Bill & Melinda Gates Institute for Population and Reproductive Health

The Challenge Initiative for Healthy Cities Highly Ranked

Lead Organization

Bill & Melinda Gates Institute for Population and Reproductive Health

Baltimore, Maryland, United States

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Women and girls living in urban slums in Africa and Asia lack access to contraception, leading to unintended pregnancies that perpetuate urban poverty, impede gender equity, increase maternal and child mortality, and contribute to climate change through unsustainable growth. TCIHC’s solution lets cities self-select to participate and leverage their own resources. In return, TCIHC provides additional funding, real-time monitoring and coaching on evidence-based solutions that can be rapidly scaled for impact and sustainability. The United Nations projects that by 2050, nearly 70% of the world’s population will live in cities, with 90% of that urbanization occurring in Africa and Asia and concentrated in urban slums. Those living in slums are often overlooked – unintentionally undercounted and unrecognized by development efforts. With an additional $100 million, TCIHC will expand its reach to 100 cities in Nigeria, India, Pakistan, Senegal, the Philippines and Tanzania and provide four million additional women with contraceptives.

Problem Statement

Women and girls living in urban slums without access to contraception cannot reach their full potential. Urban poverty, gender equity, maternal and child mortality, and climate change are global challenges that will worsen if cities continue to grow at the same rate as they are today. It is estimated that by 2050, 70% of the world’s population will live in cities, much of that growth concentrated in the urban slums of Africa and Asia. Investments in urban slums also lags behind those in rural development. Although pregnancy can be one of life’s most rewarding experiences, an early, unintended pregnancy can alter the trajectory of a young person’s life and that of their child’s, causing intergenerational impacts on health, educational attainment and career achievement, while perpetuating the cycle of poverty. Complications from pregnancy are also the leading cause of death among 15-19-year-old girls globally. Investing in expanded access to contraception in urban slums can address a host of global challenges in a significant way. Scaling evidence-based solutions to reach women and girls – both married and unmarried 15-24 year-olds – living in the urban slums of Africa and Asia is a smart investment, particularly in Nigeria, India, Pakistan, the Philippines, Senegal and Tanzania. These countries are among those with significant numbers of unintended births, high unsatisfied demand for modern contraceptives and largest projected growth of urban centers.

Solution Overview

TCIHC is a bold approach for scaling and sustaining city-led evidence-based solutions to help women and girls living in urban slums access contraception. TCIHC empowers local governments with evidence-based reproductive health solutions to improve the health and wellbeing of those living in poverty. TCIHC is demand-driven – meaning local governments self-select to participate and demonstrate political commitment by bringing their own financial, material and human resources. TCIHC serves a catalytic role – providing ongoing technical support and coaching to local governments, as well as access to its “Challenge Fund,” which helps attract more donor investment. A key mechanism for scaling this model is TCIHC University (TCIHC-U), a coaching and learning platform that synthesizes best practices for improving reproductive health through evidence-based service delivery, demand generation and advocacy interventions. With additional investment from 100&Change, TCIHC can substantially expand its impact to help four million additional women gain access to contraception in at least 100 cities in six countries – Nigeria, India, Pakistan, Senegal, the Philippines and Tanzania – where rates of unintended pregnancies are highest and where demand for contraceptives among the urban poor is not met. Local government leaders and urban poor communities will directly benefit from TCIHC’s expansion. City-led initiatives such as TCIHC can be implemented quickly and effectively and produce measurable impact at scale. In a rapidly decentralizing world, TCIHC’s demand-driven platform is designed to accelerate gains at the local level where decisions are increasingly made, while supporting global family planning goals as well as the SDGs.

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Project Funders

  • The Bill and Melinda Gates Foundation 2016 - 2021
  • Comic Relief

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