Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694573356777.pdf (Australia)
Submission to the Inquiry into the Strategic Effectiveness and Outcomes of Australia’s aid program in the Indo-Pacific Region June 15, 2018 Contact: Elsie Lardner Senior Manager, External Relations (Acting) Marie Stopes International Australia Inquiry into the strategic effectiveness and outcomes of Australia's aid program in the Indo-Pacific and its role insupporting Australia’s regional interestsSubmission 42 About Marie Stopes International Australia Marie Stopes International Australia (MSIA) is a results driven, non-profit social business that specialises in the provision of sexual and reproductive health services to individuals and communities, and is part of the Marie Stopes International global partnership, which operates in 37 countries worldwide.
Our services include high-quality sexual and reproductive health education and counselling, and access to modern forms of contraception, STI and HIV testing and treatment, cervical cancer screening and treatment and safe abortion.

We have operated for 41 years, working towards sustainability through providing a fee-for-service model where possible in order to subsidise costs for women and girls who cannot afford our services.
In 2017, 26.9 million women were using a form of contraception supplied by Marie Stopes, averting an estimated 5.4 million unsafe abortions, 8.2 million unintended pregnancies and 23,900 maternal deaths.
Support for Australian Government’s Inquiry into the Strategic Effectiveness and Outcomes of the Australia’s Aid Program in Indo-Pacific Region As an organisation accredited by the Australian Department of Foreign Affairs and Trade (DFAT) and an Australian NGO Cooperation Program (ANCP) partner, MSIA welcomes the inquiry into the efficacy of the Australian aid program outcomes.

Specifically, MSIA supports the Australian Government’s commitment to supporting the improved outcomes for women and girls.
With a departmental target ‘of at least 80 per cent of investments in Australia’s aid program, regardless of their objectives, effectively addressing issues of gender inequality in their implementation’, women and girls are prioritised in a world where they are disproportionately affected and underserved by the current health, education and governance structures that exist.
The situation in the Indo-Pacific region demonstrates that the social determinants of health for women and girls are far more detrimental than for men and boys.
In the region, trends demonstrate an overall increase in life expectancy amongst the population, yet ongoing high rates of maternal mortality demonstrate a disproportionate advantage to the male population.1 As a development partner, we have seen Australian Government investment in sexual and reproductive health services yield tangible benefits and effective outcomes for women and their communities.
In 2017 alone, DFAT support to MSI contributed to programs that averted over 800,000 unintended pregnancies and more than 700,000 unsafe abortions in the Asia Pacific region.

As experts in reproductive healthcare, MSIA welcomes the opportunity to contribute to this inquiry to demonstrate why investment in sexual and reproductive health services should remain a priority for the Australian aid program and is an effective mechanism for aid delivery.
Our submission addresses the implementation and efficacy of three outcomes areas specified in the Inquiry Terms of Reference:    increased private sector and trade development outcomes; increased emphasis on outcomes for women and girls; and innovation in Australia's aid program.

1 OECD/WHO (2016), Health at a Glance: Asia/Pacific 2016: Measuring Progress towards Universal Health Coverage, OECD Publishing, Paris, https://doi.org/10.1787/health_glance_ap-2016-en.
Inquiry into the strategic effectiveness and outcomes of Australia's aid program in the Indo-Pacific and its role insupporting Australia’s regional interestsSubmission 42 Increased Private Sector and Trade Development Outcomes Prioritising private sector and trade development outcomes in the Australian aid program can deliver a positive and sustainable impact on business environments, market growth and economic development for individuals, families, communities and nations.
The private sector already play an important role in tackling social and economic development challenges and are well-positioned to address global development issues given their resources, technical and local knowledge and influence.

However, the role of the private sector in the aid program must be managed with realistic expectations, and should have a commitment to locally-led solutions, and community ownership and engagement.
In partnership with development practitioners and civil society, the private sector can deliver social impact with commercial returns through a vision of ‘shared value’.2 Furthermore, a community-driven and inclusive approach, private sector development can help alleviate poverty, contributing to Australia’s shared agenda for security and prosperity in the Indo-Pacific region.3 As a social business, Marie Stopes International has expertise as both a private sector provider and development partner working with corporates.
In many countries where we operate, we work with the private sector, improving the contraceptive supply chain and generating income from our clinic services in order to subsidise services for women and girls who cannot afford them.

