects in Côte d’Ivoire was shaped by a study commissioned by GAC’s Côte d’Ivoire program (HQ and mission) that informed the selection of its SRHR-focused interventions. This study considered input from multiple stakeholders, including local community-based organizations.

While GAC-funded programming broadly aligned with the SRHR priorities of women and girls, addressing the full range of rights holders’ needs in sensitive areas like CSE and comprehensive abortion care proved challenging. Legal barriers to safe abortion services persisted across the world, with varying degrees of restrictions within case study countries (see Annex 6). However, evidence pointed to examples where partners adapted to the unique legal, political and cultural health landscapes of a country to meet rights holders’ needs in these areas. For example, in settings where access to safe abortion services was heavily restrictive or culturally sensitive, GAC-funded initiatives primarily focused on abortion advocacy or post abortion care. This was the case in Côte d’Ivoire, where GAC collaborated with other donors to support the development of a comprehensive reproductive health law, while supporting advocacy efforts aimed at its adoption. Additionally, to implement CSE in Côte d’Ivoire and Tanzania, implementing partners integrated relevant CSE activities into broader life skills and health education approaches to reduce resistance and improve cultural acceptance.

Despite these positive efforts, a word of caution was mentioned by multiple evaluation respondents: not all organizations have the appropriate profile (e.g., rights-based, pro choice, etc.), capacity and experience to program in legally or culturally sensitive areas (see Finding 4 for details).

Inclusivity and intersectionality

Figure 4.1:  Populations of focus across case study countries

Finding 4: GAC-funded programming demonstrated a growing commitment to intersectionality. However, efforts to address the needs of marginalized groups, including ethnic minorities, LGBTQI+ individuals, persons with disabilities, and migrants, were context dependent.

Evidence highlighted that implementing partners often applied an intersectional lens to country-level SRHR programming (Figure 4.1 and Annex 5). However, the depth and consistency of these efforts varied significantly across partnerships and country contexts. In some cases, projects targeted specific marginalized groups. For example, 50% of the projects sampled in Colombia included initiatives aimed at improving and guaranteeing the rights of LGBTQI+ persons. Evidence of projects that focused on addressing the needs of other marginalized groups such as Indigenous and Afro-descendant communities, persons with disabilities (PWDs) and garment factory workers and sex workers was also found in Colombia, Tanzania and Bangladesh, respectively.

Evidence pointed to a growing push within the department to integrate gender-transformative approaches to SRHR programming and introduce intersectionality frameworks to reach marginalized populations and address complex, overlapping vulnerabilities. However, respondents further emphasized the need for more sustained and inclusive efforts to address the needs of LGBTQI+ individuals, PWDs, migrant populations, and other underserved groups. In three of the five case study countries, the realization of LGBTQI+ rights was constrained by restrictive legal frameworks and pervasive stigma and discrimination, which affected the implementation of inclusive programming in this area. To improve the inclusivity of SRHR programming, partners and project participants identified the need to deepen intersectional approaches, expand direct engagement with marginalized groups, and address systemic barriers such as stigma and the lack of legal protections that hinder equitable access to SRH services.

However, multiple respondents strongly cautioned to avoid risks to rights holders and ensure the principle of "Do no harm" was fully applied. To do this, programming in politically and culturally sensitive areas required partnerships with legitimate rights-based organizations. While an assessment of a partner’s reputation, capacity and experience was completed during the department’s partner selection process, evidence from the partner selection review revealed variability in the depth and consistency that this was done and evaluation respondents questioned the rationale for certain partnership choices (see more in Finding 16).

Use of global evidence

Figure 5.1:  Thrive agenda and FPI

Finding 5: GAC’s SRHR approach and priorities were grounded in evidence at the strategic/policy level through alignment with the 2018 Guttmacher-Lancet Commission report and collaboration with civil society. However, there was inconsistent use of global evidence to inform SRHR project design and planning decisions.

The FIAP prioritized evidence-based decision making to enhance results and accountability for all of Canada’s international assistance initiatives, including global health and SRHR. This was also a key component of the 10YC accountability framework (Finding 17).

Interviews and document review highlighted that GAC’s SRHR approach was grounded in global evidence, particularly the Guttmacher-Lancet Commission report on SRHR (2018). The report redefined and expanded the global SRHR agenda and called for an integrated, right-based approach rooted in public health evidence. 

In addition, a distinguished feature of Canada’s SRHR approach was its close collaboration with Canadian CSOs, whose engagement helped define the government’s strategic direction. Interviews and document review highlighted that Canadian CSOs (including GAC’s SRHR implementing partners), through initiatives like the Thrive Agenda and Future Planning Initiative, helped shape Canada’s SRHR priorities, including the continued focus on the neglected areas (Figure 5.1).^{Footnote 10} Lobbying efforts by Thrive partners specifically contributed to the $1.4 billion per year 10YC announcement by then prime minister Justin Trudeau at the Women Deliver Conference in 2019. In addition, Canadian civil society partners and academic institutions collaborated with GAC to develop the 10YC accountability framework (Finding 17).

Despite strong alignment at the strategic level, evaluation evidence demonstrated inconsistent use of global evidence to inform SRHR project design and planning decisions. While case studies demonstrated that some project designs were grounded in local realities (Finding 3), there was little evidence that this was done systematically. As part of the Authorized Programming Process (APP) for the department’s international assistance programming, incorporating lessons learned and best practices was an essential step for project team leader (PTLs) during the project design phase. In addition, using the standardized proposal assessment criteria, PTLs were expected to assess the degree to which each proposed project design was aligned with global evidence and Canada’s priorities (e.g. FIAP, 10YC). Evidence from interviews and the project selection review revealed that consideration of lessons learned and best practices in project selection was uneven across the portfolio. In many cases, there were challenges in accurately accounting for and assessing the degree to which implementing partners integrated evidence into their SRHR project design. In practice, the rapid evidence synthesis demonstrated that a sample of projects did not fully align with the recognized best practices specific to three of the SRHR neglected areas (Annex 7).

In addition, PTLs were largely generalists and did not require thematic training or expertise to manage SRHR programming as part of their portfolio. In consequence, evidence pointed to inconsistent levels of PTL knowledge, understanding and experiences related to core SRHR issues, including SRHR-specific best practices. The SRHR/global health specialists supported PTLs by reviewing project proposals, but only when consulted. There was no systematic process in place to ensure these specialists were engaged at key points in the programming cycle or that PTLs incorporated this advice, when provided (see Findings 13 and 16).

Canada’s position in the global ecosystem

Figure 6.1: Canada’s leadership in the SRHR ecosystem

• Recognition as a global “champion” of SRHR
• Influential leadership by leveraging soft diplomacy and strategic partnerships
• Long-term policy commitment to a rights-based approach
• Active engagement in global forums
• Reputation remained fragile and was not always consistent
• Concerns about sustainability demonstrated the importance of Canada’s leadership

Finding 6: Canada demonstrated strong leadership in SRHR, earning recognition as both an important donor and influential advocate. However, stakeholders urged Canada to build on past progress and take a bolder stance amid the rapidly evolving global landscape.

SRHR advocacy has been a longstanding commitment for Canada and was specifically identified as a priority in the FIAP. Throughout HVHC and the 10YC, evaluation evidence highlighted Canada as a “champion” of global health and SRHR in line with the broader global paradigm shift towards a more rights-based approach aimed at addressing systemic inequalities and advancing comprehensive SRHR outcomes (see Figure 6.1). Respondents viewed Canada as a respected and influential leader in the global SRHR space, with a unique niche rooted in its political commitments and focus on neglected areas. GAC’s partners emphasized Canada’s value as a collaborative donor that championed sensitive issues like comprehensive abortion care and CSE, while also leveraging its diplomatic presence to shape global norms. GAC staff echoed these views, highlighting the importance of Canada’s long-term policy commitments which provided continuity, credibility, and visibility for SRHR on the global stage. All stakeholders recognized Canada’s ability to “punch above its weight” through soft diplomacy, strategic partnerships, and a rights-based approach to international assistance.

Canada’s leadership was also observed through its active engagement at various high-level global health and SRHR events and forums. Between 2020 and 2023, Canada led and participated in a wide range of health and SRHR-related advocacy events that spanned multilateral and global forums, bilateral engagements, high level panels and roundtables, and international campaigns. Through its roles on the boards of the United Nations Population Fund (UNFPA), World Health Organization (WHO) and GFF, Canada advocated for the integration of comprehensive SRHR into essential health services and global health responses, reinforcing alignment with the broader global health agenda.

