Today, on International Women’s Day, we have the opportunity, like never before, to ensure that every woman, child and adolescent has universal access to sexual and reproductive health services and rights. This was underscored just a few weeks ago when we met in Ghana with more than 150 delegates from 10 new Global Financing Facility (GFF) participating countries including technical partners, development financiers, civil society and the private sector, to discuss country-led strategies for closing gaps in financing and delivering results for the health and prosperity of women, children, and adolescents.
Securing and fostering the sexual and reproductive health and rights (SRHR) of women and girls is at the heart of this effort. Enabling women to decide whether to have children, when to have children, and how many children to have, is essential for leveraging human capital and reaping the dividend made possible by the largest generation of young people the world has ever seen. The combined momentum of partners including the Family Planning 2020 movement, decades of effort by United Nations Population Fund (UNFPA), and the tireless advocacy of champions is having a breakthrough on a set of issues that are central to the development agenda. Informed advocacy, partnership, and technical excellence are key to this challenge. We also need sustainable financing to make these rights a reality.
In today’s financing landscape, allies working for quality, rights-based family planning must contend with strong headwinds. After years of growth, development assistance for family planning declined in 2016. This decline is happening while demand for contraception is increasing, particularly in low and middle-income countries. According to a recent report by the Reproductive Health Supplies Coalition, the widening financing gap collides with a heavy reliance on out-of-pocket financing to fund essential family planning products. Over-reliance on user-fees for health services makes it unlikely that the countries and the global community will meet FP2020 commitments and achieve Universal Health Coverage. Many of the women and girls who have an unmet need for family planning live in poor communities or hard-to-reach regions. Many women and girls have limited ability to pay for contraception and even less ability to carry the costs of unplanned pregnancies. The GFF was created to address these persistent equity gaps in health access and advocate for increasing public financing for health.
As development partners and countries look to the future, we also look to a new—and growing—generation of young people who will lead us to it. There is a growing awareness of the important tole that adolescent sexual and reproductive health rights play in driving improved health outcomes across the continuum of reproductive, maternal, newborn, child, adolescent health care and nutrition (RMNCAH-N). Children born to adolescents suffer higher rates of prematurity, low birth weight, stunting, and infant mortality. The interplay between adolescent pregnancy, early marriage, nutritional status, gender-based violence and educational attainment creates an inter-generational cycle of household poverty and poor health for adolescents and their children.
Delegates drew inspiration from ongoing efforts in Mozambique to expand access to sexual reproductive health education and services through the national school health program. Similar efforts to link adolescent health with higher quality educational opportunity are also being pursued through the GFF in Cameroon and Bangladesh. Country delegations left the meeting in Accra with a clearer idea about how they can take advantage of the opportunity the GFF provides to make a difference.
While every country will chart its own path, we saw three common themes emerge from the discussion:
First, sexual and reproductive health and adolescent health require investments across a range of sectors including education and social protection. Systemic gender and socio-economic inequality underpins the lack of progress in many aspects of reproductive health making a sole focus on more and better healthcare insufficient for the progress we need. The GFF focus on results opens the door to evidence based action from a range of sectors and partners in support of country goals.
Second, SRHR and interventions like family planning rely a heavily on out-of-pocket and external donor financing. The GFF focus on health financing reforms that support country-led pathways to greater self-reliance create the opportunity to increase public investment in the health of women and girls. The link between the GFF and IDA concessional financing presents an opportunity to fill short to medium -term gaps while countries chart longer-term pathways towards UHC.
And finally, family planning has an important role in improving efficiency and delivering significant return on health investment to health systems and societies. But, as countries seek to move from passive purchasing of health services to strategic purchasing (which increases system-wide efficiencies) SRH services like family planning are often left out. Ensuring that family planning services are included in strategic purchasing package design and that human rights principles inform purchasing decisions is an ideal way for the SRHR community to leverage the GFF to advance the rights of women and girls.
There is clearly great opportunity for countries to harness the energy of the GFF and the FP2020 movement to further the reproductive rights of women and girls. We are looking forward to the months and years ahead as the ten countries start-off on the GFF process and foster new partnerships and bold thinking take shape.