International Development CommitteeWritten evidence submitted by International Planned Parenthood Federation (IPPF)

1. The International Planned Parenthood Federation (IPPF) welcomes the opportunity to submit written evidence to the International Development Committee Inquiry into the Post 2015 Development Goals. IPPF is a global service provider and a leading advocate for sexual and reproductive health and rights (SRHR). Through national organizations, we work in over 170 countries.

Lessons learned from the adoption of the International Development Targets and the Millennium Development Goals: in particular how effective has the MDG process been to date?

2. The MDG process has been effective in redefining the central purpose of development around poverty alleviation and increased human well-being, however IPPF is concerned that the omission of SRHR in the framework has undermined progress towards the goals. By not placing human rights at the core and dividing the issues into separate, discrete silos (such as maternal and child health, HIV/AIDS and gender), the MDGs ignored the complex interdependencies between these issues that reinforce poverty and marginalisation.

3. The wider focus of the MDGs on poverty alleviation and well-being was a welcome shift from the past narrow definitions of development that focussed primarily on economic growth. It allowed for a greater emphasis on a wider range of issues that have an impact on development and well-being outside of an economic framework. The clear, tangible goals gave policy makers and advocates alike a concrete framework which could be used to structure implementation plans and hold stakeholders to account for their efforts to achieve the required outcomes.

4. The MDGs were especially effective in influencing policy and resource allocation priorities for some sectors and issues. For example, HIV/AIDS, gender equality and maternal health (MDGs 3, 5 and 6) experienced an increase in policy priority.1

5. However, the omission of SRHR in the MDGs has undermined the progress made towards achieving some of the goals, particularly MDG 5 on maternal health. As UNFPA reported in 2009, few poverty reduction strategy papers contained targets for SRHR and funding levels for reproductive health and family planning—late additions as a target and indicators in 2007—declined during the same period, from 30 to 23% and 37 to 7% respectively.2 Despite significant declines in maternal mortality in some countries, progress is still well short of meeting the 5.5% annual decline required globally to reduce the maternal mortality ratio by three quarters by 2015.3

6. Because SRHR was not integrated into the MDGs from the beginning, progress in this area has been slow and inconsistent. Although reproductive health was added as an indicator half way through the MDG process in 2007, its inclusion was too little too late and progress towards reaching these targets has stalled. For example, the changes in the aggregate level of indicators for MDG 5B have been negligible; with only a 12% decline in adolescent pregnancy since 1990 and a 3% decrease in unmet need for contraception.4 Progress in increasing and expanding access to contraceptives has slowed, with unmet need often being the highest amongst women from the lowest economic quintiles. If these trends continue the target will only be met in Eastern Asia by 2015 and not in Africa, Latin America and the Caribbean, the Caucasus, Central Asia or Southern, Western and South Eastern Asia.

7. In developing separate and distinct silos the MDGs artificially separated out inter-related issues and did not reflect the complex interdependencies between different areas and the perpetuation of poverty. For instance, by separating HIV/AIDS, gender, and maternal and child health, the MDGs have created a multiple track policy approach to the same problem hindering integration and horizontal approaches. This approach also failed to recognise the connectivity between SRHR and other development issues, for example—the relationship between household income and fertility, and the inverse correlation between female education and infant and child mortality in developing countries.5

8. This divided, outcomes-led approach has also failed to reflect the different aspects of the issues. SRHR has been treated as strictly a health issue with little focus on the influence of socio-cultural barriers, education and other factors, which greatly influence behaviour change. In the case of MDG 3, the indicators do not recognise aspects of gender equality that are central to achieving the goals, including equality in law and the impact of gender based violence. Without a more nuanced understanding of the interaction between different MDGs and the range of factors that influences outcomes, it is difficult to see how comprehensive strategies to achieve the desired outcomes can be developed and delivered.

9. Finally, while effective at addressing the symptoms of poverty, not enough focus was placed on the structural causes of poverty such as inequality, human rights violations and population dynamics. If future interventions are to be viable, effective and reach those in the most need, they must be grounded in the principles of poverty alleviation, sustainability, equality and human rights. This grounding would ensure that interventions that aim to expand access to SRHR services and other health services would place the needs and experiences of the individual at the centre and reflect the interconnection between different issues, resulting in more effective and relevant initiatives. It would result in more comprehensive and achievable targets that reflect the needs of the wider community and ultimately allow all individuals to thrive and participate fully in economic, social and political life in their communities.

Recommendations

(i)Any new development framework must integrate SRHR from the outset, including specific indicators and targets.

(ii)Issues of SRHR should be integrated across all sectors of development, including, but not restricted to gender equality, ending poverty, economic growth, environmental sustainability and education.

(iii)The new framework should be explicitly centred around human rights principles, including empowerment, participation and non-discrimination, and reflect the interconnections between different issues.