However, while Canada was seen as a global leader in SRHR, respondents emphasized that this reputation remained fragile and was not always consistent, with varying levels of ministerial engagement since 2017. With growing concerns about the sustainability of global SRHR efforts in the current global political and economic landscape (see Finding 11), internal and external stakeholders were clear in emphasizing the importance of Canada’s continued leadership in SRHR and especially in neglected areas like comprehensive abortion care and CSE. They highlighted the need for GAC to seize the opportunity, urging it to be bolder and stand firmly for rights and fill the void left by the projected reductions in donor funding moving forward. Country case studies further underscored both the destabilizing impact of donor withdrawals and the critical role of Canada’s leadership in mitigating these effects. 

Case study evidence highlighted that Canada’s SRHR leadership at the country-level generally resulted in enhanced credibility within each country’s SRHR ecosystem. Despite diverging values with certain partner governments (e.g., in sensitive SRHR areas), negative implications to Canada’s diplomatic relationships did not surface in the five case studies. Given the political and cultural sensitivity around certain themes in different countries, Canada’s approach in these contexts was to support the local ecosystem, identify local “champions” and work through them to promote shared values rather than be the voice themselves at the political level. 

Alignment with other donors

Figure 7.1:  Canada’s average ranking in the SRHR funding landscape

Finding 7: GAC’s SRHR approach was aligned with the SRHR priorities of like-minded donors. The department made consistent efforts to collaborate, build synergies and minimize duplication in the planning and delivery of SRHR programming, both globally and at the country level.

The evaluation donor scan highlighted that Canada was aligned with the SRHR priorities of most leading bilateral donors active in the global SRHR ecosystem. The selected countries prioritized advancing rights-based and feminist approaches to SRHR, but with differing levels of focus and leadership on the 10YC’s  neglected areas, based on each donor’s respective policy, programming and funding strategies. Other bilateral donors that stood out as strong global leaders across these underfunded areas included the Netherlands, Sweden and the United Kingdom, which consistently backed relevant global partnerships and ensured long-term investments in these areas.

In addition, from 2017 to 2023,^{Footnote 11} Canada established itself as a global leader within the SRHR funding landscape. While countries like the United States and United Kingdom far outranked Canada in total SRHR funding, Canada consistently ranked in the top five for total SRHR disbursements and the percentage of officia development assistance (ODA) allocated to SRHR (Figure 7.1 and Annex 8).

Furthermore, evidence from case studies, the donor scan, document review and interviews demonstrated that Canada’s efforts were instrumental in building synergies, avoiding duplication, and advancing external coherence in the global SRHR ecosystem. This was highlighted at the global level through Canada’s active engagement and leadership in advocacy-focused platforms (She Decides, Family Planning 2030, Generation Equality, Ouagadougou Partnership) and strategic global partnerships like the GFF. At the country level, mission efforts also actively supported better donor coordination. Evidence from four out of five case study countries (Colombia, Tanzania, Côte d’Ivoire and Bangladesh) highlighted that missions used a variety of tools to support better synergies and harmonization at the country level. For example, embassy-led platforms (e.g. Colombia’s Gender Roundtable), pooled funding mechanisms (e.g. Tanzania’s Health Basket Fund), and government-led coordination structures (e.g. Bangladesh’s ministry-led donor meetings) helped foster coherence and reduce duplication among donors. There were also multiple examples of partner-led coordination efforts that helped create programming synergies between donor-funded interventions in response to country-level needs and priorities. However, while some missions demonstrated clear leadership in fostering better coordination among partners, there was no formalized guidance or process in place for missions to lead these types of efforts.

Evaluation findings: Effectiveness

Health service delivery

Figure 8.1: Average number of health care facilities supported annually across case studies (2020-21 to 2022-23)

Source: partner-reported project data

Finding 8: Case study evidence highlighted examples where GAC-funded SRHR programming contributed to increased access to SRH services for women and girls^{Footnote 12}. However, progress varied across contexts, with noted barriers related to supply stock outs, health care worker shortages and persistent stigma and traditional values around SRHR in communities.  

Case study evidence demonstrated that GAC-funded SRHR initiatives led to more adaptive, community-centred, and integrated SRH service delivery, increasing access to SRH services for women and girls, including in the neglected areas (see sidebar). However, results varied from case to case (see Annex 4). 

Across the five case studies, SRHR initiatives increased the provision of SRH services, commodities and other SRHR supplies for women and girls, including youth. For example, to enhance access to contraceptive services and products, SRHR programing in Colombia included a range of complementary approaches, implemented by variety of partners. Profamilia, a local CSO, deployed 12 health brigades across eight municipalities, providing both short - and long-term contraceptive methods, alongside other SRH services. This was implemented in collaboration with the International Planned Parenthood Federation, a key global SRHR partner for GAC.  In Mozambique, safe abortion and post-abortion care services expanded as a result of targeted SRHR projects. For example, the Supporting Family Planning and Abortion initiative demonstrated a steady increase in service quality and accessibility with the proportion of safe abortions more than doubling over three years.

Case study evidence also demonstrated improvements to SRHR-related competencies among health care workers (HCWs), including in sensitive SRHR areas and for marginalized populations. For example, in Colombia, 47% of the projects financed by GAC included actions aimed at strengthening health sector capacities through technical assistance, counseling and training for SRHR service providers. In Bangladesh, programming worked to improve SRHR for marginalized groups through a variety of mechanisms including educating HCWs. According to partner data for project type interventions, an average of 4,018 community health workers (2,787 female and 1,231 male) were trained annually between 2020/21 and 2022/23 across case studies.

Evidence from all case studies highlighted improvements to health facility infrastructure and increased availability of equipment that helped rights holders access essential SRH services (Figure 8.1).  However, there were instances where such health equipment was not fit for use and distributed without adequate training. For example, a project in Côte d’Ivoire supported health facilities by providing incubators and medical refrigerators. However, issues arose with the compatibility of equipment that didn’t match local voltage standards. Additionally, training on proper use was reported as lacking.

Progress on health service delivery results was limited by several constraints. Stockouts of supplies (including family planning commodities) disrupted service delivery and in some cases, led to unwanted pregnancies. HCW shortages also limited access to services and affected HCW training activities as trainers were reassigned to clinical roles. Stigma, cultural norms, and country-specific legal frameworks also hindered access to services.

Health promotion and social norms change

Finding 9: Case study evidence demonstrated examples where GAC-funded SRHR programming contributed to improving healthy SRHR-related behaviours and practices. However, progress in this area was affected by partnership choices, short project life cycles and persistent harmful gender norms and stigma around SRHR.

In all case study countries, evidence highlighted that SRHR interventions were designed to promote positive social norms and healthy SRHR-related behaviours and practices within the broader social environment (see Annex 4). Programming focused on raising awareness and building knowledge through engagement activities, including CSE, with a wide range of stakeholders, including women and girls, parents and caregivers, teachers and educators, religious and community leaders, healthcare professionals, and men and boys. There was widespread recognition among partners that achieving SRHR results in all areas and ensuring their sustainability required shifting deeply rooted community norms and behaviors.

Examples from SRHR programming across case study countries demonstrated improved SRHR knowledge and healthy behaviours among women and girls and the wider community, including in the SRHR neglected areas (see sidebar). For example, in Côte d'Ivoire, SRHR initiatives involved religious leaders, community chiefs, and husbands, which helped challenge harmful gender norms and improve awareness around family planning, contraceptive use and SGBV. Activities around positive parenting also contributed to encouraging inter-generational dialogues and reducing stigma around youth sexuality. In Bangladesh, SRHR programming contributed to reducing instances of SGBV through community-driven interventions and educational training that challenged harmful social norms and promoted respectful relationships and gender equality. In Tanzania, open conversations around SRHR became more normalized, empowering youth to make informed decisions about their own SRH and improved access to adolescent friendly services.

