Elevating
stories
of impact

Since taking office in 2017, the Trump-Pence administration has consistently advanced policies designed to erode the sexual and reproductive health and rights of women and girls, both at home and around the world. One of the most destructive examples of this is the Global Gag Rule (GGR), which puts politics ahead of women’s lives by blocking their access to needed health care.

PAI has a long history of documenting the devastating impacts of the GGR. Given the current administration’s expansion of the policy in ways never seen before, our impact data is vital in making the case for its permanent repeal. In 2019, we ramped up our efforts to elevate stories of impact by bringing a PAI grantee from Uganda to Capitol Hill so U.S. lawmakers could hear firsthand how this disastrous policy is harming women, girls and communities abroad.

“The GGR wreaked havoc by cutting off funding for much-needed health services, especially amongst communities that are already underserved.”

As the executive director of the Center for Health, Human Rights and Development (CEHURD), Moses Mulumba knows all too well the devastating impacts the GGR is having on women and girls in Uganda. With support from PAI, he had the opportunity to share his story before members of the U.S. House of Representatives.

Mulumba testified before the House Foreign Affairs Committee during the February 2020 hearing on unique challenges women face in global health. The hearing was the result of nearly a year of preparation by PAI and other members of the International Family Planning Coalition, which PAI co-chairs, and represents a key part of our overall advocacy strategy to permanently repeal the GGR.

Since the administration imposed and expanded the policy twice, PAI has been leading efforts to legislatively end the GGR through advocacy and research, arming our congressional champions with direct evidence to bolster the case for permanent repeal. In 2019, a Democratic majority took control of the House of Representatives, including many members who ran on a platform of holding the Trump-Pence administration accountable. The time was right to energize long-time allies and educate freshman representatives on the harmful impacts of the GGR.

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• PAI worked with members of Congress to secure 189 co-sponsors in the House and 46 co-sponsors in the Senate for the Global HER Act, which would permanently repeal the Global Gag Rule.

At the urging of PAI and our coalition partners, the committee agreed to hold a hearing on women’s global health — the first in over a decade. In the months leading up to the event, PAI worked closely with supportive members of the committee to ensure that they would expose the harm caused by the GGR and enter key impact data into the official record.

PAI supported Mulumba in his travel to Washington, D.C. and helped him prepare his testimony. He gave the committee a compelling account of the challenges women and girls in Uganda face trying to access basic reproductive health services and the devastating impacts that the GGR is having on organizations like his.

Mulumba described how CEHURD was forced to end its work on a multiyear U.S. government project and lay off staff when the organization refused to agree to the GGR restrictions. CEHURD had been working to ensure that health care facilities had adequate stocks of lifesaving medicines and supplies. No other organization could be found to take over the work and, as a result, the entire project was closed.

“It is not an easy choice to comply and keep the funding or refuse and lose access to those resources; jobs and indeed lives are on the line,” Mulumba stated. “Nevertheless, CEHURD cannot work on one area of health and not others or prioritize some human rights and not others. This would compromise our values as an institution.”

PAI also submitted written testimony for the congressional record, highlighting key findings in several countries from our three years of research into the impacts of the expanded GGR.

The reinstatement and expansion of the Global Gag Rule (GGR) demonstrates how repressive political decisions from other countries can affect population health and well-being in countries like Uganda. The GGR wreaked havoc by cutting off funding for much-needed health services, especially amongst communities that are already underserved.

MOSES MULUMBA
Executive Director, CEHURD

The Trump-Pence administration claims that the policy is having no negative impact on women and girls, but the evidence and real-life stories from on-the-ground advocates, like CEHURD, paint a very different picture. PAI won’t stop fighting to keep women and girls — and the impact that the GGR is having on their health and lives — front and center until this disastrous policy is eliminated once and for all.

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NEXT: BUILDING THE FOUNDATION FOR CHANGE

BUilding the Foundation
for change

Civil society organizations (CSOs) have a deep understanding of their local context and culture and are in the best position to advocate for positive change for citizens. That’s why PAI is working with family planning advocates in Niger to channel their collective expertise so they can expand access to sexual and reproductive health care for women and girls.

In Niger, a complex set of social, cultural, religious and economic factors are at play, all of which impact women and girls and their sexual and reproductive health care. PAI chose to work in Niger because the need is great: The country has one of the highest fertility rates in the world, with nearly eight children per woman, and the use of modern contraceptives is among the lowest globally.

The environment is also challenging for Niger’s civil society. The advocacy resources are scarce, gaining access to decision-makers to discuss women’s and girls’ health needs is difficult and CSOs are trying to work within a dysfunctional system. Both the political and cultural environment make it routine to disregard and deny sexual and reproductive health needs. This is why change is slow but also underscores the essential role advocates play in pushing for progress.

PAI saw an opportunity to engage Niger’s civil society and strengthen its ability to tackle sexual and reproductive health and rights advocacy. In 2019, we focused our efforts on building a strong and diverse base of advocates committed to taking on these challenges and influencing decision-makers to improve the lives of women and girls.

