Putting women first in “women’s health”

By Dr Samukeliso Dube , Executive Director, FP2030

There are straightforward ways of defining health systems, or reproductive health systems, for context: Supply chains. Commodities. National budgets. Refrigeration and climate-controlled storage facilities. Regulatory frameworks. They’re all critical components of resilient and functional health systems... But are they compelling? Do they illicit feelings? Do they tell a story?

These pieces are all important, of course. But in our quest to galvanize progress for access to contraception we have unintentionally become too granular. We risk missing the forest through the trees – or missing the women through the IUDs, pills, and patches. More importantly, I believe we’re missing the mark on delivering human rights.

Recently, I was fortunate enough to convene about two dozen CEOs in the family planning field to discuss the latest findings in the FP2030 measurement report. The report showed many promising metrics, but it also showed some clear warning signs for our field ahead: stagnant funding, political fights, and a growing anti-human rights agenda. The release of this report came just weeks after the first-ever Latin American country, Honduras, made an FP2030 commitment.

This timing – a moment of clear progress against a backdrop of uncertainty - shows what a unique crossroads we find ourselves in as a movement. If we double down on a human rights agenda, revitalize leadership, and renew funding efforts, our potential is nearly limitless. If we throw our hands up in despair at the challenges ahead, the consequences seem limitless as well.

The meeting of CEOs was intended to chart the way forward amidst these challenging times. The participation was diverse: we were joined by leaders from advocacy groups, international donors, and the entire managing director team from FP2030. Despite this diversity, there was resounding agreement on a few themes:

First, we are missing the mark on human rights. Our movement is quite focused on metrics, money, and commodities. It makes sense, as not only are these critical components of a strong health system, but they also have clear markers of success. Either a woman shows up at a clinic and receives the method she wants, or it’s out of stock. Either the money flows to the clinic and they can provide their services, or it doesn’t. But that’s not all we’re interested in, is it? An investment in family planning is fundamental to achieving human rights, enabling people to decide if when and how many children they want to have.

If an IUD makes it to a clinic, and a woman requests it, but the doctor says “oh but you’re married, you’ll want to have children soon. Maybe just use condoms for now?” our movement has still failed, because we’re not interested in just the IUD, we’re interested in the choice – and in the power to choose. Not only do we want women to have choices, but we also want all people to have the education, power, and autonomy to act on their decisions.

This will require a nuanced shift in messaging, funding, and our way of “doing business as usual” to marry what women want and what women need. Together, we need to better weave through the critical importance of gender, social norms, and empowerment to our work. I’m pleased that FP2030 recently released its first gender strategy, in which we commit to weaving gender transformative approaches into our work, but that’s only the first step.

Which leads us to the second call to action: collaboration. Our movement for family planning continues to be too siloed. It’s time for those of us with the most power to actively push back on siloed funding proposals and requests. And stop reinventing another family planning curriculum! We must actively seek out meaningful partnerships with other movements for human rights and equality. We must not only reach out to people advocating for the rights of people with disabilities, the rights of LGBTI people, and the rights of sex workers, when it is convenient. We need to be active partners in their movements. I’m saying, maybe vulnerably: FP2030 wants to do more in these fights, but we don’t always know what needs to be done. We want to lend our megaphone – as the largest community of practice on family planning globally -- to those that need it, and we look forward to working with a more diverse set of commitment makers as our movement grows.

Lastly, our movement needs to get creative. There are efforts we have been discussing for years that we need to get creative around: partnerships, supply chains, funding for example. Equally, we need a more creative narrative that reflects the lived realities of the women we’re talking about – we need to better explain that family planning transforms lives. We need creativity in how we talk about family planning, because we’re talking about sex, we’re talking about pleasure, we’re talking about relationships – or at least, we should be. The anti-choice and anti-human rights groups are unabashedly creating sensationalist propaganda, and yet our movement has removed the sex agenda from planning families. Let’s talk about sex! Our movement has got to get creative and retire the stuffy stoicism that tends to surround this field.

We cannot make these changes alone. I encourage you to ask yourself: in your own work, how are you focused on the women and people at the end of the line, so to speak? The people showing up to the clinic with a plan for what they want, but end up talked out of their choice, outrightly turned away, or maybe they’re too fearful to show up in the first place. How can we better understand their experience, and change the ways we fund this work, talk about this work, and advocate for advancement? Our movement is stronger when we reach across development silos, and it’s never been a more critical time for meaningful partnership. Let’s get to work, together.