While case study evidence from individual projects highlighted promising shifts in SRHR knowledge, attitudes, and social norms, progress remained uneven across cases. Strong community engagement through project activities (in particular with men and boys) was a clear enabling factor. However, evidence highlighted that cultural and religious values, harmful gender norms, persistent stigma and inconsistent government support were hindering factors to achieving and sustaining social norm and behaviour change results. In some cases, evidence demonstrated that, if not carefully tailored to the local context, SRHR programming could even inadvertently reinforce stigma, lead to resistance within the community and further reduce access to services. In addition, evidence highlighted that positive social norm results, in particular in culturally or legally restrictive contexts, were dependent on selecting the right partners with the requisite experience, expertise and technical capacity to engage communities and conduct effective, transformative and rights-based programming in sensitive areas such as CSE, SGBV and comprehensive abortion care (see Findings 4 and 16).

Case study evidence further emphasized the importance of long-term, sustained interventions (rather than short-term projects) to solidify progress and accurately measure results on social norm and behaviour change. GAC’s SRHR reporting in the 10YC annual reports provided little evidence on actual social norm and behaviour change and was limited to data on "reach", pointing to a critical gap in outcome-level evidence generated by the department (see Finding 17).

Policies, regulations, and financing

Finding 10: Case study evidence demonstrated examples where GAC-funded SRHR programming strengthened the capacity of governments and civil society to promote and protect SRHR for women and girls, though the sustainability of these efforts was affected by the degree of government buy-in and level of local ownership and leadership involved in SRHR programming.

Across case studies, evidence highlighted examples where SRHR programming improved the ability of governments and key stakeholders to develop public policies and strategies that supported the protection of SRHR for rights holders (see sidebar and Annex 4). In Tanzania, GAC-funded initiatives contributed to shaping national health sector policy, including through advocacy efforts that led to the integration of gender equality and adolescent health in the development of the Health Sector Strategic Plan V and the new Health Basket Fund Memorandum of Understanding. In Colombia, the Centre for Reproductive Rights was instrumental in defending Ruling C-055 in 2022 which decriminalized abortion. In Bangladesh, the Child Early and Forced Marriage project reinforced the Child Marriage Restraint Act, strengthening local mechanisms to prevent child marriage and protect adolescent girls. In Côte d’Ivoire, Canada's mission actively supported the review of an SRHR protection law, currently awaiting approval at the national assembly.

SRHR initiatives also strengthened the capacity of local civil society, especially women's rights organizations, to advocate for the equal enjoyment of SRHR. For example, in Colombia, the department partnered with a local CSO (Profamilia) to support their public policy-focused advocacy efforts. Profamilia mobilized adolescents and children to support lobbying efforts for Law 2344 on the elimination of child marriage and early unions. This helped strengthen public policy for children and adolescents.

However, advocacy and policy-level results were largely country-specific and were not generalizable beyond specific case studies. Evidence demonstrated that government buy-in and support for SRHR was a key factor that led to successful policy change and helped promote national ownership of SRHR issues and solutions.

In addition, SRHR was highly politicized; the lack of government support, direct government opposition as well as restrictive legal frameworks for certain areas of SRHR obstructed progress and affected the health and wellbeing for rights holders, particularly in areas like comprehensive abortion care and LGBTQI+ rights. The project selection review revealed that cultural and political “readiness” was considered in some cases but was not consistently documented throughout the process.

Evidence further highlighted that sustainability of advocacy results was linked to the degree of local ownership and leadership in planning and delivering SRHR initiatives. Local organizations were embedded in communities and had a direct relationship with SRHR rights holders as well as key stakeholders at the local, regional and national levels. They were best placed to understand the local context, customs, culture and challenges, which helped align advocacy efforts with local realities. Interviews and the literature reviewed highlighted that this local positioning and deep local knowledge helped improve programming relevance, results and sustainability, in particular in areas like advocacy, but also for social norms change. However, institutional barriers within GAC limited the amount of funding GAC provided directly to local partners to deliver SRHR programming. Only one out of 35 case study projects was managed through a direct signed financial agreement between GAC and a local implementing partner (see Finding 16).

Global progress on SRHR

Finding 11: While advancements have been made in achieving global SRHR results in certain areas for women and girls, opposing socio-political movements, global crises, geopolitical shifts, and donor funding withdrawals posed challenges to the achievement of SRHR results and their sustainability.

In line with case study findings, evidence highlighted that at a global level, progress on certain aspects of SRHR for women and girls had improved over time (Annex 9), but challenges continued to persist (particularly in the SRHR neglected areas) and were linked to several external factors.

Since 2017, global SRHR programming, including GAC-funded initiatives, has been increasingly vulnerable to the proliferation of organized and well-coordinated political and social movements that aimed to challenge the expansion and protection of certain rights, including various aspects of SRHR, gender equality and LGBTQI+ rights. In some cases, these efforts have led to clinic closures and decreased SRH services, reduced access to contraception and comprehensive abortion care, as well as NGO self-censorship, staff layoffs and project cancellations. Evidence from the document review demonstrated that certain cultural and religious values and sensitivities around key SRHR issues (e.g., comprehensive abortion care, CSE) had contributed to the rise of these socio-political movements. Case studies further highlighted that, when present, these elements directly served as persistent barriers to achieving SRHR results and their sustainability. This was particularly the case for SRHR neglected areas as well as services supporting vulnerable populations, including safe abortion, CSE, adolescent SRH and LGBTQI+ rights, as well as harmful practices such as FGM/C and child, early and CEFM (see Findings 8 and 9).

In addition, global crises, such as political instability, inflation, climate change and infectious disease outbreaks, exacerbated inequalities and strained health systems. For example, in Bangladesh, climate shocks and rapid urbanization created acute SRHR risks for the poorest people and those in informal settlements. Case study evidence revealed that projects struggled to fully integrate approaches that addressed these compounding realities.

SRHR programming was also more recently affected by broader geopolitical shifts and changes to the traditional donor funding landscape. The most impactful setback for the SRHR ecosystem was the sweeping policy changes and funding freezes from the United States. In January 2025, the United States halted most foreign aid, dismantled the USAID, and withdrew support from key global partners, including the UNFPA and WHO. According to the 2025 Donors Delivering for SRHR report, a further 60% cut to global health funding has been projected in 2026, which is expected to significantly impact SRHR support in areas like family planning, SGBV and safe abortion (see sidebar). Beyond the United States, the outlook for SRHR funding among major bilateral donors was marked by widespread projected budget cuts, policy shifts, and uncertainty.^{Footnote 13} Major donors reported they would redirect development funds toward defence and security capacity building, reducing their historical SRHR-focused development financing. Several key donors projected reductions in ODA between 2024 and 2029. France, Germany, the Netherlands, Norway, Sweden and the United Kingdom explicitly planned or had already implemented reductions in overall development assistance, while others like Denmark and Australia introduced targeted increases, though it was not clear if this would translate to increased SRHR support (see Annex 10).

COVID-19

Finding 12: While the COVID-19 pandemic disrupted SRHR program delivery worldwide, GAC’s response enabled the continuity of critical SRH services.

The launch of the 10YC in 2020 coincided with the global COVID-19 pandemic. This period of increased health needs, mobility restrictions and lockdowns put significant strain on national health systems, delayed SRHR program implementation and limited access to essential health services, including SRH. For example, case study evidence from Bangladesh and Colombia highlighted that women and girls, including those from marginalized groups faced heightened barriers due to lockdowns, economic hardship, and stigma. As a result, instances of SGBV (including child marriage) surged.

In 2020-21, GAC received additional, one-time financing to support their international response to COVID-19, which raised the department’s total health-related disbursements. The crisis response also included specific additional funds for partner organizations to pivot and ensure that SRH services could continue in the dynamic pandemic context. Additionally, the department provided funding to multilateral partners to extend the reach of its investments. According to the COVID-19 International Assistance Response Lessons Learned report, there was a high degree of departmental coordination and leadership which ultimately supported a successful pandemic response.

Internal reports highlighted how partners sustained access to family planning and SRHR services in nearly 30 countries. While GAC’s key performance indicator (KPI) data showed a drop in community-based health services from 1.5 million people in 2020-21 to 250,000 in 2021-22 due to public health restrictions and limited community access, overall SRH service reach increased because of the crisis funding and costed extensions. Furthermore, case study evidence highlighted how programming adapted by shifting some SRH services to virtual platforms, including hotlines and telemedicine.

