FCDO’s approach to sexual and reproductive health

The cuts to bilateral and multilateral Official Development Assistance on sexual and reproductive health and rights (SRHR) since 2020 have had a considerably negative impact upon the aid recipients of SRHR programmes, particularly on women and girls and those belonging to marginalised groups. The abrupt nature of the aid cuts damaged the UK’s relationships with aid partners and its reputation as an aid delivery partner.

The Committee welcomes the FCDO’s recent policy statements which have renewed the FCDO’s commitment to SRHR. To turn words into action, this should be backed up by consistent and long-term funding.

In order to meet previously set targets in this area, the FCDO should calculate a minimum percentage of bilateral Official Development Assistance to be spent on sexual and reproductive health and rights (SRHR). It should explain to the Committee why it has chosen this target and ensure adequate commitment of funding. This should not be lower than spending levels before the covid-19 pandemic. The proportion of bilateral spending on population programmes/policies and reproductive health should also not be any lower than before the covid-19 pandemic at 4% of bilateral ODA spending per annum. To ensure reliability and predictability of funding, the FCDO should ensure that programme funding is given on a multiyear basis. Programmes should run for a minimum of 5 years where possible.

Multilateral organisations are sometimes best placed to act and implement aid programming on sexual and reproductive health. The UK has historically been a key donor to multilateral organisations working on sexual and reproductive health. Evidence to the Committee has shown the benefits of both bilateral and multilateral funding. The FCDO should continue to support key multilateral organisations such as the UNFPA, the Global Fund, Unitaid and UNAIDS that are uniquely placed to work with national governments, and with civil society and communities, on aspects of SRHR. As a minimum, it should meet its prior commitments to these organisations. It should also restore discretionary funding to at least the same levels as before the covid-19 pandemic. (Paragraph 18) Family planning

The Committee is pleased to see the FCDO’s continuing commitment to family planning as a core part of its work on sexual and reproductive health, including the provision of safe and legal abortion services. However, the FCDO’s abrupt and sudden cuts to SRHR programmes directly led to the reduction in vital services for women and girls and damaged the UK’s work and reputation in this area. As part of its renewed commitment to SRHR programmes, the FCDO should ensure that it meets its original funding commitment made in November 2019 to the UNFPA Supplies Partnership to enable the delivery of vital healthcare services for women and girls. It should also consider restoring core funding to the UNFPA to £20 million annually. (Paragraph 27) The FCDO’s approach to sexual and reproductive health 41

The use of telemedicine and self-management in SRHR programmes could increase the accessibility, reach and effectiveness of such programmes. The FCDO should consider how to incorporate the use of telemedicine and self-management of SRHR in its aid programming, such as in providing access to safe abortion, and update the Committee no later than Autumn 2024 on its progress. (Paragraph 28) Maternal and newborn health

The FCDO’s approach papers on ending preventable deaths of mothers, babies and children by 2030 (EPD) and health systems strengthening (HSS) show a positive step in the right direction. However, in the absence of key targets for progress or regular updates, it has proved difficult to assess the effectiveness of the UK’s work in this area. The Committee welcomes the FCDO’s commitment to publish a future progress report on its EPD and HSS work in 2024, and to provide future updates on this work. However, more frequent updates on the FCDO’s work on EPD and HSS are needed in order to map the progress towards SDG commitments by 2030. The FCDO should publish key targets and achievements on an annual basis for its approach papers on Ending Preventable Deaths and Strengthening Health Systems.

Access to clean water and the provision of adequate sanitation and hygiene reduces the risk of maternal and newborn mortality. In complementarity to its approach on SRHR spending, the FCDO should calculate and justify a minimum bilateral ODA percentage that it must spend on WASH to reach its development targets. This target should not be lower than 2% per annum. The FCDO should also ensure that WASH and SRHR programmes adopt a complementary and integrated approach.

