“Do No Harm” in Family Planning

By Suzanna Dennis and Sarah Friedmann

When you spend all day working to advance reproductive health rights, it is easy to view the world through that lens. Universal principles like the interdependence of all human rights go out the window when faced with so many challenges to the human experience. Why worry about complex issues like good governance? It is more manageable to focus on that piece we can change: women’s and girls’ access to quality reproductive health.

But this siloed approach can do more harm than good. By failing to take into account good governance, the international family planning community has the potential to bolster the legitimacy of troubling regimes and undermine state-building efforts.

Rwanda is the family planning donor darling, having increased contraceptive prevalence rate by ten-fold since 2000. A report published by USAID in 2012—and co-authored with governments including the government of Rwanda—reports that the key to Rwanda’s success was “a strong government vision, with leadership and commitment to family planning [that] has systematically created and sustained an enabling environment.” A 2013 Policy Brief by AFIDEP, a regional think-tank concurs, “Rwanda stands out with strong leadership by the President who openly supports and promotes FP as a development tool.” This is the same strong leadership that, according to Steven Feldstein, the Deputy Assistant Secretary in the U.S. Bureau of Democracy, Human Rights, and Labor says is making “consistent efforts to reduce space for independent voices and to diminish the ability of the media, opposition groups, and civil society to operate.” Human Rights Watch and Amnesty International report a whole slew of human rights abuses including targeted assassinations and unlawful detentions.

Another darling of the family planning community also highlighted in the USAID report is Ethiopia, which has made impressive gains in maternal health and family planning with its health extension worker program. Ethiopia is also known for arbitrary arrests, politically motivated prosecutions, repressive laws limiting CSO activities, and abuses against indigenous communities.

The International Conferences on Family Planning have been hugely important for the community. But we question that three of the four host countries—Uganda, Ethiopia, and Indonesia—have questionable governance and/or their governments are responsible for human rights abuses.

But all these countries are great on family planning, right?

Wrong, sort of. Sure, they are doing well on family planning. But what good is family planning when an adolescent girl’s father or mother is unjustly imprisoned? What does that mean for her opportunities, access to health services, and her ability to realize her full potential? Interdependence of human rights means that peoples’ lived experience is complex. One set of rights—like reproductive health—does not trump freedom of speech or assembly, or the rights of women, or members of the LGBT community.

Celebrating reproductive health successes in an otherwise rights-repressive environment is also short-lived and counterproductive. Countries with limited rights protections, especially for women, are often more insecure and prone to conflict (and/or autocratic regimes in an attempt to mitigate this insecurity). Either way, as insecurity mounts in a country, rights protections often diminish, including those for women. This insecurity can then reverse inroads made on reproductive rights. Perpetuating reproductive rights in a country without also advocating (even quietly) for broader changes to a country’s human rights regime is short-lived at best.

Now, all eyes should be turned to Malawi, another of USAID’s family planning success stories. On February 23^rd, Jessie Kabwila, a sitting Member of Parliament and speaker for the opposition party was arrested and detained. In an alleged scandal termed the “WhatsApp Coup,” she is accused of treason.

We were introduced to Jessie Kabwila in Malawi last year, on a trip to gather stories about how important reproductive health and rights are to women and girls, and people who are making a difference. Jessie is one of the most passionate and outspoken members of Parliament on women’s and girls’ rights, including child marriage and family planning, particularly for youth. She was also a key ally for our partners, JCM, as they worked with HPP to successfully increase Malawi’s budget for contraceptives for three consecutive years. We cannot speak to Kabwila’s innocence or guilt. We just know that one of Malawi’s most powerful champions for the rights of women and girls is behind bars. We hope that Malawi doesn’t become another in a long list of countries that is doing great on family planning at the expense of everything else.

So our challenge to donors, and even CSOs like PAI supporting partners in the field: Take off your blinders to governance issues. Try to situate your work within the broader social and political context in a country. What does that look like? Join us in congratulating Malawi on a great increasing of its budget for contraceptives. But let’s not be afraid to point out the importance of due process and rule of law.