Memorandum submitted by Marie Stopes International
INTRODUCTION
As a leading UK based NGO promoting sexual and
reproductive health and rights in over 35 countries across Africa,
Asia and Latin America as well as in Europe, Marie Stopes International
welcomes the fact that the Departmental Report 2003 underscores
the importance of reproductive health access to reducing global
poverty and combating HIV/AIDS. We recognise this and the fact
that the main burden of poverty and ill health falls on women,
associated with their lack of control over sex and reproduction,
as being in accordance with the principles of the International
Conference on Population and Development (ICPD) held in Cairo
in 1994.
The Department is to be commended on its expressed
intent to uphold the principles of ICPD, particularly in the face
of growing attempts on the part of the US administration and fundamental
factions within Europe to undermine them. The attempts of these
groups to emotionalise the debate around reproductive health and
their call for "abstinence only" policies to combat
even HIV/AIDS pose a serious threat to the lives of hundreds of
thousands of women in the developing world, condemning them to
a perpetual cycle of poverty and ill health.
The need to champion reproductive health and
the ICPD Programme of Action on an international front is all
the more important in the wake of the enlargement of the European
Union, with several accession countries possibly being open to
the arguments of the opposition to this programme. Marie Stopes
International interprets the highlighting of reproductive health
in the report as a signal of the Department's intention to ensure
that the ICPD goal of universal access to reproductive health
remains firmly on the international development agenda.
The commitment of the Department to achieving
the internationally agreed Millennium Development Goals (MDGs)
is recognised and supported. Although attainment of the ICPD goal
is relevant to achieving the MDGs, it is not specifically included
among them. Hence Marie Stopes International is concerned, that
focusing on attainment of the MDGs could have detrimental impact
on efforts to achieve universal access to reproductive health
by 2015. It is in the light of this that the Departmental Report
2003 has been viewed.
ENSURING UNIVERSAL
ACCESS TO
REPRODUCTIVE HEALTH
— As set out in the Public Service
agreement 2001-04 under Objective IV Improvements in Health Outcomes,
5 (c) specifically states ensuring universal access to reproductive
health. We note however, that this has been measured solely in
the prevalence of contraceptive use. The Departmental Report notes
an increase of 7% over the last year, which is to be commended,
but gives no further breakdown to demonstrate as to whether particularly
underserved or vulnerable groups such as young people and refugees
have improved access to these services.
— In contrast to a former DFID publication
"Beyond ICPD+5 Action on Reproductive Health", the Report
2003 does not cover targets such as awareness creation, contraceptive
supply shortages, the provision of safe abortion as well as the
need to treat the consequences of unsafe abortion. All these remain
pressing issues to ensure reproductive health access for all by
2015 and in particular achievement of the Millennium Development
Goals of reduced infant mortality and improved maternal health.
— Lack of support for comprehensive
reproductive health services is particularly worrying to our partner
organisations in Africa, where the political will to support reproductive
health programmes is frequently lacking. Awareness creation on
the benefits of spacing births in order to reduce infant and maternal
mortality is an urgent need, as is the need to ensure supply security.
The estimated statistic of an average of just five condoms per
African male per annum illustrates the extent of this crisis.
It is with concern, therefore, that we have noted that the new
Public Service Agreement 2003-06 no longer specifies the objective
of universal access to reproductive health.
REPRODUCTIVE HEALTH
AND HIV/AIDS
— Marie Stopes International welcomes
the report's emphasis on the role of access to reproductive health
services and contraceptives in combating HIV/AIDS. Experience
from the field, however, indicates that HIV/AIDS programmes are
being supported to the detriment of reproductive health services.
For example in Myanmar, where the government does not provide
contraceptives in any form, there has been a 500% increase in
the cost of contraceptives as a result of DFID's withdrawal of
support to the social marketing of these products in favour of
assistance to HIV/AID programmes. Over 50% of women using services
of our partner organisation in Myanmar live below the poverty
line in rural and periurban settings and can no longer afford
contraceptives. They face the consequences of pregnancy related
health hazard and unwanted pregnancies. This is occurring in a
country where the maternal mortality rate is already the highest
in the region on account of unsafe abortion.
— Divorcing HIV/AIDS programmes from
reproductive service delivery is of particular concern to the
partner organisations of Marie Stopes International. Their experience
shows that it is easier and more effective to reach groups at
risk working through existing, reproductive health services rather
than setting up parallel ones, which can seldom ensure the confidentiality
of users.
— Marie Stopes International would
like to express its concern at the perceived shift of DFID's focus
from reproductive health access to a major emphasis on HIV/AIDS.
