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2023-12-31-accounts

CHOOSE CHOICE

2023 Annual Report and Financial Statements

Trustees’ Report

The Board of Trustees presents its trustees report together with the audited consolidated financial statements for the year ended 31 December 2023 under the Charities Act 2011. These are also prepared to meet the requirements for a directors’ report, strategic report, and financial statements for the purposes of the Companies Act 2006.

CHARITY DETAILS

Registered name and charity number

MSI Reproductive Choices 265543 (registered in England and Wales)

Company number

1102208 (registered in England and Wales)

Registered office

1 Conway Street Fitzroy Square London W1T 6LP

Board of Trustees

The Trustees of MSI Reproductive Choices are the charity’s Trustees under charity law, and the Directors of the charitable company.

Trustees

Frank Braeken, Chair Glenda Burkhart Dr Mohsina Bilgrami Fiona Duby Tania Holt (joined 29 September 2023) Claire Emma Morris Dr Kristin-Anne Rutter Jess Search (stepped down 31 July 2023) Myriam Sidibe Dr Mark Slack (joined 1 January 2024)

Chief Executive Officer

Simon Cooke

Independent Auditors

PricewaterhouseCoopers LLP 1 Embankment Place London WC2N 6RH

Principal Bankers

Standard Chartered Bank Plc 1 Basinghall Avenue London EC2V 5DD

Barclays Bank Plc 1 Churchill Place London E14 5HP

Investment Manager

GAM Investments 8 Finsbury Circus London EC2M 7GB

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Contents

Annual Review

Choice matters .......................................................................................................................................... 4 We are MSI Reproductive Choices ........................................................................................................... 5 Messages from our Chair of the Board and CEO ..................................................................................... 6 2023 in numbers……………………………………………………………………………………………………. 8 In their own words: stories on ‘Why I choose choice’............................................................................... 10 Looking ahead: what’s at stake? ............................................................................................................. 21

Strategic Report

Our strategic report ................................................................................................................................. 22 Our regional performance ....................................................................................................................... 27 Diversity, equality, and inclusion ............................................................................................................. 32 Our commitments .................................................................................................................................... 36 Our people ............................................................................................................................................. 40 Structure, governance, and management .............................................................................................. 44 Financial performance ............................................................................................................................ 51

Statement of Trustees' Responsibilities ………………………………………………………………..57 Independent Auditor's Report ….……………………………………………………………………….…58 Financial Statements …..…………………………………….…………………..……………………………62

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Choice matters

When you give someone reproductive choice, you give them agency over their body and power over their future — and that builds a fairer world for us all.

But people are still being left behind. 257 million people want contraception and have no access to it, and 35 million women and girls resort to unsafe abortion each year.

Why choice matters

With MSI’s support, a woman can choose if or when to become pregnant. That creates immediate impact in her dayto-day life, but also has a generational knock-on effect for her future, finances, career, family, and community. We’re proud to accelerate gender equality, break cycles of poverty, and contribute to the global Sustainable Development Goals.

Our partners and supporters are the bedrock of MSI, helping to expand choice and change the course of millions of lives for the better.

1 Copenhagen Consensus Center, https://copenhagenconsensus.com/post-2015-consensus/health-women-children

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We are MSI Reproductive Choices

6 continents 36 countries 9,000 team members 500+ partners One MSI

We are a global leader in providing reproductive choice. Our local teams, based in their communities around the world, have an unmatched ability to deliver cost-effective, life-changing reproductive healthcare, including abortion and contraception.

Choose Choice: a manifesto

Your body. Your education. Your career. Your future. You should decide what you do with them.

And yet, for millions of women worldwide, that choice is impossible. Because they cannot access the contraception they want, or the safe abortions they need. Paying with their potential, and even their lives.

Reproductive choice, and the freedom it affords, is a fundamental human right. And that is why we fight for it. Through our clinics, services, and our partnerships, we make choice possible.

We believe that a world in which every woman can choose when and if she has children, is a fairer, safer and more sustainable one. We open doors. We break down stigma.

And we go further than anyone else to make sure everyone who needs us can decide their own future, on their own terms.

Until every girl is respected. Until every woman is empowered. Until every pregnancy is wanted. Until no-one is left behind.

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Messages from our Chair of the Board and CEO

Frank Braeken, Chair of the Board of Trustees

Looking back, 2023 feels like the culmination of everything that we had worked towards in the previous decade. A magnificent team who reached more women than ever before, and a brand and vision that stands strong. But I am confident we can expand our life-changing healthcare to reach more people. The view from the top of our Everest is a world where everyone in in control of their own body, health, and future.

I have always been proud of what MSI does, and I was even prouder when last year I was asked to be its Chair. One is fortunate if, in the last innings of your career, you can do something this meaningful — with experiences that make the role “sing”. Recently, I had the opportunity to visit an MSI Lady in her home in Kano, Nigeria. In the courtyard were 30 to 40 women waiting to be counselled on their contraceptive options. To know that this incredible work is being repeated many times over across our 36 MSI country programmes and that we are having this tremendous impact every day astounds and energises me. And we need that energy because we must push hard to do more — there are still millions more women who need access to choice.

We must stay close to the core of our mission: giving women control over their bodies and their futures, including access to abortion. When a woman can decide what is right for her life, it supports families, drives change in communities, helps countries thrive, and builds a fairer world for everyone. Yet today, so many are still prevented from participating fully in their societies and economies with all the positive benefits that brings. I have always clearly felt and seen what this work is all about: every time you give three dollars to MSI, you change a woman’s life — not to mention changing the course of a nation, or even a continent.

Knowing the incredible work our teams do, I am confident that MSI will continue to attract new donors, that providers will find ways to reach deeper into communities, and that we will support millions more. Of course I am biased, but I think that anyone who truly understands what this organisation is about and the impact it brings will want to join our mission. It is up to all of us to reach those who still need us.

Simon Cooke, CEO

In 2023, we supported our 200 millionth client. That’s 200 million futures supported by MSI teams since we opened our first blue door in 1976.

Passing this huge milestone prompted me to reflect on the incredible contribution MSI teams have made to reproductive rights over the last 47 years. Thousands of healthcare providers have served their own communities, innovating and persisting through profound social, political and technological changes, always with clients — and their needs, hopes and dreams — at the forefront.

MSI has evolved considerably in the face of these changes. But we’ve stayed true to our founding principles: an impact-focused social business, unafraid to challenge the rules in pursuit of everyone’s right to choose, and uncompromising in our commitment to bring choices to the most marginalised communities, at the very last mile. Our services are increasingly delivered in partnership with national governments, and we are proud to work hand-in-hand with the public and private sectors, as well as local partners to build sustainable access to reproductive choice. One by one, we’re giving women and girls a chance to change the course of their lives, creating generational impact.

While the trend in reproductive rights over these decades has been towards progress, we are still rocked by the 2022 decision to overturn the constitutional right to abortion in the United States. It reminded us that hard-won rights can be lost. That reality check, combined with a visible rise in US-fuelled anti-choice and anti-rights activity globally, and the deeply concerning trend of voters turning to populist leaders, is disturbing for those of us working to advance liberty and human rights. Our teams are having to be braver and bolder to protect gains made in the face of an aggressive opposition.

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This confluence of factors can feel overwhelming. But what I see from being part of MSI, is that by focusing on the things within our control, we can make a huge — and quantifiable — difference. Reproductive healthcare contributes to improved global health, progress in girls’ education, political participation, women’s ability to adapt to the climate crisis, poverty reduction, economic development and more. And just £6 invested in MSI, can provide someone with contraceptive choice for an entire year.

In 2023, we were humbled and thankful to receive an extraordinary contribution of £81.9 million from the Ballard Legacy fund — a donor who wanted to ensure access to choice was part of their legacy. They recognised the unparalleled return on investment the world receives from investing in choice, as well as MSI teams’ ability to deliver life-changing programmes at scale. At a time of intense funding uncertainty for many global health organisations, this gift reminds me of the immense power of philanthropy. And it gives me cause for optimism. That in the face of grave global challenges, and attacks on our rights and freedoms, more and more individuals will stand up and choose to invest in choice, in impact, and in women’s lives and futures.

At MSI, we know that when we choose choice, the whole world benefits. That is why we keep fighting for it. We are grateful to every single one of our supporters and partners for being on this journey with us. Our impact is testament to what’s possible when individuals, organisations and governments unite to stand up for choice. There’s never been a more important moment to do so than now.

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2023 in numbers

Who did we reach?

We work to deliver care to women wherever they are — from the world’s most remote communities to humanitarian frontlines. We reach people with little or no prior access to reproductive healthcare, so no one is left behind. In 2023, we estimate that:

What was our impact?

Right now, more than 37 million women are using contraception provided by MSI or from a public sector facility we support.

“You saved my life. When I was scared and unsure, you were there for me, and treated me only with kindness, compassion, and love.” – MSI abortion client and donor

2 Couple years of protection (CYPs) is a measure that estimates the protection from pregnancy provided by contraceptive methods over a one-year period. Each contraceptive method has a unique CYP which depends on how long the method can be used for, the likelihood of wastage, and how effectively they prevent pregnancy.

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Changing lives on a global scale

IN MSI’S HISTORY, WE’VE SUPPORTED OVER 200 MILLION PEOPLE.

Behind every number is a woman or girl with greater agency over their body, healthcare decisions, and future path. Reproductive choice has a ripple effect that shapes lives and communities, so year on year, we create both immediate and generational impact.

The last ten years of growing impact looks like:

130 million unintended pregnancies prevented, changing the course of women’s and girls’ lives

300,000 women’s and girls’ lives saved. Pregnancy-related deaths would be 15% higher without MSI programmes, in the countries where we work

£9.4 billion in direct healthcare costs saved. Investing in sexual and reproductive healthcare pays dividends

Visual of growth

More than 12,000 public sector healthcare workers trained by MSI in providing contraceptive choice and abortion care for their communities

“I firmly believe that reproductive choice is the single most important factor enabling women to achieve their goals in life.” – Gary L., MSI donor

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In their own words: ‘Why I choose choice’

MSI is made up of almost 9,000 dedicated professionals fighting for and delivering reproductive choice around the world. We partner with thousands more individuals and organisations to make choice possible for women and girls. In the following stories, you’ll hear from our healthcare providers, clients, and partners on why and how they choose choice.

Their own experiences of 2023 and first-hand stories bring MSI’s mission and work to life — from delivering contraception to women who never had access before, to leveraging their power as a religious leader to advocate for choice.

1. I choose choice by giving women life-changing contraception

Anna provides contraception in Sierra Leone. She’s a force of nature, well known across the country for changing lives. She shares her story, and why she’s proud to provide contraception.

“They call me ‘Mama G’. G as in General. That’s because I’ve worked in family planning for 24 years, so they see me as a leader. I’ve worked all over Sierra Leone providing contraception. I’ve been by boat to Bonthe Island and visited rural communities by foot. A lot of women and girls know me, they point to me and say, ‘Oh, it’s Mama G! This woman helped me. She changed my life!’ That makes me so proud.

There are many MSI clients who stick in my mind. For instance, there’s a woman, a mother of two, who lives in the northern part of Sierra Leone. After our community talk, she told me her husband wanted eight children, but she didn’t want any more. I counselled her on contraceptive choices, and the next day she asked for an IUD. Over the years, I saw that she didn’t have more children, and she eventually enrolled her children in education, which was very rare in those communities. She saved her money and started helping other women, giving out loans and talking to them about contraception. Community people believe community people, so this helped break down misconceptions. This whole community changed. Children started being sent to school. The men saw this change and now they’re calling MSI to keep coming back! They say, “Had it not been for you, our eyes would still be closed.”

I am proud to provide contraception. Giving a woman choice is so important; it makes her happy, makes her live longer, empowers her.

MSI is doing a lot to expand contraceptive choice. We’re serving women and girls directly to bridge healthcare gaps, travelling to communities where 6 out of 10 people don’t know of any other option to access contraception. We’re partnering, advocating, and educating in schools. We have community-based health mobilisers and roaming nurses. We’re selling quality products at pharmacies. Our presence is felt everywhere.

My role now focuses on training public health providers. We coach and support them, help strengthen supply chains and ensure quality. The more the merrier, I say! When they feel confident in providing contraceptive choice, they’ll continue to serve these communities when we’re not there. In this way I feel we’re making a long-lasting impact.

Sierra Leone was once known as the deadliest place in the world to get pregnant. But MSI has helped maternal deaths plummet by giving women contraception and better reproductive health services. Our smart evidence team worked out that an estimated 40% more women in Sierra Leone would be dying in childbirth and pregnancy without us. That’s showing what I’ve known to be true all along: contraception is life-saving.

Unfortunately, the data isn’t always enough to secure money. Here in Sierra Leone, funding shortfalls are causing our services to close. There’s a lot for women and girls to lose, including their lives. We’re doing everything in our power to ensure services stay open.

My passion for this work is all about changing and saving people’s lives. And MSI matches my passion. I left for a few years, but I came back, because MSI is building capacity in people, thinking about the long-term, bringing choices to our clients and opportunities to our staff. MSI works for women and girls, and that’s what my life is dedicated to.

I may be 60, I may be a grandmother, but I am not tired… so I don’t think I should go and sit. I have more to give so I choose to continue, I choose MSI, and I choose choice.”

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Last year, we trained 12,000 healthcare workers to deliver a comprehensive suite of contraceptive methods, from short-term to long-term and permanent options

We estimate that without our services, the number of maternal deaths in Sierra Leone would have been more than 40% higher in 2023

We measure and track impact to ensure that our services are rooted in equity. 82% of the clients we support are from marginalised or underserved communities — helping expand choice to those who have been left behind by health systems.

2. I choose choice by providing healthcare in a humanitarian crisis

Mi Mi (name changed) leads programme support for MSI Myanmar. She manages our frontline staff’s safety and ability to deliver care, which is difficult right now. Myanmar is one of nine MSI countries experiencing a humanitarian crisis, and all of them remain determined to keep delivering women’s healthcare. She tells us more:

“The situation here in Myanmar is precarious to say the least. Following a military coup in 2021, we’ve experienced conflict between armed groups, violence, increased poverty, collapsing systems — all kinds of turmoil. We have lost the future that we’d imagined.

Public health facilities aren’t functioning well. They suffer from a shortage of supplies and staff, and some hospitals have been forced to close for months. The value of MSI and our work has come into sharp focus: we are still operating, and we’re filling the gaps wherever we can.

Movement within and out of the country isn’t easy. Some roads, airports, and even phone lines are closed. That makes our role as healthcare providers harder. But we all agree — we can’t pause our services. MSI Myanmar has outreach teams that travel to rural communities, delivering reproductive healthcare to people with no other access. I’m sure you can imagine that the logistics of travel, while ensuring staff safety, can be a headache. But I’m proud of our teams who are trying to overcome these challenges to reach communities with health services.

We’ve adapted how we work and continue to pivot regularly. We have made closer ties with midwives and nurses in communities to build their capacity to deliver care, and have strengthened our civil society partnerships. We’ve also changed approaches for our outreach community visits, and when it is unsafe for us to enter a community (in case our staff aren’t from the locality and may face armed groups), we buckle down in an office and get the word out that the local women can visit us to receive services.

The price has been especially high for women. Our healthcare and education have been interrupted, there’s increased trafficking and sexual violence. A lot of women here used to work in factories — those are now closed, leaving many jobless. By the end of 2023, the UN reported almost 2.6 million people had fled their homes. Without jobs and homes,

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it’s not easy for women to access healthcare like contraception… meaning there will be more unwanted pregnancies, unsafe abortions, and maternal deaths if organisations like MSI don’t step in to make reproductive healthcare available.

I have a 16-year-old daughter. I think about her future, and the future of all the girls and women who should have control over whether or not they become pregnant… especially in the face of escalating violence and an uncertain future. So this makes me proud of the work we do.

Compounding political insecurities, we experienced a severe cyclone in 2023. They say the winds were roaring at 280kms per hour! Our teams continue working throughout these emergencies because pregnant women, women giving birth, and women wanting to avoid pregnancy still need our help. Giving women healthcare choices helps them reclaim their lives and builds community resilience in the face of the climate crisis.

And all this is on top of our business-as-usual, providing women’s holistic healthcare across the health system in seven regions!

I’ll end on a positive note. I’m happy to report that — even with the extreme challenges we’re facing — our teams reached 117,000 women and girls with reproductive choice in 2023 (which is more than we achieved in 2019, before the military coup, which is outstanding if I do say so myself). And we must continue. Women need reproductive choice, and we have an unwavering commitment to give it to them.”

Our security teams support MSI country programmes with tactics on adapting, engaging with authorities, staff safety & resilience — sharing learnings from what works in other countries, while responding to each unique situation

3. I choose choice by travelling to the most remote communities to serve those who need us most

Inonge is the Operations Director for MSI Zambia. She oversees the outreach programme, where teams travel far distances into communities to provide care. She shares their fresh approach to reaching people with lifechanging reproductive choice.

“My beautiful home of Zambia is a vast landscape with rugged rural regions, where many live without the things you and I take for granted — like contraception. Women who want contraception often cannot access it.

Our outreach teams travel into Zambia’s most rural and remote communities with the highest unmet need for contraception. We use different sources of data and information to map out areas of poverty to help us know where to go to reach those who need us most. And when our teams arrive, we offer people a range of contraceptive methods and a different future path — one that they choose.

When I travel with our outreach teams, it’s not uncommon to find 100 women from a community queueing for contraception in the morning. Some tell me how they walked tens of kilometres to get there; some passed through

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game parks, risking their lives against lions and elephants. These women can sometimes be desperate to use contraception, saying they can’t afford to look after the children they already have. In these moments, this is no longer ‘a job’. We are here to save their lives in every sense.

When your work is this important, you constantly want to do more. Previously, each outreach team could only reach 20 community sites every month. We kept asking ourselves the million-dollar question: how can we reach more people in the most efficient way possible?

So we tried a new approach: we split our teams in half! Each team now partners with four healthcare providers from the Ministry of Health. This means we can divide them into two sub-teams, and they can be in two places at once. While one sub-team serves the furthest communities more than 100km from ‘basecamp’, the other is delivering services in more urban places.

Working with the public sector in this way is innovation and partnership at its finest. Public healthcare providers are integrated into our teams and mentored by MSI to build their skills in delivering quality reproductive choices — shortterm, long-term, and permanent methods. This doesn’t end here. When they return to their public sector facilities, they bring these skills back to teach others. In return, they bring insights from the public health system and enable us to tap into their community networks, so we can mutually grow and reach more people. The impact we can have on women’s lives is exponentially greater.

The number of people each team can serve every month is now 4,700 (a 420% growth from the old model). I know that other MSI country programmes are using this split-teams model now, too. At MSI, we make our approaches and insights known, we share learnings between MSI country programmes and with the entire sector, and we’re proud to shout about the impact of choice. So in 2023, I was glad to speak on different platforms about our innovative splitteams outreach model, and was humbled for our approach to be featured on the global health news site Devex.

One in three of the people MSI supports with reproductive healthcare through our last-mile services is living in poverty, so giving them the choice to space pregnancies or avoid getting pregnant can be truly transformative. One by one, we’re breaking cycles of poverty and opening opportunities for women’s and girls’ futures, giving them a chance to change the course and quality of their lives. I’m so glad to be part of it.”

That’s how many of our clients knew of no other way to access family planning services but MSI (or MSI-supported public clinics). Many are in communities left behind by health systems, and they rely on MSI teams for reproductive choice

4. I choose choice by using my power as a religious leader to advocate for reproductive rights

Reverend Cliff is a minister of the church, and coordinates the ‘Religious Leaders Network for Choice’ in Malawi. They partner with MSI Malawi to fight for reproductive rights. He shares why he is pro-choice and the unique power of religious leaders in expanding access to contraception and abortion.

“I don’t know how much you may have in common with me, a deeply religious man living in Malawi. But given that you’re reading this, I expect that you, like me, choose choice.

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Many ask me why I choose to be both a religious leader and an advocate for reproductive rights. Well, I believe religion is for moral guidance, not an all-powerful conscience. We need to liberate people, not just from sin but all sorts of social injustice — including the way that we deprive people of their sexual and reproductive health and rights.

I choose choice because I look around with open eyes and an open heart. The lived experiences of individuals are guided by so many things, and religion is just one. So I take in the whole picture: the women dying from unsafe abortions; the high instances of child marriage, teenage pregnancies, and sexually transmitted infections; people struggling without information about their own reproductive health. Will any personal or community growth come out of this?

The landscape right now is worrisome. The overturning of Roe v. Wade (abortion rights) in the USA has empowered the anti-choice movement everywhere. Malawi has not been spared. We already have one of the world’s most restrictive abortion laws, and we have so-called “pro-family” groups blocking our nation’s progressive legal reforms. But I turn my worry into action. Many look to religious leaders for direction about how to live their lives, and I know I have a unique power and voice to make change.

The popular view is that religion is inherently anti-choice. But I happen to know many religious people who are prochoice because of their faith, and some of us came together in 2019 to form the ‘Religious Leaders Network for Choice’. The bottom line is that all people should have the power and resources to make decisions about their bodies. And we work closely with MSI and in coalition with other local organisations to make that a reality.

I value our partnership with MSI. They help us build our capacity to change mindsets. I (and my peers) now confidently deliver Value Clarification and Transformation workshops to different stakeholders including other religious and community leaders. We sensitively challenge negative attitudes and beliefs on abortion and contraception. When someone like me facilitates these learning sessions, they’re even more powerful. I know many people who had a rigid stand against abortion and youth access to contraception because of their faith, who then changed their whole perspective. I’ve seen some of them turn into champions for choice in their communities.

With MSI’s support, we ramped up our advocacy in 2023. We’ve now trained over 1,000 religious leaders, 350 traditional leaders, 100 journalists, and have engaged with youth and MPs. We created more resources on the intersection of religion and reproductive choice to help combat all the misinformation. Working with MSI has given us a platform for exposure and networking both locally and internationally — meaning more impact.

Advocacy and culture change takes time. But the most important thing is that we eventually do achieve full access to sexual and reproductive health services and reproductive justice for all. The current surge of youth-led initiatives demanding change is a great motivator for me, and so too are the deep partnerships we are building. I have studied liberation movements and how their efforts have borne fruit, and I am confident that change will come.”

MSI works with and learns from grassroots, local, national and global partners across six continents to ensure women and girls are no longer denied healthcare and rights. Since 2016, we’ve contributed to the reform of over 92 policies

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5. I choose choice by providing abortion

Shanti is a nurse, team leader, and abortion provider for MSI Nepal. She tells us more about what abortion care is like in Nepal, and what she hopes for the future of abortion.

“I see women every day who are conscious about their career, family, economic status, their dreams. They come to me seeking an abortion because they want the future that’s right for them.

These are the lucky ones. For one, they live in Nepal — where abortion laws are liberal and the government supports it. For another, they have found MSI which means they’ll receive safe and quality abortion care.