As development partners, we have a history of engaging the private sector to leverage their resources and expand our reach and operate at scale.
This includes work with individual healthcare providers, healthcare businesses, corporate partners, pharmaceutical companies and other private industries such as manufacturing.

Out contribution: Marie Stopes International Australia was a partner in the first round of the DFAT Business Partnerships Platform, strengthening our work with the private sector in Viet Nam.
MSIA worked in partnership with Pou Yuen, part of the Pou Chen Group, the largest footwear manufacturer in the world, to improve the sexual and reproductive health of garment factory workers in Viet Nam.

MSIA supported Pou Yuen to upgrade their in-factory health facility to provide 6,935 sexual and reproductive health services and 34,485 workers with education about the importance of the sexual and reproductive health.
Through this partnership, Australia’s aid program contributed to the achievement of their strategic and development goals in Viet Nam while building the influence of their program as a trusted development partner.

Under DFAT’s Gender Equality Fund, the Australian aid program is supporting the implementation of new regional program called Empower to enhance women’s participation in the private sector and economic development opportunities in Cambodia, Myanmar and Viet Nam.
This regional program also has social outcomes, including increasing access to and utilisation of sexual and reproductive health information, services and products for women and girls and other marginalised groups.

Through the Empower program, Australian aid program will support 466 female healthcare entrepreneurs known as MS Ladies to deliver high-quality, comprehensive SRH services and to expand and grow their own businesses in their community.
Over four years, we expect that 700,000 women and girls will be reached with sexual and reproductive health education, services and products and that MS Ladies will have the opportunity to increase their involvement in the private sector and become agents of change and leaders in their community.

2 “Creating Shared Value through Partnership - Ministerial Statement on Engaging the Private Sector in Aid and Development,” n.d., 20.

3 Newton Cain, Tess.


“The Role of the Private Sector in Promoting Economic Growth and Reducing Poverty in the Indo-Pacific Region.” The Lowy Institute.

Accessed June 15, 2018. https://www.lowyinstitute.org/publications/role-private-sector-promoting-economic-growth-and-reducing-poverty- indo-pacific-region.
Inquiry into the strategic effectiveness and outcomes of Australia's aid program in the Indo-Pacific and its role insupporting Australia’s regional interestsSubmission 42 Increased Outcomes for Women and Girls Framing outcomes in the Australian aid program to focus on women and girls is not only an effective mechanism for prioritising an underserved group, it has proven to be a successful approach to alleviate poverty,4 address gender equality and enhance women’s participation and leadership.
In line with Australia’s values outlined in the 2017 Foreign Policy White Paper, Australia is a ‘determined advocate for liberal institutions, universal values and human rights’.

Values of universalism and human rights encompass the rights of women and girls, who deserve to grow up and live in a world where they are equal.
Strengthening the outcomes for women and girls in the Australian aid program is in line with the agenda to advance human rights, promote sustainable development and address climate change and other strains on the environment as a result of population growth.

By prioritising women and girls in the Australia aid program, specifically women’s economic empowerment, leadership and ending violence against women and girls, Australia is able to influence effective economic growth of partner governments.
This in turn will increase the sustainability of their programs and decrease the dependency on official development assistance.

A key element of advancing women’s economic empowerment and leadership is safeguarding their reproductive choice and expanding their access to contraception.
Women, Contraception and the Demographic Dividend: When women and girls’ education, health and needs are prioritised, their economic capacity and potential can be unlocked, strengthening the outcomes of an entire country and contributing to a demographic dividend.

A demographic dividend is realised when the age structure of a country has fewer dependents than those of the working population, which can result in significant increases in the gross domestic product.
However, this can only be achieved when young people, particularly women, can access an education and exercise their rights.

A key barrier to countries realising their demographic dividend is a lack of reproductive choice.

The fulfilment of sexual and reproductive health and rights (SRHR) is essential for women and girls achieving their full potential.
Sexual and reproductive health and rights can contribute to women and girls completing their education, optimising opportunities in the economy and accessing healthcare services.5 Essentially, when women and girls lack access to contraception and are faced with an unplanned pregnancy, they are less likely to stay in school.6 Each additional year of schooling increases a woman’s future earnings by at least 10 percent.7 Young girls with limited education and opportunities for formal employment are more likely to be impoverished.8 Sexual and Reproductive Health and Ending Violence against Women: Violence against women and girls is at epidemic proportions globally inhibiting women and girls from realising their full potential.
All forms of violence against women and girls are barriers to gender equality, and constitute a violation of their rights and fundamental freedoms.