This shift is reflected in the 2003-06 Public Service Agreement,
which, as mentioned above, no longer lists access to reproductive
health among its objectives, as well as in the new structure of
DFID. In particular, the Policy Division (not detailed in the
Departmental Report) demonstrates this shift with a unit dedicated
to HIV/AIDS but not linked to reproductive health. There is also
no longer a unit that provides the required expertise on reproductive
health and the ICPD goal of universal access.
FUNDING OF
UNFPA
— The shift away from funding for reproductive
health services would also seem to be behind decreased levels
of funding for the UNFPA, with support falling from £40 million
in 2000-01 to £9 million in 2002-03 and stabilising at £18
million per annum thereafter. We appreciate the Department's intent
to link future funding to UN organisation to improved and more
coherent performance in developing countries. It is, however,
feared that, in the present, potentially hostile, political climate
for reproductive health issues, and given US defunding of the
UNFPA, reduction in support on the part of the UK government could
seriously jeopardise UNFPA's position as the major provider of
reproductive health.
SUPPORT TO
NON-GOVERNMENTAL
ORGANISATIONS
— While the report specifically recognises
the important link between improved reproductive health and poverty
eradication, the lack of a reproductive health NGO among those
having a partnership programme agreement with DFID is conspicuous.
Other NGOs presently having a partnership agreement with DFID
may address HIV/AIDS prevention within their programmes but do
not necessarily ensure access to quality and comprehensive services,
information and supplies in reproductive health. It is to be hoped
that in future the Department will review PPA partners to ensure
provision of comprehensive reproductive health services towards
achieving poverty reduction and the Millennium Development Goals.
— The report highlights DFID's efforts
to build government capacity to strengthen health care systems
in the developing world by involving all stakeholders. While Marie
Stopes International recognises the long term benefits of this
approach to the development of health care delivery, we are concerned
that, given the very sensitive nature of reproductive health related
programmes, many development world governments are ill equipped
at present to offer quality and confidential services. This is
particularly true of services for vulnerable groups such as young
people and refugees. The feedback from our partner organisations
supports the observation that these governments are frequently
inexperienced in working with NGOs (and vice versa) and consequently
NGOs are not involved in health care policy formulation and programme
design. The ensuing outcome is a gap in the provision of adequate
and acceptable services, particularly to underserved groups threatening,
in particular, the achievement of the Millennium Development Goals
related to child mortality and improved maternal health, deemed
to be among the most difficult to attain. Mention in the Report
of DFID collaboration with the Malawi government and the NGO Banja
La Mtsogolo in partnership with Marie Stopes International is
a welcome but, at present, exceptional example of combined efforts
that could serve as a model for reproductive health care delivery
for other countries.
— DFID funding to NGOs for reproductive
health programmes is provided mainly via the Civil Society Challenge
Fund (CSCF). The CSCF focuses on programmes to mobilise communities
around advocating for their rights. Marie Stopes International
wholeheartedly supports efforts to empower communities. Given
the sensitivity of the issue of reproductive health and the above
mentioned reluctance or inability of governments to presently
provide adequate and accessible reproductive health services,
however, it is imperative that DFID ensures short and medium term
provision of information, supplies and services through NGOs in
order to achieve the Millennium Development Goals and ultimately
poverty reduction by the year 2015.
THE DEVELOPMENT
POLICY OF
THE EUROPEAN
UNION
— The large support DFID provides to
the European Community and its leading role in increasing the
poverty focus of EC development funding is acknowledged and appreciated.
On 20 May of this year, the Council of Ministers in Brussels adopted
a new regulation on sexual and reproductive health in developing
countries, which specifically refers to achieving the ICPD goal
of universal access to reproductive health together with the Millennium
Development Goals in order to reduce poverty. In recognition of
the fundamental role of reproductive health for these goals it
has also created a focal point on reproductive health within the
EU Commission. In line with this regulation and EU emphasis on
sexual and reproductive health and rights, we would like to see
DFID continue to use its influence on EU development policy to
ensure the fulfilment of commitments made by member states to
meet the ICPD goal.
CONCLUDING REMARKS
In conclusion, Marie Stopes International would
like to highly commend the Department for International Development
on the demonstrated progress it has made against the Public Service
Agreement 2001-03. We would like, however, to urge DFID to enhance
its approach to reducing poverty by incorporating the goal of
universal access to reproductive health into the Public Service
Agreement 2003-06 and by reflecting in its structure and funding
priorities, the importance of this goal to attainment of the Millennium
Development Goals and poverty reduction.
12 June 2003
|
