Global Consultations Report · 2026
Essential, Not Optional:
Strengthening Health Systems to Uphold Health Rights and SRHRJ in Times of Polycrisis*
Consolidated findings from over 100 organizations and rights advocates worldwide · Global Consultations, April 21–23, 2026
Introduction
About This Report
This report consolidates the key discussions, emerging issues, lived experiences, and collective recommendations raised throughout the pre-consultations, learning sessions, and global consultations attended by over 100 organizations and rights advocates from around the world. The global consultations took place from April 21–23, 2026.
This report captures the diverse perspectives and contextual realities shared by participating organizations, movements, and advocates across regions — particularly on how intersecting political, economic, social, and climate crises are affecting health systems and access to sexual and reproductive health, rights, and justice (SRHRJ).
The report also reflects the collective analysis and priorities that informed the development of this year’s May 28 theme and Call to Action. It aims to contribute to ongoing advocacy, movement-building, and cross-movement solidarity efforts toward strengthening equitable, accessible, and rights-based health systems that uphold the right to health for all.
Context
How Are Crises Colliding to Undermine Our Rights?
In 2026, the world is experiencing a polycrisis* where overlapping political, economic, social, and environmental crises converge and intensify one another. This is not only reshaping health systems, but systematically undermining the realization of human rights, including the right to health, SRHR, bodily autonomy, equality, and access to life-saving care. It neglects critical areas such as mental health, where under-resourced systems fail to provide support and care.
These overlapping crises also expose and deepen structural inequalities embedded in global political and economic systems, including legacies of colonialism, extractive economic models, and unequal power relations that continue to shape who has access to health, resources, and decision-making power — and whose rights are routinely denied or deprioritized.
Over 40 countries holding elections in 2026, affecting 1.6+ billion people
ODA fell 23.1% to USD 174.3B in 2025 — a historic decline in foreign aid
Climate change projected to push 132M more people into poverty by 2030
Global military spending reaches USD 2.4–2.8 trillion annually
Disinformation and algorithmic censorship restricting SRHRJ information access
Weak legal frameworks leave communities vulnerable to unsafe practices and denied rights
Crisis Dimension
Political Crises
This section highlights the risk of health priorities being neglected during political transitions. In 2026, over 40 countries will hold national elections, affecting more than 1.6 billion people globally, presenting both opportunities for progress and risks of further rollback.1 Anti-rights actors are increasingly coordinated across borders, seeking to capture political and multilateral spaces.
In regions like South Asia, some countries have experienced elections and transitions to new governments following youth-led revolutions. These shifts, despite signaling democratic energy, have resulted in uncertainties in terms of long-drawn policy changes, threatening to push health and SRHR agendas to the sidelines.
Crisis Dimension
Crises Arising From Conflict and Geopolitical Tensions
Across settings affected by conflict — such as Palestine, Sudan, Ukraine, Lebanon, Iran, and the Democratic Republic of the Congo — international humanitarian and human rights law obligations are being severely undermined. Civilians, especially women, girls, and gender-diverse people, face gruesome violations of their rights to health, safety, dignity, and survival.
These contexts also reflect violations of the right to be free from gender-based violence, as conflict increases exposure to sexual violence. Forced displacements are happening and health systems and infrastructure, including hospitals and clinics, are attacked, damaged, or destroyed, while health workers are displaced, detained, or killed.
Access to essential health services, including SRHR services such as contraception, maternal health care, comprehensive care and support for victim-survivors of sexual violence, and safe abortion, is severely restricted, with direct consequences for preventable morbidity and mortality. Global military expenditure now reaches approximately USD 2.4 to 2.8 trillion annually, significantly exceeding investment in primary health care and gender equality, and reflecting a global prioritization that undermines the right to health.2
Crisis Dimension
Economic Crises
The persistent underfunding of SRHR represents a failure to fulfill the obligations of governments under the right to health. Debt burdens, shrinking fiscal space, and market-driven health reforms weaken public health systems and accelerate the shift toward privatized and fragmented care — undermining availability, accessibility, acceptability, and quality.
