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The article discusses the politics involved with reproductive health. A decade ago, the world's leaders met in Cairo at the International Conference on Population and Development (ICPD). There, they crafted a plan to achieve "reproductive health and rights for all" by 2015. That plan was wide-ranging--from more contraception and fewer maternal deaths to better education for girls and greater equality for women. The ICPD plan also aimed to change the way those at the sharp end of making policy and delivering services thought about reproduction. It wanted to move away from a focus on family planning (and, by extension, government policies on population control) towards a broader view of sexual health, and systems and services shaped by individual needs. Over the past week, hundreds of government officials, public-health experts and activists met in London to mark the anniversary of the ICPD and to take stock of progress towards achieving its goals. On paper, that progress has been impressive. Governments around the world have introduced legislation that reflects the ICPD's aims. But when it comes to turning policy into practice, "mixed success" is the verdict of a report card just released by Countdown 2015, a coalition of voluntary bodies involved in the field. According to the United Nations' Population Fund (UNFPA), 61% of married couples now use contraception, an 11% increase since 1994. This has helped push global population growth down from 82m to 76m people a year over the past decade. But in some places--particularly in sub-Saharan Africa and parts of Asia--birth rates remain high. Few poor countries have earmarked enough of their budgets to meet their citizens' reproductive-health needs. Nor have donors lived up to expectations.