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Sexual and Reproductive Health and Rights: Overseas Aid

Volume 736: debated on Wednesday 12 July 2023

[Relevant documents: Oral evidence taken before the International Development Committee on 23 May and 4 July 2023, on the FCDO’s approach to sexual and reproductive health, HC 1216.]

I will call Sarah Champion to move the motion and then call the Minister to respond. As they are both experienced parliamentarians, they will not really need me to say that—as is the convention for 30-minute debates—there will not be an opportunity for the Member in charge to wind up.

I beg to move,

That this House has considered sexual and reproductive health and rights and overseas aid.

As ever, it is a pleasure to serve under your guidance, Mr Davies.

The Minister is well versed in this topic. He knows that it is essential we ensure that women and girls are empowered to make decisions about their own bodies and that they are free to pursue education, employment and prosperity on their chosen path in life, wherever they are in the world. This is a cause that I care deeply about, and I am delighted to have sexual and reproductive health and rights—SRHR—as a key priority this year for the Select Committee on International Development, which I chair. As part of the Committee’s inquiry, I am very much looking forward to hearing from the Minister of State for Development and Africa on this issue in September. As the inquiry is ongoing, I will focus on a separate piece of work, largely carried out by the Royal College of Obstetricians and Gynaecologists. I will also refer to evidence that has been submitted to IDC.

Last week, I had the pleasure of hosting the launch of RCOG’s new report, “Getting Back on Track: The Case for Reinvestment in Global Sexual and Reproductive Health and Rights”. The report notes the achievements of UK advocacy, leadership and overseas aid on SRHR over the last decade, as well as the impact of recent aid cuts on SRHR and gender equality. The testimonies from RCOG members and other healthcare professionals working on women’s health around the world who have experienced the devastating impact of cuts on the frontline are essential to understanding the issue. I strongly encourage the Minister and his officials to consider closely the findings and recommendations of the report.

The moral obligation to support women and girls on SRHR is clear. Bodily autonomy is the foundation upon which women and girls can exercise their full rights. The rights of women and girls are being rolled back in some parts of the world, which is infuriating and shows that the UK’s advocacy for global gender equality and SRHR has never been more important.

My Committee has heard from several organisations about the importance of UK overseas aid to delivering comprehensive SRHR services and achieving universal access for every woman and girl. UK aid can and does make a real difference to the lives of women and girls around the world, but we must continue and expand our support in a sustainable way.

It is important to look at this issue through an intersectional lens. The Committee has heard that the most marginalised face additional barriers to accessing sexual and reproductive health services. They are often not delivered in a way that is accessible to women with disabilities. That could be as simple as a lack of a wheelchair ramp into the clinic or a lack of sign language interpretation. LGBTQ+ people can also find it difficult to access services due to the stigma, discrimination and even criminalisation of same-sex relationships and gender expression. We must do all we can to change that. I am very proud that our embassies around the world stand up for those rights.

Not only is investing in SRHR the right thing to do, but it makes financial sense. United Nations Population Fund research shows that for every $1 invested in family planning and maternal health in low-income countries, over $8 is accrued by averting unintended pregnancies and reducing the demand for, and cost of, maternal and other health services. Organisations such as the UNFPA are vital actors in the SRHR space, which is why it was so disheartening to hear it tell the Committee recently of the devastating impact of UK Government cuts on its services. In 2021, UK aid to UNPFA’s supplies partnership was cut by 85% with very little warning. Its only clue as to what was coming was from media reports about the UK’s reduction in official development assistance spending from 0.7% to 0.5%.

UNFPA provides 40% of the world’s contraceptive supply, reaching approximately 20 million women and young people every year. It told the Committee that because of the lack of funding, it had to immediately cut the commodities it provides—contraception—by 30% and has since had to make sweeping cuts across the board. While there has been a path to the restoration of funding for UNFPA supplies, the UK Government ultimately remain off track to meet their 2019 commitment of £425 million, with support for the UNFPA’s core operating fund remaining significantly reduced. Will the Minister make a commitment today that the UK Government will restore support to the UNFPA’s core operating fund alongside their existing commitments to their supplies partnership?

Supporting women and girls to take control of their reproductive health is essential in achieving the UK’s international development objectives, in particular its ambitions for gender equality. Government investment must reflect that. I understand that the Minister knows this, but action, not just empty promises, is desperately needed. Women and girls being able to access their reproductive health rights also underpins the success of all three of the ambitions of the Foreign, Commonwealth and Development Office’s women and girls strategy. Girls with access to education, safe and sensitive contraception and abortion services are less likely to drop out of school. Enabling women and girls to choose if and when they have children frees them to pursue employment and participate more fully in social and political life. Empowering women to make decisions about their SRHR is essential in tackling gender-based violence.