How should the “Sustainable Development Goals” be established following Rio +20 relate to the “Development Goals” being considered by the High-Level Panel?

10. Creating a single set of outcomes and targets to alleviate poverty globally proved to be an effective policy tool and has guided the formulation and implementation of development policy at the national level. It is unlikely that having two separate, distinct frameworks would be as effective as maintaining a single universal framework.

11. Thus, IPPF recommends that the Sustainable Development Goals and the Development Goals under consideration by the High Level Panel should be merged into one set of sustainable development goals. The group of 30 countries tasked with designing the SDGs should consult closely with the High Level Panel and both groups should announce a clear and transparent process to negotiate a single set of goals. Civil society at every level should be included in the process of negotiating the content and structure of the goals at every stage.

Recommendations

(iv)Merge the Sustainable Development Goals and the Development Goals into a single set of sustainable development goals with specific targets and goals for each area.

(v)Ensure civil society participation, including representation from marginalised groups at all levels in the development of the content and structure of the harmonised development goals.

The coverage of future goals: should they be for developing countries only or should progress be monitored in all countries?

12. The recent debt and economic crises, and rising commodity prices indicate that in a globalized world, societies are far more interconnected. The impacts of economic shifts are no longer contained in one region but instead ricochet around the world. The geography of poverty is changing and the dividing lines between rich and poor are far less clear cut than in the 1990s. Differentiating between developing and developed countries with respect to progress on poverty alleviation is no longer appropriate; the Global North should be held as accountable as the Global South.

13. To reflect this reality, the future framework must remain global and all countries should be monitored for progress against the goals. If only developing countries are monitored, there will be little accountability for those experiencing poverty in high and middle-income countries, which make up a larger percentage of the global poor.6

14. Similarly, the unmet need for SRHR should not be seen as primarily a developing world challenge. Progress in securing SRHR has been slow, patchy and in many places is reversing (for example, in Central America). Within middle income countries there are gross inequalities in terms of levels of access to SRHR services, which is currently masked by the aggregate measurement of indicators. The future development framework should be aimed at alleviating poverty for all, and have a monitoring framework which disaggregates data to ensure that there is accountability towards reaching hard to reach groups, especially young people, unmarried women, those in the lowest economic quintile.

Recommendations

(vi)All future goals should remain fully global, with the progress of all nations being monitored.

(vii)Future monitoring should be disaggregated within nations to ensure that the inequalities affecting the most marginalised groups are recognised and recorded.

The process: are the right voices being heard? What are the opportunities for and constraints to global consensus?

15. As a member of the Beyond 2015 campaign, IPPF feels strongly that the development of a new framework should be led by experts, governments and civil society from the South. The dialogue should be participatory and involve those at community level who are affected by poverty, injustice and inequality.

16. As the only legitimate voice of the community, local NGOs and civil society working at both national and local level have a critical role to play in ensuring that this process is inclusive and participatory. They should be consulted in the design and implementation of the consultation process and be given the information and resources they need to consult with their partners and community.

17. Further, significant efforts should be made to engage marginalised groups, including disabled people, women, young people, sexual minorities, indigenous groups, refugees and internally displaced people and sex workers.

Recommendation

(viii)It is imperative that the voices of civil society organisations, marginalised groups and those most affected by poverty and injustice are heard throughout every phase of the development, planning and delivery of the post-2015 agenda.

Targets: was the MDG “target-based” approach a success? Should it be retained? How should progress be measured?

18. The MDG target-based approach was effective at focussing attention on specific interventions and provided a simple tool for governments and civil society to measure progress and be held to account. It also resulted in an improvement in data quality and collection, which helped governments understand better their domestic situation and to develop evidence-based responses.

19. However, the targets can be misleading as they mask inequalities between and within countries. The lack of disaggregated data across economic quintiles and geographical region has masked persistent inequalities,7 while at a national level the lack of disaggregation masks inequalities between certain social and economic groups, leading to a distorted picture of progress. In the SRHR context, this means that the experiences of vulnerable groups, such as women living with HIV, disabled women, migrant women, minority and indigenous individuals, those living in the lowest economic quintiles, and young and older women, are under recognised and underreported.

20. Further, the target-based approach did not take into account the interrelated nature of many of the MDGs, especially as they relate to SRHR, and did not capture the cross-sectoral linkages between issues. As a result, despite the enormous contribution that SRHR can make to increasing economic growth,8 increasing girls’ access to education, environmental stability and women’s empowerment, very few actors integrated it into their MDG strategies.

21. Finally, the lack of financial targets was challenging and resulted in underfunding, and in the case of family planning, significant decreases in funding. The next framework should contain financial targets and countries should produce costed implementation plans.