Rising out-of-pocket costs and increased taxation to meet countries’ debt obligations further entrench inequality, disproportionately affecting women in all their diversity, people living in poverty, marginalized communities, and informal workers — those already excluded from equal enjoyment of rights.
Public investment in health, including SRHR, remains chronically insufficient, while militarization, debt servicing, and austerity measures continue to divert resources away from the fulfillment of economic, social, and cultural rights. Recent data show that ODA provided by Development Assistance Committee (DAC) members and associates fell to USD 174.3 billion in 2025, representing a 23.1% decrease compared to 2024.4
A 23.1% decline in ODA — dropping to USD 174.3 billion in 2025 — marks a historic contraction in the global commitment to funding health and SRHR in the communities that need it most.
Crisis Dimension
Climate and Environmental Crises
Climate change, recognized by the United Nations as one of the defining crises of our time, further threatens the realization of human rights.5 It is accelerating in both scale and severity, driving increased heat exposure, extreme weather events, air pollution, infectious disease transmission, food insecurity, malnutrition, and mental health impacts. These impacts directly undermine the right to health and disproportionately affect marginalized populations, deepening existing inequalities in rights realization.
Pollution, toxic waste, rapid and unplanned urbanization, deforestation, and resource extraction are not only ecological harms but also direct threats to SRHR and the right to health. Toxic air and water pollution is increasing the risk of respiratory illnesses, giving rise to reproductive health complications, and maternal mortality.
As populations concentrate in informal settlements and slums, access to clean water, sanitation, and healthcare becomes precarious. Overcrowding increases risks of communicable diseases, maternal health complications, and gender-based violence. Women, girls, and gender-diverse people in urban poor communities often face heightened barriers to SRHR services including contraception, safe abortion, and protection from exploitation, violence, and abuse.
Economic, social, climate, and environmental crises are also intersecting: in contexts of austerity and economic instability, conflict, and climate and environmental crises, governments increasingly shift responsibility for health onto individuals and families, undermining governments’ obligation to respect, protect, and fulfill the right to health. By 2030, climate change is projected to push an additional 132 million people into poverty, constraining governments’ ability to fulfill economic and social rights.6
Marginalized communities — including adolescents, persons with disabilities, Indigenous peoples, caste- and tribe-affected populations, sex workers, displaced persons, migrants, asylum seekers, refugees, people living with HIV and TB, and informal workers — face compounded barriers to realizing their rights to health and SRHR, including dignity, informed consent, and quality care.
Crisis Dimension
Food Scarcity, Safety, and Nutrition Crises
Rising food insecurity, driven by conflict, climate shocks, economic instability, and weak governance, is undermining health and SRHR worldwide. Women, girls, and gender-diverse people are often the first to sacrifice meals, deepening gender inequality and exposing them to harmful coping strategies such as early marriage or transactional sex.
In Asia and Africa, prolonged droughts and displacement from disasters have left millions food insecure, with pregnant women unable to access adequate nutrition or safe delivery services. In the Pacific Islands, climate-induced disruptions to agriculture and fisheries have reduced food availability, leaving women and girls vulnerable to malnutrition and limiting access to SRHR services.
Safe, nutritious food is integral to our right to health — yet adulteration of food, through contamination, unsafe additives, and poor regulation, is a growing threat to health and SRHR. In countries across Asia, Africa, and elsewhere, cases of adulterated essentials, including milk and cooking oil, have been linked to malnutrition, reproductive health complications, and other chronic illnesses affecting the quality of lives, particularly of those from marginalized communities who lack the purchasing power to buy quality products. Women and children are disproportionately affected as unsafe food affects pregnancy outcomes, child development, and overall bodily autonomy.
Crisis Dimension
Digital, Mental Health, and SRHR Crises
The polycrisis* is not confined to physical systems — it is also unfolding in digital spaces. Digital repression, disinformation, and algorithmic censorship are increasingly restricting access to accurate, evidence-based SRHRJ information. Human rights defenders face surveillance, harassment, and technology-facilitated gender-based violence, undermining the rights to privacy, safety, and freedom of expression. Civic and digital spaces are therefore becoming contested terrains, where access to rights, information, and participation is actively constrained.
