Women’s, Children’s and Adolescents’ Health in 2026: From Crisis Management to System Correction
Rajat Khosla lays out six priorities to move women’s, children’s and adolescents’ health from resilience to reform in 2026.
The past year confirmed that gains in women’s, children’s and adolescents’ health (WCAH) were more fragile than previously assumed. In 2025, sharp financing contractions, political retrenchment on rights, particularly sexual and reproductive health and rights (SRHR), and multiple and intersecting crises, converged to expose how fragile past gains really were. Having relied heavily on external financing and political prioritization through the Millenium and then Sustainable Development Goals, today WCAH suffers from the structural failures of the global development system.
In 2026, the question is no longer whether WCAH is under threat. The question is whether global governance, financing, and political leadership are capable of course correction.
2025: structural inflection point
The disruptions of 2025 were systems changing. According to estimates from the Institute for Health Metrics and Evaluation, development assistance for health declined by around 20 per cent in real terms between 2023 and 2025, with Sub-Saharan Africa experiencing the steepest reductions. These cuts did not simply reduce program coverage; they destabilized health systems already operating close to breaking point. Evidence from PMNCH partners across more than 20 countries showed widespread program downsizing, organizational closures, and loss of frontline health workers, particularly in sexual and reproductive, maternal, newborn, child and adolescent health services.
At the same time, political and ideological pressures reshaped the operating environment in ways that compounded these financing shocks. The expanded application of the Global Gag Rule – defined by some as a major escalation of regressive policies - donor-imposed restrictions on diversity, equity and inclusion, and broader rollbacks on sexual and reproductive health and rights (SRHR) translated directly into service disruptions, reduced access to contraception and safe abortion, and weakened civil society engagement. These measures functioned less as isolated policy choices than as instruments of governance, actively reshaping power, voice, and accountability across global health and development systems.
This shift has become increasingly visible within governance spaces. Systematic regression on language and narrative on SRHR is increasingly becoming the new normal in multilateral spaces. The narrowing of civic space within formal governance processes weakens accountability, marginalizes community-level and rights-based evidence, and disproportionately affects organizations representing women, adolescents, and other marginalized populations.
Parallel dynamics evident in the growing reliance on bilateral financing arrangements and development compacts in particular, illustrate how aid is increasingly structured around geopolitical alignment and narrowly defined sectoral priorities, often with explicit or implicit exclusions of SRHR. These agreements do not merely constrain available resources; they redefine the scope of permissible public expenditure, effectively trading development assistance for policy compliance and limiting national governments’ ability to finance comprehensive, rights-based health responses.
Collectively, these trends pose a direct challenge to global solidarity. As financing becomes more fragmented, conditional, and politically instrumentalized, the shared commitments that underpinned multilateral cooperation on women’s, children’s and adolescents’ health are eroded. Reforms aimed at improving efficiency and coordination, including initiatives such as the UN80 reform process, risk further marginalizing rights-based and civil society actors if underlying power asymmetries and political contestation are not explicitly addressed.
It is against this backdrop that PMNCH has recalibrated its 2026-2030 strategy toward system correction rather than crisis mitigation alone. Through a coalition with civil society organizations, PMNCH launched a call to action that responds directly to the current moment by prioritizing the stabilization of civil society as core health infrastructure, the protection of SRHR within national and global policy frameworks, and the defense of inclusive, evidence-based governance. The call articulates specific demands for predictable and flexible financing, meaningful participation of civil society in decision-making spaces, and renewed political commitment to women’s, children’s and adolescents’ health and rights as non-negotiable foundations of effective global cooperation.
Without deliberate safeguards and collective political action, ongoing reforms risk consolidating decision-making among a narrower set of actors, further weakening the normative foundations of equity, participation, and universality on which progress in women’s, children’s and adolescents’ health ultimately depends.
2026: a harder policy environment
Entering 2026, three structural shifts define the WCAH landscape. First, financing constraints have become embedded rather than temporary. Expectations of a rapid rebound in development assistance have faded. Instead, countries face a prolonged period of constrained external financing combined with high debt servicing and limited fiscal space. Calls for domestic resource mobilization have intensified, but without commensurate reform of global debt, tax, and trade regimes, many governments are forced into regressive choices that disproportionately affect women, children and adolescents.
