Partial progress in sexual and reproductive health and rights: the influence of sociocultural, behavioural,...

The concept of sexual and reproductive health and rights has evolved in the 21st century from previous narrower conceptualisations. In 2018, the Guttmacher-Lancet Commission proposed a broader and integrated defining framework, together with a package of essential health service elements. Despite this, progress on the sexual and reproductive health agenda has been inconsistent, with progress in some areas and considerable gaps in others. Even in areas that have seen breakthroughs in biomedicine and technology, progress has been partial owing to inadequacies in funding, policy, and implementation. Additionally, initial executive orders of the Trump administration in early 2025 presented a major challenge to sexual and reproductive health and rights in the USA, and orders on US foreign aid threaten devastating impacts on sexual and reproductive health and rights in recipient low-income and middle-income countries. As discussions of sexual and reproductive health and rights are often seen to be sensitive or controversial, even when had at a senior government level, any consideration of time trends in sexual and reproductive health outcomes need to consider the complex interplay between trends in social and cultural factors, politics and legal frameworks, and technology and biomedicine. The perceived sensitivity of sexual and reproductive health means that providing adequate education on sex, sexuality, and relationships is crucial, and this education is often resisted by religion or traditionalist sentiments. Furthermore, technological change means that many young people receive this education online, which has both positive and negative effects. A thorough understanding of the driving factors behind global epidemiological trends in sexual and reproductive health-such as fluidity in gender and sexual identity, biomedical innovations in contraception and the treatment and prevention of HIV and other sexually transmitted infections, gender-based violence, access to safe abortion, fertility needs, and comprehensive sexuality education-is crucial in assessing progress on the sexual and reproductive health and rights agenda. To this end, this Series paper provides an overview of trends in sexual and reproductive health and rights outcomes since 2018.