Findings: Efficiency and internal coherence*

Departmental capacity to deliver on the 10YC

Figure 13.1: YSD positions to support HVHC and the 10YC.

Finding 13: YSD support improved the department’s capacity to deliver on the 10YC through a variety of programming, coordination and technical advisory functions. However, while global health and SRHR specialist expertise was a valued resource, the lack of a systematic approach to engage with PTLs led to capacity challenges to plan and deliver SRHR programming.

While a wide range of departmental stakeholders were involved in SRHR planning and delivery (see Figure 0.4 for program background), the Global Health and Food Systems Bureau (YSD) was the 10YC and SRHR policy lead, responsible for addressing policy-related issues, ensuring coordination, maintaining communication and providing technical support to branches with 10YC responsibilities. Within the YSD bureau, the Health and Rights of Women, Adolescents and Children Division (YSH) and the Policy, strategy and coordination Division (YSC) served a variety of programming, coordination and technical advisory (e.g., SRHR/global health specialists) support functions. Since 2017, the level of dedicated YSD resources responsible for global health did not reflect the growing demand stemming from rising commitment targets. Since HVHC, the average disbursements under the 10YC more than doubled, while YSD full-time equivalent (FTE) positions only increased by 4% (Figure 13.1).

Evaluation evidence showed that YSD support was effective at improving departmental capacity to deliver on SRHR programming under the 10YC (Findings 14, 17 and 18). However, a key challenge emerged regarding the engagement between program officers in the geographic branches and YSD’s global health and SRHR specialists.^{Footnote 14} Respondents emphasized that this sector-specific specialist expertise provided clear value for program officers involved in SRHR programming, but the lack of an official mandate and limited dedicated FTE resources challenged their ability to effectively engage throughout the full project cycle (Findings 5 and 16).^{Footnote 15}

Given their respective technical expertise, GAC’s thematic specialists (e.g., gender equality, environment, RBM, global health, SRHR, SGBV) all provided clear value to PTLs throughout the programming process. In fact, both gender equality and environment specialist support were mandated to ensure compliance with policy and legal requirements. However, documents and interviews demonstrated that there was no comparable mandate or systematic process in place to ensure global health/SRHR-specific specialist engagement at key points in the programming process (e.g. review of project designs/proposals, monitoring of projects, reviewing final reports/evaluations). Unlike some of their counterparts, these specialists were not mandated to support SRHR/global health programming. As a result, they were virtually not engaged in SRHR department-initiated (DI) and call for proposal (CfP) project planning. Evidence highlighted this as a major challenge, in particular, when PTLs did not have sufficient expertise or experience in SRHR. PTL rotation also contributed to the underutilization of this valued resource. These challenges led to instances where relevant specialist input was not reflected in final programming decisions and contributed to additional challenges related to SRHR performance measurement (Finding 17) and sector coding (Finding 18).

Global health governance

Figure 14.1: Global health governance roles and responsibilities.

Finding 14: The global health governance structure played a key role in ensuring accountability and guiding investment planning for GAC’s SRHR investments. While it supported departmental coordination efforts, discussions focused mainly on financial aspects of the 10YC and provided limited strategic direction on SRHR programming coherence and results.

While the foundational architecture for GAC’s global health governance^{Footnote 16} structure pre-dated both HVHC and the 10YC, it evolved over time, expanding both its mandate and reach within the department (Figure 14.1). Most importantly, prior to the 10YC, the DG Global Health Committee (DG GHC) met on an ad hoc basis with sector-specific membership (limited to MNCH and to reproductive, maternal, newborn and child health (RMNCH). Under the 10YC, its mandate was formalized and membership expanded to include all DGs with global health responsibilities. Documents and interviews underscored this is a key development which enhanced the department’s ability to meets its global health governance objectives – to provide operational and financial oversight of the 10YC.

Within the governance function, the DG GHC and Global Health Working Group/Focal Points played an important department-wide coordination function to ensure the right balance of investments were made across branches to meet commitment goals. Credit was given to the Policy, Strategy and Operations Division (YSC), which provided secretariat support to these committees. Interviews and a systematic review of committee meeting minutes further demonstrated that the two committees were effective forums for sharing information, identifying constraints and promoting strategies to meet global health/SRHR financial targets, in particular for scaling up funding for the neglected areas.

However, because the 10YC was framed primarily as an investment commitment, branches were consistently under pressure to meet financial targets. Because of this, governance discussions focused heavily on financial spending (e.g. meeting 10YC targets, directing money to certain types of partners) with minimal attention to SRHR results. While the need for a better alignment of programming across sector areas and branches was also periodically identified, meeting minutes did not reveal strategic solutions to improve SRHR programming coherence within the department (Finding 15). Evidence highlighted that these challenges limited the function’s ability to fulfill a key component of its mandate: “provide strategic direction for the delivery of the $1.4 billion commitment by 2023/24.” These limitations also reflected a critical gap with the stated 10YC policy-level priorities, which clearly indicated more result-level SRHR objectives that were in line with the FIAP: “increase access to comprehensive sexual and reproductive health and rights.”

Managing by commitment / internal coherence

Finding 15: The lack of 10YC/SRHR operational guidance, decentralized planning and pressure to meet financial targets led to coordination challenges and instances of fragmented programming under the 10YC.

During the evaluation period, guidance for 10YC/SRHR implementation was limited to commitment announcements and targets, mandate letters, with policy cover from the FIAP. There was no formal implementation plan or operational guidance in place to link FIAP/10YC policy objectives with SRHR programming and advocacy efforts.  In addition, given the large number of 10YC and SRHR responsibility centres within the department, roles and responsibilities were not well understood by evaluation respondents. While YSD was the policy lead for the Health and Nutrition action area and the 10YC, it did not have an official programmatic mandate. YSD’s oversight for SRHR planning and delivery was therefore largely limited to its role within the global health governance structure (Finding 14): it did not have formal authority at the program/portfolio level to strategically manage for SRHR results (Finding 17). As a result, program decision-making was largely decentralized. SRHR programming was also interconnected with multiple other sectors, each with their own programmatic leads (e.g. humanitarian assistance, peace and security, education, environment).

Given the pressure to meet 10YC financial targets and the corresponding annual investment cycle, branches had to mobilize funding quickly, limiting opportunities for meaningful coordination with other responsibility centres and programmatic leads as part of their respective planning processes. Outside of global health governance (and except for a call for proposals), there was no evidence of a mechanism in place to guide financial decisions with a view to ensure coherence.

Evidence demonstrated that, while there were positive examples of internal coherence (see sidebar), the elements above led to coordination challenges and some instances of fragmented programming under the 10YC. For example, interviews and documents highlighted a lack of guidance and coordination mechanisms in place to support the internal coherence for both SGBV and CSE/education programming (see sidebar). This contributed to internal inefficiencies and resulted in missed opportunities to enhance the cost-effectiveness for certain SRHR investments.

In addition, examples from case study evidence revealed a lack of synergy and integration between multilateral SRHR programming planned at HQ and bilateral programming managed by the geographic branches (and respective missions). Multilateral programming decisions were largely made at HQ, without sufficient consultation and communication with missions. As a result, geographic branches were regularly unaware of multilateral programming in the pipeline when they engaged in their own bilateral programming in country, which, at times led to a duplication of effort. This aligns with the findings from the 2025 OECD-DAC Peer Review of Canada, which highlighted that this lack of coordination “limits the scope for locally responsive strategies when priorities do not fully align.”  

Based on meeting minutes, improving coordination across programmatic areas, including 10YC responsibility centres, was recognized by the department’s senior management as essential for a more strategic use of 10YC investments.

Partnerships

Figure 16.1: HVHC and 10YC disbursements by selection mechanism (% of total)

Finding 16: While there was demonstrated value in a diversity of partnerships to deliver SRHR programming, there was a missed opportunity under the department-initiated selection mechanism to strategically select partners based on their capacity to deliver relevant SRHR results and support their sustainability.

GAC partnered with a wide variety of organization types to deliver SRHR programming under both HVHC and the 10YC through both multilateral and bilateral development assistance. Partners included Canadian CSOs, foreign CSOs (including international, regional and local CSOs), government institutions, MLOs and private-sector actors. Multiple lines of evidence strongly supported the value of having a diversity of partnership types to deliver SRHR programming (Annex 11).