Recommendations

(ix)Future frameworks should require all monitoring against targets to be disaggregated across economic quintile and geographical region, and by social and economic groups within countries.

(x)Future frameworks should integrate financial targets and require costed implementation plans.

Financing global goals: are new mechanisms needed?

22. With the emergence of BRICS, the current economic crisis and the persistence of deep pockets of poverty and inequality in many communities and countries, it is clear that traditional definitions of developing/developed countries are of limited validity and use. New Blocs have emerged, blurring the lines between the G77 and OECD, emerging economies are rising up as innovative launch pads for poverty alleviation,9 and demonstrating an interest in testing out new forums for cooperation such as BRICS and the Next Eleven.10

23. The MDGs largely relied on a model of external financing for development, through aid and foreign investment. The economic crisis has shown this to be a risky and fragile strategy, vulnerable to changes in donor country governments and the instability of a global financial market. While aid and foreign investment will continue to be a key part of realising development goals, the financial crisis shows in the long term the future MDG framework will need to provide incentives for rich countries to look at financing beyond aid. Importantly, developing and developed countries will need to explore how to work together to put development finance on a more sustainable footing in order to sustain important progress that has been achieved.

24. Emerging economies are becoming significant aid givers. Between 2000 and 2010 ODA from non-DAC economies increased from $1,146 to $7,235 million.11 The new framework offers an opportunity for a new multilateralism, which cross cuts across old dividing lines and allegiances. It also offers the opportunity to give a platform to new and innovative ways of financing and programming for poverty alleviation.

25. Further, as described above, in-country financing mechanisms need to be developed and countries should commit to funding targets from internally generated revenues. In countries where high income inequalities persist there should be efforts made through taxation and social insurance schemes to re-distribute wealth.

Recommendations

(xi)To avoid losing hard-won progress on the MDGs, the future framework should include stable financing and a comprehensive response to economic shocks.

(xii)The future framework should provide incentives to both donor and recipient countries to make progress on tax reform, for example through a target for increasing the proportion of developing country expenditure financed through tax.

The role of the private sector and other non-state organisations

26. Non-state actors (the private sector and civil society organisations) have a critical role to play in achieving the MDGs, both as service providers and in holding the state to account. If governments are unable to provide services or health systems are weak, non-state actors often fill the gap. This is particularly true in the case of sexual and reproductive health, where governments may be reluctant to provide services, or be unable or reluctant to reach out to certain groups such as adolescents, unmarried women and other vulnerable groups. Without the participation of the private sector the unmet need for these services would be even higher.

27. Further, non-state actors have a critical role to play in holding the state to account for its failure to provide services, meet basic needs or develop the necessary infrastructure. Civil society must be empowered and resourced to monitor their government’s progress against an agreed and transparent framework of indicators, and be able to hold them accountable for progress.

Recommendation

(xiii)The future framework should recognise the importance of the non-state sector in partnering with governments to achieve the goals, and as an essential oversight and accountability mechanism.

Timescale: what period should the new framework cover? Was the 15-year timescale for the MDGs right?

28. In developing the future framework, IPPF recommends that the High Level Panel reflect on the impact of the previous 15 year timescale and explore the benefits and challenges that renewing this mandate would have. It is important that any discussion of the timescale include the participation of civil society, who will be best placed to reflect on whether it is the appropriate time to allow bedded-in meaningful change while retaining political engagement.

29. The MDG framework is currently applied to a diverse range of nations with a diverse range of development challenges. The last cycle has demonstrated that for some nations a fifteen year time frame was attainable, for example, Mexico and MDGs 4 and 5. However for others, for example Sub Saharan Africa and MDG 5, a fifteen year time frame is utterly unattainable. To acknowledge national diversity and ownership over country strategies to improve development outcomes we recommend a flexible time frame which allows countries to set more realistic goals, and goal specific and country specific timeframes.

Recommendation

(xiv)The High Level Panel should reflect on the benefits and weaknesses of the previous 15 year time scale, integrating the views of civil society in this process.

The content of future goals: what would be a good set of global goals? What continuity should there be with the MDGs, and how should the unfulfilled MDGs be taken forward?

30. Although the MDGs have been successful at creating global action and lifting millions out of poverty, they have been less successful at addressing SRHR, recognising the interrelations between different issues or placing human rights principles at the core of poverty alleviation.

31. Given the abundant evidence that poverty is driven by inequality and a lack of respect for human rights, the next development framework should be explicitly structured around human rights principles and address the issues of sustainability and equality. This would allow future targets to be cross-cutting and interlinked, as well as reinforcing the existing state obligations and accountability mechanisms under international human rights law.