The involvement of trained health personnel and access to adequate health care facilities for maternal and newborn health improves health outcomes for the mother and child. The FCDO should support the strengthening of healthcare systems by prioritising investment in the development of health infrastructure, particularly WASH infrastructure. The FCDO should prioritise support for training and retention of health personnel in low-and-middle-income countries. The FCDO should calculate a minimum percentage of ODA to be spent on the training of health personnel in low- and-middle-income countries. It should explain to the Committee why it has chosen this target and ensure adequate commitment of funding. (Paragraph 39) Women and girl’s health

To meet menstrual health needs, women and girls must be able to access accurate, timely and age-appropriate information about menstruation. In addition, they need access to WASH services and inclusive infrastructure. Without adequate services and facilities, managing menstruation can be a challenge for women and girls in low-and-middle-income countries, preventing them from accessing education and employment opportunities. This could undermine the UK Government’s work in other sectors, particularly in education. (Paragraph 42) 42 The FCDO’s approach to sexual and reproductive health

The FCDO should support menstrual health by supporting the provision of WASH services and infrastructure and access to menstrual products. In particular, the FCDO should ensure that its work in the education and WASH sectors complement its SRHR work in this area, for example, ensuring that education programmes include the provision of appropriate sanitary facilities. It should also support age-appropriate education on menstruation.

The FCDO has not sufficiently addressed the threat of gynaecological disease in its SRHR programming, despite the risk it poses to the SRH of women and girls. The prevalence of cervical cancer among women and girls in lower-income countries is also concerning, especially as adequate provision of the HPV vaccine could greatly reduce the threat of cervical cancer to women and girls. The FCDO should look to incorporate care of gynaecological disease, including so-called ‘benign’ gynaecological disease, into its SRHR programming. It should also continue to support the provision of the HPV vaccine to women and girls and look to align this with its SRHR programming where possible.

Female genital schistosomiasis is a painful and debilitating but treatable condition affecting up to 56 million women. FGS is best tackled through an integrated approach with wider SRHR programming, as well as with other areas of programming such as education, WASH and HIV and AIDS. The UK should integrate female genital schistosomiasis (FGS) care into its SRHR programming. This should include (a) improving access to adequate water, sanitation and hygiene facilities, (b) increasing girls’ enrolment in education and supporting distribution of FGS medicine in schools, (c) distributing educational materials on WASH, and (d) considering integrating FGS and HIV and AIDS programming, including by discussing the integration of HIV and AIDS programming with FGS care with its multilateral partners, such as the Global Fund.

The UK Government has long been an opponent of female genital mutilation (FGM) and has worked against FGM both bilaterally and multilaterally. The UK Government should renew its commitment to preventing female genital mutilation through funding multilateral and bilateral programmes, including those tackling the medicalisation of FGM and ‘cross-border cutting’, which involves moving women and girls across national borders to undergo FGM or cutters across national borders to perform the practice. (Paragraph 55) Sexually transmitted infections, including HIV and AIDS

The goal of ending AIDS cannot be reached without access to proper care and treatment for all people living with HIV, and action to bring down the large numbers of people newly acquiring HIV (1.3 million in 2022, far above the global target of 500,000 by 2025). More than 40 years after the first cases, the AIDS pandemic continues to pose a major barrier to global development, and COVID-19 has had a serious and significant impact on the ability of healthcare services to reach global targets on HIV and AIDS. Recent reductions in the UK’s bilateral aid spending on HIV and AIDS, alongside major cuts to its funding to UNAIDS, Unitaid and the Global Fund at the same time is, therefore, particularly concerning. (Paragraph 64) The FCDO’s approach to sexual and reproductive health 43

To support the achievement of global targets on ending AIDS, and to retain the UK’s historical leadership in this important area of SRHR, the FCDO should retain bilateral investments in HIV prevention and treatment, both through dedicated HIV programming and in its support for integrated SRHR, with a special focus on marginalised groups such as adolescent girls and young women, as well as key population communities. The FCDO should continue to support, and pay its fair share to, the Global Fund, which is a major funder of HIV prevention and treatment, and invest in the community-led responses and human rights programmes which are so essential to an effective AIDS response.