However, case study evidence, document review, interviews and the evaluation’s partnership selection process review highlighted that partners were not always chosen based on their documented experience and proven capacity to achieve results in specific SRHR sectors and operating contexts. Evidence highlighted that partnership decisions were strongly linked to the consistent pressure to meet commitment financial targets, often leading program officers to rely on their previous relationships with well-established organizations to disburse funds quickly.^{Footnote 17} In addition, documents and interviews revealed a political priority to direct SRHR investments towards Canadian organizations. Finally, institutional barriers limited the department’s capacity to seek out and partner with lesser known, local organizations (see Annex 11).

Evidence pointed to a concrete opportunity to select partners more strategically. A significant portion of HVHC and 10YC funding was channeled through the DI funding mechanism (Figure 16.1). A key element for a DI project was that the department identified both the expected results and a specific organization that was best suited to achieve them. As part of the APP for DI programming, partner capacity was officially reviewed in the assessment phase, when the fiduciary risk evaluation tool (FRET) was applied. The assessment team was required to consider evidence of the capacity, experience and reputation of a potential recipient and their local partner(s) relative to the initiative being funded before approval. However, multiple lines of evidence revealed that this was not done systematically. The partnership selection review identified cases where the capacity, experience and reputation of successful recipients and their local partner(s) were insufficiently documented to accurately assess their ability to deliver results in specific areas of SRHR. Interviews and case study evidence also provided clear examples where a partner’s capacity was not well aligned with the SRHR initiative being funded.

Furthermore, as documented in Finding 13, global health and SRHR specialists were virtually not engaged by PTLs in the DI project planning or design process, including when defining the expected outcomes in the invitation letter and selecting an appropriate partner. Given the varied levels of PTL knowledge, understanding and experiences related to core SRHR issues, the lack of YSD specialist engagement for this selection mechanism was noted by multiple respondents as a missed opportunity.

Performance measurement

Figure 17.1: Key YSD investments in evidence-generation research

• Center for Reproductive Rights: $6M, FY2023-24 to FY2024-25
• Guttmacher Institute: $6M, FY2023-24 to FY2026-27
• Human Reproduction Special Programme: $33M, FY2023-24 to FY2024-25
• University of Toronto: $1.75M, 2025 - TBD

Finding 17: While performance measurement practices improved since 2017, SRHR accountability remained heavily focused on financial aspects with limited attention given to SRHR results. This hindered the department’s ability to tell a coherent SRHR results story and manage for SRHR results in line with the 10YC accountability framework and the department’s RBM guidance.

Performance measurement challenges for GAC’s global health investments were recognized in the 2019 Evaluation of the Maternal, Newborn and Child Health Initiative and continued to limit the department’s capacity to measure and report on SRHR results throughout HVHC and into the 10YC.^{Footnote 18}

However, between 2020-21 and 2022-23, YSD supported the development of performance measurement tools and processes that aimed to strengthen the department’s accountability and transparency for its 10YC/SRHR investments. In 2020, YSD developed the Accountability Framework in collaboration with external global health stakeholders, including Canadian civil society partners and academic institutions. The Accountability Framework was designed to support the 10YC in three key areas:

1. accountability and transparency,
2. managing for results and,
3. informed decision making.

In 2020-21, YSD also created new health and nutrition project-level KPIs and has since led an annual data collection exercise with a variety of partners. At the time of the evaluation, project-level KPI data was available for 2020-21 to 2022-23. Finally, since 2020, YSD has published three 10YC annual reports. Case study and interview evidence highlighted that YSD’s support improved the department’s internal capacity to collect SRHR project-level performance data. However, the 10YC annual report was heavily focused on financial reporting with very limited attention given to SRHR results. In addition, the collection of annual KPI data was not systematically leveraged to brief senior management to inform portfolio-level evidence-based decision making. Project-level KPI data demonstrated overall reach for SRHR interventions funded by GAC in a given fiscal year, but was not intended to measure individual project performance over time. KPI data alone was not sufficient to tell a comprehensive results story at the SRHR program/portfolio level.

Moreover, despite the development of these performance measurement tools and processes, there was no official monitoring, evaluation and learning (MEL) plan associated with the department’s SRHR/10YC investments. While the Accountability Framework was approved by GAC senior management, it was never fully resourced. YSD’s focus has instead been on financial tracking and investment planning. Unlike other thematic programs such as Women’s Voice and Leadership (WVL), YSD did not have an official programmatic mandate, costed MEL plan or resourcing strategy (Finding 13) to effectively manage for SRHR results in line with RBM guidance at the meso (program/portfolio) level (see sidebar). Without dedicated MEL resources for SRHR and with no mechanism in place to connect these tools with program officers and their partners, meaningful use of the Accountability Framework was limited.

Both internal and external stakeholders demonstrated a strong appetite for SRHR results. Since 2021, YSD has made efforts to fund research and monitoring services for the department’s SRHR programming, but dedicated MEL resources remained limited (Figure 17.1).

10YC sector coding

Finding 18: SRHR sector coding practices have improved since 2017 thanks to the development of specific 10YC coding training and related guidance. However, coding inaccuracies remained a challenge, hindering the departments’ ability to accurately track and report on SRHR investments.

SRHR investments were tracked thematically using GAC’s 10YC coding methodology, based on the OECD-DAC sector codes. Sector codes were initially entered by PTLs during project design into the SAP Finance and Administration System’s (FAS's) Project Self-Service (PSS) and were expected to be updated regularly. Sector coding was the department’s primary data source for planning, tracking and reporting on its international assistance investments. It also served as an important accountability mechanism for the department’s financial contributions to the 10YC and was an essential input for senior management to make informed financial decisions.

The application of sector coding for SRHR was decentralized and while there was general sector coding guidance available for PTLs, it was not specific to SRHR. Recognizing these gaps, in 2020-21, YSD developed coding guidance and provided tailored training for PTLs that improved their capacity and helped strengthen departmental accountability and transparency for its SRHR investments under the 10YC. YSD also developed new sector codes for the neglected areas to better capture those respective investments. 

However, despite these improvements, multiple lines of evaluation evidence pointed to continued coding inaccuracies, limiting the department’s ability to reliably track its SRHR investments. As of March 2023, a total of 459 SRHR projects totalling nearly $1.6 billion in disbursements had been funded. In 2023, an internal coding review of GAC’s SRHR investments revealed that 51 projects (i.e., at least 11% of total projects) were coded inaccurately, 18 of which were miscoded SGBV projects. Miscoding errors ranged from assigning SRHR codes to projects that were not SRHR, not assigning SRHR codes to projects that were and miscoding projects within different global health and SRHR sectors. In recent years, coding has also been acknowledged by the department’s senior management as an area that needs more attention and improvement.

Evaluation evidence highlighted that the most common SRHR coding errors stemmed from inconsistent LM interpretations: using project activities rather than outcomes to initially assign sector codes in SAP. These common errors were linked to the absence of formal department-wide coding training for PTLs and limited YSD specialist support when reviewing LMs to assign sector codes. Initial coding was also not consistently revised during implementation. While this was attributed to the consistently heavy workloads for PTLs, respondents also noted that the pressure to meet financial targets created a reluctance to “recode” initiatives after project design for fear of failing to meet commitment objectives if coding changed.

Conclusions, considerations and recommendations

Conclusions

Strong relevance to stakeholder needs

Since 2017, and catalyzed by the FIAP, GAC’s transition from MNCH to SRHR reflected a paradigm shift away from the traditional service-delivery programming model to a more comprehensive, rights-based approach. Throughout HVHC and the 10YC, GAC’s SRHR investments consistently aligned with its policy priorities under the FIAP as well as its financial and advocacy objectives. Within case study countries, programming supported partner governments’ national-level health and SRHR agendas and largely reflected the needs and priorities of rights holders and their communities. Additionally, partners demonstrated a growing commitment to intersectionality, though efforts to address the needs of marginalized groups varied across contexts and were dependent on selecting appropriate partners.