Some are not so lucky. They might instead find unauthorised ‘abortion providers’ — there’s even one across the street from our clinic trying to lure clients in. They are not safe or quality. I was saddened to hear about a woman who recently died from heavy bleeding in one of these places. Some women even take things into their own hands, using unsafe methods to abort their pregnancies. Even with our liberal laws, the stigma surrounding abortion lurks, leaving devastation in its wake.

Last year, a woman came to us after taking dodgy medical abortion pills from a non-registered supplier. I was grateful to be able to support her with post-abortion care, and thankfully, this woman got her life back. I’m happy about providing abortion. If anyone can confidently say that abortion saves lives, it’s me, because I see this every day. And even if it isn’t a life-or-death situation, women should have choices to protect their own health and wellbeing.

Let me tell you about my great team at MSI Nepal who are expanding abortion access. We build awareness via radio jingles, social media, billboards, tv ads, you name it! Our lovely contact centre staff field peoples’ calls and messages and give information and advice. The free, government-accredited phone number is also featured in school textbooks so adolescents can seek help with us.

Our clinics offer in-person abortion. When a client enters our blue door, we are there for them. When we see a young person feeling uncomfortable sitting in the waiting room, we take them into a separate counselling room quickly. We don’t ask if they’re married or interrogate their reasons for having an abortion. We let them know that we will respect their confidentiality and choices, and we provide them with healthcare.

But some people can’t come to a clinic. And not all government health providers are able to provide abortion. So we hire and train healthcare providers based in local communities, and coordinate with local governments to bring reproductive healthcare to rural places. We also have roaming nurses called MSI Ladies that trek to far-reaching places (when I say trek, I mean they literally scale mountains!) to provide medical abortion as well as contraception and support.

2023 was an interesting year globally when it comes to abortion; it feels like we’re on a precipice and anti-choice ‘noise’ is getting scarily louder. But when I look around, I see my brave colleagues who are as passionate as I am about making abortion available to those who want it.

In the future, I want nations to learn from Nepal’s liberal stance. I hope for more international funding. And I’d love for everyone to know about their rights and where they can seek safe services.

I’ve had the privilege of providing countless women with abortions, even one of my family members. Some women come and ask for me by name, they write to me, and they want to touch my feet out of respect. They respect me, and I respect them. And we should all respect abortion. Namaste.”

In 2023, MSI prevented 9 million unsafe abortions. Pregnancy-related deaths would be 15% higher without our programmes, in the countries where MSI works

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ABORTION QUALITY
Our Abortion Quality Index is used to monitor the safety and quality of our care. In 2023, 32
of our MSI country programmes reported on their quality scores, generating insights on
future improvements3

6. I choose choice by advancing gender equality and inclusion

Mana Zita is a Timorese working mother who leads MSI Timor Leste’s work in gender equality and social inclusion. Reflecting on 2023, she shares more about how and why MSI is creating more inclusive healthcare & equal culture, from the inside out.

“We have this saying in Timor Leste — ‘ Ema kontinua moris ba nafatin’ — which roughly translates to ‘The person lives on’. I believe every single person who encounters MSI lives on… and can create a future they want.

I started working at MSI when I was 23 — about 15 years ago now — and I have learned so much. The emphasis now on safeguarding, on building inclusivity, and on how we communicate and use language is energising. We do refresher trainings and values workshops, people are respectful, women can freely express themselves. This organisation is a safe space.

When we host community information sessions on reproductive healthcare, I meet all kinds of people: people with disabilities, people who can’t hear or see, people with different sexualities, people who need information shared in a different way. These groups are vulnerable in Timor Leste, and around the world. They face discrimination and have less access to information and services.

My role is addressing their unique needs and partnering with organisations and the government to build more inclusive sexual health. We must be thinking about inclusivity when we’re providing services. If we don’t, people are left behind and we move even further towards an unequal, unjust world — one that I wouldn’t be proud to be a part of.

MSI’s inclusion and equality work spans many projects and initiatives. After all, education and culture is weaved throughout every aspect of our communities and lives. But let me touch on just a couple.

Our work to prevent sexual and gender-based violence, and to give support to survivors, is something I’m incredibly proud of. Because of the nature of our compassionate healthcare delivery, MSI staff can be the first to hear of a person’s experience of violence. We respond with compassion and support and have built a network so we can refer survivors to the support they need. Our growing partnerships really are the crux of this. In 2023, we continued building partnerships across civil society in Timor Leste, and piloted school and community engagement curriculums to help prevent this violence.

Last year, we also hosted successful male engagement sessions. To be frank, it’s difficult to make headway without getting men on board. Otherwise we see women who access contraception then remove or stop using it because of unsupportive men in their life. We partner with other local organisations to host male-only sessions about topics relevant to them, including a component on sexual and reproductive health and rights. We make men aware of its

3 MSI country programmes that do not report quality scores are our commercial programmes which have a different way of reporting, and those where the volume is too low (below 140 cases per year).

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importance and how they can support women’s rights and decision-making. I personally see the shifts, and I’m glad of this progress, as my 9-year-old son will grow up in a different environment and will support the women around him.

I met a young transgender person at a community session, and was honoured that they opened up to me. They explained they were feeling really down, knowing that their family and community will disown them. I listened and ended up meeting with their family to act as a bridge. Now, they still have their family support and they’re doing well in their career, too… the person lives on!

This culture-shifting and system-changing work is slow. But looking at how far we’ve come even since I’ve been with MSI, and seeing young people’s attitudes now, I know that this work is multiplying, cascading, progressing. One day, every single one of us will have the reproductive choice we deserve.”

 CULTURAL CHANGE Men are still a barrier to the women in their lives accessing contraception and abortion. 1 in 4 of the clients we served in 2023 do not believe that men in their communities are supportive of family planning. We host community dialogue and male engagement sessions to support a step change toward gender equality

 REACHING THOSE EXCLUDED A focus of our programme delivery is reaching those that are traditionally excluded from accessing sexual and reproductive healthcare, such as adolescents, people living in poverty and those with a disability

7. I choose choice by accessing contraception, so I can have the future I want!

Hingis (24) and Sheila (25) are friends who are both MSI clients and university students in Ghana. We spoke to them at their university about their hopes and dreams for the future — and why they choose to use MSI’s sexual and reproductive health services.

H: “There is stigma around contraception here in Ghana. One time, I went to get the morning-after pill at a pharmacy, and they started preaching to me about making better choices. Why would they offer it if they felt this way? I paid for it and quickly left.

I first heard of MSI on social media and got in contact. The woman I spoke to was friendly and told me my options. I wanted to pick a method that wouldn’t disturb my studies. Once I had decided on the method that was best for me, she directed me to the nearest centre for an in-person appointment. The staff there made me feel relaxed and the nurse reassured me that no-one was judging me for being there.”

S: “Having access to contraception from MSI has also helped me to continue as a student. Before I came to MSI, I was scared that family planning wouldn’t work, and I was scared to try it. When I started taking contraception and it worked, I felt so much calmer.

I can live without the fear of getting pregnant and dropping out of school. I can focus on my studies better. Without contraception, I would probably be a single mum now — I would have got pregnant too early and would not have been prepared to raise a child. It should be your choice if you want to get pregnant.”

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H: “When my friend went in for her abortion, she was scared. But the nurses talked her through it and everything about it was safe and without any complications. I think if she had done it alone then she might have died, had complications or wouldn’t be able to give birth again. Going to MSI was a good thing. Now, she’s at university and working. If she had carried on with the pregnancy, I’m sure she wouldn’t be able to attain what she has now.”

S: “You know, in the next ten years, I’m hoping to be a lawyer. A lot of people in our country need help and I think I can help them. I want to also be a CEO of my own company.

My hope for women and girls in Ghana is for everyone to have a bright future. More people know of the importance of contraception now, so there is hope!”

H: “Once I have completed my national service after university, I hope to get a job in a hospital. I have a long way ahead of me with my studies, so it’s important that I have contraception, so that I don’t get pregnant right now. I don’t want to be in a situation that I didn’t choose.

Things are evolving, and access to contraception has helped to close this gap between men and women. Women can now plan when to have kids and when not to. Now, women are out there in the working world. We can be making money, pushing our families to the top and making our country proud.”

In 2023, MSI supported 2.3 million adolescents with reproductive health information and services at a critical juncture in their lives. When we launched our tailored adolescent strategy in 2018, 6% of our clients were adolescents — we’ve almost tripled that to 17%

We estimate that 345,000 girls have been supported to continue their education in 2023. Research shows that each additional year of school increases a girl’s future earnings by 10-25%, supporting their future economic stability

Around 12% of our conversations via our contact centres are with adolescents. Social messaging platforms like Facebook and WhatsApp are a popular way for young people to reach out to us for advice and information on their sexual health

8. I choose choice by funding MSI and partnering to build a better future

Mara is a Senior Manager at the philanthropic Children’s Investment Fund Foundation, also known as CIFF. She’s worked closely with MSI since 2021. She shares her thoughts on why funding partnerships are so crucial, and her firsthand experiences of visiting MSI’s frontline programmes.

“I am a proud funder, on behalf of CIFF, of MSI’s global work providing sexual and reproductive healthcare to millions of women and girls.

We partner with MSI because their strategy aligns with our values, and they have a steadfast commitment to deliver for women and girls — including those who are hard to reach. MSI’s approaches to gender equality, reaching youth, and equitable services are very important to us.

When I think of MSI’s work in 2023, my mind transports to the Democratic Republic of Congo where I visited in October. At a rural healthcare site, MSI was providing services and training local health nurses. I met an 18-year-old who shared she was recently widowed soon after her son was born, but she had a huge smile on her face, because she’d just chosen to receive an implant. She was so proud, excitedly telling me that she could have a break, maybe go to school or work before she had more children. For her, and for so many others, having choice can be truly lifechanging.

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And when I visited an outreach site in Kano, Nigeria, I’ll never forget how there were hundreds of women patiently waiting during Ramadan and on a hot day. They’d started queuing long before we got there, determined to choose a method of contraception, and have agency over their lives. It blew me away. As I spoke with them while they waited, it stood out to me how diverse their experiences were. Some had given birth to 10 or 13 children and shared they were “ready to finish” now; others were adolescents seeking their first contraceptive method because they wanted to wait to have children.

I’ve also spoken to male traditional leaders who saw their religious texts as supportive to contraceptive services. They said things are changing and resources are scarce, so they wanted to support access to contraception for the women in their communities.

All this to say, I’ve seen firsthand how organisations like MSI are doing amazing work. Over the last decade, there’s been inspiring progress to empower women to choose sexual and reproductive healthcare services if they want them.

However, we’re experiencing a global context where both funding and rights are being squeezed. This is a huge challenge and women and girls are feeling the impacts. The freedom to choose and have control over our own bodies is a universal right which is why we need people and philanthropies who care about this issue to step up to provide access to choice.

So, why do I choose choice and enjoy partnering with MSI? For that girl in DRC who was over the moon with her contraceptive method. For the woman in Nigeria who was absolutely exhausted after having had 12 children, of whom only 6 survived. And for the 17-year-old girl who can remain in school because she could access a safe medical abortion. These people are my why.

Funding partnerships like ours create huge change at the most local level. Which is the foundation for a better, more equal and joyous world where we can all thrive.”

Fuelled by our partnerships and donors, MSI supported 93,000 women and girls with reproductive choice every day in 2023. Each was supported to make their own decisions about their body and future, helping to unlock their potential

9. I choose choice by ensuring it’s here for the long-term

Asma is the Country Director of MSS, a locally based NGO in Pakistan supported by the global MSI partnership[4] . She reflects on what she’s seen change over the years, and the innovations in motion that are making reproductive choice more sustainable for the future.

4 The MSI Partnership refers to the global network of MSI’s support office and our country programmes in 36 countries around the world.

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“I can hardly believe that I started at MSS in Pakistan back in 1996! I was a volunteer then. Now, I am at the helm, leading the entire programme. That’s my way of saying that I’ve seen a lot of change in my time.

With the support of donors and the global MSI partnership, we’ve grown, reshaped, and innovated, and now we’re one of the biggest providers of sexual and reproductive healthcare in Pakistan. We’re built from the grassroots up. Our field and support teams are made up of local people who share our clients’ culture and language, which has enabled us to grow our presence and impact while shifting attitudes around contraception.

Because we’re rooted here, it also helps us think long-term. We’ve ramped up efforts to make sure reproductive choice is sustainable, so women and girls will be able to access it for generations to come.

So, how are we doing that? One way is for our clinics to generate their own funding. In 2023, we broke even in our 17 clinics, meaning they are sustaining themselves with no donor income. A huge achievement! We’re working towards the same in our 20 pharmacies that provide quality health products while generating income. All profits are channelled back into our work reaching rural and poor communities. That makes us a social business, combining the best of the commercial and non-profit worlds to create impact.

Another way that we’re looking ahead is by diversifying our services (and therefore, our income streams). Known for providing contraception, we’re evolving our ability to provide different types of healthcare for ‘every stage of woman’ — from menstruation to menopause.

Governments also have an important role to play. I know many MSI country programmes are partnering with governments in their own ways to strengthen health systems. I think this is a groundbreaking shift to train and empower people, to cascade knowledge and skills outwards.

Some years ago, we invested in franchising —training healthcare providers across the nation to provide quality reproductive healthcare. In 2023, we transitioned some of them from our direct support to receive government support and quality monitoring, and domestic funding. This is a sustainable approach as we build the capacity of a local healthcare provider, and then ensure they’re in a network of national support and can continue to provide quality services in future.

I remember one of our clients living in an underserved area. She had lost her hand in an accident with a threshing machine so had a disability, was suffering from depression, and had four children to look after. Our field officer and I were visiting her community to train up a local health provider. She told us she was in constant fear of getting pregnant again, so we counselled her on her options and she quickly decided to get an IUD. In a follow-up visit, she shared how her life had transformed now she has this major worry off her shoulders. And I think about the fact that we’d trained her local provider who was walking distance from her home, so she wouldn’t lose access in future. That’s what sustainability is all about.

Choosing choice, for me, is about enabling future potential. I hold this mission very dear to my heart. Making sure women have access to reproductive healthcare is a big contribution to their lives and to this nation. And if we can ensure that choice is here to stay, well, that’s the legacy I want to leave.”

MSI’s respectful maternity care training package was professionally certified by the CPD Certification Services in 2023. Our training ensures women giving birth have safe and respectful experiences, and in its first year we trained over 300+ MSI providers

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Looking ahead: what’s at stake?

Protecting women’s health in 2024 and beyond

While we take stock of the year that was, it’s essential that we remain focused on the current realities and keep looking ahead. 2024 is the biggest election year in history, with more than 60 elections set to shape the future of women’s health and rights.

In this critical year, those of us who believe in the right to choose — healthcare organisations, governments, and donors — need to step forward.

The world still has a public health crisis on its hands, and anti-choice groups around the world are doing everything they can to deny people their basic reproductive rights.

Funding for women’s health remains uncertain. International government donors continue to reallocate women’s health funds to competing priorities like economic instability and global conflicts. And MSI teams who focus on providing services to women and girls in some of the hardest to reach communities — for example in Sierra Leone, Madagascar, and Afghanistan — are at risk of closure. This threatens to undo decades of progress.

Right now, the largest generation of young people in history approach their reproductive years. The world can’t afford to deprioritise sexual and reproductive healthcare at this critical juncture.

Our investment now will help women and girls to remain in education and pursue careers, break the cycle of poverty, and support communities and nations to thrive.

“We are in the midst of a war over women's rights for reproductive freedom. This is literally a matter of life and death. Support is needed now, right now, to carry on and expand the fight in which MSI plays a vital role.” – Rich R., MSI donor

Partner for choice

MSI delivers quality contraception and abortion care at scale. We reach the world’s poorest and most remote communities where the need is greatest.

But we can only continue to do this with strengthened investment and support. You can help protect women’s access to healthcare and transform lives with a donation or by partnering with us. Calculate your investment impact with our new calculator at msichoices.org/impact

£6
can provide someone with their choice of
contraception for an entire year. Join us to
unlock potential, change the course of women’s
futures, and build a fairer world.		 QR code to www.msichoices.org/impact

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Our strategic report

2023 proved to be an exceptional year for performance and growth. Together with our partners, we supported 23.3 million women and girls with sexual and reproductive healthcare, across 36 countries and six continents, delivering a record year of impact.

Our 2023 objectives: how did we do?

This was the third year of our 10-year strategy, MSI 2030: Your Body, Your Choice, Your Future , in which we set out our bold vision for the future: by 2030 no abortion will be unsafe and everyone who wants access to contraception will have it.

Our overarching commitment for 2023 was to stay focused on this vision, and to achieve the milestones laid out in our 2023 planning.

----- Start of picture text -----
2023 objectives How did we do?
Remaining on track to expand access and We delivered 44.5 million CYPs in 2023, a 7% growth on the
impact, with a goal of achieving 41.9 million previous year. Of those, 35.4 million were contraceptive CYPs.
couple years of protection (CYPs) in 2023. This means we supported more people than ever before with
their contraceptive choices.
Increasing our revenue through our social We achieved £3.4 million in service income growth across our
business channels (including social marketing social business channels, with a total revenue of £55.0 million,
and commercial centres) to support a 7% increase on the previous year. Income from our services
sustainability and ensure we are less is a crucial part of our social business approach and supports
dependent on donor income. financial sustainability.
Generating growth in our grant and donor We pursued our new funding strategy in 2023, with continued
income pipeline to ensure we’re able to reach stewardship and engagement with our committed donors, plus
the most marginalised communities. renewed efforts to reach new donors, with an emphasis on the
US and UK. 2023 was one of our most successful years for
funding.
Supporting our programmes to align with MSI’s governance, clinical quality, values and behaviours are
MSI’s high standards for governance, clinical all supported by our mission-driven culture and improving ways
quality, values and behaviours of working. While this goal is more qualitative in nature, we
seek to improve our standards year on year.
In 2023, a particularly noteworthy achievement was almost
60% of MSI country programmes improved on their clinical
care from 2022 (read more about this on page 36). We also
welcomed two new Board Members, developed MSI’s first HR
community, and introduced new 360-degree feedback on
MSI's leaders to help shape leadership development.
Continue to build a ‘One MSI’ culture that We continued to work towards our Diversity, Equality and
reflects the diversity of our team members Inclusion (DEI) vision set out in the bespoke DEI strategy we
and provides equal opportunities to thrive. launched in 2022. We’re making significant progress towards
those goals, which you can read more about on page 32.
----- End of picture text -----

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Our 2030 commitments: are we on track?

----- Start of picture text -----
MSI 2030 goals How did we do?
Between 2020 and 2030, we will serve at least In 2023, we reached 23.3 million clients with sexual and
120 million women and girls with voluntary high- reproductive healthcare, totalling 62.4 million clients over
quality sexual and reproductive healthcare, or at the last three years. This means we’re on track for meeting
least 20 million a year throughout the decade. our 2030 goal.
By 2030, we will achieve “gold standard” in In 2023, 32 programmes were measured for Clinical
MSI’s three quality measures across all MSI Quality and Abortion Quality, while 29 were measured
country programmes: Clinical Quality Score against the Client-Centred Care metric. With all three
(CQS), MSI Abortion Quality Index (MSAQI), metrics now embedded in routine evaluation processes,
and Client-Centred Care (CCC).
we are able monitor progress and identify where there’s
still work to be done to deliver this goal, ensuring
continuous quality improvement.
This goal has changed from 2025 to 2030. Over the last
two years we have finessed the tools we use to measure
these goals and reviewed our targets, setting pathways
towards “gold standard” by 2030.
We are on track for meeting our 2030 goal.
By 2030, 100% of the countries where we work In 2023, we contributed to 13 high impact changes in
will have improved access to sexual and policy, law regulation and finance . Over these first three
reproductive health and rights because MSI is years of the strategy delivery, we have influenced 36
actively influencing laws and policies, to create positive changes to the enabling environment across 41%
an enabling environment. of MSI programmes.
We are on track for meeting our 2030 goal.
By 2030, at least 35% of all MSI programme In 2023, 28% of all MSI programme revenue was
revenue will be from product sales or service generated from product or service income from clients who
income. This will ensure services are available have the means to pay either out-of-pocket or via health
for the long term. insurance, up from 27% last year.
We are on track for meeting our 2030 goal.
----- End of picture text -----

“I am not ready to get pregnant, I am still young. I want to go to school and continue my studies. Family planning has contributed a lot to my life — if I use contraception, I will be able to fulfil my dreams.” - Bibiana, 19, who accessed contraception through the Youth for Health programme in Tanzania

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Our 2023 strategy update

Our 2030 strategy is designed around three ‘Access’ pillars (the ‘what’) for sustainable service provision, and three ‘Enabling’ pillars (the ‘how’) that ensure we have the funding, partnerships, and organisational transformation necessary to deliver our goals. Read about our progress within each pillar in 2023:

Leaving no one behind

At the heart of our MSI 2030 strategy is ensuring that no one, whoever they are or wherever they live, is left behind. We take a twin-track approach:

We take services directly to communities that the health system doesn’t reach. Our focus on reaching the most marginalised communities has led to us supporting more ‘hard-to-reach’ clients. In 2023, we reached 12.8 million clients with little or no prior access to these services. Over 75% of our contraceptive services (in CYPs) were delivered to people from underserved communities and 2.3 million of our clients were adolescents — over 300,000 more than last year.

We partner with governments to support them to deliver sexual and reproductive healthcare. Last year, MSI partnered with governments in 22 governments to strengthen reproductive healthcare, and supported over 7.5 million clients to access high-quality care through the public sector. Across 6,000 public sector clinics, we trained health providers, put client-centred data and evidence at the heart of decision-making, developed stronger supply chains and built community awareness. Our collaborative efforts are shaping health systems, so that high quality sexual and reproductive healthcare is available for decades to come.

Strengthening private sector provision

We are committed to building a sustainable private sector network that understands women’s healthcare needs and in 2023, we supported more than 3.6 million clients across this network including at our centres and specialist maternity centres.

As part of our commitment to quality care, in 2023 we proudly launched our respectful maternity care training package, to upskill obstetric providers (both at MSI and across the sector) on ensuring empowering and respectful childbirth experiences for mothers. We shared the training package and the results of our training evaluation in Kenya at the XXIV FIGO Conference and will offer the training more widely now it has been officially certified. We also rolled out a real-time client feedback system in six countries to help our teams constantly improve quality.

We maintained progress towards our sustainability goals, with 90% of centre operating costs being self-generated by service income and 49% of our centres now having a service income to cost ratio of 100%. The diversity of services offered through our centre network to support women throughout their reproductive lives is supporting this drive, with our award-winning ‘Every Stage of Woman’ campaign driving awareness of MSI as a provider of high-quality advice and services throughout every part of a woman’s reproductive life.