32. To create effective and long-lasting change, any future goals or targets must be results-based and required to deliver measureable impact, especially for the poorest communities. They must be backed by adequate resources and financial mechanisms. They must be transparent in both their development and delivery, ensuring that the state can be held to account at every stage of the process. Further, it is essential that non-state providers are integrated into the development and delivery at all stages and that the goals are implemented in partnership between governments and non-state actors.

33. MDG 5 and other unmet MDGs should be carried forward into the next framework, ensuring that areas where progress is lagging—such as MDG 5—are not dropped or deprioritised.

34. To achieve the goal of poverty alleviation, any future framework must recognise the wide-ranging benefits of SRHR and its relevance to other sectors beyond its critical role in tackling maternal mortality.12 To ensure concrete outcomes in this area, three new specific goals should be introduced on health, women’s empowerment and youth.

35. A goal on health should emphasise the essential, though critically underfunded, role of preventative health care. This could include targets around the provision of family planning services and anti-retrovirals, programmes focused on the prevention of non-communicable diseases, access to safe abortion services where legal and distribution of bed nets for malaria prevention.

36. The goal on women’s empowerment should go beyond the existing targets on access to education and also include specific actions on addressing discrimination against women and girls (such as gender-based violence, economic discrimination, reproductive health inequities and harmful traditional practices).

37. The goal on youth should address the specific barriers that people under 25 face in accessing reproductive health—including a lack of information, discrimination and social stigma—and the increased risks that adolescent girls face in pregnancy and childbirth. It should also address the needs of the unprecedented number of young people entering their reproductive years over the next 15 year period, which will result in a projected 40% rise in demand for family planning. When girls and young women have access to critical lifesaving services and information, and when they are able to make meaningful choices about their life path, they are empowered. Their quality of life improves, as does the well-being of their families and the communities in which they live. Their collective ability to achieve internationally agreed development goals is strengthened.

Recommendations

(xv)The next development framework should be explicitly structured around human rights standards and principles, and address issues of sustainability and equality.

(xvi)The mechanisms for implementation in the next development framework should be strengthened, specifically with respect to requiring measurable impact and allocation of adequate resources.

(xvii)The next development framework should contain strong accountability mechanisms with indicators that are aligned with existing accountability frameworks (for example, the current MDGs, Every Woman Every Child, FP2020 Summit), in line with national data collecting systems. It should also require indicators to be disaggregated by age, gender, marital status, economic quintile, geographic location and include costed implementation plans

(xviii)On top of these accountability requirements, the next framework should also have scope for national plans to include specific indicators in line with national development priorities and national data collection systems.

(xix) All existing MDGs that have not been achieved should be carried forward into the next framework, particularly MDG5.

(xx)The future framework should explicitly recognise the essential role of SRHR in poverty alleviation and sustainable economic and social development. To ensure concrete outcomes in this area, three new specific goals should be introduced on health, women’s empowerment and youth.

October 2012

Cited References

African Union Commission, Maputo Plan of Action (MPOA) on the Continental Policy Framework on Sexual and Reproductive Health and Rights (SRHR), May 2010

Melamed, Claire, After 2015: contexts politics and processes for a post-2015 global agreement on development. Overseas Development Institute, 2012

Web reference: http://www.odi.org.uk/resources/details.asp?id=6231&title=millennium-development-goals-mdgs-post-2015

Accessed 19 September 2012

Sakiko Fukuda-Parr, Are the MDGs priority in development strategies and Aid programmes? Only a few are! International Poverty Centre, Working Paper number 48 October, 2008

Web reference: http://www.ipc-undp.org/pub/IPCWorkingPaper48.pdf

Accessed 17 August 2012

Sumner, Andy. Where do the world’s poor live? Where will they live in 2020 and 2030? Institute of Development Studies, 2012.

Web reference: http://www.ids.ac.uk/files/dmfile/AndySumner-BriefingonGlobalPovertyProjections.pdf

Accessed on 19 September 2012

United Nations Department of Economic and Social Affairs, The Impact of AIDS 2004

Web reference: http://www.un.org/esa/population/publications/AIDSimpact/91_CHAP_VIII.pdf

Accessed 19 September 2012

United Nations Department of Public Information, We can end poverty 2015: Goal 5 Improve maternal health. 2010

Web reference: http://www.un.org/millenniumgoals/pdf/MDG_FS_5_EN_new.pdf

Accessed 19 September 2012

UNFPA, Financial Resource Flows for Population Activities in 2009

Web reference: https://www.unfpa.org/public/global/publications/pid/3292

Accessed 6 September 2012

United Nations, Millennium Development Goals Report 2012

Web reference: http://www.un.org/millenniumgoals/pdf/MDG%20Report%202012.pdf

World Bank, WDR 2012 : Gender Equality and Development

Web reference: http://wdronline.worldbank.org//worldbank/a/c.html/world_development_report_2012/abstract/WB.978–0-8213–8810–5.abstract

Accessed 19 September 2012