Experiences of violence can lead to long-term physical, mental and emotional health problems, and in extreme cases violence against women and girls can lead to death.9 The economic impacts of sexual and gender based violence at a country-level are 4 McCarthy, Joe.

“Educating Girls Is he Key to Ending Poverty.” Global Citizen.
Accessed June 15, 2018. https://www.globalcitizen.org/en/content/educating-girls-is- he-key-to-ending-poverty/.

5 UN Women.

“Women and the Sustainable Development Goals.” Accessed June 15,2018. https://sustainabledevelopment.un.org/content/documents/2322UN%20Women%20Analysis%20on%20Women%20and%20SDGs.pdf 6 Singh,Susheela.

“Adding it Up.

The Costs and Benefits of Investing in Sexual and Reproductive Health.” UNFPA.

Guttmacher Institute.


Accessed June 15, 2018. https://www.unfpa.org/sites/default/files/pub-pdf/Adding%20It%20Up-Final-11.18.14.pdf.

7 “UNICEF Says Education for Women and Girls a Lifeline to Development.” UNICEF.

Accessed June 15, 2018. https://www.unicef.org/media/media_58417.html.

8 Mihai, Mihaela, Emilia Ţiţan, and Daniela Manea.

“Educa ion and Poverty.” Procedia Economics and Finance 32 (2015): 855–60.

https://doi.org/10.1016/S2212-5671(15)01532-4.
9 Understanding and Addressing Violence Against Women, World Health Organisation, 2012 <http://apps.who.int/iris/bitstream/10665/77431/1/WHO_RHR_12.43_eng.pdf> Inquiry into the strategic effectiveness and outcomes of Australia's aid program in the Indo-Pacific and its role insupporting Australia’s regional interestsSubmission 42 substantial, and include costs associated with the provision of health, social and legal services as well as costs of lost productivity and earnings.10 Ensuring fulfilment of SRHR is a critical component of gender equality.11 It is also a key strategy to reduce violence, and to support women and girls who have experienced violence.
The absence of available, accessible, high quality and inclusive reproductive health information and services threatens women’s and girls’ dignity and freedom to make autonomous decisions about their body, their health and their life.
Women’s Participation, Leadership and Sexual and Reproductive Health Rights: Women’s leadership and participation is integral to economic, growth, climate change resilience and adaptation and according to DFAT’s Gender Equality and Empowerment Strategy, ‘women’s participation in decision-making, leadership and peace-building is important as a right in itself.’ Providing women with reproductive choice allows them to adopt leadership roles historically dominated by men.
Women’s increased leadership and participation in community decision-making, gained through improved control over their fertility and lives, can improve community resilience.
As the predominant holder of household responsibilities, including caring responsibilities, growing food and collecting water and fuel wood, women are keenly aware of the local needs.12 This is particularly true for areas affected by climate change where communities have been shown to fare better during natural disasters when women have community leadership roles, including those in preparedness and reconstruction.13 Gender Equality, Sexual and Reproductive Health and Adaptation to Climate Change: With the increase in frequency of natural disasters and extreme weather events, climate change and the negative consequences as a result are becoming more relevant in the Indo-Pacific region.
Women and girls are disproportionately affected by these events and experience higher fatality and morbidity rates.14 The fulfilment of SRHR for women and girls can create more economically and socially resilient communities that can better adapt to climate change.

A focus on women and girls, specifically their reproductive health as part of mainstream climate change adaptation programming can contribute to more resilient and adaptive communities.
Our Contribution: Marie Stopes International Australia works to provide sexual and reproductive health services to women and girls in the Indo-Pacific region.

The Australian aid program has been one of the biggest contributors to Marie Stopes’ service provision in the region and in 2017; 2.7m women in the Asia-Pacific were using a Marie Stopes-supplied contraceptive.
As one of the largest non- government providers of comprehensive and high-quality sexual and reproductive health services in Papua New Guinea and Timor-Leste, our role includes addressing deeply rooted problems of poverty and injustice that prevent women and girls from fully achieving their SRHR.