At the same time, under-resourced mental health systems fail to meet rising needs, leaving young people especially vulnerable to anxiety, depression, and stigma. These pressures intersect: digital spaces can both empower and harm, influencing mental health outcomes and shaping attitudes toward bodily autonomy and reproductive rights.
For example, across countries in Asia and Africa, young women are increasingly relying on mobile platforms for SRHRJ information and mental health support. However, in the absence of robust legal frameworks, many face risks of misinformation and cyber-violence and harassment that exacerbate health challenges and overall wellbeing.
Crisis Dimension
Legal and Governance Crises
The lack of robust legal frameworks undermines the obligation of governments to respect, protect, and fulfill the right to health and SRHRJ. Outdated or poorly enforced laws leave communities vulnerable to unsafe practices, discrimination, and denial of services. Weak sexual violence laws, gaps in legislation, and poor implementation of laws meant to end harmful practices perpetuate injustice.
In many contexts, close-in-age consensual and non-exploitative relationships between adolescents are criminalized, exposing young people to prosecution rather than protection. Laws that fail to address marital rape, that permit child marriage, or that criminalize same-sex relationships and abortion further erode rights. Without strong legal protections, austerity measures, environmental harms, and social backlash are compounded, reinforcing inequality and eroding trust in institutions.
This moment demands more than mere recognition of the crises and vague commitments. True change happens when lived realities, community-led evidence, and collective action shape how systems are designed, financed, and held accountable.
Collective Recommendations
To Governments
We demand decisive, collective action from all to confront these intersecting crises, address structural inequalities, and reclaim the right to health and SRHR as a fundamental human right.
1 On Accessible and Quality Health Care Information, Delivery and Services
(i) Build equitable, accessible, and non-discriminatory health systems
Ensure that all health and SRHR services are accessible to everyone, free from discrimination, coercion, violence, and stigma, particularly in contexts where intersecting crises deepen exclusion and inequality. Ensure that the right to health is upheld without distinction of any kind, including on the basis of sex, sexual orientation, gender identity and expression, sex characteristics (SOGIESC), age, disability, health status, ethnicity, race, religion, language, nationality, profession, migration status, socioeconomic status, or geographic location.
(ii) Remove structural and systemic barriers to accessing health services
Eliminate provider bias, stigma, and coercive practices that restrict access to care and limit informed consent, including denial of services, moral judgment, and discriminatory treatment, especially in fragile and overstretched health systems. Remove unnecessary administrative and documentation requirements that create barriers to care, particularly for young people, unmarried individuals, migrants, and those without formal identification. Ensure that no one is subjected to forced conversion therapy, mandatory waiting periods, or coercive procedures, including requirements to view ultrasounds or listen to fetal heartbeats as a condition for accessing abortion or other SRHR services.
(iv) Integrate survivor-centric gender-based violence responses within health systems
Guarantee survivor-centered, trauma-informed, and accessible health, legal, and psychosocial services for all survivors of gender-based violence, recognizing this as a core expression of people-centered health systems. Institutionalize accountability, protection, and reparations mechanisms within public health systems, and ensure coordinated, multi-sectoral service delivery that upholds dignity, autonomy, confidentiality, and informed consent.
2 On Making Strategic Investments to Strengthen Health Systems
(i) Strengthen equitable and people-centered public health systems
Invest in strong, publicly financed health systems that address gender inequalities, social determinants of health, disabilities, and local vulnerabilities. Expand, adequately resource, and ensure effective coordination of community-based and primary health care systems. This includes comprehensive SRHRJ services, menstrual health, psychosocial support services, and the prevention, diagnosis, and management of reproductive health conditions such as endometriosis, which remains under-recognised and under-treated within health systems.
(ii) Institutionalize comprehensive sexuality education (CSE)
Invest in increasing access to scientifically accurate, rights-based, age-appropriate, and inclusive CSE in both formal and non-formal settings. Ensure CSE is grounded in consent, bodily autonomy, gender equality, and freedom from violence, and is protected from political, ideological, or religious interference. Recognize CSE as both a critical preventive health intervention and a transformative education and rights-based tool that shapes knowledge, attitudes, and behaviors across the life course.
