Reproductive health at crossroads: progress and challenges since the International Conference on Population and Development in Cairo

Thirty years after the 1994 International Conference on Population and Development (ICPD) in Cairo, sexual and reproductive health and rights (SRHR) stand at a critical juncture. This commentary reviews the progress, persistent gaps, and new challenges since ICPD. It focuses on three main domains along the reproductive continuum: prevention and treatment of sexually transmitted infections (STIs), including HIV; infertility and assisted reproductive technologies; and pregnancies not ending in live births, including induced abortion, miscarriage, ectopic pregnancy, and stillbirth. Since ICPD in Cairo, scientific advances have transformed prevention and care. These advances have greatly improved population health and expanded reproductive options. However, their benefits are unevenly distributed. Socioeconomic inequities persist; marginalized populations are the least likely to benefit from innovation. Meanwhile, antimicrobial resistance, stigma, and underfunded health systems threaten sustainability. In infertility care, global disparities in access to services coexist with risks of over-medicalization and commercialization in some high-income settings. For pregnancies not ending in live births, restrictive abortion policies, ongoing stigma, and lack of recognition of miscarriage and stillbirth continue to undermine health, autonomy, and equity. Emerging pressures-including climate change, demographic shifts, and declining political and financial support to SRHR-put progress at risk. We argue that recommitment to the ICPD's rights-based, human-centered framework is needed. The future SRHR agenda must combine scientific innovation with social justice, solid financing, ethical governance, and intersectional policy. Only then can we protect gains and prevent deeper reproductive inequalities.