Beyond contraception, abortion, and post-abortion care, we supported clients with services including: Safe motherhood services, including antenatal and post-natal care and deliveries – 580,000 supported HIV & STI testing consultation and treatment – 500,000 supported Cervical cancer screening and preventative therapy – 180,000 supported Immunisation services including HPV vaccines and under 5 childhood vaccines – 184,000 supported

“Many women and girls can’t have the futures they want. To have 3-5 years of not worrying over an unplanned pregnancy… that is freedom.” – Kathi D., MSI donor

Putting choice in her hands

We’re providing quality products for people to manage their healthcare on their terms, while harnessing digital technology to drive awareness and deliver a continuum of care.

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In 2023, we expanded access to high-quality and affordable medical abortion, post-abortion care and contraceptive products through our social marketing operations. We launched new products, increased the number of outlets where people can buy our sexual and reproductive healthcare products, and continued the roll out of new digital approaches to support product distribution. We also trained pharmacists and retailers on product quality and how to effectively advise clients.

Our global network of contact centres ensures our clients can access information and advice when using our products. In 2023, our contact centres had 3.8 million interactions with people over the phone, WhatsApp or online messaging platforms, a 27% increase on the previous year. We continue to leverage digital channels and partnerships to signpost women for further information and referrals and in 2023, we made 630,000 referrals to high quality services.

Funding the mission

Economic uncertainty and global conflicts continue to impact on traditional donor budgets, causing funding shortfalls. Although we continue to engage new donors, we have to work harder for less funding over shorter periods.

Last year, we further diversified our funding sources and grew our future funding pipeline. We made the case to new partners for why reproductive choice is key to building a more equitable world for women. And we repositioned the MSI brand to broaden awareness of MSI and the critical need for investment in reproductive choice, and launched an advertising campaign aimed at potential funding audiences in the UK and US. In 2023, over 50% of our donor income came from private giving and 50% from government donors, compared to 25% and 75% five years ago. We have also grown the income generated through our social business activities and are doing all we can to maximise the value of every £1 we spend on our programming.

Our focus remains firmly on serving hard-to-reach women and communities: it is only with donor funds that we can reach the most marginalised and underserved groups. Often it is more costly to reach them due to the challenges of logistics and distance, but they are deeply reliant on our services.

Making choice possible through partnerships and advocacy

In 2023, we deepened our reputation as an influential, recognised and trusted partner. We continued our work to remove legal, policy and financing barriers to access, built new partnerships to deliver services, and fought back against the anti-choice opposition that threatens our mission.

Throughout the year we explored new spaces for thought leadership, with highlights including the Skoll World Forum, Open Society Foundation’s Democracy Summit, Zambia and Impact Europe. This was in addition to high profile presence at sector fora such as Women Deliver and the Ouagadougou Partnership Annual Meeting.

We continued to nurture high-level relationships with governments, partners, and funders, and formalised our collaboration with Women on Web, Mama Network, The Pleasure Project, and the Centre for Countering Digital Hate. MSI country programmes mapped their key partners (civil society organisations, technical and parliamentary working groups) which for the first time captures the rich and diverse network of the 500+ organisations with whom we work.

Our national level advocacy contributed to 13 high-impact policy changes including:

“To achieve success in community advocacy, you have to involve the community gatekeepers. Working with MSI, we explain to community and religious leaders how child spacing allows women to fully recover from pregnancy and helps children to grow up healthy. It benefits both mother and child. Now more women go to health centres to support their reproductive care.” – Marafan, community leader in Nigeria

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Transforming our organisation

We are evolving as an organisation by investing in our global workforce to ensure we are truly inclusive, client-centred and community-led, while harnessing the power of digital technologies to expand our reach.

We continued to make progress towards the Diversity, Equality and Inclusion (DEI) goals we set out in our DEI Strategy and framework in 2022. We also made progress towards leadership representation at MSI. By the end of 2023, 97% of our country directors were from the nation or region where they work, and women made up 47% of our senior leadership. We continue to roll out our women in leadership programme to support our female team members to progress into leadership roles. You can read more about our diversity, equality and inclusion on page 32, and on our efforts to support the development of our team members on page 40.

We also continued to bring to life our Digital and Technology strategy, with our digitally-enabled contact centre technology now in 19 countries. We’ve invested further in an app (CLIC+) for teams operating in challenging and remote locations to improve data visibility, responsive reporting, and client experience; this is now available to 8 of our MSI country programmes, with 12 more planned.

Our commitments for 2024

In 2024, we are committed to keeping up momentum on delivering our 2030 strategy, while continuing to invest in the diversification of our funding base to reduce our reliance on traditional donors.

Increasing our flexible funding will allow us to go where women need us most, adapt and respond to climate and humanitarian emergencies, and ensure we’re having the greatest impact and reach possible to transform the lives of millions more women and girls.

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Our regional performance

While guided by our global strategy, the way we work in each region and country is responsive to their unique contexts. Our regional leaders have shared updates on the progress our teams made in 2023.

Africa

MSI Africa works across 16 countries with one shared goal: to ensure every person on the continent has access to life-saving reproductive health services. Nigeria is MSI’s largest country programme and is reported on separately (see below).

In 2022, we developed our new structure to support greater learning and impact across the region and in 2023, we embedded these changes. We partnered across the public and private sectors, always complementing the health agenda of each country. In many places, we have focused on supporting public sector health sites — improving quality of care and transferring high-performing facilities back into government control. In other countries, we are on the ground providing services in communities with no other access to reproductive healthcare.

MSI Africa delivered 19.5 million contraceptive CYPs (an 18% increase on 2022) and support 1.2 million people with an abortion or post-abortion care service. Out of 10.4 million client visits throughout the year, almost 9 million were for contraception, abortion, or post-abortion care. This included in humanitarian settings, such as Tigray in Ethiopia and many of the Sahel countries, where our providers went above and beyond to keep services open.

We continued to build sustainable services. This meant streamlining our centres, strengthening our maternity facilities, and improving product distribution. In 2023, our centres were operating at 103% service income to cost (excluding those in challenging humanitarian contexts). We also negotiated more contracts with insurance companies to cover reproductive healthcare — across seven countries where we’ve focused these efforts, 17% of our centres’ income came from health insurance.

The Africa region saw strong growth in our social marketing operations, and we focused on expanding our product range. Abortion and post-abortion care clients supported with MSI products grew across key markets like in Ethiopia by 23% and in Zambia by 28%.

Due to decreasing donor funds, we made the tough decision to close some centres and maternity facilities, including in Kenya and Ethiopia, to prioritise future sustainability. We now operate nine basic or comprehensive emergency obstetric care facilities, supporting women with maternity care and other services.

Spotlight On: Nigeria

In 2023, MSI Nigeria generated more than 7 million CYPs, reaching more than 3.4 million clients with contraception and post-abortion care services, driving incredible impact for women and girls.

Nearly all MSI Nigeria’s clients were from low-income and hard-to-reach communities, with little-to-no access to reproductive healthcare. We delivered contraceptive choice in these communities with our national network of 24 mobile outreach teams, 300+ MSI Ladies and by supporting 2,900 public health facilities through our health system strengthening partnership with the government at a local and state level.

We strived to reach adolescents, too. Nearly 1 in 3 of the women and girls supported by our outreach services were under 20 years old. And we worked to ensure public sector facilities were accessible to young people. In 2023, 314,000 girls and young women aged under 20 accessed contraception from a public facility supported by MSI Nigeria — driving change for young people.

Our contact centre ensured that clients were only ever one call or social media message away from advice and a safe service. We received 53,000 client calls in 2023 — more than 1,000 calls per week — and saw a significant rise in messages via digital channels, with an almost four-fold increase in the number of messages.

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MSI Nigeria worked to significantly increase our commercial base in 2023. Income from our five centres grew 20% from 2022, achieving a service income-to-cost ratio of 105%. In tandem, the social marketing channel generated a surplus that supports the financial sustainability of the programme, and expanded access to quality reproductive healthcare products.

“Access to family planning services in Bauchi State was slow, but with the help of MSI Nigeria, we are being trained. Now we explore all of the contraceptive methods with clients and work with MSI to create more awareness in our communities. Before, women and adolescents would end up losing their lives due to unsafe abortion, but now with the help of these contraceptives, their story may not be the same.” – Wasilatu, a public sector provider trained by MSI Nigeria

Asia

In 2023, Cambodia, Timor Leste and Papua New Guinea (which constituted the MSI Pacific Asia region) joined the MSI Asia region, which now consists of 12 countries. The region delivered 5.4 million contraceptive CYPs and provided 727,000 safe abortion and post abortion care services.

Our providers had 2.4 million client visits, of which 1.4 million were for contraception, abortion, or post abortion care services. This included in humanitarian settings such as Afghanistan and Myanmar, where our teams are on the frontlines bravely providing women with critical services.

We focused on supporting adolescents, with more than 81,000 accessing contraception, safe abortion or post-abortion services in a way that best suits their needs — a 25% rise on 2022.

We also continued to collaborate with the public sector, to shape health systems and ensure sustainable access to quality sexual and reproductive healthcare. In Nepal, we embedded three additional MSI Ladies into the public sector, and in Bangladesh, the government outsourced our outreach teams to support underserved areas.

In 2022, Pakistan experienced devastating climate-related flooding, so in 2023, the programme started working with a local partner to pilot an integrated contraception and climate resilience project, focused on supporting women in areas that are particularly prone to climate-related disasters.

Our base for sustainable services is going from strength to strength. In 2023, our centres increased their service income to cost ratio from 92% in 2022 to 98% in 2023 (excluding those in humanitarian contexts). In Bangladesh, our maternity centres increased their service to cost ratio from 100% in 2022 to 105% in 2023.

The Asia and Pacific region saw a 76% increase in social marketing service income from £4.5 million in 2022 to £7.9 million in 2023, driven largely by Myanmar, despite the operational and import challenges they faced.

Meanwhile, we invested in digital access to information and services via our contact centres across the region, with Bangladesh, Cambodia, and Vietnam rolling out new technology to support a better client experience.

India social marketing

Our India social marketing programme, Population Health Services India (PHSI), is the largest of its kind across the MSI partnership and is a market leader in expanding access to safe abortion medication, affordable modern contraception and other reproductive healthcare products. It supports people to access high-quality and affordable sexual and reproductive healthcare products from a range of health outlets including pharmacies, which in some communities will be the only source of healthcare.

PHSI works across India supporting 200,000 pharmacies and 15,000 doctors, with distribution outlets in other countries including Cambodia and Nepal. Product distribution is delivered with commercial best practice approaches and a focus on building the skills of our social marketing teams to expand reproductive choice.

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Latin America

In 2023, our operations in Latin America faced many challenges, from rampant misinformation and online content suppression in Mexico to political and economic upheaval in Bolivia. Our teams have continued to demonstrate their commitment to providing compassionate, high-quality care.

In 2023 in Mexico, we supported more than 83,700 clients, preventing 21,700 unintended pregnancies. Following the Supreme Court’s decision to decriminalise abortion in Mexico nationwide, Fundación MSI is now present in six of the 12 states which allow elective abortions before 12 weeks, and opened clinics last year in Coahuila and Quintana Roo — expanding access to both Mexican and US women across the border. To expand the options available and complement our existing telemedicine programme (which has grown 62% from 2022), Fundación MSI has also launched an early medical abortion telemedicine service for American women.

In Bolivia, we served almost 76,000 clients in 2023, preventing 58,400 unintended pregnancies, 22,000 unsafe abortions and 42 maternal deaths. We trained 316 public sector providers, building skills in the health system for the long-term, and continued our focus on equity and inclusion, reaching nearly 14,000 adolescents and young people, and 14,500 rural and peri-urban women from over 150 communities, with outreach services and youth centres. By the end of 2023, 135,000 people were using a method of contraception provided by MSI Bolivia.

UK

In the face of unprecedented demand, MSI UK remained steadfast in expanding access to reproductive choice. From our clinics, which are all rated either ‘outstanding’ or ‘good’ by the UK regulator, to our contact centre which was recognised with a national award: quality is at the heart of everything we do.

In 2023, our teams across England supported over 94,000 people to access abortion care — 26% more than the previous year. This follows new contract wins in Buckingham, Oxford and Berkshire East, South Yorkshire, and Nottinghamshire, and perhaps most significantly, it reflects the increasing demand for abortion care nationwide.

Despite the pressure on our services, we’re reducing average waiting times and continued to campaign for improved commissioning of abortion services nationally.

2023 also saw some big advocacy wins, with national ‘Safe Access Zones’ around abortion clinics signed into law. MSI has long advocated for this protection, which once it is implemented will safeguard over 100,000 women a year, ensuring our clients can access abortion care without being intimidated or harassed outside clinics.

“My favourite part of the job is being supportive, empathetic, kind and having the ability to make a difference. All I have ever wanted to do is help, so to be able to help someone in their decision makes me proud every day and that will never change.” – Angela, abortion provider for MSI UK

Australia

With a new Managing Director, we developed a refreshed strategic plan to strengthen our role as Australia’s leading non-profit advocate and provider of abortion and contraception services.

In May, a Senate Committee report ‘ Ending the postcode lottery’ was released with 36 recommendations to address barriers to reproductive health services. In August, regulation was changed to remove the requirement for doctors and pharmacists to have unnecessary registration and compliance obligations to prescribe medical abortion pills. MSI Australia strongly advocated for these changes, and it has resulted in better access to abortion.

We also saw progress in abortion expansion at the State and Territory level in Australia in 2023 — including when the ACT Government launched a policy of free access to abortion and contraception care for all residents and MSI Australia was contracted to provide these services.

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Quality and safety continue to be the cornerstone of our services. In the second half of 2023, our five licensed day hospitals were all awarded 3-year accreditation by the Australian Council on Healthcare Standards.

Options

Options Consultancy Services Ltd (Options) is a private company owned by MSI Reproductive Choices. All profits generated go back into supporting MSI’s goal of expanding access to reproductive choice. We build resilient and responsive health systems in partnership with governments, the private sector, civil society and communities.

In 2023, Options maintained focus on ensuring national ownership of well-financed, high-quality, inclusive, and accountable health services. Some achievements included:

Increased family planning budgets : Due to advocacy efforts, in Kano, Nigeria, the annual family planning budget allocation increased 95%, and in Bugiri and Kaliro districts in Uganda they increased by 400%. Bugiri and Kaliro districts saw a 673% increase in budget for adolescent services.

Strengthened civil society : Options worked with 171 local civil society organisations (in Madagascar, Malawi, Nigeria, Tanzania and Uganda) to strengthen advocacy. We managed African-led, community level grant-making programmes, reaching 62 organisations with £2 million in grants for mental health, disability inclusion, gender-based violence, and organisational strengthening.

Climate and health : In 2023, we furthered our analysis of the intersection between climate, health and gender, and its impact on access to reproductive healthcare, deepening our ability to integrate climate considerations into our work, helping to shape and improve programmatic responses to the issue.

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Regional Performance

----- Start of picture text -----
Income Income CYPs CYPs
2023 2022 2023 2022
£'000 £'000 000's 000's
----- End of picture text -----

Africa
Asia & the Pacific
India Social Marketing		 142,889
139,706
45,062
45,023
8,683
8,964		 26,547
24,103
5,362
5,237
3,132
2,292
Total CountryProgrammes 196,634
193,693		 35,041
31,632
Self-Sustaining
UK and Europe
Options
Australia
Other Self-Sustaining
Global Support Office
Sub-grants to Partners
Sub-total
Statutory Adjustments
Total*		 49,241
40,039
16,603
24,911
23,943
21,943
12,659
13,437		 124
110
-
-
48
44
178
181
102,446
100,330		 350
335
24,515
22,884
7,157
5,597		 -
-
-
-
330,752
322,504		 35,391
31,967
83,603
-		 -
-
414,355
322,504		 35,391
31,967

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Diversity, equality, and inclusion

Achieving our Diversity, Equality, and Inclusion (DEI) goals will help MSI expand our influence and reach the most marginalised with our services, while nurturing a positive organisational culture. Our 2022-2025 Global DEI Strategy is our first, and it outlines how we will embrace diversity of all kinds, improve team member and client engagement, boost gender equality, and build inclusive practices.

Diversity

A workforce that is representative of people from different backgrounds and communities, and with a variety of personal characteristics.

Equality

Using equitable approaches to have a workplace in which every individual has equal access to the resources and opportunities they need to succeed.

Inclusion

Having a workplace in which everyone, regardless of individual differences, feels able to participate and contribute meaningfully.

A message from our Global DEI Panel

We, the Global Diversity, Equality, and Inclusion Panel , are an advisory panel made up of team members from across MSI’s country programmes and the global support office. We’re volunteers who are passionate about ensuring DEI underpins our culture and work, and give our time and energy to support MSI to achieve its DEI goals.

DEI is not a ‘nice-to-have’ and cannot thrive with a top-down approach — it must be woven deeply into leadership, programming, organisational design, and culture. MSI’s formal commitments to DEI are outlined in the MSI 2030 Organisational Strategy , the 2022-2025 Global DEI Strategy , our published Commitment to Gender Equality , and our Board Diversity Policy . It is our privilege as the panel to work with our leadership and team members to bring these commitments to life.

MSI works in 36 countries across six continents, and DEI looks different in every country. While MSI’s global DEI goals provide a solid framework, each country office has developed its own ‘DEI action plan’ to ensure that the initiatives and priorities they take on are appropriate to their own context. A major strength of MSI’s DEI programme is how it is led and driven locally, and supported globally (mirroring how we operate and deliver services).

As a panel, we review progress together for a birds-eye view of inspiring activities across the MSI partnership — from sign language training in Zambia, to a DEI lens being applied to recruitment practices in Pakistan, or the roll-out of MSI’s ‘women in leadership’ training in Nepal. Having this visibility means we can identify trends and issues, share best practices and ideas across the MSI partnership, and provide guidance where it’s needed.

In 2023, we met each quarter to discuss what we were learning from our MSI country programmes, areas of opportunities for progress, and challenges in achieving our DEI goals. We also met with our executive leadership to make recommendations and seek advice, and touched base with DEI leads in MSI country programmes. From the huge success of our ‘DEI Week’ which was celebrated across the globe (you can read more about that in the upcoming section), to addressing the challenges in working across many languages, we’re proud of the progress being made.

We’re still on our DEI journey. In the year ahead, we plan to increase the visibility of this crucial work, and support and learn from MSI country programmes as they bring DEI initiatives to life. We’re proud to inspire MSI to become a truly diverse, inclusive, and equal organisation.

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The Global Diversity and Equality Panel

Stella Abua-onuorah Inonge Wina Chinyama Abbha Dhuriya Anaisabel Galindo Flores Chloe Hanse Fatou Janssen Eunice Kufoalor Piyali Mallick Robert Mwangi Esi Asare Prah Emma Riach Layla Shaaban Abdi Teyib Aminata Toure Daniel Vilondo

DEI in Action

Our DEI Strategy is supported by global metrics that we’re working towards, and country-level DEI action plans that address the DEI issues in their local contexts.

We are pleased with our progress towards our global metrics so far and remain united in our commitment to meet all our goals by 2025. Here’s our current progress towards them:

Our Global DEI Panel has been supporting our MSI country programmes with DEI culture-building. In 2023, this included:

Building DEI accountability at the leadership level is key, and our leadership are supported to role model inclusive behaviours. Our Global Board Diversity Policy describes our approach to diversity and inclusion within our Board, and 97% of MSI country programmes are now led by people from the same nation or region.

We continue to recruit talented, dynamic people with diverse backgrounds and experiences, all united by a belief in our mission and a focus on delivering measurable results. We’re proud to be an equal opportunities employer and are committed to creating an inclusive workplace where everyone feels able to participate and contribute meaningfully.

 ‘MSI country programmes’ for the purposes of this metric refers to country programmes across Asia (including Population Health Services India), Africa (including our commercial programme in South Africa) and Latin America (MSI Mexico and MSI Bolivia) which provide sexual and reproductive health and rights services, and does not include MSI UK, other Commercial programmes, Options Consultancy Services Ltd and/or support offices in the UK, US or Australia.

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We have made strides to open up our global support office with 36% of support office team members based outside of the UK at the end of 2023.

In 2023, we also designed and launched a bespoke DEI workshop to build team members’ knowledge of the key concepts relating to diversity, equality and inclusion. This compliments our DEI e-learning module to equip our team members with the knowledge and understanding to meaningfully apply DEI in their day-to-day work.

“The information and services given to me as a person with a disability were very good. MSI Zambia had an interpreter who made communication very easy for me. The service providers treated me well and they were very friendly to me. We are also human; we have a right to get information.” – Beauty Soko (39), an MSI Zambia client with a hearing impairment

DEI Week

In October 2023, we celebrated our annual DEI Week, with a range of activities showcasing the role every single team member plays in creating gender equality and social inclusion across MSI and the communities in which we work.

Among these many activities were:

MSI’s gender equality and women in leadership

We have continued to identify and break down barriers to gender equality and female progression across the MSI partnership.

Global Health 50/50 monitor the gender-related policies and practices of 200 global health organisations in their Gender and Health Index Report. In 2023, MSI was recognised as a ‘High-Performer’. Our global support office ‘Menopause Policy’ was recognised as the only one of its kind, supporting team members experiencing symptoms of perimenopause and menopause. We also have channels in place to ensure our team members have access the same high-quality sexual reproductive healthcare services as our clients.

Over 300 women from 17 MSI country programmes have now attended our ‘Women in Leadership’ programme, and we’re continuing to roll this out further. It addresses barriers faced by female colleagues and builds skills for strong leadership. Team members who went through the programme in Ethiopia shared that their confidence in decisionmaking and their ability to influence have increased. In the two years since the programme ran there, female representation in Ethiopia’s leadership positions has increased by 22%, and in management positions by 25%. Followup support including group coaching, internal networks, research projects and Q&A sessions with female leaders continue to create meaningful change.

In 2023, we also introduced a scholarship fund through which three successful female applicants received funding to undertake transformative development opportunities supporting their career growth at MSI.

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“The best woman leader is not one who excels above everyone else, but one who celebrates the rise of fellow women, even to a level above themselves.” - Pester Siraha, Country Director MSI Zimbabwe

Gender equality & social inclusion in our programming

MSI believes that to expand access to sexual and reproductive health and rights, we must consider and address the unequal power relations and inequalities experienced by individuals because of their social identities. This includes those rooted in gender, but also other characteristics such as age, location, disability, wealth, education, ethnicity, race, and sexuality. We want everyone to be able to use our services, no matter who they are or where they live.

We base our reproductive healthcare delivery on respect and informed choice, which strengthens people’s agency, challenges negative gender norms, and can help to improve their social and economic position. We design service delivery, social and behaviour change activities, and advocacy in a way that challenges prevailing power dynamics, inequality, and discrimination.