In its new report, the RCOG makes the case that if the UK Government are to be successful in achieving their key aims in the women and girls strategy, those aims must be matched with dedicated and sufficient long-term funding. Otherwise, it simply will not work.

I thank the hon. Member for giving way. She is making a good speech, and I congratulate her on securing the debate. One area that the Royal College of Obstetricians and Gynaecologists has focused on in the past, and rightly so, is the high rates of maternal and new-born baby morbidity and mortality in many low and middle-income countries, particularly in Africa. Will the hon. Member address that point and make some suggestions to the Minister about how Britain can better support that agenda through its aid strategy and improve safety around pregnancy and childbirth?

I will indeed cover that, and also benign gynaecological conditions, which are another major killer for women. I congratulate the hon. Member on all his work on global health over the years. He continues to be an advocate in this place.

UK aid has contributed significantly and meaningfully towards ensuring that all women and girls can access their sexual and reproductive health and rights, and we should all be proud of that track record. RCOG members in Pakistan who had been providing training as part of the UK’s women’s integrated sexual health—WISH—programme reported dramatic increases in access to safe abortion care, post-abortion care and family planning by those who participated in their schemes. However, the decision to cut ODA threatens to stall or even reverse that progress around the world.

WISH is supposed to be the Government’s flagship sexual and reproductive health programme, but even that is not safe from the cuts. MSI Reproductive Choices had its funding under the WISH programme slashed by 78%. My Committee has also heard that a three-year health programme for the most marginalised communities in Bangladesh received a £1.1 million cut to its £2 million budget two years in, with no notice whatsoever. A direct grant in Ghana, which was providing safe birth, child health and psychoeducation for pregnant women and mothers through building new maternal health self-help support groups and outreach clinics, received a 25% cut.

The Government are not putting their money where their mouth is. The most recent data shows that bilateral spending on SRHR decreased by more than 50% from £515 million in 2019 to £242 million in 2021. The Minister is aware that it is not good enough, and I am aware that he is trying to change it, so I look forward to hearing more about that in his remarks.

Estimates by the Guttmacher Institute suggest that the cuts could already have resulted in 9.5 million fewer women and girls having access to modern methods of contraception, 4.3 million more unintended pregnancies, 1.4 million more unsafe abortions and, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said, a possible 8,000 more avoidable maternal deaths.

Countries with the greatest need for SRHR funding and programmes have been hit the hardest by the cuts, and within those countries, the most marginalised are often the most affected. Professor Friday Okonofua, an obstetrician and gynaecologist based in Benin City, Nigeria, said in RCOG report that it is the most marginalised people who are reliant on donor-funded services. In Nigeria, where nearly 80% of health payments are out of pocket, the loss of funding from the UK Government has only widened this dire gap in services.

Making donations towards SRHR in humanitarian crises is welcome, but not enough. UK support must be in the form of sustained programming that delivers against the UK’s commitments to the UN sustainable development goals, and promoting the health of women and girls must be the backbone of international development. As RCOG recommends, will the Minister commit to restoring funding for SRHR, and spend £500 million each year for the next three years on SRHR programming and supplies?

RCOG is calling on the Government not only to restore investment in SRHR, but to strengthen their global advocacy on SRHR by investing in new and existing global partnerships and collaborations. The UK’s financial commitment to the Family Planning 2020 initiative had a significant impact on the global funding landscape for SRHR. It contributed to enabling an additional 24 million women and girls to access family planning services. I ask the Minister again to make a financial commitment to the Family Planning 2030 initiative, so that we can continue the programme’s success.

Only by linking our national actions to global goals and commitments can we hope to achieve truly universal access to SRHR for every woman and girl. As well as being one of the largest donors of support for SRHR supplies, the UK has been one of the most progressive in its advocacy. RCOG is calling on the Government to strengthen their global advocacy on SRHR by championing stigmatised issues such as abortion care. That is something I care about deeply, particularly as abortion rights are being rolled back around the world. I was proud that the UK co-led a statement at the UN General Assembly last year on the importance of respecting the bodily autonomy and SRHR of women and girls. It has also been reassuring to see the UK Government commit to prioritising safe abortion care as part of their commitment to supporting SRHR in the women and girls strategy.

Mainstreaming safe abortion services and post-abortion care is essential to reduce maternal morbidity and mortality. Unsafe abortion remains one of the world’s leading causes of maternal mortality. The risk of dying from an unsafe abortion is highest for women in Africa, where nearly half of all abortions happen in potentially dangerous circumstances. In his response, will the Minister say how the Government plan to champion safe abortion care in their programming, and in nations’ universal healthcare plans, as part of an effort to strengthen health systems?

We have seen the success of telemedicine in early abortion care in the UK. Guidance from RCOG, the World Health Organisation and other authorities on clinical standards affirms that telemedicine is a safe and effective delivery model for expanding access to abortion care. RCOG has encouraged the FCDO to invest in telemedicine and in self-management of abortion in settings where that can offer safe additional pathways to increased access. As RCOG has suggested, I would like the UK Government to champion the prioritisation of women’s and girls’ gynaecological health needs on the global health agenda.