(iv) End militarization and prioritize public investment in health, education, and care systems
Cease all armed conflict, occupation, and attacks on civilians and civilian infrastructure, including health and education facilities, and reallocate public resources away from militarization, occupation, and security expansion toward publicly funded health systems, education, social protection, and care economies. Adhere to international humanitarian law and invest in the safeguarding of health facilities as neutral, life-saving spaces.
(v) Integrate SRHRJ into climate, conflict, and humanitarian responses
Ensure that humanitarian, climate, and conflict response frameworks include comprehensive SRHRJ services from the outset, including contraception, safe abortion, maternal health care, GBV response, and psychosocial support, even in disrupted or fragile settings. Invest in health systems to be anticipatory, adaptive, and responsive to intersecting crises in line with international standards as provided under the Minimum Initial Service Package (MISP) and the Sphere Handbook.
(vi) Strengthen supply chains
Invest in improved access and availability of essential and quality medicines, vaccines, diagnostics, and other health supplies necessary for the realization of the right to health, ensuring continuity even under conditions of systemic disruption.
3 On Safeguarding Rights in Times of Polycrisis
(i) End austerity and transform economic systems for health justice
Immediately reverse austerity-driven policies and fulfill obligations to progressively realize the right to health through sustained, adequate, equitable, and gender-responsive public financing. Strengthen domestic resource mobilization, reduce out-of-pocket expenditure, and reject privatization models that deepen inequality. Advance debt justice and economic reforms that expand fiscal space for health, care, and social protection.
(ii) Eliminate gender-based violence through comprehensive legal and policy action
Through legal and policy reforms, recognize gender-based violence as a systemic human rights and public health crisis that is intensified in contexts of overlapping political, economic, and social instability. Adopt, fully fund, and enforce comprehensive legal and policy frameworks to prevent, address, and eliminate all forms of discrimination, gender-based violence, including sexual violence, intimate partner violence, obstetric violence, and technology-facilitated gender-based violence.
(iv) Protect health workers and community-based providers
Through strong implementation of laws, ensure the safety, dignity, and labor rights of all health workers, including community health workers, abortion providers, doulas, acompañantes, and frontline health providers. Address legal and policy gaps to protect them from violence, harassment, burnout, and criminalization, and guarantee fair compensation, safe working conditions, and professional recognition.
(v) Protect civic and digital space in times of polycrisis
Put in place laws to guarantee freedoms of expression, association, assembly, and access to information as foundational conditions for functioning health systems and effective SRHRJ delivery. Eliminate discriminatory laws to end the criminalization, surveillance, harassment, and defunding of feminist, LGBTQIA+, youth-led, and human rights organizations. Put in place strong digital governance laws to ensure access to accurate SRHRJ information, prevent algorithmic censorship, and address technology-facilitated gender-based violence.
4 On Strengthening Government Accountability Through Partnerships
(i) Uphold the obligations of the government to respect, protect, and fulfill the right to health and SRHRJ
Governments must recognize and act on their primary responsibility as duty-bearers under international human rights law, ensuring that all policies, laws, and investments advance the realization of health and SRHR without discrimination.
(ii) Strengthen accountability mechanisms
Establish transparent, participatory, and rights-based accountability systems that enable communities and civil society to monitor, evaluate, and demand action on health commitments. This includes establishing community-led monitoring systems and grievance mechanisms at local health facilities and across different levels of health systems.
(iii) Ensure meaningful participation and leadership of marginalized communities in health systems
Governments should strengthen partnership with civil society and affected communities, the most marginalized, recognizing them as knowledge-holders, and ensure their meaningful participation in co-creating, implementing, and monitoring health systems. This should include women*, young people, LGBTQIA+ persons, persons with disabilities, Indigenous peoples, migrants, and other structurally excluded groups in all stages of health system governance.