The FCDO should also actively encourage the effective integration of HIV into sexual and reproductive health services, by explicitly including HIV in SRHR policy documents and funding calls and requiring the inclusion of organisations with HIV expertise in the SRHR programmes that it funds. These services should also be designed, implemented, monitored and evaluated in close partnership with community-led and civil society organisations, recognising the vital role that they play in ensuring that services are responsive to local needs and are able to reach those most left behind.

The FCDO should have a holistic and integrated approach to all of its sexual and reproductive healthcare programming to enable recipients to live a healthy life and reach their full potential. When funding sexual and reproductive healthcare, the UK should also consider investing in a ‘one-stop shop’ approach to SRHR which would help to ensure truly comprehensive sexual and reproductive healthcare and reduce barriers to accessing lifesaving HIV and SRHR services, such as travel costs, time, and stigma. (Paragraph 68) Reaching marginalised and hard-to-reach groups

Access to SRHR services and comprehensive sex education is vital to adolescents; however, adolescents may often face barriers to accessing sexual and reproductive health services. Ensuring that women and girls are fully educated on sexual and reproductive health can empower them and give them the autonomy to make informed decisions in life. Better education among women and girls is also linked to better sexual and reproductive health outcomes. Considering the UK’s commitment to girls’ education, the FCDO should embed comprehensive age-appropriate sex education into its ODA-funded education programmes.

People accessing SRHR services may be vulnerable, such as adolescents. The FCDO should ensure that staff who are delivering FCDO-funded aid programmes receive training to be able to recognise safeguarding concerns when interacting with aid recipients. These staff should be empowered to signpost aid recipients to the appropriate services and support.

People with disabilities may face additional barriers to accessing SRHR programmes and providing services to people with disabilities may often take additional resources. Consequently, organisations implementing development programmes may be disincentivised from reaching marginalised groups as programmes are often required to show that they have reached as many recipients as possible. The FCDO should ensure that all SRHR programmes are accessible to people with disabilities. 44 The FCDO’s approach to sexual and reproductive health FCDO’s SRHR programmes should include a dedicated budget, baselines, targets, and key performance indicators so that people with disabilities are fully integrated into aid programmes. In addition, all FCDO programming on SRHR should record disaggregated data on aid recipients, including age, sex, and disability to assess how successful they are at inclusivity.

People from marginalised groups, such as people with disabilities and LGBT+ people, may face additional and unique challenges in accessing SRHR services. The FCDO should ensure its commitment to the principle of ‘Leave No One Behind’ in all its SRHR aid programmes. The FCDO should include hard-to-reach aid recipients, often those belonging to often marginalised and excluded groups, in the planning, development, and delivery of aid programmes on SRHR and should invest in community and civil society organisations led by these populations, recognising that they are essential partners in achieving health outcomes.

The FCDO has made positive progress in tackling sexual and reproductive health in humanitarian contexts, such as by adopting the Minimum Initial Services Package. The FCDO should ensure that SRHR services in these contexts reach the most marginalised groups and consider how to further implement SRHR aid programming in humanitarian contexts to meet need. This should include knowledge- sharing between teams within the FCDO who work on fragile, conflict-affected, and humanitarian contexts and sexual and reproductive health, such as teams working on global health, humanitarian crisis response and the Office for Conflict, Stabilisation and Mediation. (Paragraph 86) Diplomatic support for sexual and reproductive health

Over recent years, there has been an alarming rollback on the rights of women and girls globally, of which SRHR are integral, and further criminalisation of LGBT+ people. The merger of the Foreign and Commonwealth Office with the Department for International Development offers an opportunity for the FCDO to better use its diplomatic position to obtain its development goals on sexual and reproductive health and rights, such as by supporting access to these rights by women and girls and other marginalised groups. The UK should continue to position itself as a global leader on SRHR by (a) continuing to advance the principle of ‘Leave No One Behind’ across its aid programming and (b) continuing to raise the issue of the rights of women and girls, LGBT+ people and other marginalised groups both in multilateral fora and in bilateral conversations with partners in regard to SRHR. It should ensure that its diplomatic and development work on SRHR are integrated and complementary. (Paragraph 91) The FCDO’s approach to sexual and reproductive health 45