AMANITARE, the African partnership for Sexual and Reproductive Health and Rights of Women and Girls, noted with great concern the controversy that surrounded the recently approved Health, Nutrition and Population strategy of the World Bank that had initially given little reference to sexual and reproductive health and rights (SRHR). This indicated less funding and a lower priority for SRHR in development strategies around the world and particularly Africa. Many governments use the Bank strategy to guide their PRSPs, which have a direct impact on overseas funding and the World Bank resource allocation. Moreover this would undermine all the gains made towards the realisation of the MDGs especially universal access to HIV treatment by 2010 and universal access to sexual and reproductive rights by 2015. We would have questioned our own existence as AMANITARE if the draft was not amended.
The majority of women in Africa lack access to basic sexual and reproductive health services and information, safe labour and delivery services, emergency obstetric care, essential drugs and contraceptive supplies. They are also in danger from labour complications, unsafe abortions, and HIV and other sexually transmitted infections, which remain the leading causes of illness and death among women aged 15-49. Women now represent two-thirds of those infected with HIV in Sub-Saharan Africa. These shocking realities should now more than ever prompt multilateral organisations such as the Bank to not only increase resource allocation towards the realisation of SRHR but also promote public health and human rights for women and girls in Africa as a priority.
this would undermine all the gains made towards the realisation of the MDGs
Despite the dramatic improvement of the final draft in support for SRHR and its affirmation of the plan of action of the international conference on population and development signed in 1994 by many countries, we feel the need for the strategy to highlight the causes and consequences of poor access to SRHR for women and girls in Africa and to state workable plans for reversing the trend. This would enable us to hold our governments accountable for allocating resources for SRHR in national budgets and PRSPs.
The second objective of the Bank’s new policy spells out its approach to preventing poverty due to illness. Our experience in Africa has shown that illness is both a cause and a result of poverty. Women in Africa are very poor due to the patriarchal society that favours men in terms of property ownership, access and control. This means that to access SRHR services, women must seek approval, beg for money, and take time away from tending the farm or looking after cattle, which may be considered more important. They therefore remain sick for longer, meaning that they will work less, feed the children less and produce less, perpetuating the vicious cycle of poverty. It is therefore imperative that the Bank tackle the issue of poor access and lack of SRHR services as a means of poverty alleviation and not vice versa. It makes more sense in Africa to prevent illness due to poverty and not poverty due to illness, especially for women and girls.
The fourth objective of the Bank’s new strategy acknowledges that good governance, transparency and accountability are crucial to running a successful health provision scheme by any government. This is vital especially in Africa where outright theft, corruption, mismanagement of funds, poor procurement procedures, mistreatment of the poor by health providers and kickbacks for services provided remain rampant. This brings into question the effectiveness of government regulatory instruments for ensuring that resources allocated for health, especially SRHR services, are not redirected to other uses or mismanaged altogether. We feel that the World Bank should explicitly acknowledge that civil society organisations serve as a strong mechanism for monitoring governments and setting the agenda in health provision issues, especially for the poor and vulnerable groups in our communities. A health surveillance monitoring system which incorporates civil society should be in place in all African countries.
Our duty now will be to closely monitor the application of the Bank’s strategy at country and regional levels. We must ensure that SRHR remains in the core of each country strategy and more importantly that resources allocated in this vein are not redirected to other uses by governments and that their distribution reach everyone, with free access for the poor and vulnerable.
AMANITARE is a ten-year (1999-2009) initiative of women individuals, groups and networks from all African countries to facilitate the implementation of the principles embodied in the outcomes of UN conferences on human rights, population and women.