In 2023, we continued to deliver tailored programmes to reach individuals who face significant barriers in accessing health services — such as women living in extreme poverty, adolescents, and people with disabilities. Our ‘Big Sister’ peer approach in Democratic Republic of Congo, our parent & youth meet-up sessions in Kenya (co-designed with youth champions), and ‘husband schools’ that engage men and boys are examples of this important work.

We increased our focus on meaningfully engaging the people we serve in the design, implementation, and evaluation of our programming. Regional MSI ‘Communities of Practice’ brought together learnings from all our MSI country programmes in how they’ve rolled out different approaches. We are in a constant state of learning and improving.

“I hope in the future women will be empowered to work on their own and also get a lot of income to take care of themselves without a man!” – Beatrice, 30, MSI Ghana client and business owner

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Our commitments

At MSI Reproductive Choices, we believe it’s not just what we do that matters, but also how we do it. In this section, you can read more about our organisational commitments and why ‘the how’ matters to us too.

Quality

96,934 clinical competency assessments carried out 7,093 internal clinical quality assessments conducted 133 external clinical quality assessments conducted across 700 sites and teams 44 abortion medication samples tested for quality assurance

Behind our safe reproductive health services are over 13,000 clinicians who work tirelessly to deliver high quality, standardised services, with the support of our in-country clinical supervisory teams who ensure that the necessary mechanisms are in place to keep our clients safe.

MSI’s Global Medical Development Team (MDT) holds the overall accountability for the quality of our services and manages the clinical governance systems that monitor and improve quality of care. This takes the form of internal and third-party clinical quality assessments of facilities and service provision; the annual competency assessment of clinicians for every service they provide; a robust system for reporting clinical incidents; and a Medical Advisory Team in each MSI country programme chaired by that programme’s Clinical Director. Findings from these systems are presented to the Board of Trustees at least three times per year.

2023 saw 133 external clinical quality assessments conducted by our network of Senior Specialists for Clinical Support and trained peer assessors. These assessments covered 670 service delivery points and 32 support offices, with particularly strong performances noted in our centres, outreach teams and maternities.

In tandem, MSI country programmes conducted 7,093 self-clinical assessments, as well as 96,934 competency assessments of clinical providers. Improving and maintaining the quality of these self-assessments has been an area of focus for MDT over the past year, with the launch of two online courses for assessors, and will continue to be a priority for 2024.

The quality of the pharmaceuticals and surgical equipment used by MSI are placed under strict scrutiny too. In 2023, 1,463 medicines and medical devices were quality-assured by our dedicated product safety team. 44 samples of abortion medication (misoprostol tablets or mifepristone and misoprostol combi-packs) were tested to ensure that the amount of active ingredient found in the products is within the expected limits. Alongside robust supplier vetting, these random product tests are done annually to guarantee that our clients are receiving safe, effective medicines, and that product integrity is protected at every stage of the supply chain.

The MSI Clinical Risk Mitigation Approach

Using the scale and types of services provided, we calculate the inherent clinical risk of each service across every MSI country programme. We also calculate the percentage of this inherent risk that has been mitigated, using routine data collected across the partnership. The risk mitigation figures of all 110 services are calculated on a quarterly basis, and presented to the Board of Trustees regularly, giving us good visibility of where risks lie so that we can allocate quality assurance resources wisely.

Being accountable

‘Accountable’ is one of our values, and ‘speaking up’ is part of our culture. Ensuring our staff, clients and partners have an appropriate channel to voice concerns is key to maintaining a safe and ethical workplace. Any concerns regarding safeguarding or fraud, bribery or corruption, breaches of the law or other incidents that make our clients or team members feel uncomfortable can be confidentially reported in person, via telephone or online.

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We use an independent whistleblowing hotline, Safecall , to provide an all-hours service, which is toll-free wherever possible. All staff are trained in ‘speaking up’ and the communication channels to do so are promoted at all MSI sites.

Anti-fraud and bribery

MSI has a zero-tolerance approach to fraud and bribery to protect our mission and the clients we serve, and uphold our reputation and values. Through our global Anti-Fraud and Bribery Programme (AFB programme), we reduce the risk and incidence of fraud and bribery.

The AFB programme comprises policies, standards, training and tools, including a comprehensive Fraud Register where fraud allegations are entered, ensuring that any allegation is immediately received by MSI senior management and managed efficiently in line with policy.

A key component is continually promoting and reinforcing MSI’s zero tolerance to fraud and bribery through messaging, training, discussions, case studies, posters and more. MSI organises quarterly Communities of Practice where MSI country programmes share best practice on how to prevent, manage and investigate fraud. A newsletter is sent out on a regular basis where reminders, learnings and best practice are shared. AFB training is mandatory for new staff, and existing staff complete refresher training every two years. Country Directors have responsibility for implementing the AFB programme, supported by a dedicated AFB lead and our Legal, Safeguarding and Donor Compliance team. Investigations are managed in country or by our Global Internal Audit team.

UN Global Compact

MSI is a signatory of the UN Global Compact and is committed to supporting the Compact’s 10 principles. We pledge to participate in and engage with the Compact, to continue strengthening our worldwide global policies relating to human rights, labour, anti-fraud, corruption and bribery, and to maintain appropriate systems to minimise environmental damage. We published our latest Communication on Engagement in March 2023, setting out how we engaged with the principles. This can be found on the website of the UN Global Compact.

Modern slavery

As an organisation that promotes the rights of women and girls, we are absolutely opposed to modern slavery and human trafficking in all its forms. In addition to our Modern Slavery Policy, the accompanying training, and the global due diligence programme, we are committed to reducing modern slavery risk through our procurement processes and supply chains. For further information, MSI’s Modern Slavery Statement can be viewed on our website.

Data protection

Protecting the privacy and confidentiality of our clients is central to our mission as a client-centred organisation. MSI has a Data Protection Officer who is responsible for our compliance with UK data protection law. To ensure a high standard of data protection across all our operations, MSI operates a global Data Privacy programme, managed from the global support office, comprising policies, tools and standards as well as training, support and monitoring. Each MSI country programme has a Data Privacy Champion who implements the programme including managing breaches, undertaking privacy impact assessments and ensuring local compliance, supporting staff training and reducing or mitigating risks to data privacy wherever possible. Through the programme, MSI is accountable, transparent, and fair in the way that it processes and protects personal data.

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Safeguarding

MSI is committed to safeguarding clients and staff across the global partnership. We have a framework in place to prevent and manage incidents of sexual exploitation, abuse, and harassment. Where incidents do occur, these are identified and responded to in a way that maintains survivor and/or whistleblower safety and welfare.

MSI continuously seeks to learn lessons from reviews of past incidents, developments within the wider safeguarding sector, and from our team members’ experiences, to improve our organisational approach to safeguarding and prevent future incidents. All incidents are reviewed by a Global Safeguarding Decision Committee made up of senior management and are managed in line with our global policy.

We implement safe recruitment practices and promote a values-based approach to recruitment, supported by background-checking procedures to employ people who treat others with care and respect. Country Safeguarding Leads work alongside senior management teams to identify and mitigate a range of safeguarding risks that have the potential to occur across our operating channels.

Within the public sector, MSI seeks to complement established safeguarding frameworks, and where necessary advocates for increased safeguarding approaches. All MSI team members receive regular training on the ethical conduct expected of representatives of MSI, and how to speak up about and respond to safeguarding concerns. Team members’ duty of care and safeguarding responsibilities are reinforced through additional behaviour change initiatives, such as discussions around case studies designed to equip our staff with the skills and understanding to identify and sensitively respond to a range of nuanced safeguarding issues.

“Some of our clients don’t have anybody else, somebody to go home to, somebody to talk to and share their worries with, and to be that person to advocate for them gives me an immense sense of pride.” – Grace, empowers our clients and colleagues providing support to our nurses and midwives across England

Membership of the Fundraising Regulator

MSI Reproductive Choices is a member of the Fundraising Regulator and complies with the requirements of the Code of Fundraising Practice for the UK. No third-party fundraisers were engaged in 2023 nor did MSI engage in any doorto-door or street fundraising (2023: nil) that would require policies to protect vulnerable people and other members of the public. No complaints were received (2023: nil).

The Climate Crisis

MSI contributes to the fight against the global climate crisis by supporting the communities where we work to build resilience to climate change. At times, we pivot our services to provide relief from disasters caused indirectly or directly by climate change.

In 2023, climate change has continued to impact these communities. Increased fragility is caused directly by extreme weather including droughts and floods, as well as through conflict and exacerbated by climate change. Women and girls are the most vulnerable, and MSI continues to help to build their resilience by offering reproductive choice.

When climate disruptions hit — like in any humanitarian crisis — it is essential that women have access to reproductive choice and the power to decide if or when to become pregnant. In 2023, MSI helped 4.5 million people living through climate disasters and conflict.

Reproductive choice means that women can play their full part in finding solutions to the climate crisis. Binetou, who leads an environmental group in Joal, Senegal, helps to rebuild the local mangroves that have been impacted by climate change. She told us: "With contraception we can support ourselves, look after our children and get on with everyday activities. We use contraception to reclaim our lives."

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MSI, alongside the global community, recognises the need to mitigate further climate change, to adapt and build resilience, and to protect natural resources and biodiversity. Our commitment to ‘leave no footprint’ means that we’re continuously working to reduce our impact on the environment. In September 2023, MSI published its first Carbon Reduction Plan for the global support office. The Board of Trustees committed MSI to reach net zero by 2050 for a range of UK emissions scopes. MSI’s key emissions drivers are travel and delivery of supplies to the frontline.

During the COVID pandemic, our medical team developed a virtual quality assessment methodology, which allowed quality assessment of MSI country programmes’ clinics to take place using video streaming technology, where appropriate. This innovation has led to a sustainable reduction in flights, even now normal travel has resumed. We have set targets to further reduce emissions from international travel, for example by using tools that can enable hybrid conferences to work more effectively. We have also issued tools to improve freight efficiency.

MSI reports UK energy and carbon use in line with the Streamlined Energy and Carbon Reporting (SECR) guidelines. In total, relevant emissions in the 2023 financial year are 367 tonnes of CO2e. Actual electricity and gas usage was collected from billing information, and land transport from mileage reports in our expenses system. UK Government GHG Conversion Factors have been used to derive carbon emissions.

----- Start of picture text -----
Energy and Carbon Report (UK Only) 2023 2022
Scope 1 – Emission for purchased gas
Total UK energy use 526,393 kWh 554,328 kWh
Total CO2 emissions 132 tCO2e 101 tCO2e
Scope 2 – Emission for purchased electricity
Total UK energy use 867,878 kWh 931,866 kWh
Total CO2 emissions 180 tCO2e 180 tCO2e
Scope 3 – Indirect emission from business travel
Total UK energy use 396,988 kWh 371,762 kWh
Total CO2 emissions 92 tCO2e 87 tCO2e
Total UK Energy use 1,791,259 kWh 1,857,956 kWh
Total CO2 emissions 404 tCO2e 368 tCO2e
CO2 emissions per m2 floor space 50kg 50kg
----- End of picture text -----

Data and Evidence

Evidence is an integral part of our programmes. We measure and track impact to ensure that our services are rooted in equity. Our researchers work hand-in-hand with our country teams, governments and partners to gather quantitative and qualitative data to:

We collect 300 million client data points from across 50,000 communities every year

To understand the impact of our work and the outcomes achieved for our diverse client base, we report programme data disaggregated by sex, age and disability. All MSI country programmes are required to collect comprehensive client data for the purposes of research, monitoring and evaluation, which is processed in accordance with the relevant data protection legislation, regulations, and internal policies. Such data is publicly reported each year where it is possible to do so without compromising confidentiality, and where the data obtained is considered valid, reliable, and representative.

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We are proud of the scale of our efforts to collect data, track results and share best practices, all of which is helping to remove barriers, drive equitable access at scale, and help the global health sector to maximise its impact.

Our people

MSI is made up of almost 9,000 dedicated professionals. In 2023, our team members continued to demonstrate our values and extraordinary commitment to delivering for women and girls, while helping build and participate in a supportive, innovative MSI culture.

Listening to our team members

Creating an inclusive environment in which we can all thrive remains a top priority for MSI, and we recognise the importance of working collaboratively at every level. At our global support office, we’ve continued to work closely with our Team Member Council, which is a vital channel for input into decisions. We’d like to express our sincere gratitude for the members of this group and their significant contributions throughout 2023.

Following the engagement pulse survey carried out at the end of 2022, our teams were encouraged throughout 2023 to reflect on the results, ensuring that any team-level commitments were actioned. Additionally, through 2023, the HR team at our global support office held individual meetings with each department to discuss people-related activity and obtain feedback from team members, to help shape the HR strategy and ensure alignment of needs and expectations.

Developing MSI’s HR Community

In 2023, MSI’s first face-to-face global HR strategy workshop took place, during which 22 HR colleagues from across the MSI partnership came together with our global support office HR team for a week of activities, presentations and discussions centred around our MSI 2030 strategy. During the week, HR colleagues attended sessions on:

The week also featured an optional evening drop-in clinic to discuss the 2022 pulse engagement survey results in more detail and reflect on any patterns or trends in employee experiences, which might help to identify both global and local priority areas. Overall, the workshop was a fantastic opportunity for our people and culture professionals to share diverse ideas and perspectives and build on MSI’s HR network.

Learning and development

Our focus on management and leadership remained a priority in 2023. After a thorough review of our learning and development activities, and focus groups and interviews, we designed a new Learning, Development, and Wellbeing Strategy . It aligns with our mission, our business objectives and is future-focused to ensure we are providing effective solutions.

In January 2023, we held a leadership meeting in South Africa with our executive team, country directors and senior leadership team. We introduced new 360-degree feedback on MSI's leaders to help shape leadership development. Later in the year, MSI’s country directors virtually shared stories of success since introducing the leadership practices in their programmes.

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We ran bespoke individual and team learning and development initiatives. Around 14,500 of MSI’s team members and partners across 52 countries are enrolled on our Global Learning Management System, Kaya. The platform ensures mandatory training compliance and allows us to author and roll out digital content to improve knowledge and capability both internally and across the sector.

We continue to promote a coaching culture. We provide coaching support to our team members across MSI, as well as mentoring opportunities such as ‘Mission Include’ which is designed to support professional growth and nurture inclusive and supportive leadership across MSI.

Wellbeing

The physical and mental health and wellbeing of our colleagues remains a priority for MSI. There are now fully trained Mental Health and Wellbeing First Aiders in place in all MSI regions. All new starters must carry out this training as part of their onboarding process. We will also be introducing a new training for line managers on mental health in 2024.

Our Employee Assistance Programme was expanded out to 12 MSI country programmes, as well as the global support office. We hope to be able to expand this further in 2024 and beyond. The services available include counselling, critical incident response, personalised coaching, management assistance, practical advice on legal, financial and lifestyle matters, and support for parents.

Our new wellbeing calendar helps us create and deliver monthly content and webinars globally on wellbeing themes such as stress management, anxiety, resilience and gratitude. We have also delivered bespoke stress management and resilience sessions to teams across the global support office.

Our values

MSI’s culture and the way we work is driven by our values.

Mission Driven: With unwavering commitment, we exist to empower women and men to make choices about their

bodies and their lives.

Client Centred: We are dedicated to our clients and work tirelessly to deliver high-quality, high-impact services that meet their individual needs.

Accountable: We are accountable for our actions and focus on results, ensuring long term sustainability.

Courageous : We recruit and nurture talented, passionate and brave people who have the courage to push boundaries, make tough decisions and challenge others in line with our mission.

Resilient: In challenging situations, we work together and support each other, adapting and learning to find solutions, whatever we’re up against.

Inclusive: We believe that diversity is a strength. We all play our part in creating a culture where every team member can thrive, feel valued and contribute meaningfully to our mission, and where all our clients feel welcome and supported.

“I counsel women on their reproductive health. When our clients choose their own contraception method, they can go out to work or take care of their children or just have the opportunity to know themselves and explore other options rather than just having to give birth. If every woman had the opportunity to access their reproductive choices, there would be change. They would get power.” – Josephine, MSI Ghana midwife

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Equal opportunities for people with disabilities

MSI seeks to ensure that the processes we have in place to support recruitment, internal promotions and access to career development opportunities do not unfairly disadvantage any specific individual, group, or community. We have a responsibility to ensure equal access of opportunities to all, and decisions are not influenced by any personal characteristics such as age, gender identity, race, nationality, ethnicity, religion, sexual orientation, parental or disability5 status.

At our global support office, we have made a commitment to interview all recruitment applicants that declare a disability and who meet the criteria for the role. Candidates who require adjustments to application processes to meet specific physical or cognitive needs are encouraged to make a request, and we will make reasonable adjustments wherever feasible.

Facility modifications have been made to ensure improved access for people with disabilities at our London-based global support office. Team members may submit a request for workplace adjustments at any time, and MSI may conduct a risk assessment and approve reasonable requests to enable team members with a health condition or disability to continue to perform their role and access learning and development opportunities comfortably and safely, with support to meet their unique needs.

Executive remuneration

As a social business, MSI attaches great importance to responsible governance. MSI generates a significant portion of its revenue from its own private sector operations, with the balance supporting high impact programmatic activity with funds coming from institutional donors, foundations, and private individuals.

Our focus on MSI as a social business operating in part in the private sector is reflected in the compensation of the CEO and Executive Team. MSI focuses on financial and operational KPIs that deliver better impact and value for money for donors and stakeholders. MSI’s compensation is designed to attract and retain high-calibre individuals with significant experience of handling large international operational organisations with revenue greater than £250 million. We look for individuals with a track record of delivery in an international, commercial context.

MSI’s compensation for the most senior executives includes an at-risk, performance-related pay component that reflects the deliverables expected of the organisation and the individual. This element of executive compensation is never charged to MSI donors.

Given that a significant piece of market pay is at risk, the executive can earn beyond market pay if stretch deliverables are met or over-achieved. KPIs are focused on growth and delivery of stringent financial and operational metrics and are difficult to achieve. Compensation is capped, there is no long-term incentive plan and no other non-cash benefits.

Executive compensation benchmarking is oriented to an external peer group of international NGOs with whom we compete for resources, as well as commercial businesses of similar scope and size. An assessment is done every three years. MSI’s Remuneration Committee pays close attention to the external environment while seeking at all times to ensure a balance between fulfilling our mission, controlling overhead costs, and ensuring maximum returns for donor and taxpayer funds.

Pay equity

MSI’s 2023 gender pay gap was calculated based on 699 MSI employees in the UK. This included 538 people working for MSI’s UK programme, which provides abortion services through our network of clinics, and 161 people in the London-based global support office supporting the work of our programmes in 36 countries. Our combined median

5 A physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal dayto-day activities. UK Equality Act 2010, Section 6

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gender pay gap for these two groups is 29.5% , the median pay gap for our UK-based global support office workforce is 14% , while the median pay gap for our UK healthcare operation is 28.8% . The majority (77%) of our UK-based workforce are employed in our UK division, so our combined figures for MSI are weighted towards the UK clinical operations. The low representation of women in senior clinical positions (e.g., anaesthetists and surgeons) contributes to our combined gender pay gap and we continue to take positive action wherever possible to attract and retain talented women in these roles.

Our global support office pay gap shifted from -5.6% in 2022 to 14% in 2023. This is primarily a result of an internal restructure of our Global Information Services team, which moved a number of roles held by men that sat within the lower and lower-middle pay quartiles from our global support office to MSI UK. This reduction in male representation at the lower and lower-middle pay quartiles meant that the median hourly pay rate for men was higher, resulting in a larger gap for the global support office and reducing the gap for MSI UK. We know that in the STEM field, representation of women is generally low, and the work of our Diversify Digital working group seeks to understand and address this within MSI.

You can read our full gender pay gap report for 2023 on our website at msichoices.org.

Recognition

There are numerous global initiatives that recognise the hard work and dedication of our team members, including the annual MSI Stars Awards which celebrate team members who embody MSI’s values. The MSI Channel Awards, Marketing and Evidence Awards, and Social Marketing Awards acknowledge outstanding performance. And our Clinical Excellence Awards recognises exceptional standards of clinical quality.

At the global support office, we reviewed the salary structure and job evaluation methodology in 2023. This involved having every job evaluated by a specialist consultancy (Birches Group LLC), obtaining comprehensive multi-sector benchmarking data, and ensuring that roles are paid in line with our desired position in the labour market. This has resulted in greater transparency regarding pay equity, and we’ll use the learnings to drive stronger, more equitable approaches to remuneration across the MSI partnership.

For global support office team members, MSI’s discretionary company bonus scheme is designed to provide eligible team members with a one-off lump sum payment if the organisation meets its business plan for the relevant year. We’re pleased to confirm that, due to the hard work and commitment of our team members, MSI’s 2023 business objectives were successfully met, and eligible team members received a bonus payment in March 2024.

We continue to encourage team members to submit their innovative ideas to help improve the organisation and better support our clients, and we reward team members for any proposals that are operationalised. We also have a Recognition Policy which allows for managers to recognise those who truly go above and beyond, through the provision of a voucher or one-off cash bonus.

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Structure, governance, and management

MSI Reproductive Choices’ policy statement of the board of trustees and members

The organisation was incorporated by Dr Tim Black and Mr Phil Harvey for the purpose of providing contraception and access to safe abortion services, primarily for the benefit of women and girls in low and-middle income countries worldwide. This was done on the premise that these services contribute positively to:

We believe that access to contraception is a fundamental human right and that every woman should have that right, and the means to choose the number and spacing of her children.

The Members and Trustees endeavour to ensure at all times that the organisation’s objectives, goals, strategies, and measures align to the following principles:

  1. MSI’s mission shall remain, in perpetuity, the prevention of unwanted pregnancies and births, and our purpose is to ensure the individual’s fundamental right to have children by choice and not by chance.

  2. We put our clients and their family planning needs at the centre of our organisational activity, with the focus of the organisation’s services designed to maximise choice and quality of care.

  3. We stress the necessity of informed choice of clients in provision of contraception and safe abortion services. In pursuit of this, MSI’s programming will aim to serve unmet demand by:

  4. a. filling gaps in service provision and maximising how we use our available resources.

  5. b. service innovation and the de-medicalisation of services.

c. introducing the full range of voluntary family planning services and safe abortion provision wherever possible.

d. being a catalyst for the provision of more efficient, effective, and better-quality client-oriented, and sustainable services.

  1. Our goals are best achieved by programming as a social business: namely a non-commercial organisation capitalised primarily with retained earnings and donated funds to deliver essential goods and services including safe abortion at affordable prices, whilst generating sufficient surpluses to maintain and sustain its capital base at a level that will enable it to further its goal. As a social business we will seek to maximise:

  2. a. programme investment opportunities

  3. b. return on investment

  4. c. social dividends

  5. d. the sustainability of our programmes

  6. e. our quality of care

  7. We will always aim to be a catalyst for more effective contraception services generally, and greater private sector involvement in countries where governments and local organisations are unable, unprepared, or slow to meet demand for contraception.

