Chances are, time will be short. So if that means there is only one issue Theresa May can champion with Donald Trump, we think it should be to look together at how the UK and US governments could support sexual and reproductive health and rights (SRHR) for women and families worldwide, especially in emergencies. So whilst some might think there is no common ground, here is my take on the key messages:
Why is a focus on women’s rights and SRHR a critical issue?
Let me start by saying that supporting women’s rights worldwide is a matter of social justice. Women and girls are the largest group of marginalised people on the planet. Addressing poverty and injustice with our aid and development efforts means supporting them and the intersectional groups of women and girls worldwide who experience multiple forms of exclusion and discrimination.
In addition to this, prioritising aid spending for women’s rights in some of the poorest and most fragile parts of the world is not just the right thing to do, it also makes smart business sense and gives significant levels of return on investment. As Secretary of State Penny Mordaunt highlighted in DFID’s strategic vision on gender, “Enabling women and girls to choose for themselves when they have children allows them to complete their education and to take up better economic opportunities. The Copenhagen Consensus estimated that achieving universal access to sexual and reproductive health services by 2030, and eliminating unmet need for modern contraception by 2040, would deliver $120 of social and economic benefits for every $1 invested.”
$120 of social and economic gains for every $1 invested – surely that’s a return on investment that’s too good for any business-minded person to turn down?
Gains for women and girls have been happening in recent years but they are slow and extremely fragile leaving huge numbers of marginalised girls and women behind. Comprehensive SRHR are key to achieving the Sustainable Development Goals. Restrictions on health funding will result in easily preventable maternal deaths, cuts in services linked to newborn, infant and child health and decrease access to modern contraceptive methods.
So what areas should the UK and US governments prioritise together?
Theresa May can be proud of the role the UK government plays as a global leader in supporting the sexual and reproductive rights of girls and women. The power of this leadership was made clear at the 2017 London Family Planning Summit, at a moment that galvanised political momentum towards FP2020 goals to reach 120 million women, men and adolescents with the family planning information and services they need.
Given the evidence of the importance of SRHR for women’s health, rights and well-being as well as for wider development aims, the UK remains one of the largest donors to sexual and reproductive health and family planning worldwide. And it is a significant voice for a comprehensive approach to SRHR, including access to safe abortion, in international fora such as the International Conference on Population and Development and the UN Commission on the Status of Women.
Historically the US government has played a critical role in funding SRH globally including voluntary family planning and maternal and newborn health care. This is a global leadership role and a legacy of which the US should be proud and aim to sustain.
Current US policies however have resulted in significant reductions in support for SRHR worldwide, with the potential to affect the lives of millions of women and families.
In addition to raising concerns about this reduction in funding Theresa May has a chance to discuss how together the UK and US can support women and girls worldwide to meet their healthcare needs, including with comprehensive family planning.
Some key priorities the UK and US could work on together
Emergencies – Ensuring access to comprehensive family planning services in all crisis-affected and fragile settings
There are 32 million women and girls who are displaced by conflict or crisis, many of whom have limited or no access to life-saving family planning services. Although family planning is one of the most life-saving, empowering, and cost-effective interventions for women and girls, it is consistently neglected and underfunded in most humanitarian responses.
Donors, governments and humanitarian actors must commit to ensuring universal access to family planning for all women and adolescents affected by conflict and crisis. Specifically, the Minimum Initial Service Package – including family planning services – should be implemented at the onset of every crisis. Systems and funding must be put in place to ensure delivery and continuity of comprehensive family planning services – including access to all contraceptive methods – through all phases of humanitarian response, including in protracted crises.
Ask people for their input – Invest in participatory governance and social accountability processes to transform health systems
Social accountability is a dynamic process that empowers women and adolescents to directly monitor the healthcare services they receive, and negotiate to receive the services they need and want. Investment in and use of social accountability approaches can build trust and catalyse solutions to improve family planning and sexual and reproductive health outcomes, and help ensure women’s and adolescents’ rights are respected, protected and fulfilled.
Evidence shows investments in social accountability can dramatically increase acceptability, quality and utilisation of family planning: an evaluation of one social accountability approach – CARE’s Community Score Card© (CSC) – in Ntcheu district, Malawi, showed 57% greater use of modern contraception in the treatment group compared to the control group at endline.
Ensure programming for adolescents is designed and co-created with adolescents themselves
Globally, there are 1.8 billion young people between the ages of 10 and 24. Many of them urgently need family planning but face powerful barriers to accessing services, such as poverty, stigma, discrimination and lack of knowledge.
Young people are powerful agents of change; harnessing their passion, ideas, and insights will ensure that we develop solutions that work for them.
Unless young people themselves are engaged to design and deliver family planning policies and programmes that address their realities and meet their needs, we will not be able to fulfil the family planning needs and rights of the billion young people who live in FP2020’s 69 focus countries.
Ensure frontline health workers are authorised, trained and supported to provide family planning and reproductive health services
The World Health Organization estimates that there is global shortage of 7.2 million skilled health workers, presenting a powerful barrier to access and expansion of family planning services. To address this critical gap, we must expand and strengthen the cadres of health workers who are on the frontlines of service delivery, including nurses and midwives.
These frontline workers are the first – and sometimes the only – healthcare providers in many communities, especially in rural and under-served areas.
In many settings, however, frontline health workers are not recognised by the health system, are inadequately trained, and poorly paid. In many countries, they are not legally authorised to provide comprehensive family planning services, including provision of the full range of contraceptive methods. When properly trained and supported, frontline health workers could play a critical role in unlocking equitable access to family planning services.
One key take-away
Whatever happens during the Trump visit, it is important that he leaves knowing how committed the UK government is to SRHR and particularly SRHR in emergencies, and that whatever future Global Britain and Trump’s administration have together, there are actions they can take now to immediately help the millions of women fleeing war and crisis who want a healthy and safe environment to choose to have their babies and raise them.
