The last few decades have seen substantial progress in reducing preventable maternal mortality and expanding contraceptive use, yet tremendous suffering prevails worldwide due to the continued failure to realize greater reproductive justice, particularly for the world’s 1.9 billion women of childbearing age. The vision for reproductive rights has now expanded beyond enabling women and couples to have control over the number and spacing of their children, yet this remains an elusive goal for many. High rates of unintended pregnancy and deficiencies in maternity care are found in all settings, and unsafe abortions are widespread in many countries. Multiple socio-cultural and political sensitivities pose major challenges to improving reproductive health and well-being, as do the difficulties of operationalizing reproductive health programs. Overall, the burden of poor reproductive health is greatest in Africa, where poverty levels are highest, gender equity tends to be relatively low, and effective healthcare is less accessible or affordable. Harmful traditional practices such as child marriage are proving difficult to eradicate, especially where exacerbated by poverty and conflict, but intimate partner violence remains a common behavior in all regions. Everywhere, vulnerable groups include adolescents, poor women, and marginalized ethnic/racial and religious minorities. The achievement of universal access to maternal, sexual, and reproductive health services, an enhanced focus on equity, and improving quality of care are critical to fulfilling the human rights of women, improving development prospects, and alleviating suffering.