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  1. That despite some donor, government, and political sensitivities about the provision of safe abortion, we will ensure that our programmes remain committed to offering these services, as a public health responsibility, as a means of empowerment and as a primary means of saving and improving women’s lives.

  2. We remain committed to ensuring that the MSI Partnership maintains its standards, its commitment to strengthening country and national programmes, and to empowering Country Directors to pursue strategies that respond to local conditions, working with local partners where possible to ensure maximum impact.

  3. We will always evaluate the impact of our services with evidence-based statistical measures. A core measure of the organisation’s success will be couple years of protection (CYPs) whilst we will also use other quantitative and qualitative indicators to measure our contribution to national efforts that increase contraceptive uptake and reduce maternal and newborn death and morbidity.

  4. Every part of the organisation will seek to lower the cost burden of delivering contraception. We will emphasise programme efficiency with measures including CYPs per FTE, cost per CYP, and programme income/cost.

  5. We will continue to advance our mission in a pioneering fashion, assuming balanced risk. We will guard against the tendency of all social service organisations to become more cautious with the passage of time, by staying true to our unique social business model. We will maintain policies and pursue strategies that encourage measured risktaking in the delivery of high-quality family planning, safe abortion, and maternal health services where these are provided.

  6. MSI will always emphasise the provision of evidence-based high-quality services which set a standard for others to follow, and will use global standards of care which put our clients’ needs first. We shall seek and maintain relationships with donors who are aligned to our mission, our high standards, our focus on ‘advocacy by doing’, and the use of data to measure success.

  7. In everything that we do, we will emphasise respect for human rights, for gender equality, for the environment and for transparency.

At MSI Reproductive Choices, success will always be measured in results achieved, not in effort expended.

The Board and Members of MSI Reproductive Choices, May 2024

Constitution of the charity

MSI Reproductive Choices is a charity registered in England and Wales, constituted as a company and limited by guarantee. The charity is governed in accordance with its Articles of Association.

Charitable objectives

The objects of MSI Reproductive Choices are:

Public benefit

MSI Reproductive Choices enables women to have children by choice, not chance. The organisation’s charitable objectives, aims and strategy provide public benefit through:

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The Trustees confirm they have given due consideration to the Charity Commission’s published guidance on public benefit and have taken it into account in reviewing the organisation’s future plans and strategy. The Board is satisfied MSI’s activities are carried out wholly in pursuit of its charitable objectives.

Organisational Structure

MSI Reproductive Choices is a global organisation providing high quality, affordable contraception and safe abortion services across 36 countries. It is constituted as a charitable company limited by guarantee. MSI Reproductive Choices (the Charity) – or the Company for the purposes of company law – refers to:

MSI Reproductive Choices’ UK operations (its abortion and family planning clinics and the global support office) and MSI’s 20 international branch offices. The global support office provides support and technical assistance to programme operations in 36 countries worldwide.

MSI Reproductive Choices (the Group) refers to the Charity and subsidiary entities. The Group is also referred to as the MSI Partnership or the Partnership. Unless otherwise stated all references to MSI refer to MSI Reproductive Choices (the Group).

The Charity’s subsidiaries are listed in note 21 (a full list is also available at our registered office) and MSI Reproductive Choices’ investment in subsidiaries is contained in note 10(a).

Our Board and Governance

The Board of Trustees provides MSI Reproductive Choices with governance and strategic oversight. The Board meets three times a year as a minimum for a full day meeting, and more often where required.

MSI’s Board of Trustees is made up of individuals who are leaders in their field and committed to the organisation’s mission. Their backgrounds include senior level experience, both within the UK and abroad, in the commercial health sector; clinical and teaching experience in women’s reproductive health; leadership in the non-profit sector; business; finance; government and advocacy.

In March 2023, Glenda Burkhart resigned as Chair of the Board after three years in the position. Frank Braeken, who has been on MSI’s Board of Trustees since November 2016, was elected as her replacement. Tania Holt joined the Board in October 2023, and Mark Slack joined in February 2024. Jess Search, who stepped down from the Board in June, sadly died in July 2023. We honour her in the section below.

The Trustees periodically review the skills and experience necessary for the Board to be effective. When the Trustees identify the need for a new Trustee, the Trustees identify potential candidates; interview the potential Trustee(s) to establish their suitability and commitment; and undertake vetting. The potential Trustee is then invited to be an observer at the next Board meeting, after which the Trustees may formally invite the selected candidate to become a Trustee.

MSI provides an induction programme for new trustees. In addition to introducing MSI’s mission, goals, finances, strategy and health service portfolio, legal responsibilities are also covered, including the relevant Charity Commission guidance. All Trustees participate in anti-fraud and bribery and safeguarding training, and where possible visit one of our programmes in operation. Our February 2024 board meeting was held in Nigeria, where board members could see the full range of our services first hand.

In memory of our trustee Jess Search

Jess Search, trustee of MSI Reproductive Choices and former chair of the MSI United States’ board, sadly died on July 31st aged 54, having been diagnosed with a brain tumour.

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Jess was part of the MSI family. She was a committed supporter of our mission from her first visit to one of our clinics in Nicaragua in 1988 where her mother was working for us — she grew up with the mission in her blood. She was passionate about fairness, justice and inclusion and consistently challenged, pushed and inspired us to think differently, do more and be better.

Jess was a passionate and inspiring contributor, unafraid to speak up for those whose voice she felt needed to be heard, and always an energetic and enthusiastic presence. Everyone at MSI is so proud and thankful for the huge support and contribution Jess gave to our work around the world.

Section 172(1) Statement

The Trustees have considered, both individually and collectively, their duty to promote the success of MSI in pursuit of its charitable objectives, as detailed in section 172(1) of the UK Companies Act 2006, which includes a duty to promote the success of the company, and in doing so have regard to:

Specifically, the Trustees have discharged their duties through consideration of the matters below. The following points are not intended to be an exhaustive list, but are illustrative of how the Trustees have fulfilled these duties during the year:

The Board has delegated specific responsibilities and activities to five sub-committees. These are the International Clinical Governance Committee, the Finance Committee, the Audit Committee, the Remuneration Committee and Nominations Committee. Membership of these Committees is appointed by the Board, and the chair of each committee reports back to the Board at each Trustee meeting. The committee structure is as follows:

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----- Start of picture text -----
Members Required attendees Purpose
The International Clinical Governance Committee
Claire Morris (Chair) CEO To oversee client safety
Fiona Duby COO To review the clinical performance of international programmes
Mark Slack Global Medical To review the results of clinical quality audits
Myriam Sidibe Director To ensure MSI responds to clinical issues raised in client surveys,
serious untoward incidents and clinical incident reports
Finance Committee
Frank Braeken (Chair) CEO To provide oversight of the financial performance and position of the
Glenda Burkhart CFO group including annual business plan, results, global supply chain,
Mohsina Bilgrami COO global information services, major business cases and investment
Tania Holt Group Director of decisions.
Financial Control
Director of Informatics
Audit Committee
Kristin-Anne Rutter CEO To oversee the group’s Strategic Risk Register and sources of
(Chair) CFO assurance
Fiona Duby COO To ensure an effective group audit function is in place
Tania Holt Group Director of To oversee the external auditor
Financial Control To assist in formulating the assurance needs of the Board
Director of Internal
Audit
Director of Legal and
Donor Compliance
External auditor
Remuneration Committee
Glenda Burkhart To approve remuneration arrangements for the CEO
Frank Braeken (Chair) To oversee succession planning and development for the CEO and
Mohsina Bilgrami senior management
To oversee and review group HR policies and practices
Nominations Committee
Kristin-Anne Rutter To identify and make recommendations to the Board on candidates for
(Chair) appointment as Trustees
Claire Morris To oversee succession planning for trustees
Frank Braeken
----- End of picture text -----

The Trustees serving in the year ended 31 December 2023 and up to the date of signing this report are noted on page 2. The Executive Team, based mainly in London and led by the Chief Executive Officer (CEO), is responsible for the implementation of the strategic direction and for the group’s operational management. The Executive Team reports via the CEO to the Board of Trustees as required.

MSI Reproductive Choices’ subsidiaries have their own Boards of Trustees (or Directors), which fulfil local statutory and regulatory requirements, and provide a further layer of robust governance. Operationally each branch and subsidiary has a senior management team headed by a Country Director who reports into the global support office. MSI Reproductive Choices UK, which is a division of the parent charity, reports to the MSI Board of Trustees through the group CEO who chairs the UK Divisional Board.

Risk Management

The Trustees are responsible for the management of risk. Risk management ensures strategic risks are identified and monitored, allowing informed decision making and timely action. MSI seeks to reduce risks that are a threat to the delivery of strategic objectives and put in place actions that address and mitigate the likelihood and / or impact of each risk to an acceptable level. MSI is committed to establishing an organisational culture where risk management is an

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integral part of every activity and all staff understand they have an important role to play in escalating risk, and in ensuring risks are managed effectively. During 2023, the Executive Team held dedicated meetings to review the Strategic Risk Register.

Risk management performance is monitored by the Audit Committee, reviewing the management process once per year and the Strategic Risk Register at least three times per year. The Audit Committee Chair reports on risk at each MSI Board meeting. Key Risk Indicators are reported quarterly for each of the risks described in the Strategic Risk Register, and these, together with any trends in the movements and assessments of each risk, are used to inform risk management performance. Group Internal Audit function delivers a risk-based audit programme approved by our Audit Committee. The Audit Committee reviews internal audit reports as part of the system of risk management.

Principal risks and uncertainties

----- Start of picture text -----
Risk Controls and Mitigations
Portfolio risk: large  Identification of critical programmes
programme failure impedes  Additional review and oversight by the Audit Committee
scale
 Annual mandatory internal audit visits
Insufficient donor funding to  Proactively review and manage the donor funding pipeline
fulfil strategic objectives 
Invest to diversify income via new relationships and domestic
financing
 Quantify the financial and service delivery impact of losing key donors
and develop mitigating strategies
 Donor CRM system upgrade
Adverse clinical outcomes,  Global clinical quality assurance programme
including client death  Global clinical incident reporting framework
 MSI product quality standards and field testing
 Global tracking of provider competency and assessments
 Additional obstetrics guidelines and targeted support
 Governance structure with clear reporting line from “ward to Board”;
the Global Medical Director reports on clinical quality at each Board
meeting
Lack of sustainable access to  Quarterly commodity security review, supply gap analysis and
donated commodities demand forecasting
 Pro-active engagement in developing countries local partners and
advocates for government allocations
 Ensure full counselling of the range of family planning products
Non-viable commercial  Centres sustainability strategy including launch of diversified
channels lead to closures or services under Every Stage of Woman
working capital consumption  Increased oversight at executive level and CFO approval for working
capital investment
Risks posed by complex geo-  Global Security Framework and Crisis Protocols
political situations or the  Support country teams with resilience and influence activities
“opposition“
 Proactive management of “opposition” and similar risks to the
prioritisation of SRHR and MSI’s reputation
Inability to recruit or retain  Global Recruitment strategy
talent for critical roles  Succession planning for critical roles
 Regularly review compensation to position MSI competitively
Major cyber-attack or  Infrastructure roadmap for MSI 2030 including ‘Modern Workplace’
information systems failure and ‘Connectivity’ initiatives
----- End of picture text -----

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Global cyber security policy, software, monitoring, penetration testing,
and team member training

Global advocacy programme supporting dedicated advocacy leads
andprojects in MSI country programmes
Fraud, corruption, theft, risk of
overstating results and
unethical practices

‘Speaking Up’ culture and use of independent reporting channels

Dedicated Safeguarding Team

Comprehensive global Anti-Fraud and Bribery programme

Data Governance review and launch of updated validation standards
Non-compliance with
statutory, regulatory or data
protection requirements
Independent reviews of UK and global corporate governance

MSI country programme governance review and compliance
dashboard

Global Data PrivacyProgramme with trained Information Leads

Trustees’ indemnity

Each of the Trustees has the benefit of an indemnity which is a qualifying third-party indemnity as defined by Section 234 of the Companies Act 2006. The indemnity was in force throughout the last financial year and is currently in force. The Company also purchased and maintained throughout the financial year Trustees’ and Officers’ liability insurance in respect of itself and its Trustees.

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Financial performance

Income

In 2023, MSI secured total income of £414.4 million, an increase of 28.0% from £322.5 million in 2022, this increase was primarily driven by the receipt of a generous unrestricted legacy from the Ballard Legacy Fund of £81.9 million. We are holding this legacy in a designated reserve as we have agreed at board level the uses in outline for these funds, which will be substantially deployed over the next 5 years. Income excluding the legacy grew by 3% from 2022.

Donation income (excluding legacies) was £6.1 million, a decline from £9.7 million in 2022. Grant income remained stable at £147.5 million (£147.3 million in 2022) as donors continue to recognise the importance of the work we do. The profile of grant income is trending away from large multi-year multi-country agreements contracts. The impact of this is taken account into our business planning and going concern assessment and will lead to greater spend on fundraising activities than in the past.

Contributions of donated supplies and equipment also remained stable at £18.1 million in 2023 from £18.0 million in 2022, indicating how essential the supply of granted family planning commodities (either directly from institutional donors such as UNFPA or through government allocations) are to MSI’s service provision.

Earned service income increased by 7% in the year, from £143.5 million to £153.5 million excluding the impact of foreign exchange fluctuations, this growth is over 10% at constant exchange rates. The growth in service income is a testament to MSI’s focus on growing earned income in our clinics and social marketing channels as donor funds reduce, to ensure the sustainability of our services. A regional split of income can be found on page 31.

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Expenditure and surplus

In 2023 MSI spent 94% (2022 95%) of total expenditure on charitable activities, and 5% (2022 5%) on support costs. Cost of raising funds were 0.6% (2022 0.4%) of total expenditure.

Total expenditure increased by 4% to £313.8 million from £302.1 million. Growth in expenditure, excluding realised foreign exchange losses of £0.14million (2022: £4.4 million gain), is in slightly ahead of income at 2% (excluding foreign exchange fluctuations this is closer to 9% at constant exchange rates).

MSI recorded a gain of £1.6 million (2022

– loss of £1.5 million) on our investment portfolio reflecting a turnaround from the adverse macroeconomic market conditions in previous year. The portfolio has for many years been invested almost wholly in ESG compliant assets.

The substantial increase in the group operating surplus to £102.1 million (from the prior year surplus of £18.9 million) is driven predominantly by the generous legacy of £81.9 million received and receivable, and which is recognised in full as income in 2023.

Net funds increased by £94.8 million (2022: £20.6 million). This lifted total reserves to £245.6 million.

The chart below shows the percentage spend by channel and demonstrates the diversity of service delivery models that MSI uses to reach clients and achieve impact.

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Couple years of protection or CYPs is one of our key metrics, quantifying the impact of the services that we provide. 76% of CYPs in 2023 were generated in Africa as that is where the majority of our high-impact donor funded programmes are based.

We continue to innovate to improve service efficiency and effectiveness, working closely with local Ministries of Health in all countries in strengthening the quality and sustainability of public SRH services, as well as MSI delivered services.

Cash and short-term deposits

Cash and short-term deposits increased in 2023 by £50.4 million to £216.7 million predominantly driven by the generous legacy (of the £81.9 million, £64.9 million was received during the year in cash). In addition, a large proportion of MSI funds are cash received in advance for donor projects and obligated against specific activities.

Of the total cash balance, £143.2 million is restricted. Restricted cash relates to the balances held in group entities where the funds have been generated locally and the future used is restricted to that location, along with cash received from donors which will be expended in line with the contractual and geographical conditions imposed by the donor. The unrestricted cash held in the UK parent charity at the end of the year was £59.9 million (2022 54.0 million). An analysis of total cash balances by region is shown in the table below:

----- Start of picture text -----
Cash and Short-term Deposits by Region 2023 2022
£m £m
Region
Africa 7.5 6.6
Asia 8.5 9.1
Pacific Asia including Australia 7.4 10.5
Rest of the World 7.3 4.8
UK, including restricted funds 186.0 135.3
Total Group 216.7 166.3
----- End of picture text -----

The “free cash” metric – ie cash and near cash assets held in the UK and without restriction - is carefully monitored and managed monthly, with £17.5 million of the balance held in the external investment fund, comprising assets that can be readily realised. With uncertain times ahead and institutional donors making tough decisions about their own funding priorities, a strong reserves position is essential. Central cash reserves will continue to be carefully managed to ensure the sustainability of the group, whilst retaining as much operational capacity as is prudently possible.

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Reserves

The term ‘reserves’ is used throughout the Group’s annual report and accounts meaning the technical definition of restricted and unrestricted reserves (including designated funds), driven by charity accounting standards. However, in setting the group’s Reserves Policy, MSI places utmost importance on liquid reserves that are readily accessible. And thus in practice the group’s general reserve is equal to its free cash.

MSI holds reserves to ensure the organisation can continue to deliver the mission in times of substantial income fluctuations and where expenditure on charitable activities cannot or should not be scaled back in the short to medium term (for instance if there is a short-term gap in donor funding in a service area). At the same time, the reserves policy is designed to ensure that income is not retained in reserves for longer than necessary.

The Trustees review the reserves policy annually through the Finance Committee and consider the Group’s reserves requirements from both a long- and short-term perspective. The 2030 strategy set a target general reserves / free cash level of £45 million with £20 million to be held in accessible assets in an investment fund by the end of 2030. The target was set taking account of the scale of the group’s operations, the likely financial impact of the strategic risks facing the group, and monthly operating costs of approximately £24 million.

Our 2023 closing general reserves (which is equal to our “free cash” – ie cash and near cash assets held in the UK and without restriction) were £59.9 million which is ahead of our target due to the strong surplus position during the year and continuing focus on sustainability of our social marketing and self-sustaining programmes.

In assessing the adequacy of the Group’s reserves, Trustees take a prudent view, based on the likely timescale to realise assets, or secure borrowings against those assets and thereby generate liquid funds. The Trustees also monitor other liquid assets and the potential to procure medium term secured financing against the group’s tangible fixed assets. At 31 December 2023, MSI held general free reserves of £59.9 million (2022: £54.0 million), the increase is linked to the ongoing focus on the sustainability of our operating models. This amount excludes designated reserves and in particular the new Ballard Legacy Fund of £81.9 million.

At 31 December 2023, the Group accounts show the following unrestricted reserves:

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This gives total unrestricted reserves of £200.2 million (2022: £102.8 million). MSI’s unrestricted funds represent the cumulative surpluses from the group’s worldwide operations, and have been substantially increased in 2023 by the generous Ballard legacy. The Trustees oversee the use of reserves, including surpluses from commercial operations, to support family planning and sexual and reproductive health services around the world. The reader of the accounts should note that the key metric is the free cash of £59.9 million representing approximately 10 week’s expenditure.

MSI held restricted funds at 31 December 2023 of £45.3 million (2022: £47.9 million). These restricted funds are from two sources; income received from donors to directly support charitable activities, and net assets held in overseas programmes which are restricted for use within the country where the surplus arose.

Going Concern

In order for the group’s accounts to be prepared on the going concern basis, it is necessary to demonstrate that the group has cash reserves to meet its liabilities as they fall due in the foreseeable future. As noted above, MSI’s management and trustees recognise the crucial importance of liquidity and cash stewardship, especially in times of uncertainty. The group maintains medium term cash flow forecasts, stretching out over 18 months from the balance sheet date. These forecasts are prepared under a range of scenarios, starting with the annual business plan and adjusting downwards for known factors and allowing for contingencies to cover additional unspecified risk. We then compare this forecast UK cash position (total cash and free cash) to the available banking facilities.

Our forecasting considers key risks including the impact of the downward global economic trend which may affect the funding ability of our institutional donors meaning our donor pipeline is trending away from multi-year multi country awards towards smaller annual contracts from a wider body of donors; the potential for reduced funding by UNFPA, the major global donor of family planning commodities; and risks around working capital and bad debt associated with the expansion of commercial channels.

Financial forecast models have been developed up to the end of 2025, considering differing scenarios, confirmed sources of income, group-level potential risks, and the impact of mitigating actions.

In our donor funded channels our modelling focuses on the risk of securing grant income. Note that in this channel, our operating models are skewed towards variable costs, with staff engaged on time-bound contracts linked to the relevant grant. The key challenge is to ensure that we look ahead and adapt our spend to the funds available and in this we have a strong track record, our ability to control cost and manage project closures at pace enables us to flex our cost base if needed.

In our base case scenario, 2024 grant income is currently projected to be ahead of our business plan (this revenue is underpinned by signed contracts and winning project bids). The 2025 grant income base case scenario is built on an assumption that 88% of 2024 funding can be achieved in with a down-side coverage of 77% (based on virtually certain contract awards). There is a continued risk of uncertainty in the supply of donated commodities, and this has also been included in our down-side scenarios. We have recognised potential liabilities associated with contracts that may be ending and allocated to donors as appropriate. We will continue our robust performance and cash monitoring strategy whilst the present uncertainty over funding sources remains. We are grateful for the firm support that has already been committed from our donor community.

Growth targets in our commercial channels, particularly social marketing, will increase the need for working capital. To mitigate this there is a continued focus on service income to cost ratios, along with pursuing service diversification and closing our lower performing centres

The board has agreed a 5-year spending plan for the substantial majority of the generous Ballard legacy, of which £64.9 million was received in cash in 2023. Accordingly, this legacy is treated as a separate designated reserve, and

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has been excluded from our free cash for modelling purposes. Working capital projections show a potential downside risk of £7.1 million, but we remain cash positive throughout the 18-month modelling period. Additional standby working capital facilities of £10 million are available but have not been included in the projections and provide additional headroom if necessary.

The Trustees have reviewed these scenarios, the working capital available to the group and the principal financial risks facing the organisation. After careful consideration, and discussion with the Executive Team, the Trustees consider there is reasonable certainty that both the Company and the Group have sufficient resources to continue operating for the foreseeable future and therefore the financial statements have been prepared on a going concern basis.

Investments

MSI holds an independently managed investment fund, almost all of which can be liquidated at short notice, and which is included within our “free cash” calculation. This forms part of the group’s liquid reserve. The MSI board has defined a set of investment parameters - essentially that MSI’s fund should comply with ESG (Environmental, Social, and Governance) principles. The completion of the switch from MSI’s historical portfolio into ESG compliant assets is substantially complete but this will continue in 2024 as suitable products become available.

The intention is to increase the value of the managed investment fund to £20.0 million, held in accessible assets. Our investment policy is:

At the end of the financial year, the Charity held £17.5 million in the external investment fund. This was an increase of £1.8 million. MSI’s portfolio is benchmarked against two funds, and the 2023 performance was ahead of both the benchmarked funds.

MSI Reproductive Choices' external investment fund manager is GAM Investment, and performance is reviewed halfyearly by the executive management, while the Finance Committee scrutinises the portfolio mix and performance at least three times a year.

