Will the London Family Planning Initiative Measure Up?

Given the constant ultra-conservative attacks on this most basic of rights – the right of women to control their fertility – last week’s London Family Planning Summit had in some respects a refreshing quality. Contraception was affirmed, discussed and touted, loudly and publicly. Numerous media articles published for the Summit highlighted the economic benefits of investing in contraception, and the enormous potential to save lives, both maternal and new born.

A “can-do” atmosphere prevailed. Hosts Melinda Gates and Andrew Mitchell, the UK Minister for International Development, made significant new pledges of funding for family planning in the poorest countries. For Gates, this was an additional 560 million USD over 8 years, and for the UK’s international development arm, DFID, an additional 800 million USD over the same period.  Prime Minister David Cameron gave by far the most rousing speech outlining his personal commitment to women’s rights and to ensuring that the fight for women’s empowerment is at the core of the post-2015 development framework that will replace the current Millennium Development Goals.  Importantly, Cameron co-chairs the UN Panel of Eminent Persons tasked with developing this new framework.

High-level government officials and heads of State, from India to Uganda, announced increased support, financial and programmatic. Some couched this support in terms of “Family Planning,” given the topic chosen by the organizers. Many, particularly from African governments, mindful of national programs and their own commitments to the now 18-year-old agreement reached at the International Conference on Population and Development, insisted on “sexual and reproductive health and reproductive rights” and a full package of services and information rather than a stand alone investment that would reinforce siloed approaches. Providing adolescent girls with information and services was highlighted as a key intervention; when 2/5 of girls in Sierra Leone have their first child between the ages of 12 and 14, that is indeed an urgent need.

All well and good — but for those of us trying to discern whether the rights of women will truly be at the center of this Family Planning Initiative, as promised by DFID and the Gates Foundation in response to our months of advocacy, there were moments of disquiet.  Several speakers made it clear that their national plans involved hard targets for increasing the number of users of contraception, rather than simply making contraception available and accessible, which the ostensible goal of the Summit. For example, the representatives of Indonesia and Bangladesh spoke in terms of achieving certain ambitious contraceptive prevalence rates and total fertility rates – thus raising the very real possibility that coercion might result without safeguards. The Additional Secretary of Health of India outlined her government’s plan for post-partum IUDs for the 12 million women who deliver in institutions. These women are routinely discharged very quickly after childbirth – how much time will they have to decide whether to “accept” an IUD in these conditions?

Then, at the side session on Monitoring and Accountability in late afternoon, we heard for the first time that something about this Initiative was going to be hard to do: providing 120 million women with access to services in some of the poorest countries on earth? No. Ensuring a reliable supply of contraceptives in faraway places? No. What was going to be hard to do was “measuring human rights.” Evidently, the members of the Initiative’s Monitoring & Accountability Working Group at work need to familiarize themselves with the extensive quality of care and human rights literature on the subject, notably that produced by the Population Council and the World Health Organization. It would certainly help if representatives of women’s groups and of human rights groups were invited to join this Working Group, for a start.

The human rights of women must be measured when one is spending $4.6 billion on an initiative that is supposed to, precisely, uphold their rights. Measuring whether there is coercion in services is not hard to do. Measuring whether this is a wide range of methods available is not hard to do. Measuring whether women are satisfied with the services they receive is not hard to do. If programs do not measure these and other aspects of human rights and quality of care, however, they will send a clear message that the human rights of women are a distraction, and that something else is more important – controlling that pesky African fertility, perhaps? Let’s see whether the Initiative measures up to its claims.

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