International Assistance and Cooperation in Sexual and Reproductive Health: A Human Rights Responsibility for Donors

This briefing paper focuses on what is expected of donors regarding their human rights responsibility in the area of sexual and reproductive health (SRH). According to the document, donor countries and organisations  have an obligation, deriving from the ratification of certain treaties, to contribute to the progressive realisation of the rights to SRH in other countries. As stated in this paper, "they must take systematic, concrete and targeted steps towards this objective and may be held to account in this respect." International human rights treaties include: The International Covenant on Economic, Social and Cultural Rights (ICESCR, 1966), the Convention on the Rights of the Child (1989), and the Convention on the Rights of Persons with Disabilities (2006).

The paper points to national and international documents that place responsibility on States to seek assistance and offer/provide assistance on extending access to health care, particularly SRH, which accounts for as much as 18 per cent of the overall global disease burden and 32 percent of the disease burden among women of reproductive age (15–44). "Under ICESCR, States are required to take targeted steps to progressively realise the right to health, subject to the maximum available resources." Types of support and examples of support and non-support are inserted throughout the paper, such as:

• A donor can support technical cooperation on human rights through contributions to an international organisation, e.g., Sweden, having implemented human rights foreign policy and shared responsibility in 2002, supported the employment of an Associate Professional Officer as a Health and Human Rights Officer in the WHO country office in Uganda.
  
• Donors can act in breach of their responsibility to provide international health assistance, often for reasons of political pressure, with disregards for human rights agreements. Donors provided Occupied Palestinian Territories almost 50 per cent of the Ministry of Health’s budget until the election of the Hamas party. As noted here, following "Hamas’s refusal to renounce violence, some major donors turned off their life-saving assistance without notice."
  
• Donors can enhance the human rights awareness in their own and other organisations, e.g., the German Federal Ministry for Economic Cooperation and Development (BMZ) provided specialist events and in-house training courses for the BMZ and its implementing organisations on human-rights-based SRH practical implementation, as did the United Kingdom (UK) Department for International Development (DFID), including the publication of How to Reduce Maternal Deaths: Rights and Responsibilities.
  
• Donors can take into account the value of local participation and sesitivity to cultural aspects of SRH, e.g., in Guinea-Bissau where female genital mutilation (FGM) is still widely practised, donors recognised the track record of the non-governmental organisation (NGO) Tostan, whose approach is to engage the community in respectful discussions on human rights.
  
• Through monitoring, donors can hold accountable: their own staff, the policy making and programme implementing bodies of their partners, and governments, international donors, and NGOs. For example, the United Nation’s (UN) Special Rapporteur studied, reported on, and commended the Swedish Government's human rights policies and actions in a programme in Uganda. In another example, to promote public accountability for health policy, CARE Peru "supported a variety of social reporting mechanisms and a wide range of civil society allies. These have included support to ForoSalud, Association for Human Rights (APRODEH), and a National Coalition on Health Rights and Sexual and Reproductive Surveillance Group...." It also promoted specific issues in public debate, through health-focused reporting, to provide tools for advocacy; and it developed structures, such as citizen- and civil society-based accountability mechanisms, promoting citizen surveillance of health services.
  

The paper's recommendations focus on what States can and should do to ensure their compliance with human rights responsibilities of international assistance in the field of SRH. Among a number of recommendations to both developing countries and donors, are the following:

• Developing countries should commit to exercise leadership in developing and implementing their national development strategies through a broad consultative process, including attention to SRH rights.
  
• "Donors must coherently respect, protect and fulfil the rights to sexual and reproductive health in their policies, as well as other activities at the international, national and local levels..." This includes positions taken in negotiation at international development conferences; work with policy making of international organisations, such as the World Bank and the International Monetary Fund, as well as in multilateral agreements, and strategy, programme, and project development with nations and inter-governmental and non-governmental partners; and harmonisation work with other donors.
  
• "Donors must ensure that the rights to sexual and reproductive health are taken account of in all stages of the programme cycle, including situation analysis, impact assessment, implementation, monitoring and review."
  
• Donors must ensure that they promote non-discrimination in particular for marginalised groups and communities, such as persons living in poverty; women; adolescents; persons affected by disabilities; persons living with HIV/AIDS; indigenous persons; commercial sex workers; elderly persons; and lesbian, gay, bisexual, and transgender persons. They must also guarantee participation of affected populations and their representatives in the design, planning, implementation and review of their policies, programmes, and projects on the rights to sexual and reproductive health.
  
• Donors must not attach conditions to development assistance which would undermine a developing country’s ability to guarantee the rights to sexual and reproductive health. They must respect each country's right to determine their own SRH policies.
  
• Donors should support programmes to enhance demand for these rights. "Through supporting civil society, donors can help enhance awareness of rights and support marginalised groups to claim their rights and hold duty bearers to account." This may include training of their own staff.
  
• Donors must support monitoring of and accountability for SRH, including supporting the empowerment of civil society to actively enact monitoring and accountability; capacity building to enhance rights monitoring; and the inclusion of parliaments, the judiciary, civil society, and human rights organisations in monitoring SRH human rights.