Listed as one of the world’s least developed countries on the Human Development Index, Djibouti has seen a dramatic increase in poverty in recent decades. Health system weaknesses, however, have not prevented improvements in reproductive health (RH). Maternal mortality has declined and HIV prevalence has stabilized. Progress has come by expanding quality RH services, a move backed by UNFPA since 1995. Assistance today focuses on generating high-quality evidence to inform public policies, expanding services to vulnerable populations, providing integrated support to survivors of gender-based violence, and engaging religious leaders in promoting reproductive health and rights.