The UK and Gates Foundation FP Summit 2013

1. The UK and Gates Foundation FP Summit 2013 Lessons for the Pacific Professor Glen Mola PSRH Samoa, July 2013

2. The recent history of FP in the developing world: where we have come from 1950s-60s • The fear of the population explosion in the developing world: China decides that 1 child families is the only way for the nation to survive in the next generation and creates a national policy thus • India tries to curtail population growth by incentives and some coercive polcies • Western countries support and assist India with FP financing, but are excluded by China which gets on with its own agenda by itself

3. 1970s-1980s • There is a backlash in India (and some other developing countries) where national government FP initiatives are seen as draconian, coercive and unethical, and western countries withdraw support • Many Western countries turn their backs on FP program support and begin to criticize China for its strict one child family policies • Growth of the view that one merely has to improve living standards and fertility rates will decrease to those of ‘rich’ countries

4. 1980s-90s • The evidence starts coming in that FP is beneficial to maternal health, is the most cost effective public health strategy for the prevention of maternal death, and has the potential save newborn and children’s lives as well • The maternal and children’s agenda starts to take centre stage

5. ICPD I (1996) • The world comes together to analyse the impact of FP programs and propagate the women’s and children’s agenda • Targets are set • Access and gender issues are emphasized • The view that economic development will achieve sustainable population trends becomes the consensus*

6. *We all want to be rich as Americans and Australians • The problem is that the planet cannot sustain this goal • If everyone in the world has a car, a computer an iphone, eats meat every day and uses the USA per capita amount of carbon (17.6 tons) the world will end as we know it by the end of this century [because world average temps will rise by 4-6C, northern Europe be covered by snow and ice (like northern Canada) and sea levels will rise by 5m]

7. China aspires to have ‘western’ lifestyles: Carbon emissions have tripled since 2000. India stays at 1.6 tons/capita

8. ICPD 2 (2006) • Targets have become politically incorrect • “Rights based” approach has become a mantra by which all discussion on FP is judged • Population is no longer to be discussed, - as it is irrelevant in the above context The assumption that humankind will sort itself out and all will be well prevails

9. Post ICPD 2+ – no clear path, but • Climate change now known to be driven by human activity • Min. global warming (4Co) expected by the end of the century will mean extinction of up to 40% of species in the world and render significant parts of the planet uninhabitable for human beings as well • Family Planning returns to the agenda not only as a means of improving individual and family health, but also for human survival

10. The UK summit on FP - 2013 • Supported by UK-DFID, Gates Foundation and most other donor partners involved in FP • “Putting FP back on the Agenda”: the rebirth of Family Planning • Then there were 8 focus topics identified that showed the completely cross-cutting nature of Reproductive Health and FP with regards achieving the MDGs

11. Focus of the FP Summit • Making FP a global national priority • Giving women power to plan their families • Family Planning saves Maternal and NB lives • Slowing Population growth for family, community, national wellbeing & development • The Economic consequences of FP and RH • The relationship between Population & Climate Change • Human rights & Meeting the Unmet need for FP • Getting ‘Wet, Clean and Healthy’

12. Human rights & Meeting the Unmet need for FP • Many people seem to think that strategies to help meet unmet need for FP run the risk of violating human rights • In fact is the opposite is true, - because many women to not have a choice to use FP: either because of • Lack of education, knowledge, access, or • Lack of empowerment due to age, marital status, poverty or other social circumstances

13. Often forgotten Human Rights • The right to have FP available to you irrespective of age, marital & SE status without needing to seek permission from others • The right to high standards of health, education, privacy and life Poor standards of health service violate human rights, as do shortages of FP commodities, and negative attitudes of health workers,

14. ‘Conscientious objection’ or other disagreement to FP provision • Re: Religious, moral, personal objections • It is unethical for health workers to allow their personal beliefs jeopardize their patients health and lives. A recent court judgment in the European court of human rights found that “Individuals who object on grounds of conscience to providing contraceptives must refer patients to willing providers, and provide services where they have a monopoly and in emergency situations.”

15. But in many parts of the Pacific; conscientious objection is not the main reason for the impediment to access • Only on “tuesdays” • Nurse did not come to work today • We don’t take new clients after 11am • We are out of “Depo”, “Implants” etc. • We don’t provide that method of FP here • ‘You have a headache…..’, (abdo pain, weakness, dizziness, or any other symptom)’ …then you had better stop your FP’ • ‘Sister, my periods have stopped so I think I should stop my Depo…’ ‘Well it’s your choice… ‘

16. And many health workers think that FP is actually dangerous