(iv) Strengthen democratic governance, transparency, and accountability in health systems
Intersecting crises are weakening institutions and eroding public trust. Governments must work with civil society and communities to ensure health systems remain responsive to intersecting crises, including conflict, climate change, economic instability, and public health emergencies. These partnerships can help build accountable institutions that uphold human rights, prevent corruption, and guarantee equitable allocation of public resources towards health and SRHR.
Collective Recommendations
To Funders and Donors
1 Shaping Priorities and Resource Flow to Tackle Polycrisis
(i) Invest in neglected and underfunded areas of SRHRJ
Increase sustained investment in neglected and underfunded areas of SRHRJ, including menstrual health, midwifery care, endometriosis research and advocacy, and integrated services for people affected by climate change, humanitarian crises, HIV, TB, mental health conditions, and disability. Ensure that research, services, and innovation respond to intersecting inequalities and the evolving needs of crisis-affected populations.
(ii) Provide rights-based, equitable, flexible, and long-term funding
Provide direct, flexible, long-term, and core funding for feminist, youth-led, LGBTQIA+, Indigenous, and community-based organizations working on SRHR and health justice. Provide sustained funding for feminist and social movements, grassroots, last-mile, and community-led organizations including advocacy, organizing, coalition-building, care work, crisis response, and collective infrastructure. Recognize movements as essential infrastructure for accountability, service delivery, and rights protection in contexts of intersecting crises.
Recognize and actively protect SRHR defenders, abortion rights activists, acompañantes, and feminist organizations that are operating under conditions of polycrisis*. End donor complicity in shrinking civic space and ensure funding systems do not expose organizations to heightened risks from criminalization, digital violence, harassment, judicial persecution, and coordinated anti-rights attacks.
(iii) Design sustainable funding models
Create quick-response funding mechanisms, supported by a diversified donor and funder base, that are capable of responding rapidly to conflict, climate and natural disasters, and public health emergencies. These mechanisms must ensure continuity of essential services, including SRHRJ, even in crisis contexts. Transform funding models to prioritize equity, decolonial approaches, and the redistribution of resources toward the Global South.
2 Easing Access to Funding
(i) Simplify and reform funding processes
Reduce bureaucratic barriers, administrative burdens, and ensure timely disbursement of funds to make funding accessible. Adapt reporting and compliance requirements to be proportionate and accessible, particularly for grassroots, youth-led, and small organisations. Proactively address barriers created by restrictive legal and regulatory environments that limit access to funding.
3 Contributing Towards the Building of Resilient Health Systems
(i) Advance global economic justice and debt relief
Funders and donors must use their influence with global financial institutions to expand fiscal space for health, care, and social protection. By supporting debt relief, rejecting harmful conditionalities, and promoting financing models grounded in equity and rights, funders can ensure governments are able to progressively realize the right to health and SRHRJ. Initiatives such as the Debt x Health initiative demonstrate how debt relief can be directly linked to investments in health.
(ii) End all harmful conditionalities and ideological restrictions
Development assistance should be grounded in human rights and equity, not used as a tool of political or ideological control. In times of polycrisis*, when barriers to health and justice are already heightened, donors have a responsibility to ensure their funding expands access rather than deepens exclusion. Funders and donors must actively advocate to reverse policies such as the Global Gag Rule that have entrenched barriers and caused lasting harm.
(iii) Do proactive advocacy
Funders and donors must go beyond reversing harmful restrictions by actively investing in advocacy that strengthens comprehensive SRHRJ services and accountability. In polycrisis contexts, where conflict, climate shocks, economic instability, and public health emergencies converge, this proactive approach ensures accessible, rights-based funding towards SRHRJ and resilient health systems under the most challenging conditions.
(iv) Shift accountability toward people, not just funders
Funders must reform funding practices to ensure accountability is directed toward communities and movements rather than solely toward donor priorities, indicators, and reporting systems.
Notes
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* On the term “women”
While we use the term ‘woman/women’ we do so with a critical reflexivity that recognizes the nuances and right to people’s unique sexual and gender identities and expressions. We also recognize that ‘women’ are not a monolithic group and that they have diverse identities that vary due to their social location and the socio-economic, political, and multicultural contexts in which their lives are embedded. When using ‘woman’, we include transgender women, gender-diverse people, and women in all their diversities across contexts.