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Statement of Trustees’ responsibilities

The Trustees (who are also directors of MSI Reproductive Choices for the purposes of company law) are responsible for preparing the Trustees’ Report (including the Strategic Report) and the financial statements in accordance with applicable law and regulation. Company law requires the Trustees to prepare financial statements for each financial year. Under that law the Trustees have prepared the financial statements in accordance with United Kingdom Accounting Standards, comprising FRS 102 “The Financial Reporting Standard applicable in the UK and Republic of Ireland”, and applicable law (United Kingdom Generally Accepted Accounting Practice). Under company law the Trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of the affairs of the charitable company and the group and of the incoming resources and application of resources, including the income and expenditure, of the charitable group for that period. In preparing these financial statements, the Trustees are required to:

The Trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the charitable company’s transactions and disclose with reasonable accuracy at any time the financial position of the charitable company and the group and enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charitable company and the group and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

The Trustees are responsible for the maintenance and integrity of the charitable company’s website. Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.

In so far as the Trustees are aware, there is no relevant audit information of which the company’s auditors are unaware; and they have taken all the steps that they ought to have taken as Trustees to make themselves aware of any relevant audit information and to establish that the company’s auditors are aware of that information.

This report of the Trustees, under the Charities Act 2011 and the Companies Act 2006, was approved by the Board of Trustees on 24th May 2023, including approving in their capacity as company Directors the Strategic Report contained therein, and is signed as authorised on its behalf by:

Name: Frank Braeken, Trustee and Chair Date: 17 June 2024

57

Independent auditors’ report to the members of MSI Reproductive Choices

Report on the audit of the financial statements

Opinion

In our opinion, MSI Reproductive Choices’ group financial statements and parent charitable company financial statements (the “financial statements”):

We have audited the financial statements, included within the Annual Report and Financial Statements (the “Annual Report”), which comprise: Group and Company balance sheets as at 31 December 2023; the Consolidated statement of financial activities (incorporating the income and expenditure account) and the Consolidated cash flow statement for the year then ended; and the notes to the financial statements, which include a description of significant accounting policies.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (“ISAs (UK)”) and applicable law. Our responsibilities under ISAs (UK) are further described in the Auditors’ responsibilities for the audit of the financial statements section of our report. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Independence

We remained independent of the group in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, which includes the FRC’s Ethical Standard and we have fulfilled our other ethical responsibilities in accordance with these requirements.

Conclusions relating to going concern

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the group’s and the parent charitable company’s ability to continue as a going concern for a period of at least twelve months from the date on which the financial statements are authorised for issue.

In auditing the financial statements, we have concluded that the trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate.

However, because not all future events or conditions can be predicted, this conclusion is not a guarantee as to the group’s and the parent charitable company’s ability to continue as a going concern.

Our responsibilities and the responsibilities of the trustees with respect to going concern are described in the relevant sections of this report.

Reporting on other information

The other information comprises all of the information in the Annual Report other than the financial statements and our auditors’ report thereon. The trustees are responsible for the other information. Our opinion on the financial

58

statements does not cover the other information and, accordingly, we do not express an audit opinion or, except to the extent otherwise explicitly stated in this report, any form of assurance thereon.

In connection with our audit of the financial statements, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the audit, or otherwise appears to be materially misstated. If we identify an apparent material inconsistency or material misstatement, we are required to perform procedures to conclude whether there is a material misstatement of the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report based on these responsibilities.

With respect to the Strategic Report and Trustees' Report, we also considered whether the disclosures required by the UK Companies Act 2006 and Charities Act 2011 have been included.

Based on our work undertaken in the course of the audit, the Companies Act 2006 requires us also to report certain opinions and matters as described below.

Strategic Report and Trustees’ Report

In our opinion, based on the work undertaken in the course of the audit the information given in the Strategic Report and the Trustees’ Report for the period ended 31 December 2023 is consistent with the financial statements and has been prepared in accordance with applicable legal requirements.

In light of the knowledge and understanding of the group and parent charitable company and their environment obtained in the course of the audit, we did not identify any material misstatements in the Strategic Report and the Trustees’ Report.

Responsibilities for the financial statements and the audit

Responsibilities of the trustees for the financial statements

As explained more fully in the Statement of Trustees’ Responsibilities, the trustees (who are also the directors of the charitable company for the purposes of company law) are responsible for the preparation of the financial statements in accordance with the applicable framework and for being satisfied that they give a true and fair view. The trustees are also responsible for such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

In preparing the financial statements, the trustees are responsible for assessing the group’s and parent charitable company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the trustees either intend to liquidate the group or the parent charitable company or to cease operations, or have no realistic alternative but to do so.

Auditors’ responsibilities for the audit of the financial statements

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditors’ report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect material misstatements in respect of irregularities, including fraud. The extent to which our procedures are capable of detecting irregularities, including fraud, is detailed below.

59

Based on our understanding of the group and its industry, we identified that the principal risks of non-compliance with laws and regulations related to the Charities Act 2011, and we considered the extent to which non-compliance might have a material effect on the financial statements. We also considered those laws and regulations that have a direct impact on the financial statements such as the Companies Act 2006. We evaluated management’s incentives and opportunities for fraudulent manipulation of the financial statements (including the risk of override of controls), and determined that the principal risks were related and determined that the principal risks were related to the posting of inappropriate journal entries and management bias in accounting judgements and estimates. Audit procedures performed by the engagement team included:

There are inherent limitations in the audit procedures described above. We are less likely to become aware of instances of non-compliance with laws and regulations that are not closely related to events and transactions reflected in financial statements. Also, the risk of not detecting a material misstatement due to fraud is higher than the risk of not detecting one resulting from error, as fraud may involve deliberate concealment by, for example, forgery or intentional misrepresentations or through collusion.

A further description of our responsibilities for the audit of the financial statements is located on the FRC’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditors’ report.

Use of this report

This report, including the opinions, has been prepared for and only for the for the parent charitable company’s members as a body in accordance with Chapter 3 of Part 16 of the Companies Act 2006 and for no other purpose. We do not, in giving these opinions, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing.

60

Other required reporting

Companies Act 2006 exception reporting

Under the Companies Act 2006 we are required to report to you if, in our opinion:

We have no exceptions to report arising from this responsibility.

Daniel Chan (Senior Statutory Auditor) for and on behalf of PricewaterhouseCoopers LLP Chartered Accountants and Statutory Auditors London 17 June 2024

61

Consolidated statement of financial activities (incorporating the income and expenditure account) for the year ended 31 December 2023

Note
INCOME FROM
Donations and legacies
3a
Charitable activities
3b
Investments
3c
Other income
3d
Total income
EXPENDITURE ON
Raising funds
4
Charitable activities
4
Total expenditure
Net gains / (losses) on investments
10b
Net income
Transfers between funds
15/17
Other recognised gains / (losses)
Unrealised exchange gains / (losses)
Net movement in funds
7
Fund balances brought forward
15/16
Fund balances carried forward
15/16		 Unrestricted
Restricted
Total
Total
funds
funds
2023
2022
£'000
£'000
£'000
£'000
88,193
-
88,193
9,735
173,402
145,746
319,148
308,799
5,256
-
5,256
1,811
1,758
-
1,758
2,159
268,609
145,746
414,355
322,504
(2,065)
-
(2,065)
(1,415)
(166,028)
(145,746)
(311,774)
(300,660)
(168,093)
(145,746)
(313,839)
(302,075)
1,602
-
1,602
(1,504)
102,118
-
102,118
18,925
2,571
(2,571)
-
-
(7,279)
-
(7,279)
1,716
97,410
(2,571)
94,839
20,641
102,826
47,902
150,728
130,087
200,236
45,331
245,567
150,728

All amounts relate to continuing activities. All gains and losses recognised in the year are included in the Statement of Financial Activities. There is no material difference between the net income for the year and net movement in funds stated above and their historical cost equivalents.

The notes on pages 66 to 84 form part of these financial statements.

62

Group and Company balance sheets as at 31 December 2023

Note
Fixed assets
Intangible assets
8
Tangible assets
9
Investments
10
Total fixed assets
Current assets
Stock
Receivables
11
Short-term deposits
Cash at bank and in hand
Total current assets
Payables: amounts falling due within one year
12a
Net current assets
Total assets less current liabilities
Provisions
12b
Loans: amounts falling due after more than one year
13
Net assets
The funds of the charity:
Unrestricted income funds
General reserve
16
Designated funds - fixed asset reserve
16
Designated funds - programme reserve
16
Designated funds - legacy reserve
16
Total unrestricted income funds
16
Restricted income funds
15
Total charity funds		 Total
Total
2023
2022
£'000
£'000
(Restated)
4,697
3,724

26,977
27,652

17,549
15,712
49,223
47,088
22,039
21,645
64,532
49,881
147,502
93,970
69,149
72,291
303,222
237,787
(97,136)
(123,905)
206,086
113,882
255,309
160,970
(9,456)
(10,165)
(286)
(77)
245,567
150,728
59,871
54,001
18,490
15,559
40,023
33,266
81,852
-
200,236
102,826
45,331
47,902
245,567
150,728
Group*		 Total
Total
2023
2022
£'000
£'000
(Restated)
4,424
3,394

15,694
14,079

18,519
16,813
38,637
34,286
10,595
9,214
46,485
36,328
139,546
82,286
51,678
55,216
248,304
183,044
(71,185)
(90,882)
177,119
92,162
215,756
126,448
(4,619)
(3,932)
(53)
(56)
211,084
122,460
59,871
53,998
17,605
14,601
36,023
38,122
81,852
-
195,351
106,721
15,733
15,739
211,084
122,460
Company*

-

MSI uses the exemption conferred by section 408 of the Companies Act in not preparing a separate Income and Expenditure Account for the Company only. The net income for the Company for the year to 31 December 2023 was £93.9m (2022: net income £25.4m).

The notes on pages 66 to 84 form part of these financial statements.

The financial statements on pages 62-84 were approved by the Board of Trustees on 17 June 2024 and signed on its behalf by

Frank Braeken Chair

Company number 1102208 (registered in England and Wales) Registered charity number 265543 (registered in England and Wales)

63

Consolidated cash flow statement for the year ended 31 December 2023

2023 2022
£'000 £'000 £'000 £'000
Net cash provided by operating activities 52,852 12,720
Cash flows from investing activities
Dividends, interest and rents from investments 5,256 1,811
Proceeds from sale of fixed assets 434 1,373
Proceeds from sale of fixed asset investments 878 4,705
Purchase of tangible & Intangible fixed assets (7,263) (5,652)
Purchase of fixed asset investments (1,640) (4,394)
Net cash used in investing activities (2,335) (2,157)
Cash flows from financing activities
(Decrease) / increase in bank and unsecured loans (336) (66)
Increase / (decrease) in long term loans 209 (340)
Net cash generated from / (used in) financing activities (127) (406)
Net increase in cash and cash equivalents 50,390 10,157
Cash and cash equivalents at 1 January 166,261 156,104
Cash and cash equivalents at 31 December 216,651 166,261
Cash and cash equivalents consists of:
Cash at bank and in hand 69,149 72,291
Short-term deposits 147,502 93,970
Total cash and cash equivalents 216,651 166,261

Notes

a) Reconciliation of net income to net cash inflow from operating activities

Net income for the year
Investment income
(Gain) / loss on investments
Amortisation and impairment charge
Depreciation charge
(Gain) / loss on disposal of tangible fixed assets
Listed investments net movement in cash balances
(Increase) / decrease in stocks
(Increase) / decrease in receivables
Increase / (decrease) in payables and provisions
Exchange movements
Net cash inflow from operating activities
b) Reconciliation of movement in net funds
Total cash and cash equivalents
Bank loans falling due within one year
Other loans falling due after more than one year
Cash and cash equivalents less borrowings
Net funds at 1 January
Increase in cash
Cash inflow from financing
Net funds at 31 December		 2023
£'000
102,118
(5,256)
(1,602)
533
3,977
(443)
521
(394)
(14,651)
(27,142)
(4,809)
52,852
216,651
(1,202)
(286)
215,163
164,646
50,390
127
215,163		 2022
£'000
18,925
(1,811)
1,504
75
4,689
(521)
(439)
25
(10,803)
(487)
1,563
12,720
166,261
(1,538)
(77)
164,646
154,083
10,157
406
164,646

The notes on pages 66 to 84 form part of these financial statements.

64

Consolidated cash flow statement for the year ended 31 December 2023

c) Analysis of changes in net debt

Cash and cash equivalents
Cash at bank and in hand
Short-term deposits
Cash and cash equivalents
Borrowings
Bank loans falling due within one year
Other loans falling due after more than one year
Cash and cash equivalents less borrowings		 At 1 January
2023
Cash flows
At 31
December
2023
£'000
£'000
£'000
72,291
(3,142)
69,149
93,970
53,532
147,502
166,261
50,390
216,651
(1,538)
336
(1,202)
(77)
(209)
(286)
164,646
50,517
215,163

65

Notes to the financial statements for the year ended 31 December 2023

1 Accounting policies

The financial statements have been prepared in in accordance with the Statement of Recommended Practice: ‘Accounting and Reporting by Charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102)’ (SORP) and the ‘Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland’ (FRS 102). They also comply with the reporting requirements of the Companies Act 2006 and the Charities Act 2011. MSI Reproductive Choices constitutes a public benefit entity as defined by FRS 102. The principal accounting policies, which have been applied consistently in the year across the group, are set out below.

a) Basis of preparation and assessment of going concern

These financial statements are prepared on a going concern basis, under the historical cost convention, as modified by the revaluation of investments to market values. The financial statements have been prepared in accordance with the Statement of Recommended Practice: 'Accounting and Reporting by Charities preparing their financial statements in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102)' issued October 2019 and the 'Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland' (FRS 102) and the Charities Act 2011. The preparation of financial statements in conformity with FRS 102 requires the use of certain critical accounting estimates. It also requires management to exercise its judgement in the process of applying the charity’s accounting policies. The areas involving a higher degree of judgement or complexity, or areas where assumptions and estimates are significant to the financial statements are discussed in note (q) to these policies.

The positive financial performance in 2023 is a testament to MSI Reproductive Choices' strong financial stewardship and continued donor support. To assess the appropriateness of adopting the going concern basis, cashflow forecasts were prepared to the end of December 2025. Different downside scenarios of increasing severity were modelled considering key risks including the impact of the downward global economic trend which may impact affect the funding ability of our institutional donors meaning our donor pipeline is trending away from multiyear multi country awards towards smaller annual contracts from a wider body of donors; the potential for reduced funding by UNFPA, the major global donor of family planning commodities; and risks around working capital and bad debt associated with the expansion of commercial channels. These working capital projections show a potential downside risk of £7.1 million, but we remain cash positive throughout the 18-month modelling period. Additional standby working capital facilities of £10 million are available but have not been included in projections and provide additional headroom if necessary.

The Trustees have reviewed these scenarios, the working capital available to the group and the principal financial risks facing the organisation and after careful consideration consider that there is reasonable certainty that the Company and the Group have sufficient resources to continue to operate for the foreseeable future and they therefore conclude that the financial statements should be prepared on a going concern basis.

No separate Statement of Financial Activities or income and expenditure account has been presented for the company alone as permitted by section 408 of the Companies Act 2006. The company had total income in the year of £248.3 million (2022: £149.7 million) and total expenditure of £156.6 million (2022 £126.8 million) giving a net gain for the year of £91.0 million (2022: net gain of £22.9 million). The net movement in funds, after investment gains/losses and other gains/losses was a gain of £88.6 million (2022: gain of £9.9 million).

b) Company status

MSI Reproductive Choices is registered in England and Wales as a company limited by guarantee and a charity. The Trustees are named on page 2. In the event of the company being wound up, the liability in respect of the guarantee is limited to £1 per Member.

c) Basis of consolidation

The group financial statements combine the results of the parent undertaking, MSI Reproductive Choices, and its subsidiary undertakings after eliminating inter-group transactions. MSI Reproductive Choices refers to MSI Reproductive Choices' UK operations and international branch offices. The subsidiary undertakings are detailed in note 21.

A subsidiary is an entity controlled by the group. Control is the power to govern the financial and operating policies of an entity so as to obtain benefits from its activities. Where the group owns less than 50% of the voting powers of an entity but controls the financial and operating policies of the entity it accounts for that entity as a subsidiary.

Where a subsidiary has different accounting policies to the group, adjustments are made on consolidation to apply the group’s accounting policies when preparing the consolidated financial statements. A few subsidiaries have a different financial year-end, in Nepal, India and Pakistan. As all programmes report on a global finance system, following MSI's group accounting policies, these subsidiaries are consolidated in the same manner as those with co-terminous year-ends.

Any subsidiary undertakings sold or acquired during the year are included up to, or from, the dates of change of control. Where control of a subsidiary ceases, the gain or loss is recognised in the Consolidated Statement of Financial Activities. The cumulative amounts of any exchange differences on translation, recognised in equity, are not included in the gain or loss on disposal and are transferred to retained earnings.

All intra-group transactions, balances, income and expenses are eliminated on consolidation. Adjustments are made to eliminate the profit or loss arising on transactions with associates to the extent of the group’s interest in the entity.

66

Notes to the financial statements for the year ended 31 December 2023

1 Accounting policies (continued)

d) Foreign currency

(i) Functional and presentation currency

The group financial statements are presented in pound sterling and rounded to thousands. The company’s functional and presentation currency is the UK pound sterling.

(ii) Transactions and balances

Foreign currency balances have been translated at the rate of exchange ruling at the balance sheet date. Income and expenditure transactions incurred in foreign currencies have been translated during the course of the year using the opening exchange rate for the month of the transaction to ensure consistency of reporting under all the group entities.

The policy of using the opening exchange rate for translation of foreign currency transactions does not have any significant nor material differences in comparison to the use of spot rate.

Foreign exchange gains and losses resulting from the settlement of transactions and related to borrowings and cash and cash equivalents are included within expenditure on charitable activities in the Consolidated Statement of Financial Activities (SOFA).

(iii) Translation

The assets and liabilities of overseas undertakings, including goodwill and fair value adjustments arising on acquisition, are translated at the exchange rates ruling at the year end.

Foreign exchange gains and losses resulting from the translation into sterling at the rates of exchange ruling at the balance sheet date from non monetary assets and liabilities are presented in the Consolidated SOFA within unrealised exchange gains/losses.

e) Income

Donations

Donations are included in the Consolidated SOFA when there is entitlement to the income, receipt is probable and the amount can be measured reliably.

Legacies

Pecuniary legacies are recognised when the legacy has been received, or before if there is sufficient evidence to provide the certainty that the legacy will be received. Residual legacies are recognised as receivable once probate has been granted provided that there is sufficient information to enable valuation of MSI Reproductive Choices' entitlement.

Charitable activities

Income from charitable activities comprises income from the provision of services to clients for sexual and reproductive healthcare, grants for the delivery of sexual & reproductive health services and consultancy services and is recognised as follows:

(i) Grant income

Income from external grants is recognised in the Consolidated SOFA as soon as it is receivable unless donor conditions related to performance and specific deliverables apply. These grants are accounted for as the charity earns the right to consideration through performance. Where income is received in advance it is classified as deferred and included in creditors until conditions of entitlement are met, at which point it is released. Where entitlement occurs before the income is received the income is accrued and included in debtors.

(ii) Granted supplies and equipment

Grants of goods in kind are included at fair value and are recognised in deferred income and stock when they are received from donors and in income and expenditure when they have been used. Granted goods include family planning commodities used in the provision of service. Grants of services in kind are included as both income and expenditure in the Consolidated SOFA when received or performed.

(iii) Service income

Service income comprises income received and receivable from clients for sexual and reproductive health services and products provided during the period. Service income is recognised when the service is provided or the product is sold.

Investments

Investment income comprises interest, dividends, distributions and rents and is recognised in the period in which it becomes receivable.

Other income

All other items of income are recognised within the other income category. Income is recognised when there is entitlement to the income, receipt is probable and the amount can be measured reliably.

67

Notes to the financial statements for the year ended 31 December 2023

1 Accounting policies (continued)

f) Expenditure All expenditure is accounted for on an accruals basis. Direct costs incurred by the group are allocated across the various types of expenditure as follows:

Raising funds comprises costs relating to the raising of grant income.

Charitable activities comprise costs relating directly to the delivery of family planning and other sexual and reproductive health services and related advocacy and awareness raising and capacity building. Costs include delivery of clinical and outreach services throughout the global partnership, such as service providers' salaries, costs of drugs and equipment, materials, premises, training and travel.

Governance costs represent the costs of compliance with statutory requirements and include the costs of audits and costs incurred on behalf of trustees relating to the governance of the organisations, such as travel and meeting attendance.

g) Employee benefits

The group provides a range of benefits to employees, including annual bonus arrangements, paid holiday arrangements and defined contribution pension plans.

(i) Short term benefits

Short term benefits, including holiday pay and other similar non-monetary benefits, are recognised as an expense in the period in which the service is received.

(ii) Defined contribution pension plans

The Group operates a number of country-specific defined contribution plans for its employees. A defined contribution plan is a pension plan under which the group pays fixed contributions into a separate entity. Once the contributions have been paid the group has no further payment obligations. The contributions are recognised as an expense when they are due. Amounts not paid are shown in accruals in the balance sheet. The assets of the plan are held separately from the group in independently administered funds.

(iii) Annual bonus plan

The group operates an annual bonus plan for employees. An expense is recognised in the Consolidated SOFA account when the group has a legal or constructive obligation to make payments under the plans as a result of past events and a reliable estimate of the obligation can be made.

h) Operating leases

Rentals applicable to operating leases where substantially all of the benefits and risks of ownership remain with the lessor are charged to the Consolidated SOFA as incurred.

i) Grants paid

Grants payable to third parties are sub-awards to partners in relation grants received by MSI in order to deliver specific activities undertaken as per the contractual obligation. These are charged to the Consolidated SOFA when an obligation exists.

j) Intangible fixed assets

Registration and license fees are capitalised at cost and are amortised over the period to which the rights relate. IT software 25% to 50% per annum

k) Tangible fixed assets and depreciation

Tangible fixed assets are stated at cost less accumulated depreciation. Depreciation has been provided on completed assets at rates calculated to write off the cost of fixed assets less their estimated residual value, on a straight line basis over their useful economic lives. Freehold land is not depreciated.

Freehold properties 40 years Short leasehold properties Over period of the lease Office equipment 20% to 50% per annum Medical equipment 20% to 50% per annum IT hardware 25% to 50% per annum Motor vehicles 25% per annum

MSI Reproductive Choices capitalises fixed assets in the UK above a value of £5,000. For MSI Reproductive Choices' branches and subsidiaries overseas, the capitalisation level may be lower and varies by entity. Assets under development are not depreciated until they have been brought into use.

