Recent studies on development aid from European donors revealed that their funding of the health sector in sub-Saharan Africa rarely includes performance measures suitable for tracking operational progress in improving sexual and reproductive health and rights. Analysis of health sector agreements verifies this. Particularly lacking are metrics related to four critically important areas: 1) reducing mortality and morbidity from unsafe abortion, 2) preventing and treating gender-based violence, 3) reducing unwanted pregnancies among the poorest women, and 4) reducing unwanted pregnancies among adolescents. During 2011 and the first half of 2012, the authors interviewed 85 experts in health service delivery, ministries of health, human rights, development economics and social science from sub-Saharan Africa, Europe and the United States. We asked them to identify measures to assess progress in these areas, and built on their responses to propose up to four practical performance measures for each of the areas, for inclusion in health sector support agreements. These measures are meant to supplement, not replace, current population-based measures such as changes in maternal mortality ratios. The feasibility of using these performance measures requires political commitment from donors and governments, investment in baseline data, and expanding the role of sexual and reproductive health and rights civil society in determining priorities.
This article reviews the unique historic and contemporary role of U.S. philanthropies in supporting international family planning and reproductive health (FPRH) programs, including how priorities are set, strategies developed, and activities funded. We then discuss the FPRH situation in sub-Saharan Africa today, where needs are the most urgent and where, increasingly, foundations are focusing their resources. We describe one case study exhibiting good philanthropic practice and conclude with thoughts about what the future holds for foundations in international FPRH. We find that as leaders in the field of FPRH, foundations have the ability to stay committed to their goals of championing the reproductive health and rights of individuals under dynamic circumstances. Although every policy environment offers opportunities and constraints, foundations, with their grantee partners, have a range of tools to foster and guide social change. As circumstances change, foundations have to be willing and able both to reassess where they provide added value and to take risks through innovative strategies.
The landmark United Nations International Conference on Population and Development (ICPD) took place in Cairo almost 20 years ago. At that time, 180 nations made a commitment to work together and to pay for services to improve the sexual and reproductive health and rights (SRHR) of women and men, particularly those living in the world's poorest countries.
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