PAI identified a group of advocacy organizations, both new and established, representing a variety of stakeholders including youth, religious leaders and a women’s organization. We introduced members to tools and resources designed to build their advocacy skills and strengthen organizational capacities.

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• Niger has one of the highest fertility rates in the world, with nearly eight children per woman.

Armed with this information, the group agreed on a collective advocacy approach around the goal of keeping girls in school. This frame helps ensure that reproductive health and family planning advocacy activities are culturally acceptable, making it easier for the organizations to introduce sensitive issues such as comprehensive sexuality education.

By working together as a consortium, the members are strengthening their presence and clout as key players in the national sexual and reproductive health and rights movement and building relationships with decision-makers, including religious and government leaders.

PAI’s partner-centered model and technical assistance are helping grantees in Niger translate their good ideas into strong advocacy objectives and strategies. By channeling their collective strengths, they are helping to build a strong civil society that will be better positioned to expand access to sexual and reproductive health services for women, girls and other vulnerable communities.

PAI’s approach has brought the importance of advocacy to the forefront for religious leaders in Niger for the first time. We really feel that we are at the heart of the action thanks to the way that PAI trusts us. Our capacities in terms of advocacy and project management have been strengthened which has allowed us to develop our own approaches adapted to our particular context and to exercise our leadership rather than being treated as mere implementers of other people’s ideas.

Imam Alou Hama Maiga
President, Groupement des Associations Islamiques pour les questions de Population et de Développement Sociale (Consortium of Islamic Associations for Population and Social Development Issues, GAIP/DS)

NEXT: SEIZING OPPORTUNITIES

Seizing
opportunities

Global efforts to achieve universal health coverage (UHC) are providing unprecedented opportunities for countries to include sexual and reproductive health care in new benefits packages. PAI works with local advocates, such as the Centre for Reproductive Health and Education (CRHE) in Zambia, to ensure that the health care needs of women, girls and other vulnerable communities are part of these emerging reforms.

Countries around the globe are embarking on bold plans to achieve UHC and expand affordable health care to citizens — but as history has shown, if family planning advocates are not part of the process, the health needs of women and girls will be overlooked.

For example, Ghana passed a landmark health insurance initiative in 2003, but because the government failed to include women’s health advocates in the process, family planning was left out of the benefits package. For the next 16 years, the cost of contraceptives and other reproductive health services remained a significant barrier for the women and girls who needed them most. The national government finally began addressing this in 2019 as part of Ghana’s UHC goals.

PAI is making sure that history doesn’t repeat itself and launched a multiyear project in 2019 to ensure that contraceptives and other sexual and reproductive health services are included in emerging — and often fast-tracked — UHC reforms.

When the government of Zambia introduced a new national health insurance initiative in 2018, CRHE and PAI mobilized quickly to ensure that family planning would be included.

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• In 2019, PAI launched a multiyear project in six countries – Ethiopia, Ghana, India, Kenya, Uganda and Zambia – to ensure that contraceptives and other sexual and reproductive health services are included in emerging UHC reforms.

With a 12-year track record of successful collaboration, CRHE and PAI leveraged our collective strength and networks to use key intel on the process and timeline to chart the path forward. PAI analyzed the technical aspects of the proposed health insurance plan and advised on opportunities to engage decision-makers on the inclusion of sexual and reproductive health services and contraceptives.

CRHE convened family planning advocates and other stakeholders for a workshop, during which PAI helped clarify the policy implications of the new insurance program on sexual and reproductive health and supported attendees as they developed an advocacy strategy. At the end of the two days, members of the coalition left with a robust plan of action.

With PAI’s continued support, CRHE led the coalition in pursuing this advocacy agenda and collaborating with government decision-makers throughout 2019. In early 2020, the network members learned their hard work had paid off when the Ministry of Health announced that family planning services would be part of the new benefits package. This includes a wide range of contraceptive options, such as birth control pills, implants, injectables, intrauterine devices and emergency contraception, which will allow women to choose what works best for them.

The decisions governments are making now around UHC will impact their citizens for years to come. It’s essential that organizations like CRHE are able to advocate for the health needs of women and girls and that PAI can give them the support they need to succeed.

The value of our partnership with PAI cannot be overstated. PAI recognizes that advocacy requires a long-term investment and its support of CRHE has helped us achieve many wins for women and girls over the years.

Amos Mwale
Executive Director, CRHE

NEXT: HOLDING GOVERNMENTS ACCOUNTABLE

Holding
governments
accountable

Government commitments to expanding access to sexual and reproductive health care through improved policies and funding are an important first step — but far too often, these promises don’t translate into real progress for women and girls at the community level. To ensure meaningful change, it takes a strong civil society to hold governments accountable to deliver on their obligations. PAI equips local advocates, like Yayasan Cipta Cara Padu (Cipta), an Indonesian CSO, with the tools and resources they need to track and measure their government’s progress and deliver results for women, girls and other vulnerable communities.

It has been said that what gets measured gets managed. The Motion Tracker is enabling family planning advocates to do just that by helping them track government commitments to women’s and girls’ sexual and reproductive health and making sure they remain a priority.