The carrying value of fixed assets is reviewed for impairment if events or changes in circumstances suggest that their carrying amount may not be recoverable.

l) Fixed asset investments

Listed investments and investment properties are stated at the market value at the balance sheet date. Investments in subsidiaries are stated at cost less any provision to impairment.

Revaluation gains or losses arising during the year are included in the Consolidated SOFA. Impairments are charged to expenditure on charitable activities. Investment income is the amount receivable by the group in the year.

68

Notes to the financial statements for the year ended 31 December 2023

1 Accounting policies (continued)

m) Stock

Stock represents medical equipment and supplies purchased or donated to fulfil MSI Reproductive Choices charitable objectives and is reported at the lower of cost and net realisable value, with damaged or obsolete stock written off. For stock that is provided as part of a charitable activity either free or at a subsidised cost, the net realisable value is based on the service potential provided by the items of stock.

n) Cash and Cash Equivalents

Cash and cash equivalents include cash in hand, deposits held at call with banks, other short-term highly liquid investments with original maturities of three months or less.

o) Provisions

Provisions for future liabilities are recognised when the group has a legal or constructive financial obligation that can be reliably estimated and for which it is more probable than not that payment will be made.

p) Reserves and fund accounting

General reserves are unrestricted funds available to be used at the discretion of the Board of Trustees for the furtherance of the charitable objectives of the group and which have not been designated for any other purpose. Designated funds comprise unrestricted funds that have been set aside by the Board of Trustees for particular purposes. The aim of each designated fund is set out in note 16.

Restricted funds are funds which have to be used in accordance with specific restrictions imposed by a donor and funds restricted by constitution which represent the accumulated surpluses from those group entities where the funds have been generated locally and the future use is restricted to that location. Restricted funds are set out in note 15.

Overhead costs relating to restricted donor funds are classed as unrestricted expenditure and are not directly attributed to restricted funds at source. The fees earned on restricted donor funds in relation to these overhead/support costs are directly attributed to restricted income and at the year end a reallocation is made between restricted and unrestricted funds in relation to these fees.

q) Key accounting estimates and assumptions

The group makes estimates and assumptions concerning the future. Those judgements and estimates that could have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year include the following:

Areas of judgement

Grant income recognition. The majority of grant income is recognised in line with expenditure against the grant contract, as this is deemed the most accurate proxy for the performance conditions within the grant being met. Where such grants are received in advance of delivering the goods or services required, the income is not recognised. Instead it is recognised as a liability (deferred income) until performance can be measured (based on spend). Income from grants that contain conditions relating to performance or payments by results is recognised as performance occurs.

Restricted funds. MSI Reproductive Choices operates in overseas territories where the local government expects surpluses achieved on non-service activities to be used in-country and not passed back to the parent company. The net assets of these programmes are classed as 'restricted by constitution' and included within the restricted funds balance.

Consolidation. As described in accounting policy 1c, where the group owns less than 50% of the voting powers of an entity but controls the financial and operating policies of the entity it accounts for that entity as a subsidiary.

Hyperinflation. The group assesses the impact of hyperinflation n line with IAS 29 'Financial Reporting in Hyperinflationary Economies'. Re-statement is only undertaken if there is a material impact to the financial statements.

69

Notes to the financial statements for the year ended 31 December 2023

1 Accounting policies (continued)

Areas of estimate

Provisions such as closed grant provision and litigation provision involve assumptions, estimation techniques and best information available at the balance sheet date. These are based on the experience and knowledge of management and evidence from past experience.

r) Financial instruments

The group has chosen to adopt Sections 11 and 12 of FRS 102 in respect of financial instruments.

(i) Financial assets

Basic financial assets, including trade and other debtors, cash and bank balances and investments in commercial paper, are initially recognised at transaction price.

Other financial assets, including investments in equity instruments which are not subsidiaries, associates or joint ventures, are initially measured at fair value, which is normally the transaction price. Such assets are subsequently carried at fair value and the changes in fair value are recognised in profit or loss, except that investments in equity instruments that are not publicly traded and whose fair values cannot be measured reliably are measured at cost less impairment.

Financial assets are derecognised when (a) the contractual rights to the cash flows from the asset expire or are settled, or (b) substantially all the risks and rewards of the ownership of the asset are transferred to another party or (c) despite having retained some significant risks and rewards of ownership, control of the asset has been transferred to another party who has the practical ability to unilaterally sell the asset to an unrelated third party without imposing additional restrictions.

(ii) Financial liabilities

Basic financial liabilities, including trade and other creditors, bank loans, loans from fellow group companies and preference shares that are classified as debt, are initially recognised at transaction price, unless the arrangement constitutes a financing transaction, where the debt instrument is measured at the present value of the future receipts discounted at a market rate of interest. Debt instruments include loans from banks and other financial institutions. These are carried at amortised cost using the effective interest rate method.

Trade creditors are obligations to pay for goods or services that have been acquired in the ordinary course of business from suppliers. Accounts payable are classified as current liabilities if payment is due within one year or less. If not, they are presented as non-current liabilities. Included as non-current liabilities is a provision for staff terminal benefits which are due to employees in country programmes in accordance with statutory obligation of the country programmes.

70

Notes to the financial statements for the year ended 31 December 2023

INCOME FROM
Donations and legacies
Charitable activities
Investments
Other income
Total income
EXPENDITURE ON
Raising funds
Charitable activities
Total expenditure
Net gains on investments
Net income
Transfers between funds
Other recognised gains / (losses)
Unrealised exchange gains / (losses)
Net movement in funds
Fund balances brought forward at 1 January
Fund balances carried forward at 31
December		 Unrestricted
Restricted
Total
funds
funds
2023
£'000
£'000
£'000
88,193
-
88,193
173,402
145,746
319,148
5,256
-
5,256
1,758
-
1,758
268,609
145,746
414,355
(2,065)
-
(2,065)
(166,028)
(145,746)
(311,774)
(168,093)
(145,746)
(313,839)
1,602
-
1,602
102,118
-
102,118
2,571
(2,571)
-
(7,279)
-
(7,279)
97,410
(2,571)
94,839
102,826
47,902
150,728
200,236
45,331
245,567
2023		 Unrestricted
Restricted
Total
funds
funds
2022
£'000
£'000
£'000
9,735
-
9,735
165,040
143,759
308,799
1,660
151
1,811
2,159
-
2,159
178,594
143,910
322,504
(1,415)
-
(1,415)
(156,750)
(143,910)
(300,660)
(158,165)
(143,910)
(302,075)
(1,504)
-
(1,504)
18,925
-
18,925
(2,471)
2,471
-
1,716
-
1,716
18,170
2,471
20,641
84,656
45,431
130,087
102,826
47,902
150,728
2022

71

Notes to the financial statements for the year ended 31 December 2023

3
Income from
a)
Donations and legacies
Monetary donations
Legacies
Total Donations and legacies		 Unrestricted
Restricted
Total
Total
funds
funds
2023
2022
£'000
£'000
£'000
£'000
6,130
-
6,130
9,700
82,063
-
82,063
35
88,193
-
88,193
9,735

2023 legacies include a generous contribution of £81.9m from the Ballard Legacy Fund where the donor wanted to ensure access to choice was part of his legacy.

b)
Charitable activities
Grant income
Save the Children International
Norwegian Agency for Development Cooperation
Population Services International
Bergstrom
European Union
Foundation for a Just Society
Ministry of Foreign Affairs of Denmark
Finnish Ministry of Foreign Affairs
Swedish International Development Agency
International Planned Parenthood Federation
ABT Associates PTE Ltd (JTA)
Australian Dept for Foreign Affairs & Trade / AusAid
Lund Trust (via Charities Aid Foundation)
Netherlands Ministry of Foreign Affairs
Global Affairs Canada
United Nations
Kreditanstalt für Wiederaufbau
Foreign, Commonwealth & Development Office (FCDO)
Children's Investment Fund Foundation
Anonymous donors
Other
Reallocation of fees earned on restricted grants
Granted supplies and equipment
Service income
Sexual and reproductive healthcare services
Fees waived
Total income from charitable activities		 Unrestricted
Restricted
Total
Total
funds
funds
2023
2022
£'000
£'000
£'000
£'000
-
589
589
540
-
1,085
1,085
2,449
-
1,372
1,372
555
-
1,449
1,449
1,609
-
2,066
2,066
89
-
2,164
2,164
1,746
-
2,338
2,338
1,157
-
2,460
2,460
2,085
-
2,758
2,758
3,945
-
2,889
2,889
3,518
-
3,630
3,630
2,727
-
3,727
3,727
6,104
-
5,416
5,416
2,328
-
8,032
8,032
6,273
-
8,688
8,688
10,602
-
8,730
8,730
16,511
-
13,845
13,845
7,714
6,703
13,882
20,585
21,274
-
16,961
16,961
12,962
-
27,260
27,260
34,557
-
11,503
11,503
8,579
6,703
140,844
147,547
147,324
13,169
(13,169)
-
-
19,872
127,675
147,547
147,324
-
18,071
18,071
17,976
156,435
-
156,435
146,567
(2,905)
-
(2,905)
(3,068)
153,530
-
153,530
143,499
173,402
145,746
319,148
308,799

Grant income is recognised in accordance with the Charities SORP and as a result may differ from cash received; please see note 1e for further information. Where the purpose of the grant is narrower than the charitable objects of MSI Reproductive Choices, is restricted to a specific location, or deemed to be restricted by time constraints, the grant income is classified as restricted. The income earned on restricted donor funds to cover overhead and support costs ("fees") is directly attributed to restricted income, and at the year-end a reallocation is made from restricted to unrestricted funds to match the qualifying overhead costs incurred. Granted supplies and equipment include family planning commodities used in the provision of services.

A geographical split of this income is shown on page 31 of the Trustees' Report.

c)
Investments
Bank interest receivable
Distributions receivable
Rent receivable		 Unrestricted
Restricted
Total
Total
funds
funds
2023
2022
£'000
£'000
£'000
£'000
4,967
-
4,967
1,406
110
-
110
168
179
-
179
237
5,256
-
5,256
1,811

72

Notes to the financial statements for the year ended 31 December 2023

3 Income from (cont)

d)
Other income
Sundry other income		 Unrestricted
Restricted
Total
Unrestricted
Restricted
Total
funds
funds
2023
funds
funds
2022
£'000
£'000
£'000
£'000
£'000
£'000
1,758
-
1,758
2,159
-
2,159
1,758
-
1,758
2,159
-
2,159

Sundry other income consists of profit on disposal of fixed assets £0.2m (2022: £0.5m) and management fees of £0.2m (2022: £0.0m). The remaining balances vary in nature across the group.

4 Expenditure

a) Total expenditure

Raising funds
Charitable activities
Subtotal
Support costs reallocation
Total
Raising funds
Charitable activities
Subtotal
Support costs reallocation
Total		 Direct
Staff
Other
Support
Total
costs
costs (5)
costs
costs (4c)
2023
£'000
£'000
£'000
£'000
£'000
532
1,357
-
176
2,065
162,240
127,364
5,674
16,496
311,774
162,772
128,721
5,674
16,672
313,839
4,148
12,283
241
(16,672)
-
166,920
141,004
5,915
-
313,839
Direct
Staff costs
Other
Support
Total
costs
(note 5)
costs
costs (4c)
2022
£'000
£'000
£'000
£'000
£'000
(Restated)
386
919
-
110
1,415
156,660
127,348
2,315
14,337
300,660

157,046
128,267
2,315
14,447
302,075

3,573
11,505
(631)
(14,447)
-
160,619
139,772
1,684
-
302,075*

b) Direct costs of charitable activities

Direct expenditure on charitable activities includes subcontracts awarded to external partners of £7.7m (2022: £6.2m). Details are available from MSI Reproductive Choices, 1 Conway Street, London W1T 6LP.

c)
Support costs
Management and office services
Finance and information technology
Programme support
People and development
External relations
Governance costs
Total support costs		 2023
2022
£'000
£'000
(Restated)
2,112
1,777
5,846
5,194

2,795
2,454
1,105
1,089
3,312
2,692
1,502
1,241
16,672
14,447
*

Support costs represent the cost of MSI Reproductive Choices' London and regional support offices and are allocated by function. Costs relate to the costs of technical assistance to programmes and to the corporate functions of information technology, people and organisational development, and external relations. Also included are the costs of our critically important global clinical quality assurance, anti-fraud and bribery and safeguarding programmes. Support costs are apportioned to specific activities based on the weighting of each function as a percentage of total costs.

Governance costs include expenditure on internal and external audit, Trustee meetings and non-audit services. In 2023 the cost of the group audit was £211,722 (2022: £215,390) exclusive of VAT. In addition, fees for the audit of country programmes totalled £485,862 (2022: £590,000). Of these £65,322 relate to audits conducted by the group auditor (2022: £80,000)

Non-audit fees paid to the current auditors in the year were taxation advisory services £43,640 (2022: £3,000) and tax compliance services £8,100 (2022: £4,000) and other assurance services £4,000 (2022: £6,000).

73

Notes to the financial statements for the year ended 31 December 2023

5 Staff costs

Staff costs:
- Wages and salaries
- Social security costs
- Other pension costs
Sessional fees, agency costs and other staff costs
Total staff costs		 2023
2022
£'000
£'000
104,959
103,262
6,736
6,679
3,985
4,019
115,680
113,960
25,324
25,812
141,004
139,772

The charity operates a defined contribution pension scheme in the UK. The assets of the scheme are held separately from those of the charity in an independently administered fund managed by Standard Life Assurance Company until June 2021 and Aviva our pension providers from July 2021. In line with government legislation, MSI Reproductive Choices automatically enrols its UK staff into its defined contribution pension scheme where certain criteria are met and all our international staff based on local context and legislation.

No directors of the parent charity received emoluments during the year for their services as trustees (2022: none). Redundancy and termination payments totalled £432,013 in 2023 (2022: £344,804). Redundancy costs are recognised and accrued based on statutory requirements in some countries and when planned redundancy has been agreed and communicated.

6 Staff numbers

The average monthly number of staff analysed by function was:
- Raising funds
- Charitable activities
The numbers of employees whose emoluments were more than £60,000 were:
£60,001 - £70,000
£70,001 - £80,000
£80,001 - £90,000
£90,001 - £100,000
£100,001 - £110,000
£110,001 - £120,000
£120,001 - £130,000
£130,001 - £140,000
£140,001 - £150,000
£150,001 - £160,000
£160,001 - £170,000
£170,001 - £180,000
£190,001 - £200,000
£200,001 - £210,000
£210,001 - £220,000
£220,001 - £230,000
£240,001 - £250,000
£250,001 - £260,000
£270,001 - £280,000
£460,001 - £470,000		 2023
2022
Number
Number
10
9
8,820
8,984
8,830
8,993
2023
2022
Number
Number
64
58
40
27
20
14
12
10
8
8
11
6
6
6
5
3
2
3
1
2
1
2
3
-
-
1
-
1
1
2
2
-
-
-
1
-
2
1
1
1

Employee numbers disclosed above include staff from all entities in the group.

The remuneration of the highest paid employee was split between base salary of £244,940 (2022: £233,068) and performancebased bonus of £239,196 (2022: £233,068). The total paid to six key management personnel in 2023 was £1,663,117 (2022 Restated: £1,596,754: six persons).

Retirement benefits were accrued under a defined contribution scheme for 180 higher paid employees (2022: 122). Total employer contributions for these employees were £717,333 (2022: £485,933).

74

Notes to the financial statements for the year ended 31 December 2023

7 Net movement in funds

Net movement in funds
2023 2022
£'000 £'000
Net movement in funds is stated after charging: (Restated)*
Amortisation of intangible fixed assets 533 574 *
Depreciation of tangible fixed assets 3,977 4,190 *
Operating lease rentals 6,190 5,869

*2022 values have been restated due to the transfer of IT Software and IT Software under development to Intangible assets.

8 Intangible assets

Cost or valuation
At 1 January
Additions
Disposals
Exchange movements on consolidation
At 31 December
Accumulated amortisation
At 1 January
Charge for the year
Disposals
Exchange movements on consolidation
Closing balance
Net book value at 31 December		 2023
2022
£'000
£'000
(Restated)
12,977
11,975

1,563
943

(544)
-
(262)
59

13,734
12,977

9,253
8,675

533
574

(544)
-
(205)
4

9,037
9,253
4,697
3,724

Group*		 2023
2022
£'000
£'000
(Restated)
12,061
11,207

1,494
741

(540)
-
(145)
113

12,870
12,061

8,667
8,120

424
462

(540)
-
(105)
85

8,446
8,667
4,424
3,394

Company*

The following amounts have been restated from Note 9 to Note 8 for 2022:

Cost or valuation
At 1 January
Additions
Disposals
Exchange movements on consolidation
At 31 December
Accumulated amortisation
At 1 January
Charge for the year
Disposals
Exchange movements on consolidation
Closing balance
Net book value at 31 December		 Group
Company
2022
2022
£'000
£'000
11,297
10,534
943
741
-
-
31
80
12,271
11,355
8,434
7,884
499
387
-
-
(3)
73
8,930
8,344
3,341
3,011

75

Notes to the financial statements for the year ended 31 December 2023

9 Tangible assets

Group

Cost or valuation
At 1 January 2023
Additions
Transfers between asset classes
Disposals
Exchange movements on consolidation
At 31 December 2023
Accumulated depreciation
At 1 January 2023
Charge for the year
Disposals
Exchange movements on consolidation
At 31 December 2023
Net book value
At 31 December 2023
At 31 December 2022		 Short
Assets
Freehold
leasehold
Office
Medical
IT
Motor
under
properties
properties
equipment
equipment
Hardware
vehicles
dev'ment
Total
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
(Restated)
35,585
4,962
5,305
10,454
5,766
17,852
1,075
80,999

282
416
230
1,393
877
879
1,623
5,700
-
-
667
-
19
-
(686)
-
(258)
(1,004)
(807)
(2,047)
(1,804)
(777)
64
(6,633)
(1,306)
(485)
(574)
(767)
(471)
(3,063)
(262)
(6,928)
34,303
3,889
4,821
9,033
4,387
14,891
1,814
73,138
17,192
3,076
4,576
8,708
4,920
14,875
-
53,347

774
262
237
762
822
1,120
-
3,977
(122)
(917)
(842)
(2,240)
(1,776)
(745)
-
(6,642)
(366)
(126)
(447)
(632)
(403)
(2,547)
-
(4,521)
17,478
2,295
3,524
6,598
3,563
12,703
-
46,161
16,825
1,594
1,297
2,435
824
2,188
1,814
26,977
18,393
1,886
729
1,746
846
2,977
1,075
27,652

*Note 9 has been updated to remove IT Software and IT Software under development which are now presented within Note 8 Intangible assets. For full details of the values transferred please see Note 8.

Company

Cost or valuation
At 1 January 2023
Additions
Transfers between asset classes
Disposals
Exchange movements on consolidation
At 31 December 2023
Accumulated depreciation
At 1 January 2023
Charge for the year
Disposals
Exchange movements on consolidation
At 31 December 2023
Net book value
At 31 December 2023
At 31 December 2022		 Short
Assets
Freehold
leasehold
Office
Medical
IT
Motor
under
properties
properties
equipment
equipment
Hardware
vehicles
dev'ment
Total
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
(Restated)
25,629
2,169
2,522
5,779
3,049
4,942
232
44,322

214
16
61
1,202
788
115
1,557
3,953
-
-
667
-
19
-
(686)
-
(27)
(891)
(625)
(1,790)
(1,543)
(537)
64
(5,349)
(324)
(43)
(115)
(205)
(112)
(325)
(2)
(1,126)
25,492
1,251
2,510
4,986
2,201
4,195
1,165
41,800
14,704
1,932
2,283
4,735
2,637
3,952
-
30,243

597
67
107
523
653
336
-
2,283
(23)
(891)
(661)
(1,991)
(1,510)
(513)
-
(5,589)
(147)
(39)
(101)
(165)
(95)
(284)
-
(831)
15,131
1,069
1,628
3,102
1,685
3,491
-
26,106
10,361
182
882
1,884
516
704
1,165
15,694
10,925
237
239
1,044
412
990
232
14,079

*Note 9 has been updated to remove IT Software and IT Software under development which are now presented within Note 8 Intangible assets. For full details of the values transferred please see Note 8.

76

Notes to the financial statements for the year ended 31 December 2023

10 Investments

Note
Investment in subsidiaries
10a
Listed investments
10b
a)
Investment in subsidiaries
Investment in subsidiary undertakings at cost:
At beginning of the year
Exchange movement on consolidation
At end of the year
b)
Listed investments
Market value at beginning of the year
Additions
Sales proceeds
Net movement in cash balances
Net investment gain
Exchange movements
Market value at end of the year
Investment portfolio allocation:
Equities
Bonds
Multi-asset funds and alternatives
Private equity
Cash held for investment purposes
Material holdings within the investment portfolio:
Equities
Invesco EQQQ Nasdaq-100 UCITS ETF GBP
SPDR S&P 500 ESG ETF
Xtrackers MSCI USA ESG ETF
iShares MSCI EM ESG Enhanced UCITS ETF
Invesco EQQQ Nasdaq-100 UCITS ETF
US Vegan Climate ETF
Bonds
GAM Star Cat Bond
Aberdeen Standard Liquidity Fund Lux - Sterling Fund
PIMCO GIS Mortgage Opportunities Fund Inst
Multi-asset funds, Alternatives and Private Equity
Link Fund Solutions Odey Absolute Return I
Lumyna MW ESG TOPS UCITS
O'Connor Event Driven UCITS Fund E
Shroder GAIA Helix E Acc
INE GWM GROWTH FD-GW.M.ARBIT.F-G1 C S1 GBPH		 2023
2022
£'000
£'000
-
-
17,549
15,712
17,549
15,712
2023
2022
£'000
£'000
1,101
1,129
(131)
(28)
970
1,101
2023
2022
£'000
£'000
15,712
17,080
1,640
4,394
(878)
(4,705)
(521)
439
1,602
(1,504)
(6)
8
17,549
15,712
8,583
7,218
2,827
2,004
3,156
3,092
2,493
2,387
490
1,011
17,549
15,712
2023
2022
£'000
£'000
765
-
1,964
1,645
1,867
1,553
890
865
-
520
-
444
449
767
1,210
-
848
608
899
975
1,223
1,128
1,034
989
961
931
1,035
1,000
Group
Company
Group
Group and Company		 2023
2022
£'000
£'000
970
1,101
17,549
15,712
18,519
16,813
2023
2022
£'000
£'000
15,712
17,077
1,640
4,394
(878)
(4,702)
(521)
439
1,602
(1,504)
(6)
8
17,549
15,712
8,583
7,218
2,827
2,004
3,156
3,092
2,493
2,387
490
1,011
17,549
15,712
Company
Company

Cash held for investment purpose is held by the investment manager for the purpose of investment in the portfolio. In the opinion of the trustees, the carrying value of the investments is supported by the underlying net assets.