Second, responsibility has shifted faster than power. Countries in the Global South are increasingly expected to finance, govern, and deliver WCAH services, yet continue to have limited influence over global financing rules, conditionalities, and agenda-setting processes. This imbalance undermines both equity and effectiveness.
Third, regional and political leadership has become more consequential. Initiatives such as the Accra Reset, African Union-led pooled procurement mechanisms, and health sovereignty agendas signaled a reorientation away from aid dependency toward regional cooperation and political agency. These developments matter not only for financing, but for legitimacy and ownership. Importantly, they have been accompanied by growing collective action to defend human rights and gender equality in the face of political backlash, including through platforms such as the Global Leaders Network, which has played a visible role in reaffirming commitments to women’s, children’s and adolescents’ health and rights.
WCAH as a governance diagnostic
Considering these shifts, WCAH offers a uniquely rigorous test of whether the current global system can deliver equitable outcomes under conditions of fiscal constraint, political fragmentation, and heightened rights contestation. Progress in WCAH depends on long-term investment, cross-sectoral coordination, and protection of rights, precisely the conditions most undermined by the aforementioned conditions. When WCAH outcomes deteriorate, it is rarely due to technical failure; it reflects governance breakdown.
Moreover, health outcomes for women, children and adolescents now reflect a convergence of policy choices in climate action, humanitarian response, debt management, and civic space regulation, all of which shape access to services, system resilience, and accountability. WCAH therefore provides a concrete lens through which to assess how cross-sectoral governance decisions affect equity and population health.
Policy priorities for 2026: from resilience to reform
The lessons of 2025 point to the need for a more explicit focus in 2026 on political economy, financing architecture, and governance choices that directly shape WCAH outcomes.
1. Stabilize civil society as core health infrastructure
Civil society organizations function as delivery platforms, accountability mechanisms, and connectors to marginalized communities. Yet they are among the first casualties of financing volatility. In 2026, predictable and flexible funding for national and community-based organizations is not optional; it is a systems requirement.
2. Re-anchor WCAH and SRHR in national fiscal frameworks
Domestic financing will increasingly determine WCAH outcomes, but only if investments are protected within national budgets and development plans. This requires explicit political prioritization of SRMNCAH services, health workers, and adolescent programs, not residual financing after other demands are met.
3. Correct the chronic underinvestment in adolescent health
Adolescent health remains structurally underfunded despite its centrality to demographic, economic, and social futures. A credible 2026 agenda must include dedicated financing, mental health services, comprehensive sexuality education, and institutionalized youth participation.
4. Defend SRHR through coordinated policy action
The rollback of SRHR observed in 2025 was strategic and transnational. Responses must therefore be coordinated, evidence-based, and unapologetic. Legal protections, service integration, misinformation countermeasures, and crisis-resilient SRHR delivery models are central to this effort.
5. Invest in regional governance and South-South cooperation
Regional platforms are increasingly where political alignment, procurement innovation, and policy learning occur. Supporting these mechanisms is not a substitute for global cooperation, but a necessary evolution of it.
6. Rebalance power and decision-making towards the global south
Countries in the Global South are increasingly expected to finance, govern, and deliver WCAH services, yet continue to have limited influence over global financing rules, agenda-setting processes, and policy conditionalities. Rebalancing this dynamic will require more than symbolic inclusion; it demands shifts in who defines priorities, controls resources, and shapes accountability mechanisms across multilateral, donor, and partnership structures.
Conclusion: from holding the line to resetting the system
In 2025, the priority was to prevent collapse. In 2026, the challenge is more demanding: to correct systemic distortions that continue to place WCAH at risk.
Protecting women’s, children’s and adolescents’ health requires political choices that rebalance power, reform financing, and defend evidence and rights as foundations of global governance. Whether the system can make those choices will determine not only the future of WCAH, but the credibility of global development itself.
Rajat Khosla, Executive Director, Partnership for Maternal, Newborn and Child Health.
Photo by Anna Shvets