Developed by the Samasha Medical Foundation (Samasha), the Motion Tracker is an approach that gives advocates a way to track government follow-through on commitments made to Family Planning 2020 (FP2020), a global initiative to empower women and girls by investing in rights-based family planning. Encouraged by the Motion Tracker’s success in Uganda, PAI and Samasha partnered on a multi-country rollout in 2019.

Cipta was selected to lead the Motion Tracker implementation in Indonesia, one of the first countries to make an FP2020 commitment. In 2017, the national government expanded that commitment, promising access to modern contraceptives for at least 2.8 million more people. But while the political will was there, the Indonesian government lacked an effective way of tracking progress on its commitments.

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• Cipta is making sure the government of Indonesia follows through on its promise to expand access to modern contraceptives for at least 2.8 million more people.

With technical support from Samasha and PAI, Cipta identified and analyzed the government’s specific commitments and developed a set of 30 indicators to track progress in areas such as the allocation of family planning funds, the expansion of access to and types of contraceptives and the development of youth-friendly health services and programs. The organization engaged government officials throughout, helping ensure that the process was collaborative and the government viewed Cipta as a partner rather than an adversary.

By measuring and monitoring progress on Indonesia’s FP2020 commitments, Cipta and the Motion Tracker are driving conversations and priorities for the country’s government and civil society. The data is being used by the government in multiple FP2020 forums and by advocates to develop work plans. It also helped formulate recommendations on how the private sector can be leveraged to increase access to sexual and reproductive health services for youth.

We know that if governments aren’t held accountable to their commitments, women and girls won’t have access to the contraceptives and reproductive health services they need and deserve. By equipping advocates like Cipta with tools like the Motion Tracker, PAI is ensuring that they have the resources they need to get the job done.

When it comes to Indonesia’s FP2020 commitments, the most common question among the stakeholders is “Where are we now?” PAI and the Motion Tracker are helping us identify and measure progress, and because the process relies on active participation and inputs from stakeholders, it’s also strengthening partners’ engagement in realizing our country’s commitments to women and girls.

Dini Haryati
Program Manager, Cipta

NEXT: MEETING CHALLENGES

Meeting
challenges

When a country experiences instability due to political upheaval, conflict or natural disasters, we know that women and girls are disproportionately impacted. The need for advocacy becomes even more important — and challenging. PAI works with grantees, such as Fundación Maquilishuatl (FUMA) in El Salvador, to ensure they can navigate these obstacles, so women and girls and their health needs are not pushed aside.

El Salvador is one of the most dangerous countries on Earth for women. The end of the 12-year civil war in 1992 ushered in an era of widespread gang violence that still afflicts the country today. Young women and girls are regularly targeted by gangs and there is an alarming rate of partner violence and femicide. These various forms of violence severely restrict access to quality sexual and reproductive health services.

Nonprofits working at the community level are critical to linking women and girls to the care they need. Established in 1985, women-led FUMA has a strong track record of working with the Ministry of Health and other national government agencies on improving access to family planning and other health services for women and girls in low-income and rural communities.

The 2019 election of a center-right president changed all of that. Collaboration and transparency between civil society and the national government have all but disappeared. The president’s push for privatization of health services, the absence of a national health plan and a lack of coordination between government agencies are jeopardizing access to sexual and reproductive health care.

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• Because the new administration has failed to implement a national health program to monitor and evaluate quality of care, there is no system in place to ensure reliable reporting of data. This lack of official information is obscuring health issues across the population, including among pregnant women and girls in El Salvador.

This is already having serious consequences for citizens. For instance, the new government’s failure to support the national health care program is causing massive disruptions in the provision of health care and access. The absence of leadership means that providers don’t have the medical treatment guidelines they need to offer quality care, and many health care facilities at the community level lack the funding to stay open. These breakdowns are having a devastating impact on women and girls in El Salvador, including increased maternal deaths.

PAI began working with FUMA before this turmoil and we will continue the partnership to ensure women’s and girls’ health needs are not lost in the chaos. With support from PAI, FUMA is increasing its local advocacy efforts by strengthening relationships with community leaders and elected municipal officials and building alliances with other CSOs to increase access to health care at the local level.

PAI is also helping FUMA identify and pursue international partnerships in an effort to increase global visibility of the situation and encourage the national government to fulfill its commitment to sexual and reproductive health as a human right.

The political situation in El Salvador represents a global trend of increasingly conservative leaders who are eroding women’s sexual and reproductive health and rights. Because of this, country-level advocates like FUMA are doubling down on their efforts to ensure that the health needs of women, girls and other vulnerable citizens are not diminished — and PAI will continue to stand by their side.

To address the new political reality in El Salvador, we are building alliances with CSOs throughout the country to strengthen joint advocacy and more extensive community-based efforts around health, as well as coordinating with municipal leadership to support work at the local level.

Magdalena Cortez
Executive Director, FUMA

NEXT: ELEVATING STORIES OF IMPACT