Inconsistent evidence-based programming

GAC’s approach to SRHR was grounded in evidence at the strategic/policy level. However, there was inconsistent use of global evidence and results to inform SRHR programming decisions. Evidence highlighted that projects were not always selected based on global evidence nor were implementing partners consistently chosen based on their experience and proven capacity to deliver SRHR-specific results. In addition to capacity considerations and other criteria, financial decisions were strongly linked to the pressure to meet financial targets and a prioritization by senior management to fund Canadian organizations. Evidence also identified that PTL’s SRHR-specific knowledge, understanding and experiences were inconsistent, highlighting the need for more systematic specialist engagement in the SRHR programming cycle to better inform evidence-based programming decisions. In addition, the department prioritized measuring and reporting on financial aspects of its SRHR programming with limited attention to results. These elements, combined with the absence of a programmatic mandate for YSD, constrained the department’s ability to effectively manage for SRHR results, maximize cost-effectiveness and demonstrate value for money on its SRHR investments.

Demonstrated leadership and results in a difficult context

Over the evaluation period, SRHR initiatives were increasingly challenged by opposing socio-political movements, global crises, geopolitical shifts and donor funding withdrawals. Despite this difficult context, case study evidence demonstrated that GAC-funded programming achieved results, in particular, by contributing to increasing access to SRH services, improving healthy SRHR-related behaviours and practices, and strengthening the capacity of governments and civil society to promote and protect SRHR. In addition, Canada played a pivotal role within this dynamic SRHR ecosystem. It demonstrated strong leadership and made consistent efforts to collaborate, build synergies and minimize duplication with other actors in the SRHR space, both globally and at the country level.

Internal efficiency challenges

YSD was the 10YC and SRHR policy lead, providing programming, coordination and technical advisory support and, improving the department’s capacity to deliver on its SRHR programming. However, it did not have an official programmatic mandate and, outside its role within the global health governance structure, it did not have formal authority at the program/portfolio level to strategically manage SRHR planning and delivery. In addition, while global health governance supported accountability and guided investment planning, it provided limited strategic direction on SRHR programming coherence and results. Finally, there was a lack of 10YC/SRHR operational guidance that connected policy priorities with SRHR programming and advocacy objectives to ensure coherence. These elements, combined with the consistent pressure to meet financial targets, resulted in decentralized decision-making and led to coordination challenges and instances of fragmented SRHR programming.

Considerations

Canada’s global leadership in SRHR

Multiple lines of evidence demonstrated Canada’s sustained leadership in SRHR since 2017, earning a reputation as a globally respected leader and advocate. This was particularly evident in programming for historically underserved areas such as comprehensive abortion care and comprehensive sexuality education. In the evolving SRHR ecosystem, marked by a dynamic and often challenging global socio-political and economic landscape, including traditional SRHR donor withdrawals, GAC is well positioned to leverage its SRHR expertise and experience.^{Footnote 19}

(Supported by findings 6, 7 and 11)

Promoting locally led development

The SRHR evaluation findings aligned with two recent OECD-DAC publications [OECD Development Co-operation Peer Reviews: Canada 2025 and Pathways Towards Effective Locally Led Development Co-operation (2024)], which clearly articulated the pivotal role played by local actors in driving international assistance results and their sustainability. Moving forward, the department should consider clearly articulating its overall objectives for local ownership and leadership in international assistance.

To do this, the department could prioritize and strengthen the efforts underway by the International Assistance Policy Planning Division (RVP) with the aim to:

• articulate a clear working definition of locally led development (LLD) for the department
• outline Canada’s approach to LLD, including objectives and principles
• develop implementation guidance for program officers, including best practices and actionable steps to follow to better integrate LLD in their international assistance portfolios

(Supported by findings 10 and 16)

Recommendations

1. YSD, with the support of YOD, should ensure SRHR and global health-specific technical support is systematically integrated into the Grants and Contributions programming cycle to guide the planning and delivery of GAC-funded SRHR programming.

Technical support could include:

• providing relevant SRHR-specific technical expertise and strategic advice to support PTLs at key points within the programming cycle
• offering SRHR-specific knowledge to support excellence in program development
• engaging in SRHR conversations and communities of practice both within the department and externally
• relevant in-house expertise and/or outsourced resources, depending on departmental needs and context.

(Supported by findings 5, 13, 16, 17 and 18)^{Footnote 20}

2. To better demonstrate value for money, YSD should prioritize measuring and reporting results at the SRHR program/portfolio level.

This could include: 

• evidence-based programming guidance (sharing best practices, lessons learned and global evidence)
• strategies and/or innovative approaches for the department to measure real change in all areas of SRHR; this will push data collection beyond “output” and “reach” data and re-examine how to leverage reporting from partners
• clear entry points within the global health governance structure to help ensure evidence of results is leveraged to inform the “strategic direction” for SRHR planning and delivery and better manage for SRHR results. 

(Supported by findings 5, 8, 9, 10, 11, 13, 14,17 and 18)

3. YSD should develop an evidence-based project and partner selection approach to deliver SRHR programming and improve its cost-effectiveness.

This approach could: 

• prioritize projects whose design and implementation are clearly informed by global evidence that reflect the identified SRHR challenge and specific needs and priorities of rights holder group(s)
• prioritize partnerships based on an organization’s experience and, proven capacity to deliver results (evidence-based) and ensure their sustainability
• maximize the value of different partnership types, depending on the specific SRHR priority identified and the political, social and cultural context of the recipient country
• ensure local knowledge, capacity and relevant experience is considered as a top priority in partner selection
• account for all local factors and conditions that may impact results (political, economic, cultural) in the project and partner selection criteria
• leverage SRHR technical support (e.g., global health and SRHR specialists) for DI funding mechanisms and competitive processes such as CfPs to ensure the right projects and partners are selected to deliver evidence-based SRHR programming. 

(Supported by findings 3, 4, 5, 9, 10, 13 and 16)

4. YSD should develop operational guidance that promotes coherence between SRHR responsibility centres within the department and strengthens internal efficiencies.

This could include:

• clearly defined objectives for the department’s SRHR investments in line with the government’s global health policy direction
• clear roles and responsibilities for SRHR responsibility centres within the department
• clear steps and mechanisms to support coordination efforts across all responsibility centres, in particular, to improve synergies between mission/HQ, as well as between SGBV stakeholders and CSE/education responsibility centers
• ensure missions have the appropriate level of authority to plan, manage and implement country-specific SRHR programming in alignment with other programming areas at mission and in coordination with HQ-managed programming
• clearer roles and responsibilities for the global health governance structure committees to support their mandate to provide “strategic direction” for SRHR planning and delivery
• entry points for SRHR technical support (e.g., global health and SRHR specialists)

(Supported by findings 1, 13, 14 and 15)

Annexes

Annex 1: Timeline for SRHR commitments

Annex 2.1: SRHR project analysis from 2017-18 to 2023-24

Between 2017-18 and 2023-24, GAC’s SRHR investments supported 435 projects,* with a total value of $1.4 billion and implemented by a wide range of partner organizations.

Table 1: Summary statistics

Table 2: Project value ranges

Table 3. Partner engagement in SRHR projects**

Annex 2.2: Top 10 SRHR recipient countries from 2017-18 to 2023-24 

Annex 3: Global health governance structure

Governance Structure for the 10-Year Commitment

Annex 4.1: Colombia case study

GAC’s HVHC and 10YC SRHR disbursements in Colombia, 2017-18 to 2023-24 ($26M)*

*Sectors under $1million not labelled in graph include population policy and administrative management ($227,000).

The Colombia SRHR ecosystem

Over the course of the evaluation period, Colombia made significant strides in SRHR, positioning it amongst the most progressive countries in Latin America. Yet, access remained uneven, particularly in rural and conflict-affected areas. Maternal mortality declined, but adolescent fertility, early unions, sexual violence, and barriers to safe abortion persisted, underscoring the need for stronger health systems and gender-sensitive programs.

The SRHR landscape in Colombia was shaped by a wide range of actors. Institutional leadership was primarily driven by the Ministry of Health and Social Protection, with support from other ministries and subnational entities. Much of the progress made in SRHR stemmed from the efforts of well-organised feminist and civil society organizations. While decades of armed conflict significantly impacted women’s and girls’ rights, post-conflict reforms ushered in a new era of grassroots and youth-led feminist movements, expanding the reach and inclusivity of SRHR efforts across the country.

GAC-funded SRHR programming in Colombia

Between 2017-18 and 2023-24, GAC invested $26 million in SRHR programming in Colombia, spanning 11 thematic areas (see sidebar). These initiatives focused on expanding access to inclusive, equitable and non-discriminatory SRH services, including for vulnerable populations in underserved communities and were aligned with national priorities, including the National Development Plan 2022-2026 (see Annex 5).