I thank the hon. Lady for securing this debate. Does she agree that the Government are right to commit to focusing spending on women and girls, and particularly on maternal mental health? Will she call for the UK to publish a voluntary national review on the sustainable development goals, given the importance of this subject?

I absolutely support what the hon. Lady says. She is a member of the International Development Committee, and the Chair of the International Development Sub-Committee on the work of the Independent Commission for Aid Impact. She has always been a champion on these issues, and the Minister has heard what she said.

The FCDO’s programming does not address the global burden of gynaecological disease as a priority in its own right, or as a key element of its integrated SRHR response. That is a glaring omission. Forthcoming RCOG research shows that overall morbidity for women and girls due to so-called benign gynaecological conditions outweighs—I was stunned when I heard this—the combined morbidity from malaria, tuberculosis and HIV/AIDS in low and middle-income countries; yet gynaecological conditions are not in the FCDO’s strategy. There is an urgent need for the UK Government and donors around the world to afford gynaecological disease the same priority as maternal mortality and diseases such as malaria, TB and HIV/AIDS. Can the Minister look into that?

As a first step, RCOG and I are seeking a commitment from the UK Government to championing the issue by investing in the collection of data and research on the scale of the burden, so that we build strong evidence on which to base future investment. Investing in quality SRHR training for all healthcare workers should be a top priority. At present, the workforce meets only 41% of the needs of low-income countries. A lack of skilled workers is a major barrier to making universal health coverage a reality. I welcome the Government’s commitment to strengthening the workforce as part of their contribution to that agenda, but as RCOG recommends, we need greater investment to support task-shifting and task-sharing between different groups and levels of healthcare workers. That is essential if we are to address shortages; support the delivery of comprehensive, integrated SRHR services, including expanded access to abortion care and long-acting reversible contraception; and support the diagnosis and treatment of gynaecological disease at the earliest stage.

The new report from RCOG is an important reminder to us all—and to the Minister—of our responsibility to women and girls around the world, who rely on our Government’s support for their essential healthcare. It should also serve as a call to action, so that we resume the progress that is needed to achieve universal access to SRHR. I urge the Minister to seriously consider the report’s recommendations for investment, as well as the points that I have raised today. We must stand together, alongside women and girls everywhere, and continue to advocate for their health, empowerment, and equality.

It is a tremendous pleasure to serve under your chairmanship, Mr Davies, and the first time that I have done so. This is a subject that you and I have discussed many times over the last 10 or 15 years, so I know that you take a great interest in it.

My pleasure in appearing before you, Mr Davies, is exceeded only by my pleasure in responding to the hon. Member for Rotherham (Sarah Champion), with whom I have had many interactions. As she knows well, I agree with a large amount of what she says, and never more so than in today’s debate. I pay tribute to her for securing the debate, and for the work she does on the International Development Committee, together with its members. It is widely regarded as being among the most expert Committees in the Houses of Parliament. I look forward to giving evidence to her Committee in September, in its inquiry on the important matters that we are discussing. If I do not answer her points in sufficient detail, I know perfectly well that she will pursue me on them.

I also thank the hon. Lady for what she said about the work of British diplomatic missions overseas; I will pass on to the missions her generous words, which I know they will appreciate. As a result of the reduction in the ODA budget from 0.7% to 0.5%, incredibly difficult decisions had to be made, and that imposed an enormous strain on those who are now, but were not then, my officials. Many extraordinarily difficult decisions were made, in furthering the will of Parliament that the budget should be cut, but we are in a better position than we were. I hope that that will become clear next week when we report back to Parliament.

Every woman and girl should have control over her own body and her own life. She should be able to make informed decisions about sex, and whether and when to have children. She should have access to good-quality sexual and reproductive health services and be able to realise her rights. That is far from the case for too many women in too many countries, which is why universal access to comprehensive sexual and reproductive health and rights forms an important part of the British Government’s approach to development and diplomacy. Our commitment to promoting those rights is set out in our strategies on international development, global health and women and girls, and is a central element of our approach to ending the preventable deaths of mothers, babies and children.

We face many challenges in achieving our aims. Global progress on reducing maternal death rates had stagnated between 2016 and 2020, even before the impact of the covid-19 pandemic. That is why I am championing our efforts to help end the preventable deaths of mothers, babies and children by 2030. The campaign joins up efforts right across the system, on issues including water, sanitation and hygiene, good nutrition, clean air, access to new health technologies, and a supportive environment for sexual and reproductive health and rights, which the hon. Member for Rotherham spoke about so clearly.