77

Notes to the financial statements for the year ended 31 December 2023

11 Receivables

Trade debtors
Amounts owed by group under-takings
Corporation tax
Accrued income
Accrued legacy income
Grants receivable
Prepayments
Other debtors		 2023
2022
£'000
£'000
20,727
20,868
-
-
369
165
11,568
14,990
16,964
-
3,844
5,541
5,632
4,254
5,428
4,063
64,532
49,881
Group		 2023
2022
£'000
£'000
9,749
6,808
6,486
13,905
-
-
3,826
7,326
16,964
-
2,922
4,441
3,637
2,246
2,901
1,602
46,485
36,328
Company

Trade debtors are stated after provisions for impairment of £2.1m (2022: £1.0m). Amounts owed by group undertakings are stated after provisions for impairment of £4.7m (2022 £2.2m). The large increase year on year is due to no longer including the value of property in the assessment. Trade debtors includes £nil (2022: £nil) falling due after more than one year. Amounts owed by group undertakings are unsecured, interest free, have no fixed date of repayment and are repayable on demand. Accrued legacy income of £17.0m (2022 £0m) relates to the residual value of the Ballard Legacy Fund still to be received.

Grants Receivable includes grant income invoiced in advance of the performance conditions being performed but for which MSI have an unconditional right to the consideration at year end.

12 Payables

a)
Payables falling due within one year
Trade payables
Accruals
Taxation and social security
Deferred income
Loans
Other creditors
Analysis of deferred income
At 1 January 2023
Amounts credited to deferred income during the year
Amounts released to income in the year
At 31 December 2023		 2023
2022
£'000
£'000
11,675
12,975
15,598
17,976
5,978
3,956
60,540
85,545
1,202
1,538
2,143
1,915
97,136
123,905
Group
Company
£'000
£'000
85,545
71,014
140,613
52,359
(165,618)
(74,052)
60,540
49,321
Group		 2023
2022
£'000
£'000
4,655
4,785
11,203
10,203
3,795
2,066
49,321
71,014
1,469
1,495
742
1,319
71,185
90,882
Company

The closing balance of deferred income represents new grant income received during 2023 where the contractual obligations of the grant are to be fulfilled in future years.

b) Provisions

Provisions 2023
2022
£'000
£'000
9,456
10,165
Group		 2023
2022
£'000
£'000
4,619
3,932
Company

Provisions include the following: staff terminal benefits of £3.2m (2022: £3.1m) which are due to employees in country when leaving their employment with MSI Reproductive Choices; grant provisions of £0.7m (2022: £0.7m) for estimated funds repayable to donors where it has not been possible to spend funds in accordance with donor requirements and due when the projects are closed; tax provisions of £0.3m (2022: £0.3m) for country programmes where the payable is disputed or the tax legislation is unclear; litigation provision £0.8m (2022: £1.1m).

13 Loans: amounts falling due after more than one year

Amounts repayable after one year 2023
2022
£'000
£'000
286
77
Group		 2023
2022
£'000
£'000
53
56
Company

In 2013 MSI entered into a long-term financing facility with Unity Trust for £4.0m for a maximum term of 10 years with an initial fixed interest rate of 3.95% for five years and a variable interest rate thereafter. The loan was fully repaid in 2023. Other loans consist of commercial and other loan facilities arranged by MSI Reproductive Choices' branches and subsidiaries. MSI also had access to a £10m Standard Chartered Loan Facility and no there we no drawdowns on this at year end. Total loan interest paid in the year across the group was £49,695 (2022 £31,007).

78

Notes to the financial statements for the year ended 31 December 2023

14 Analysis of net assets between funds

Fund balances at 31 December 2023 are represented by:

Intangible fixed assets
Tangible fixed assets
Fixed asset investments
Bank and cash
Other net current assets / (liabilities)
Long-term liabilities		 Unrestricted
funds
Restricted
funds
Total
£'000
£'000
£'000
4,312
385
4,697
14,178
12,799
26,977
15,729
1,820
17,549
73,448
143,203
216,651
94,055
(110,031)
(15,976)
(1,486)
(2,845)
(4,331)
200,236
45,331
245,567
Group		 Unrestricted
funds
Restricted
funds
Total
£'000
£'000
£'000
4,309
115
4,424
13,296
2,398
15,694
17,401
1,118
18,519
64,433
126,791
191,224
96,949
(112,706)
(15,757)
(1,037)
(1,983)
(3,020)
195,351
15,733
211,084
Company

Unrestricted general reserve held in the UK parent charity at the year-end was £59.9m (2022: £54.0m).

Fund balances at 31 December 2022 are represented by:

Intangible fixed assets
Tangible fixed assets
Fixed asset investments
Bank and cash and Short term deposits
Other net current assets / (liabilities)
Long-term liabilities		 Unrestricted
funds
Restricted
funds
Total
£'000
£'000
£'000
(Restated)
(Restated)
(Restated)
3,294
430
3,724
*
12,646
15,006
*27,652
*
13,725
1,987
15,712
66,205
100,056
166,261
8,029
(66,597)
(58,568)
(1,073)
(2,980)
(4,053)
102,826
47,902
150,728
Group**		 Unrestricted
funds
Restricted
funds
Total
£'000
£'000
£'000
(Restated)
(Restated)
(Restated)
3,278
116
3,394
*
11,704
2,375
*14,079
*
15,577
1,236
16,813
57,827
79,675
137,502
19,186
(65,720)
(46,534)
(851)
(1,943)
(2,794)
106,721
15,739
122,460
Company**

15 Restricted income funds

Donor funds
Restricted by constitution
Africa
Asia
Pacific Asia
Commercial		 At 1 January
2023
Income
Expenditure Other gains
Transfers
(Note 17)
At 31
December
2023
£'000
£'000
£'000
£'000
£'000
£'000
-
145,746
(145,746)
-
-
-
19,050
-
-
-
(2,320)
16,730
21,371
-
-
-
(883)
20,488
3,545
-
-
-
606
4,151
3,936
-
-
-
26
3,962
47,902
145,746
(145,746)
-
(2,571)
45,331
Group
Donor funds
Restricted by constitution
Africa
Asia
Pacific Asia
Commercial		 At 1 January
2023
Income
Expenditure Other gains
Transfers
At 31
December
2023
£'000
£'000
£'000
£'000
£'000
£'000
-
52,529
(52,529)
-
-
-
8,625
-
-
-
(86)
8,539
5,483
-
-
-
192
5,675
394
-
-
-
(20)
374
1,237
-
-
-
(92)
1,145
15,739
52,529
(52,529)
-
(6)
15,733
Company

Restricted funds represent the following:

a) Donor funds unspent at the end of the financial year, which will be expended in the future in line with the contractual and geographical conditions imposed by the donor. b) Funds restricted by constitution represent the accumulated surpluses from those group entities where the funds have been generated locally and the future use is restricted to that location.

79

Notes to the financial statements for the year ended 31 December 2023

16 Unrestricted income funds

At 1 January 2023
Net income (including investment gains)
Transfers:
- Transfer from restricted funds
- Movement in fixed asset reserves
- Movement in programme and sustainability reserves
- Movement in legacy reserve
- Exchange losses on consolidation
At 31 December 2023
At 1 January 2023
Net income (including investment gains)
Transfers:
- Transfer from restricted funds
- Movement in fixed asset reserves
- Movement in programme and sustainability reserves
- Movement in legacy reserve
- Exchange losses on consolidation
At 31 December 2023		 Designated Funds
Fixed asset
reserve
Programme
reserve
Legacy
reserve
Total
designated
funds
£'000
£'000
£'000
£'000
15,559
33,266
-
48,825
-
-
-
-
-
-
-
-
2,931
-
-
2,931
-
6,757
-
6,757
-
-
81,852
81,852
-
-
-
-
18,490
40,023
81,852
140,365
Designated Funds
Fixed asset
reserve
Programme
reserve
Legacy
reserve
Total
designated
funds
£'000
£'000
£'000
£'000
14,601
38,122
-
52,723
-
-
-
-
-
-
-
-
3,004
-
-
3,004
-
(2,099)
-
(2,099)
-
-
81,852
81,852
-
-
-
-
17,605
36,023
81,852
135,480
Group
Company		 General
reserves
Total
unrestricted
funds
£'000
£'000
54,001
102,826
102,118
102,118
2,571
2,571
(2,931)
-
(6,757)
-
(81,852)
-
(7,279)
(7,279)
59,871
200,236
General
reserves
Total
unrestricted
funds
£'000
£'000
53,998
106,721
92,653
92,653
6
6
(3,004)
-
2,099
-
(81,852)
-
(4,029)
(4,029)
59,871
195,351

Unrestricted and restricted funds represent reserves available to MSI Reproductive Choices for a range of purposes dependent on their designation.

Unrestricted Funds:

General Reserve - this represents MSI's global working capital. General reserves aim to provide medium and long-term security for the Group.

Fixed Asset Reserve - represents the net book value of MSI's unrestricted tangible fixed assets. These are primarily clinic buildings.

Programme Reserve - this reserve represents unrestricted funds that are not available for general use, such as unrestricted assets overseas and unrestricted funds that have been internally ring-fenced for programme investment. Legacy Reserve - In 2023, MSI received a generous unrestricted legacy from the Ballard Legacy Fund of £81.9 million. This legacy is held in a designated reserve as the outline uses for these funds has been agreed at board level.

17 Transfers between funds

At the year end a transfer of £2.6m was made from unrestricted to restricted funds (2022: £2.5m from restricted to unrestricted funds) to match the movement in net assets of the group entities considered to be restricted by constitution.

18 Taxation

MSI Reproductive Choices has no liability to UK corporation tax as the company is a charity registered in England and Wales and takes advantage of the tax exemption available to charities. The liability to taxation shown in these financial statements relates to tax due on profits of the branches and subsidiary undertakings.

19 Financial commitments

At 31 December 2023 there were no capital commitments (2022: £nil).

As at 31 December total future commitments under operating leases for land and buildings were as follows:

Within one year
Between two and five years
Leases expiring in five years or more		 2023
2022
£'000
£'000
3,586
3,253
5,710
5,478
383
3,752
9,679
12,483
Group

20 Transactions involving Trustees and Company Secretary

The charity will reimburse reasonable costs incurred by trustees in respect of travel to partner programmes and to the UK offices for trustee meetings if necessary. During the year, the charity made £7,154 reimbursements (2022: £6,120) to four trustees (2022: four) for such expenses.

80

Notes to the financial statements for the year ended 31 December 2023

21 MSI Reproductive Choices subsidiaries

MSI Reproductive Choices is an international non-government organisation delivering family planning, sexual and reproductive health services in 36 countries worldwide. It delivers these services through its branches and subsidiaries and in partnership with affiliated partners.

The charity controls the following subsidiaries, the results of which have been consolidated within the financial statements.

Member Net Net assets
City and country of incorporation, Share Share- voting Expend- income as at 31
Name of company company reg number capital holding % rights % Income iture 2023 Dec 2023
£'000 £'000 £'000 £'000
GBB Options Consultancy Services Ltd London, UK (2695347) Ordinary 100 N/A
 16,603 (16,589) 14 466
Options for International Health London, UK (9137405, charity no N/A N/A 100
 1,429 (1,429) - -
1160066)
AUD MS Health Pty Ltd Melbourne, Australia (ABN 33155 Ordinary 100 N/A
 9,408 (4,322) 5,086 4,756
182586)
ATA MSI Asia Pacific * Melbourne, Australia (ABN 79082 N/A N/A -
 1,424 (1,004) 420 2,549
496697)
Ambulatorium am Fleischmarkt Betriebs GmbH Vienna, Austria (178377W) Ordinary 100 N/A
 123 (189) (66) (97)
BDD MS Clinic Society (Bangladesh) * Dhaka, Bangladesh (Co no 6009384) N/A N/A 31
 623 (1,200) (577) 68
BDA Marie Stopes Bangladesh * Dhaka, Bangladesh (C-584936, NGO N/A N/A 45
 3,596 (3,768) (172) 1,431
2033)
Chinese Provincial Clinics China (099267) N/A N/A 100
 294 (645) (351) 125
Ying Ao Si Te Medical Technology PTY Ltd China (91110105051421470B) Ordinary 100 N/A
 776 (774) 2 847
INC Foundation for Reproductive Health Services New Delhi, India (NGO reg: F04338) Ordinary 100 N/A
 4,395 (4,395) - 4
India ** Corporate Identity No:
U85100DL2010NPL199806
Sarvajan Unnati Bodhni India * ** New Delhi, India (1886 in Book No.4 N/A N/A N/A 24 (24) - 1
Vol No.3008 (Original Deed) & 860 in
Book No.4 Vol No.569
(Supplementary Deed)
INE ISM Corporation Private Limited ** New Delhi, India Registration No. Ordinary 100 N/A
 854 (1,044) (190) 782
245603 Corporate Identity Number:
U51909
INB Population Health Services ** New Delhi, India (55-99080) Ordinary 100 N/A
 7,322 (7,884) (562) (498)
KEA Marie Stopes Kenya (NGO) * Nairobi, Kenya (OP N/A N/A 50
 6,545 (5,930) 615 (1,483)
218/051/93191/15)
Marie Stopes Kenya (LTD) Marie Stopes Kenya Limited Ordinary 100 N/A
 371 (409) (38) (72)
KEA Marie Stopes Madagascar Antananarivo, Madagascar (Ord 60- N/A N/A 66
 4,996 (5,180) (184) 1,650
133)
MS Properties Ltd (Madagascar) Antananarivo, Madagascar Ordinary N/A 73
 6 (3) 3 (23)
KEA Banja La Mtsogolo (Malawi) Lilongwe, Malawi (Co no 6025) N/A N/A 100
 4,998 (6,130) (1,132) 1,966
MGAMarie Stopes Mexico AC Mexico City, Mexico (09020865) N/A N/A 100
 551 (752) (201) (1,213)
Fundacion Marie Stopes Mexico Mexico City, Mexico N/A N/A 100
 6,475 (6,221) 254 1,866
Proteccion Y Salud Farmaceutica Ciudad de México, Mexico (70,988) Ordinary 100 100 158 (145) 13 77
MGA MS Contraceptive Social Marketing Company Ulaanbaatar, Mongolia (9019022046 / Ordinary 100
N/A		 1,122 (1,032) 90 1,089
2881756)

81

Notes to the financial statements for the year ended 31 December 2023

21 MSI Reproductive Choices subsidiaries (continued)

City and country of Member Net assets
incorporation, company reg Share Share- voting Expendi- Net income as at 31 Dec
Name of company number capital holding % rights % Income ture 2023 2023
£'000 £'000 £'000 £'000
Marie Stopes Services Pvt Ltd ** Kathmandu, Nepal (PL Ordinary 100 N/A
 42 3
45		 444
18437/058/59) Preference 100 N/A
Marie Stopes Product and Trading ** Kathmandu Metropolitan City, Ordinary 100 N/A 222 (207) 15 72
Nepal (192990/74/075)
Sunaulo Parivar Nepal * ** Kupondol, Nepal (NGO N/A N/A N/A 1,896 (1,955) (59) 1,110
420/051/52)
Triar Expertos en Salud La Paz, Bolivia (00171889) Ordinary 100 N/A 35
 (29) 6 9
MSI Nigeria Reproductive Choices Abuja, Nigeria (RC: 1965455) N/A N/A 100 15,370
 (15,412) (42) 1,734
Marie Stopes Society Pakistan Lahore, Pakistan (RP374) N/A N/A 57 3,746 (4,458) (712) 1,615
Pakistan CSM (Guarantee) Ltd * ** Karachi, Pakistan (K09269) N/A N/A 50 423 (316) 107 (345)
Merzab Pakistan * ** Karachi, Pakistan (0125321) N/A N/A 33 542 (525) 17 7
Marie Stopes PNG Port Moresby, Papua New N/A N/A 75 3,822 (3,888) (66) 279
Guinea (5-2456)
MSI Romania Foundation Bucharest, Romania (397289) N/A N/A 100 256 (270) (14) 344
Marie Stopes Sierra Leone Freetown, Sierra Leone (C.F. N/A N/A 75 3,107 (3,323) (216) 655
83/1986)
Marie Stopes South Africa Cape Town, South Africa N/A N/A 100 2,576 (2,687) (111) (1,219)
(1991/004592/08)
Population Services Lanka Colombo, Sri Lanka (N(A)27) N/A N/A 100 550
 (267) 283 1,079
Marie Stopes Tanzania Ltd Dar es Salaam, Tanzania N/A N/A 60 18,379 (18,151) 228 (168)
(27539)
Marie Stopes Ltd (Uganda) Reg No. 41190 N/A N/A 60 13,279 (13,848) (569) (744)
MSI-US * Washington DC, USA (NFP 05- N/A N/A N/A 89,219 (86,781) 2,438 677
27-55)
Vietnam Centre for Community Hanoi, Vietnam (Estab reg no N/A N/A N/A (63) (82) (145) 938
Reproductive Health * 335/QD-TWH)
Bach Khang Vietnam Co Ltd Hanoi, Vietnam (Cert no N/A N/A 100 2,248 (2,415) (167) 1,203
0105931817)
Dr Marie Company Hanoi, Vietnam (Cert no N/A N/A 100 1,818 (1,903) (85) 701
0108133213)
Yamaan Foundation for Health & Social Sana'a, Yemen (295/80) N/A N/A 0 11,256 (10,840) 416 4,727
Development *
MSI Zambia Ltd Lusaka, Zambia (66871) N/A N/A 100 4,155 (4,285) (130) 852
Population Services Zimbabwe Harare, Zimbabwe (W013/87) N/A N/A 78 4,550 (4,466) 84 73

For entities which have no share capital, e.g. companies limited by guarantee, holdings are shown on the basis of member voting rights. Further information on the activities of the subsidiary undertakings is given in the Trustees' Report.

82

Notes to the financial statements for the year ended 31 December 2023

22 Related parties transactions

The group has taken advantage of the exemption available under FRS 102 that permits non-disclosure of transactions with group undertakings that are eliminated on consolidation.

Glenda Burkhart, Chair is an Advisory Co-Chair for the International Rescue Committee. The International Rescue Committee provides grant funding to MSI Reproductive Choices, for which cash received in the year totalled £370,000 (2022: £520,000). As per MSI's accounting policy, income recognised in line with expenditure totalled £325,000 in 2022 (2022: £540,000).

The International Rescue Committee also acts as an external partner within a separate grant where MSI Reproductive Choices is the lead organisation. In 2023 a total of £320,000 (2022: £119,000) was disbursed to the International Rescue Committee under this agreement. There were no amounts owing to the International Rescue Committee at the year-end (2022: £nil).

Andrew Seddon, Vice President and Global Finance Director for MSI Reproductive Choices has been a trustee for Humentum UK since March 2022. In 2023, MSI Reproductive Choices paid for a total £5,200 for services with Humentum UK in 2023 (2022: £3,600), and no amount was owed to Humentum at year end (2022: £463).

The total value of donations received from related parties without conditions was £412 (2022: £200).

23 Financial instruments

At 31 December the company held the following financial instruments

Listed investments measured at fair value
Equities
Bonds
Multi-asset funds and Alternatives
Private equity
Cash
Investments measured at amortised cost
Investment in subsidiaries
Debt instruments measured at amortised cost
Trade and other receivables (analysed in note 11)
Accrued Legacy Income
Cash and cash equivalents, valued at balance sheet date
Short-term deposits
Cash at bank and in hand
Loans and creditors measured at amortised cost
Trade and other short-term creditors
Bank loans and overdrafts
Loans falling due after more than one year		 2023
2022
£'000
£'000
8,583
7,218
2,827
2,004
3,156
3,092
2,493
2,387
490
1,011
17,549
15,712
-
-
41,567
45,462
16,964
-
58,531
45,462
147,502
93,970
69,149
72,291
216,651
166,261
13,818
14,890
1,202
1,538
286
77
15,306
16,505
Group		 2023
2022
£'000
£'000
8,583
7,218
2,827
2,004
3,156
3,092
2,493
2,387
490
1,011
17,549
15,712
970
1,101
19,398
20,177
16,964
-
36,362
20,177
139,546
82,286
51,678
55,216
191,224
137,502
5,397
6,104
1,469
1,495
53
56
6,919
7,655
Company

24 Contingent liabilities

In the course of the charity's ordinary activities, the risk can arise of potential legal action against MSI Reproductive Choices. Where deemed necessary, the charity will seek counsel of its lawyers and other relevant professionals, and make financial provisions as appropriate.

At 31 December 2023, 14 subsidiaries reported net liabilities totalling £6.2m (2022: 15 subsidiaries totalling £7.9m). The group plans to continue providing support to these entities in normal operating circumstances as necessary for their continued operations in pursuit of the Charity's mission.

83

Notes to the financial statements for the year ended 31 December 2023

25 Donor funding

The following grants information is disclosed separately in accordance with the specific reporting requirements of the donor.

Income Cash
recognised receipts
2023 2023
£'000 £'000
Agency for Danish International Development Assistance
Expanding Access to SRHR Globally 1,180 2,918
Netherlands Ministry of Foreign Affairs
Increasing Access to Quality FP and RH 3,967 1,848
Ministry for Foreign Affairs of Finland
Integrated RMH Afghanistan Phase VIII 2,427 2,321
Norwegian Agency for Development Cooperation
Breaking down barriers to Safe Abortion and Post-Abortion Care (SA/PAC) for all women and girls (expansion) 53 -
NORAD’s support to MSI Reproductive Choices Strategy 1,032 1,592
Foreign, Commonwealth & Development Office (FCDO)
Delivering Accelerated Family Planning in Pakistan (DAFPAK) 1,771 2,123
WISH - Women’s Integrated Sexual Health (Lot 1) 9,919 11,388
Reducing High Fertility Rates and Improving Sexual Reproductive Health Outcomes in Uganda (RISE) 4,402 5,459
Scaling Up Family Planning in Tanzania 2,321 3,038
Sustaining access to high-quality SRH services 2,103 2,265
International Planned Parenthood Federation
WISH Lot 2 (Women's Integrated Sexual Health) 2,889 3,329
Save the Children International
MMR Global Fund HIV (HIV Prevention, Care and Treatment for Key Populations) 589 591

The annual financial statements are prepared in accordance with UK GAAP and Charities SORP and as a result are likely to differ from financial reports submitted to donors. Income recognised in the financial statements is likely to differ from the cash received from donors during the year. For statutory reporting purposes, donor funds used to purchase assets, e.g. fixed assets or stocks, will initially be recorded on the balance sheet rather than being recognised as expenditure in the Statement of Financial Activities.

84

www.msichoices.org

MSI Reproductive Choices

1 Conway Street Fitzroy Square London W1T 6LP United Kingdom Telephone: +44 (0)20 7636 6200 Email: info@msichoices.org Registered charity number: 265543 Company number: 1102208