Since 2017, GAC adopted a multi-level approach to SRHR programming, partnering with multilateral organizations, Canadian NGOs, foreign CSOs (see Annex 11), including one local CSO. This approach was reinforced by coordination with, and complementary funding from other donors, which expanded the scope of CSE and migrant care initiatives (see sidebar).

Partners addressed rights holders’ expressed needs for contraception, comprehensive abortion care, perinatal and menstrual health support, GBV prevention, and empowerment of women and youth. Funded initiatives also targeted marginalized groups—such as migrant women and Indigenous and Afro-descendant communities—and achieved coverage in underserved regions, particularly border areas and municipalities identified in departmental plans as priority areas with high adolescent pregnancy, maternal mortality, and GBV rates.

While GAC-funded initiatives complemented national agendas and supported local efforts, challenges in meeting the needs of key stakeholders, including vulnerable groups persisted (see sidebar). Programming in Indigenous territories relied heavily on adapted models and had not transitioned toward culturally co-created approaches that fully reflected Indigenous worldviews and practices.

SRHR results in Colombia

GAC-funded SRHR interventions in Colombia improved service delivery and expanded access to comprehensive SRH services in urban and rural areas. Activities also strengthened health workers’ capacity to provide gender-sensitive, rights-based services. For example, the EmpowHER project facilitated access for 13,915 people under the age of 25 across 19 clinics, offering counselling, contraceptives, SGBV care, and vaccinations for the human papilloma virus and/sexually transmitted infections. It also delivered 28 technical workshops, training 121 professionals in Colombia and Peru on specialized SRHR topics.

GAC-funded projects in the country also contributed to shifting social norms and influencing positive behavioural changes around issues related to gender equality, sexuality education and rejecting violence in all of its forms. For example, initiatives such as Valiente (among others) helped reduce stigma around menstruation, empowered youth to advocate for their right to bodily autonomy and introduced rights-based revisions to school curriculums and textbooks.

At the regulatory and institutional level, partners’ advocacy efforts influenced public policy to strengthen reproductive rights in country. Notable achievements included the passing of Law 2344 in 2025—championed by GAC partners—which prohibited child marriage and early unions by raising the minimum legal age for marriage to 18 without exceptions, marking a major step forward for child protection and gender equality, especially in Indigenous and Afro-Colombian communities. Additionally, the Center for Reproductive Rights played a key role in advancing Ruling C-055 in 2022, which sought legal protection for girls and adolescents who are victims of sexual violence and forced pregnancies.

Despite positive progress, SRHR programming operated in dynamic, and sometimes challenging contexts. Evaluation evidence highlighted key factors that affected the achievement and sustainability of SRHR results in Colombia (see sidebar).  

Factors affecting SRHR relevance to rights holders’ needs

Factors affecting the achievement of SRHR results

Annex 4.2: Côte d’Ivoire case study

GAC’s HVHC and 10YC SRHR disbursements in Côte d’Ivoire, 2017-18 to 2023-24 ($39M)*

*Sectors under $1 million not labeled in graph include social mitigation of HIV/AIDS ($16,000)

The Côte d’Ivoire SRHR ecosystem

Over the course of the evaluation period, Côte d’Ivoire made progress in SRHR, notably in reducing maternal mortality; however, significant challenges persisted. High adolescent fertility, early marriage, limited access to family planning and widespread GBV continued to drive unintended pregnancies, unsafe abortions under restrictive laws and elevated HIV prevalence. Despite efforts to expand youth-friendly services and integrated SRH programs, rural and marginalized groups still faced substantial barriers, underscoring the need for continued investment in SRHR and gender-sensitive programming.

The SRHR ecosystem in the country was shaped by a diverse set of actors, including national institutions, civil society organizations and international partners committed to improving access and advancing legal reforms. The Ministry of Health, Public Hygiene and Universal Health Coverage, led policy development and program implementation in coordination with local health districts and community centres. CSOs played a critical role in service delivery and advocacy, while international partners provided technical assistance, funding and strategic support. Together, these actors worked to close persistent gaps in SRHR and advocated for changes to restrictive laws.

GAC-funded SRHR programming in Côte d’Ivoire

Between 2017-18 and 2023-24, GAC invested approximately $39 million in SRHR programming, across nine thematic areas (see sidebar). Funded initiatives focused on improving access to SRH in underserved regions, addressing early pregnancies, and countering taboos around adolescent health. These efforts were aligned with national strategies such as the PNDS (2016-2020, 2021-2025), which prioritized family planning, maternal and adolescent health, and GBV prevention, and were informed by evidence from a 2021 strategic study commissioned by GAC to guide interventions in the country (see Annex 5).

GAC partnered with multilateral organizations, Canadian NGOs and international CSOs/NGOs to implement SRHR programming (see Annex 11). The majority of Canadian funds were directed to multilateral partners, while local organizations—despite strong community expertise—did not receive direct funding. In addition to its support for SRHR programming, Canada was also regarded as a valued actor within the broader ecosystem (see sidebar).

Projects focused on priority regions and adolescent girls (aged 10 to 19), including out-of-school youth. Activities promoted SRH awareness, rights empowerment, health worker training, and access to gender-sensitive, youth-friendly services, alongside health infrastructure upgrades and essential equipment. Partners at times, also engaged other actors (e.g., parents, young men and boys, religious and community leaders) to reduce gender barriers and strengthen SRHR advocacy. However, alignment with stakeholder needs were affected by several factors (see sidebar). Furthermore, programming in sensitive neglected areas (e.g. CSE) required careful framing and while no funds supported safe abortion programming directly, these issues were addressed through soft diplomacy and advocacy.

SRHR results in Côte d’Ivoire

GAC-funded SRHR programming in Côte d’Ivoire strengthened SRH service delivery by engaging health authorities and strengthening provider capacity for rights-based, youth-friendly care. In San Pedro, for example, projects supported training institutions such as the Institut national de formation des agents de santé (INFAS) (national institute for the training of health workers) with technical assistance, equipment, and information and communication technology, while reinforcing capacities in local health centres. These efforts led to improved services, greater youth engagement and increased use of adolescent-friendly spaces offering confidential care.

Partners also worked to promote healthier attitudes and practices within communities through awareness-raising activities and by strengthening capacities of key community “champions”. For example, training and engaging religious leaders and community chiefs in Daloa helped reduce stigma around youth sexuality, while initiatives such as “schools for husbands” supported efforts to combat GBV and improve perceptions of family planning.

At the regulatory level, GAC’s diplomatic efforts supported local CSOs’ advocacy for SRHR, including initiatives to revise laws on family planning and safe abortion. This included participation in legislative reviews, support for CSO-led workshops, and engagement with government stakeholders. Although abortion remained a sensitive and legally restricted issue, Canada’s involvement contributed to bringing previously stalled legislation back into policy discussions.

Despite positive progress, SRHR programming operated in dynamic and challenging contexts with evaluation evidence highlighting key factors that affected the achievement and sustainability of SRHR results in Côte d’Ivoire (see sidebar).

Factors affecting SRHR relevance to rights holders’ needs

Factors affecting the achievement of SRHR results

Annex 4.3: Tanzania case study

GAC’s HVHC and 10YC SRHR disbursements in Tanzania, 2017-18 to 2023-24 ($145M)*

*Sectors under $1 million not labeled in graph include comprehensive sexuality education ($614,000); social mitigation of HIV/AIDS ($24,000); material relief assistance and services ($96,000)

Canada in Tanzania

The Tanzania SRHR ecosystem

In the 2022 census, nearly half of Tanzania’s 60 million people were under the age of 17, yet adolescent pregnancy rates remained high and access to SRHR services was limited. While the country made strong gains in reducing child mortality and combatting major diseases, persistent challenges—such as child marriage, gender-based violence, weak health infrastructure, workforce shortages, and systemic bias against adolescents and marginalized groups—continued to undermine progress.

The SRHR ecosystem in Tanzania was structured through a decentralized sector-wide approach, involving pooling of resources from a broad range of actors. Several government ministries oversaw SRHR policies and their implementation, with the Ministry of Health playing a central role in policy formation and service delivery. Non-state actors played vital roles in financing, technical support, and service delivery. Regional and local council health management teams supervised implementation, and community-level engagement.