These barriers include policy and legislative barriers, knowledge and information about sexual and reproductive health and sociocultural factors.
In Papua New Guinea, through the support of the Australian Government’s Partnering for Families program, Marie Stopes Papua New Guinea works with individuals and communities across the country to increase awareness of and access to sexual and reproductive health services, reaching some of the most remote and rural parts of the country.
Through partnership with a local organisation, Susu 10 “Gender-Based Violence Comes at High Social and Economic Cost,” August 1, 2011. http://www.ilo.org/global/publications/world-of-work- magazine/articles/WCMS_167867/lang--en/index.htm.

11 “Rights to Sexual and Reproductive Health.” Accessed June 15, 2018. http://www.un.org/womenwatch/daw/csw/shalev.htm.

12 UNFPA & WEDO, 2009, Women at the Forefront.


Accessed June 15, 2018. https://www.unfpa.org/sites/default/files/pub- pdf/climateconnections 1 overview 1.pdf 13 UNDP, 2013, Overview of the Linkages Between Gender and Climate Change.
Accessed June 15, 2018. https://www.undp.org/content/dam/undp/library/gender/Gender%20and%20Environment/PB1-AP-Overview-Gender-and-climate-change.pdf 14 Neumayer, E, & Plumper, T, 2007, The Gendered Nature of Natural Disasters: The impacts of catastrophic events on the gender gap in life expectancy 1981-2002.

Annals of the Association of American Geographers, pp.

551-566.

Accessed June 15, 2018. http://eprints lse.ac.uk/3040/.
Inquiry into the strategic effectiveness and outcomes of Australia's aid program in the Indo-Pacific and its role insupporting Australia’s regional interestsSubmission 42 Mamas, the program is delivering integrated models of care in maternal, neonatal and child health and sexual and reproductive health, promoting a holistic continuum of care for women and girls.
In Timor-Leste under DFAT’s Gender Equality Fund, we are working in partnership to strengthen the national health system and upskill public health providers across the country to provide gender equitable and comprehensive SRH education and services.

Marie Stopes Timor-Leste is also working with the community to address the community-level and household barriers that prevent women from up taking contraception.
Timor-Leste has experienced the highest rate of decline in total fertility rate over the last decade of any country globally- falling approximately 5% each year between 2003 and 2015.15 As one of the main providers of comprehensive, high-quality sexual and reproductive health services, Marie Stopes Timor-Leste has worked to contribute to this decline in the last eleven years.

Innovation in Australia’s Aid Program Innovation and development go hand in hand.
Innovation offers an opportunity to develop and implement new and different ideas, strategies and solutions to solve some of the largest, complex problems that our world currently faces and will face in the future.

For Australia, promoting social innovation in a region where climate change will cause migration, global health issues and food insecurity can help address upcoming development issues and achieve social outcomes and impact.
Marie Stopes International Australia has welcomed the scale up of investment in innovation by the Australian Government, elevating our work with new and innovative mechanisms.

We use many innovative approaches to improve delivery of contraception at scale for women in the Indo-Pacific region.

These approaches include use of technology for real-time data collection of client information and monthly analysis of data to continuously improve health outcomes for individuals and communities.
MSIA is also innovative in the way that we reach women, utilising contact centres with national reach and travelling with entire mobile clinics to reach women and girls in need of our services.

With support from donors such as DFAT, these innovations have required upfront and significant investments.
It is important to note that innovation for global development requires more than seed funding in tech products, it requires investment in social innovation and returns, time, a high risk appetite and an acceptance of failure.

In addition, programs require large scale funding to pilot innovations, test and scale up investments for a range of innovations from product to wider paradigms innovations.
MSIA recommends the Australian Government develop a clear strategy for innovation in the Australian aid program.

