Written evidence submitted by Interact Worldwide

 

1. Interact Worldwide welcomes the opportunity to feed into the inquiry. We are a UK based NGO working in sexual and reproductive health and rights and HIV and AIDS with implementing partners in Ethiopia, India, Malawi, Uganda and Pakistan. Our partners are engaged in efforts to scale up a comprehensive and integrated response to sexual and reproductive health, including maternal health, and HIV services in low-level, concentrated and generalised AIDS epidemics.

 

2. Below Interact Worldwide will provide some comments on the reproductive and maternal health in the new White Paper.

 

3. In chapter 5 of the new White Paper DFID pledge to scale up support to maternal and newborn health, and have set themselves the goal of saving the lives of 6 million mothers and babies by 2015. Key interventions in relation to this target will centre on family planning, safe abortion, antenatal care, quality care at birth including skilled attendance and emergency obstetric care and post natal care for mothers and babies. DFID plan to work with partner countries and organisations to meet the following three targets;

· Expand health services so that 240 million more births take place in health facilities

· Increase by one third the number of contraceptive users

· Recruit one million more health workers and managers with the resources to do their jobs effectively.

 

4. Each year an estimated 30 million women and girls face complications related to pregnancy and birth, which result in physical and mental ill health, permanent disability, and even death. A woman's chances of giving birth safely are greatly increased when she is assisted by a trained birth attendant, and can access emergency care if needed, but half of all births in developing countries take place without the help of a skilled birth attendant. As a result half a million women - one every minute - die of maternal causes each year.

 

5. Moreover, while it is estimated that family planning could reduce maternal mortality and morbidity by almost one third, 140 million women globally do not have access to contraceptives. Every year, approximately 80 million women have unplanned pregnancies. Half of these will lead to abortions, a large proportion of which will be carried out in an unsafe environment. Unsafe abortion is the cause of 13 per cent of all cases of maternal mortality, although in some countries the figure is as high as 50 per cent.

 

6. Given the dire state of reproductive and maternal health in many countries these are welcome commitments. However, Interact Worldwide would like to outline the following concerns relating to how these commitments will be implemented;

 

Confusion between targets

7 Last June DFID launched a new HIV and AIDS strategy - Achieving Universal Access - which pledged to work with others to halve the unmet need for family planning including male and female condoms by 2010 and to achieve universal access to family planning by 2015. There is some confusion surrounding the difference between this target (which is already a step down from MDG5 target B - universal access to reproductive health services by 2015) and the target from their new White Paper to increase by one third the number of contraceptive users by the same date. Presumably the first is a goal that DFID will work towards with others while the second relates to what DFID plans to achieve within its own programmes. However it would be useful if this could be clarified.

 

 

 

Delays

8. Despite making both of these commitments, DFID currently has an outdated position paper on sexual and reproductive health and rights which is not considered a comprehensive approach to fulfilling UK commitments to achieve the International Conference on Population and Development Programme of Action. A revised maternal health strategy was due to be developed this year - which may have dealt with family planning and a range of SRHR interventions - but the Department has received Ministerial approval to postpone this strategy until sometime in 2010, potentially until after the next general election.

 

9. It is therefore unclear how DFID plan to meet their commitments on maternal and reproductive health. Interact Worldwide and others in the NGO community are concerned about this delay given the scale of the problem and the urgent need to expand services like family planning, safe abortion and skilled care at birth.

 

Marginalisation of reproductive health within health systems strengthening efforts

10. Indeed, our concerns over delays are amplified by the fact that many organisations working on SRHR are hearing from our partners in developing countries that the growing emphasis on health systems strengthening on the part of many donors is actually leading to reduced investment in vital services such as family planning.

 

11. Moreover, while the White Paper emphasises the role of the International Health Partnerships (IHP+) in delivering health aid, Interact Worldwide is concerned that in practice the IHP+ has led in some countries to a marginalisation of sexual and reproductive health, an area that links closely to HIV and AIDS. For example a study completed by Interact Worldwide in Ethiopia earlier this year (report attached) found that scaling up reproductive health services had not received sufficient attention in the IHP+ country compact. Moreover, the national health plan had not linked with existing reproductive health initiatives including the UNFPA Global Programme on Reproductive Health Commodity Security.

 

12. While focusing on health systems strengthening, it is critical that health planning efforts (including through initiatives like the IHP+) lead to gains in specific health areas such as HIV, sexual health, family planning etc. This is in line with the fifth Paris Principle - managing for results.

 

13. Within the IHP+ system basic criteria already exist against which national plans are assessed, and better results could be assured through the inclusion of criteria on reproductive health and its integration with HIV services, as well as on ensuring access to services for vulnerable and marginalised groups. As DFID sit on the board of the IHP+ this is something that they could push for at international level.

 

Health is about more than systems

14. During last year's IDC inquiry into DFID's new HIV and AIDS strategy many civil society organisations raised concerns about the use of a single funding target for health systems strengthening to fund the UK's response to HIV and AIDS. While a strong health system is a key component of tackling disease and mortality, other sectors including education, legal and policing reform, women's empowerment and poverty alleviation all have a role to play in improving health, as do non state actors such as NGOs, social movements and community based organisations. While we have been assured by DFID staff that these sectors are continuing to receive DFID funding it is unclear what funding commitments have been made within other sectoral lines of the DFID budget and whether these are sufficient.

 

Gender based violence and sexual rights

15. Finally, Interact Worldwide strongly welcomes the recent commitment in the DFID White Paper to triple funding for security and justice, with an emphasis on preventing gender based violence, to £120million per year. This is a welcome announcement which we hope will lead to a reduction in all forms of gender based violence.

 

16. Gender based violence is not only male violence against women but also includes sexual and other forms of violence against men which can be aimed at undermining their sense of masculinity, especially as a tactic in conflict situations. Gender based violence against sexual minorities who are seen as deviating from gender norms is a widespread phenomenon often legitimised by discriminatory laws against same sex relations.

 

17. Ending all forms of gender based violence is central to building safer, fairer and more productive societies. In addition to services such as safe accommodation and legal support to bring perpetrators to justice, all survivors of sexual violence must have access to clinical services including emergency contraception and post exposure prophylaxis for HIV.