GAC-funded SRHR programming in Tanzania

GAC played a strategic and influential role in Tanzania’s SRHR landscape (see sidebar). Between 2017-18 and 2023-24, GAC invested $145 million in SRHR programing, primarily across nine sectors (see sidebar). These investments complemented efforts to keep girls in school, promoted gender equality, and strengthened health capacities and structures.

GAC partnered with a wide range of actors to deliver SRHR programming in country, including multilateral organizations (receiving about half of Canadian funding), the Government of Tanzania, and international and Canadian CSOs/NGOs (see Annex 11). As a leading donor to the Health Basket Fund, GAC also helped shape national policy, including the integration of key reproductive, maternal, newborn, child and adolescent health indicators and gender equality into national  health plans.

The evaluation found strong alignment between GAC’s programming and the priorities of key stakeholders, including the Government of Tanzania and rights holders (see Annex 5). SRHR programming was designed to reflect the needs of rights-holders, local communities and duty bearers, focusing on government identified priority regions and primarily targeting adolescent girls aged 10 to 19. Activities focused on access to youth friendly SRH services and GBV prevention. In addition, for community leaders and parents, activities centred on challenging harmful social norms and advocating for change.

While overall alignment to stakeholder needs was strong, the relevance of SRHR programming was affected by a number of factors (see sidebar). GAC’s programming also made strides in promoting intersectionality; however, continuous adaptation was needed to ensure inclusivity and responsiveness to evolving political and social contexts

SRHR results in Tanzania

GAC-funded SRHR programming in Tanzania strengthened SRH service delivery through a dual approach addressing both supply and demand. Health workers received extensive training in clinical and gender-sensitive care, while community engagement mobilized resources to renovate clinics. For example, the BRIGHT project upgraded 103 health facilities and trained 139 healthcare providers and 320 teachers on integrated SRH and nutrition services. Other projects used outreach models such as door-to-door education by Youth Peer Educators and Community Health Workers, increasing uptake of family planning, cervical cancer screening, post-abortion care and HIV testing. Additionally, the government’s adoption of Direct Health Facility Financing improved service delivery by channelling funds directly to facilities, enabling locally driven planning.

Social norms and behavioural change were addressed through gender-transformative strategies that empowered youth as peer educators and community influencers. In several projects, community scorecards enabled young people to assess service quality and co-create action plans with leaders and providers. Comprehensive training and awareness initiatives tackled misconceptions among community members about harmful gender norms and practices. These combined efforts led to greater male engagement, improved SRHR knowledge and support, and increased reporting of gender-based violence.  

Policy and advocacy efforts yielded tangible results at both national and local levels. Implementing partners played active roles in national technical working groups, while deliberate youth representation in project steering committees—alongside government ministries and other partners—helped ensure that young voices contributed directly to policy dialogue and decision making. 

Despite positive progress, SRHR programming operated in dynamic, and sometimes challenging contexts, with evaluation evidence highlighting key factors that affected the achievement and sustainability of SRHR results in Tanzania (see sidebar). 

Factors affecting SRHR relevance to rights holders’ needs

Factors affecting the achievement of SRHR results

Annex 5: GAC-funded SRHR programming alignment with stakeholder needs and priorities 

Annex 6: The world's abortion laws

Abortion laws exist on a spectrum. In many countries, abortion is permitted under specific circumstances. Post-abortion care is always legal.

Key facts and figures (as of September 2025):

• 662 million women of reproductive age (34%) lived in 77 countries that allowed abortion on request; these laws generally had gestational limits
• 457 million women of reproductive age (23%) lived in 12 countries/territories that allowed abortion on broad social or economic grounds
• 226 million women of reproductive age (12%) lived in 47 countries where abortion was permitted when pregnancy poses a risk to a person’s health
• 416 million women of reproductive age (20%) lived in 44 countries that allowed abortion to save the life of the pregnant person
• 111 million women of reproductive age (6%) lived in 21 countries that prohibited abortion altogether.

Source: Center for Reproductive Rights

Annex 7: Alignment of GAC-funded SRHR programming with global best practices*

*Alignment with best practices was based on the analysis of a limited sample of SRHR projects and is not representative of all projects relevant to each of these three SRHR areas. The identified best practices and degree of alignment with GAC-funded programming was informed by AI analysis.

Annex 8: Canada’s position within the SRHR donor ecosystem (2018-2023)

*A purposeful sample of 10 countries was selected for the donor scan based on criteria that included, but was not limited to SRHR disbursements (e.g., focus on neglected areas, policy priorities, etc.). The donor rankings in the table consider all donors presented in the Donor Delivering for SRHR reports and is not limited to the donor scan sample.

**Canada ranked second between 2018-21; third in 2022 and seventh in 2023

***The Donors Delivering for SRHR reports captured SRHR, family planning and RMNCH disbursements separately and acknowledged duplication within these categories. For simplicity, the evaluation report used the SRHR category for comparison purposes; however, this does not include the full range of SRHR investments Canada has made under HVHC and the 10YC.

Annex 9: Evidence of global progress on SRHR results

* Sources:

• Starrs, Ann, et al. 2024. “To Achieve Development Goals, Advance Sexual and Reproductive Health and Rights.”
• The Lancet 403 (10429): 787–789; Bearak, Jonathan, et al. 2020. “Unintended Pregnancy and Abortion by Income, Region, and the Legal Status of Abortion: Estimates from a Comprehensive Model for 1990–2019.”
• The Lancet Global Health; Starrs, Ann M., et al. 2018. “Accelerate Progress—Sexual and Reproductive Health and Rights for All: Report of the Guttmacher–Lancet Commission.”
• The Lancet 391 (10140): 2642–2692;
• Wisbaum, Wendy. 2022. Evidence Gaps and Research Needs in Comprehensive Sexuality Education: Technical Brief. UNESCO;
• Khan, Lina, Tomasz Kozakiewicz, Megha Bhattacharyya, Tasnim Azim, Marcellina Schmidt, Tobias Polak, Birte Snilstveit, and Shannon Shisler. 2024.
• Sexual and Reproductive Health and Rights in Low- and Middle-Income Countries: An Evidence Gap Map. 3ie Evidence Gap Map Report 31. New Delhi: International Initiative for Impact Evaluation (3ie);
• Action Canada for Sexual Health and Rights. n.d. Neglected Areas Toolkit. Accessed November 7, 2025.

Annex 10: Projected ODA funding reductions by other donors

Several donor countries projected reductions in ODA between 2024 and 2029: France, Germany, the Netherlands, Norway, Sweden, the United Kingdom and the United States reported funding cuts. Despite reductions in overall ODA, future strategies in the Netherlands and Sweden suggested potential reinvestment in global health and SRHR priorities. In contrast, both Denmark and Australia signalled increases to overall ODA, though only Denmark specifically mentioned increased SRHR support [Source: Donors Delivering for SRHR Report (2025)].

Annex 11: Case study partnership analysis

Across the evaluation case studies, GAC partnered with a wide variety of organization types to deliver its SRHR programming.

Case study country disbursements by partner type, HVHC and 10YC, 2017-2018 to 2023-2024*

^*Partners representing less than 1% of funding and those labeled “TBD” are excluded from these graphs. Country-specific exclusions are Tanzania: <1% TBD, Canadian private sector, and foreign private sector; Mozambique: <1% “TBD” and Canadian private sector; Colombia: 13% “TBD” and <1% Canadian private sector; and Côte d'Ivoire: <1% “TBD” and Canadian private sector.

Annex 11: Case study partnership analysis (cont.)

While partners programmed across all SRHR sector areas, the area of focus differed by partner type:

Top five sectors by partner classification, HVHC and 10YC, 2017-18 to 2023-24

Annex 11: Case study partnership analysis (cont.)

Evidence demonstrated that each partner type had unique advantages which supported SRHR delivery and results in complimentary ways, but success was dependent on the context and the specific SRHR sector being supported.

^*INGOs are non-governmental, non-profit organizations that operate internationally, either by having a global presence through country or regional offices or coordinating activities across borders via an international network. While certain Canadian organizations can be considered INGOs (Oxfam, Care, Save the children, etc.), they are classified under Canadian CSOs in this report to make the explicit distinction.

Annex 12: Line of evidence from findings to recommendations