Demonstrating Efficacy Marie Stopes International Australia supports the focus on women and girls, private sector and innovation as part of the Australia’s aid program and has consistently demonstrated effective programming in these areas.
Reproductive health programming has been recognised globally as one of the most cost-effective approaches to improving maternal health.16 Reducing unintended pregnancies also supports significant economic and social return on investment by improving education opportunities for women and girls; expanding the workforce; increasing household and community income; increasing per capita investment in education; and supporting savings across public health services.17 Investments in sexual and reproductive health services for women, girls and families are 15 “Timor-Leste’s Youth Population: A Resource for the Future.
| STATISTICS TIMOR-LESTE.” Accessed June 15, 2018. http://www.statistics.gov.

l/timor-lestes-youth-population-a-resource-for-the-future/.

16 Darroch, Jacqueline E. “Adding It Up: Investing in Contraception and Maternal and Newborn Health, 2017.” Guttmacher Institute, June 21, 2017. https://www.guttmacher.org/fact-sheet/adding-it-up-contraception-mnh-2017.

17 “WHO | Investing in Our Common Future: Joint Action Plan for Women’s and Children’s Health.” WHO.
Accessed June 15, 2018. http://www.who.int/pmnch/topics/maternal/201006_jap_pamphlet/en/.

Inquiry into the strategic effectiveness and outcomes of Australia's aid program in the Indo-Pacific and its role insupporting Australia’s regional interestsSubmission 42 highly cost-effective.
Every $1.30AU spent on contraceptive services in developing regions can save up to $3AU in maternal and newborn healthcare due to declines in unintended pregnancies.18 However when assessing Australia’s aid program as a whole, it is difficult to measure progress.

The independent mechanisms which exist to the measure the efficacy of aid outcomes such as the Centre for Development Policy’s Aid Effectiveness Tracker19 and the Office for Development Effectiveness (DFAT) are supported by MSIA.
The last performance report conducted by DFAT of the Australian Aid program (2016-2017) has demonstrated that the aid program is achieving their outcomes for engaging the private sector and promoting innovation.
However, they have not yet achieved the outcome for empowering women and girls demonstrating a need for a scale-up of gender focused investments including in sexual and reproductive health.20 In addition, since the rapid scale up of contracts to commercial entities in the Australian aid program, there have been no performance reports or evaluation.

As a result, it is currently difficult to comment on aid effectiveness as a whole under the managing contractor and facility model.
MSIA would welcome an independent evaluation to look into the effectiveness of aid delivery managed by commercial entities compared with other aid delivery mechanisms.

Conclusion As an implementing partner for the Australian Government, MSIA welcomes the focus on women and girls and believes in prioritising women and girls’ access to sexual and reproductive health and rights.
Scaling up investments in this area is highly recommended, as it is an evidence-based mechanism for alleviating poverty, promoting economic growth and achieving gender equality.

MSIA recommends the Government should retain its 80% target on all Australian aid funding being focused on women and girls.

We encourage this target to be implemented across all Government investments.
Furthermore, a focus on private sector and innovation has encouraged development partners to consider new ways of delivering and implementing programs and at a large scale.

There is evidence to demonstrate that best-practice development ideas can come from these new approaches and mechanisms, however it is important to measure and demonstrate actual outcomes, tracking efficacy of programming over time- for both non- profit and private development agencies.

Key Recommendations 1.


Increase support for sexual and reproductive health and family planning programs delivered through the Australian Aid program in order to continue to promote gender equality.

2.

Continue to explore mechanisms to integrate and/or mainstreaming sexual and reproductive health through non-health development programs such as economic empowerment and climate change.

3.

Maintain the Australia Government’s 80% gender quality target.
We encourage this target be a whole-of- government approach.

4.

Conduct an independent evaluation of the effectiveness of aid delivery managed by managing contractors compared with other aid delivery mechanisms.

5.

Develop a clear strategy for innovation in the Australian aid program.
18 “Greater Investments Needed to Meet Women’s Sexual and Reproductive Health Needs in Developing Regions | Guttmacher Institute.” Accessed June 15, 2018. https://www.guttmacher.org/news-release/2017/greater-investments-needed-meet-womens-sexual-and-reproductive-health-needs.

19 “Effectiveness | Australian Aid Tracker.” Accessed June 15, 2018. http://devpolicy.org/aidtracker/effectiveness/.

20 “Performance of Australian Aid 2016–17.” Department of Foreign Affairs and Trade, 2018, 84.
Inquiry into the strategic effectiveness and outcomes of Australia's aid program in the Indo-Pacific and its role insupporting Australia’s regional interestsSubmission 42