Ensuring the Bank’s investment in and prioritisation of reproductive health up to 2015 and beyond

Sponsors: International Planned Parenthood Federation (IPPF), White Ribbon Alliance, WBG (Health, Nutrition and Population Division)

Panelists: HRH Princess Sarah Zeid (Champion of The White Ribbon Alliance), Gwen Hines (UK Executive Director, WBG), Nicole Klingen (Sector Manager for Health, Nutrition, and Population, WBG), Alison Marshall (Senior Adviser, Advocacy, IPPF), Jeni Klugman (Gender and Development Director, WBG), Jackson Chekweko (Executive Director, Reproductive Health Uganda, IPPF Member Association)

Alison Marshall, IPPF

• 220 million women without reproductive health care, 80 million unwanted pregnancies related mortality is 98% in developing countries
• This is scorecard on reproductive health  – this is revisited updated since 2009

• CAS lack reference to reproductive health
• Need a stronger standard for “gender informed”
• On investment – there is a decline in absolute investment, and as a proportion of HNP spend
• Need greater engagement, transparency, accountability
• Challenges: elevating the profile of repro health, investment increase to hit unmet need
• The Bank needs a new strategy to replace the reproductive health action plan
• Need to harmonise repro health indicators with Bank-wide strategies and measurement systems

Jackson Chekwo, Reproductive health Uganda

• Desperate situations being faced by people with unmet repro health needs
• We campaigned for parliament to reject WB loans if they do not include reproductive health services
• We appreciate WB services so far, but more needs to be done

Nicole Klingen, World Bank

• We have work to do towards post-2015
• Welcome the scorecard, we want to improve
• We want universal access, we want repro health looked at as a whole, we try to work on health systems
• We do not want health sector interventions, these do not work as well
• We have to invest in the range of services
• In last 2 years we had 100% of high burden countries with repro health covered in CAS
• Indicators are in the IDA 17 RMS
• We have more investment than reported in the scorecard – because of health systems support
• We have also made new commitments for results based financing, including new commitments in IDA, also regional projects
• We work in partnerships, not alone; for example increase in family planning in Burundi

Jenny Klugman, World Bank – Gender and Development director

• We want to push this agenda further, including on economic opportunities for women; but I underline the intrinsic value and the rights to reproductive health care; the right to live free from fear
• But there are implications for the development process – links to economic opportunities; we see too little progress, for example retreat of women’s labour force participation
• We see structural inequalities as well, need to understand barriers, and design responses; this is true in a range of sectors
• We need to track results on the ground, health sector is doing a good job in results based financing
• We support a standalone goal at international level on gender
• Look for our new report at end of May

Gwen Hines, World Bank, UK Executive Director

• This is a personal issue as well as political and economic – I am really shocked that there are still based on this – it is a right of women to decide when and where to have children and we need to fight back against efforts to roll back
• For WB strategy – we have some countries, particularly fragile states, which are not going eliminate poverty; we need to tackle family planning in these countries; there is a huge unmet need; think about issues like unsafe abortion which contribute to mortality
• This is a supply chain issue not a culture issue; this is super value for money to invest in repro health; $1 invest yields $2-$6 return
• We are making progress, there is more to do, we are coming a long way – for example London summit on family planning
• We need to tackle the stigma and adolescent fertility, IPPF is doing great work
• I don’t buy this is a cultural and religious issue – people need the right to choose, women want family planning; you need to adapt to the field you are in, do not accept that it can’t be done
• Tilla Evans new HNP global practice director is great on this, but we need the rest of the Bank to listen as well – ag, education, etc.

Princess Sara Ziad of Jordan, White Ribbon Ambassador

• Investing in repro health is the right thing to do, not just good politics or economics
• Maternal and child mortality is tragic with human suffering; family planning decreases mortality rates, as well as reducing abortions, unwanted pregnancies
• Contraception is a pro-life strategy
• Family planning is a fundamental human right; and you save lives, empower women, and contribute to the economy
• We must act decisively, we must do better

Discussion

Q: Needs assessment can be a valuable contribution

Q: Reproductive rights – not just health – how can we do this in post-2015, what are the right targets?

Nicole K – on post 2015, we need an overall health outomes goal; we are still developing a UHC framework with WHO, including reproductive health services; indicators will be really important; it is possible to measure UHC

Gwen H – WB doesn’t do politics, so a global framework that establishes repro health rights allows the WB to have space to act

Q: there is a fight in NY/UN on SRHR to keep commitments; where does sexual health element fit?

Nicole – working with Global Fund on the results-based financing, you can include screening and rights and education

Q: we are teaching and doing awareness with adolescent health in India; what is being done to reducing lack of sanitation in India; what about female foeticide?

Gwen H – mentoring is a great way to go, sanitation and hygiene is really important even if people don’t like to talk about it; we need more evidence on infanticide; we need to learn about the boy preference as our intervention failures defy logic; we need to be open to new ideas

Q: on women’s economic empowerment, how much appetite within the WB to take this on and make it a big issue

Jenny – we can’t assume rising education solves econ opps. There is interest in growing economic opportunities for women, we have done 100 evaluations in this area

Gwen – this is important, UK is pushing strongly; it can’t be just about women, there is local context and high unemployment; there is a transition phase around child care, community relations and  gender equality

Nicole – think this about in phases, first family planning, then nutiriton, then education, then macro environment for jobs – this is not a developing country issue alone

Q: the WB can remind members about CDAW commitments for example; can we more explicitly integrate human rights into a new plan for the Bank

Alison – I want to see rights in a new plan

Nicole – WBG change leads to GP on HNP, population with be a central part and rights agenda will be part of that