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* Polycrisis
The term “polycrisis” was originally coined by French complexity theorists Edgar Morin and Anne Brigitte Kern in the late 1990s to describe the “complex intersolidarity” of multiple interconnected global crises. Rather than viewing crises as isolated events, they argued that political, economic, environmental, social, and institutional crises interact with and intensify one another. The concept has since been further developed by scholars including Adam Tooze, who popularized the term in contemporary global discourse. See: Lawrence, M., Homer-Dixon, T., Janzwood, S., Rockström, J., Renn, O., & Donges, J. F. (2024). Global polycrisis: The causal mechanisms of crisis entanglement. Global Sustainability, 7, e6. https://doi.org/10.1017/sus.2024.1
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* Strengthening Health Systems
This involves the development and implementation of primary health care oriented health policies and realistic strategic plans that focus on improving the institutional and organizational capacity of a country to provide health services to the whole population. See: World Health Organization Regional Office for Africa. Health systems strengthening. https://www.afro.who.int/health-topics/health-systems-strengthening
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References
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1
Al Jazeera. (2026, January 1). All the big elections to look out for in 2026. https://www.aljazeera.com/news/2026/1/1/all-the-big-elections-to-look-out-for-in-2026
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2
Stockholm International Peace Research Institute. (2026, April 27). Global military spending rise continues as European and Asian expenditures surge. https://www.sipri.org/media/press-release/2026/global-military-spending-rise-continues-european-and-asian-expenditures-surge
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3
Fòs Feminista. (2026, January 26). Getting UN80 right: Protecting mandates while improving coordination. https://fosfeminista.org/news-and-stories/getting-un80-right-protecting-mandates-while-improving-coordination/
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4
Organisation for Economic Co-operation and Development. (2026, April 9). A historic decline in foreign aid: Preliminary 2025 ODA data. https://www.oecd.org/en/data/insights/data-explainers/2026/04/a-historic-decline-in-foreign-aid-preliminary-2025-oda-data.html
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5
United Nations Development Programme. (2018). UN Secretary-General’s climate address. https://www.adaptation-undp.org/un-secretary-generals-climate-address
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6
World Bank. (2020). Revised estimates of the impact of climate change on extreme poverty by 2030 (Policy Research Working Paper No. 9417). https://documents1.worldbank.org/curated/en/706751601388457990/pdf/Revised-Estimates-of-the-Impact-of-Climate-Change-on-Extreme-Poverty-by-2030.pdf
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May 28 Resources
Explore campaign materials, the Call to Action, and actions on the official May 28 website.
Read the co-created global demands from over 100 organizations on SRHRJ and rights-based health systems.
→ Download Campaign Materials 2026Graphics, toolkits, and assets to amplify the May 28 message in your community and networks.
→ Take Action Suggested Actions 2026Practical steps and advocacy opportunities for individuals, organizations, and movements.
→ About About May 28Learn about the history and mission of the International Day of Action for Women’s Health.
→ Archive Past CampaignsExplore previous years’ themes, calls to action, and advocacy milestones from the campaign’s history.
→ Media Resources for MediaPress materials, key facts, and guidance for journalists and media professionals covering the campaign.
→
Crisis Dimension
Social Crises
Attacks against gender equality and bodily autonomy are intensifying. Activists are resisting, but civil society organizations and feminist movements — which are essential to the realization of rights through service delivery, accountability, and rights claiming — are increasingly restricted through legal, financial, and administrative measures. Shrinking civic space and rising authoritarian practices further undermine the rights to freedom of expression, association, and participation, all of which are essential to rights-based health governance.
The global architecture meant to uphold solidarity and human rights is also weakening. Multilateral reforms, including proposals to merge UNFPA and UN Women, risk diluting mandated responsibilities on SRHR and gender equality, weakening institutional capacity to uphold rights in practice.3
Declining official development assistance (ODA), restrictive funding conditionalities, and shifting geopolitical priorities are further constraining governments’ ability to progressively realize the right to health.