Let me turn to the worrying trends that are putting at risk the progress we have made on sexual and reproductive health and gender equality. Attempts to roll back the rights of women, girls and members of the LGBT+ community are increasingly well funded and well organised, and we are determined to confront them. Britain is a proud champion of these hard-won rights. We continue to promote and protect them around the world by working closely with our allies, including in the multilateral sphere. We must challenge the lies, polarisation and division that are undermining that progress. That is why the UK led a landmark joint statement at the UN Third Committee last October. Along with 71 global partners, we committed to working tirelessly to advance gender equality, and to supporting the rights of all women and girls. At this year’s Women Deliver conference in Kigali, the UK will help to catalyse united action against the roll-back of women and girls’ rights, and action to further gender equality. There is much to do, but there is cause for hope and the UK has a key role to play.

I turn to another challenge that we face, which is the reduced domestic Government funding for sexual and reproductive health and rights across the world, which was prompted by the covid pandemic and crises around the world. The UK’s official development assistance has also reduced. It remains the Government’s policy that we will get overseas spending back to 0.7% when the economy allows, but meanwhile we are doing as much as we can to find multipliers that can enhance and augment our taxpayers’ money. We have set out a strong pathway towards that through our strategies on women and girls and on ending preventable deaths.

We remain a key supporter of sexual and reproductive health and rights, and we have a significant portfolio of programmes and policies. For example, through FP2030—the global family planning partnership—the UK is helping partners around the world to advocate for better access to family planning. The global financing facility supports stronger, more sustainable access to health systems. The women’s integrated sexual health programme has enabled more than 9.5 million women and girls in Africa and Asia to use modern methods of contraception, and the UK remains a world leader in efforts to end the AIDS epidemic, including through our health system strengthening work, our work to end preventable deaths, and support for the World Health Organisation and the Global Fund to Fight AIDS, Tuberculosis and Malaria. We are pushing for equitable access to comprehensive sexual and reproductive health services, dismantling barriers to access, targeting underserved groups and championing SRHR for all.

On FP2030 and the women’s integrated sexual health programme, can the Minister talk about the financial commitments that go alongside the commitment to leading on policy?

I can certainly say to the hon. Lady that we will do everything we can. As she set out in her speech, this is a very high priority for the Government, and we will do everything we can to make sure that those efforts are adequately resourced.

The Foreign Office and other donors have to adapt our approaches to ensure that the work can be financed sustainably. That means placing accountable country leadership and investment at the heart of our development agenda. For example, the UK has provided more than £200 million to the UNFPA supplies partnership since 2019 to improve the availability, quality and supply of life-saving reproductive health products. That covers family planning, safe abortion, about which the hon. Lady spoke extremely eloquently, and maternal health medicines. Over the last two years, the UNFPA supplies partnership has successfully secured domestic financing commitments from 43 low and middle-income countries regarding their own reproductive health supplies, totalling $26.4 million, and many committed for the first time.

The final element of our approach is ensuring that our efforts on sexual and reproductive health are fully integrated into our broader work on strengthening health systems. That was set out in our G7 Health Ministers communiqué in May. We and the other member states have committed to universal access to comprehensive health services—which include maternal, sexual and reproductive health services—at every stage of life. In making that pledge, we recognise that those services are a vital part of achieving the UN sustainable development goals.

To conclude, we are acutely aware of the challenges that we face in advancing this work, many of which were set out so eloquently by the hon. Lady.

I know the Minister well. If he cannot comment now, can he do some research when the RCOG report on benign gynaecological conditions comes out? I was genuinely shocked to discover that those conditions were killing more women than the other major diseases combined, and that we are not focused on that. I would be extremely grateful if the Minister made a commitment to look into that.

I will certainly look into it. I was extremely struck by what the hon. Lady said about the scale of that issue, and by the comparison that she set out so clearly.

Despite the challenges, the UK continues to prioritise work on sexual and reproductive health and gender equality across the full span of our development and diplomatic work. That includes targeted support to reduce maternal mortality, determined efforts to reduce the roll-back of SRHR and women and girls’ rights, and work to secure sustainable financing. We will continue to advocate for the world’s most marginalised and underserved people so that we secure rights and choices for all.

When it comes to making progress on international development, Britain’s aims cannot be understood unless they are seen through the eyes of girls and women, who suffer the extremes of poverty first and hardest. In putting girls and women at the forefront of everything that we do, a particular aim of the Government’s is to get as many girls into school as we possibly can. As I told the House this morning, in the last five years for which figures are available, we were able to procure the education of more than 8 million girls.

We are also focusing on family planning; ensuring that women have the ability to decide for themselves whether and when they have children; and bearing down on all sexual violence against women, but particularly in the hideousness of conflict. Those three aspects of our policy drive us forward in what we believe is the critical battle of our times: the need to do something about the appalling discrepancies of opportunity and wealth that disfigure our world today.

Question put and agreed to.