It’s that time of year again. No, I’m not talking about US government’s budget gridlock or even back-to-school. For those who monitor the World Bank and other International Financial Institutions (IFIs), fall is time for the World Bank and International Monetary Fund’s Annual Meetings. As someone who started my career as a gender-focused “IFI-Watcher,” I always get excited for the civil society-organized events around these meetings held last week. Join me for a sneak peek into the push and pull behind the Bank’s recent history on reproductive health.
A Firefight at the Bank
The recent history begins in 2007, when the World Bank came under heavy fire from the reproductive health community when they allegedly attempted to remove references to reproductive health in their new Health, Nutrition and Population (HNP) sector strategy. Around the same time, Juan Jose Daboub, an activist Managing Director at the World Bank, allegedly deleted references to family planning in World Bank documents and country programs. All of this was happening at the same time as then-Bank President Paul Wolfowitz was forced to resign amid an ethics controversy involving his long-time partner.
The reproductive health community and supportive IFI-Watchers responded quickly with sign-on letters and other advocacy tactics, and got the Bank to restore the references to reproductive health and family planning. The newly formed Sexual and Reproductive Health and Rights (SRHR) Working Group on World Bank included a who’s who in the reproductive health community. But without a threat to respond to (or funding to support a workplan), the SRHR Working Group on World Bank fizzled out in late 2008.
In 2009 the Bank’s Independent Evaluation Group did a review of the Health, Nutrition and Population strategy and found waning Bank support for family planning and population programs, and executed programs performed poorly. The report just confirmed what we already knew.
Putting Out the Fire
In response to the HNP and Daboub scandals and the poor internal evaluation, in 2010 the Bank developed a Reproductive Health Action Plan 2010-2015 to reduce high fertility, improve pregnancy outcomes, and reduce sexually transmitted infections with a focus on countries with high maternal mortality and fertility rates. The Action Plan “underscores the Bank’s strong commitment to reproductive health in line with the Program of Action of the 1994 International Conference on Population and Development.” All this is to be achieved through strengthening the Bank’s capacity and reproductive health expertise, and improving data collection and monitoring. Unfortunately the Action Plan was not launched with any funding to implement it.
The International Planned Parenthood Federation did an interim Scorecard reviewing implementation of the Action Plan in 2011, and found that “the Bank could be doing much better to deliver on its commitments.” They are currently working on an updated review. From what I’ve gathered, no one within the Bank seems to be successfully championing the Action Plan, and three years on it is not clear what it has accomplished.
Are Things Heating Up Again?
Looking forward, I’m still waiting to see a robustly funded and implemented Reproductive Health Action Plan. I’m excited to see IPPF’s next Scorecard, which will hopefully be a rallying point to get more reproductive health groups re-engaged. I’m also curious about the recently announced $700 million commitment for women’s and children’s health: how much of that money will support reproductive health, and how much of it will be grants versus loans that countries have to pay back. I’m interested to figure out how the reproductive health community can make the best of the Health, Nutrition and Population Civil Society Consultative Group, which meets twice a year to advise the Bank on its health sector work.
All this is happening against the backdrop of a massive restructuring led by Jim Yong Kim, the first Bank President with a health background. The reforms promise a more efficient Bank, but have staff fearing for their jobs which can distract from day-to-day activities.
Moving forward, there may be opportunities to advance reproductive health through a gender lens, since gender equality has become the norm at the Bank (at least in principle). In particular, the Bank’s new strategy includes gender as a cross-cutting theme, and it is likely that next replenishment of the Bank’s low-income financing window (IDA 17) will continue with gender as a special theme.
The bottom line is that—like the United Nations—the Bank is governed by member states. Some of these member states are supportive of reproductive health, and some are not. Staff and management have a similar mix of diverse views and backgrounds, both at the country level and at headquarters. As a community, we can continue our “watch and wait” strategy; another controversy is sure to flare up. But if the Bank is to truly become a positive force advancing reproductive rights, we need to do more than put out fires.