Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694818553681.pdf (Australia)
Marie Stopes International Inquiry into the human rights issues confronting women and girls in the Indian Ocean – Asia Pacific region 22nd May 2014 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 Inquiry into the human rights issues confronting women and girls in the Indian Ocean – Asia Pacific region Key messages1  Australia is party to a number of global agreements and conventions that support the sexual and reproductive health rights of women and girls.
When reproductive rights are realised, women are better informed, healthier and better able to exercise individual choice.

Crucial to fulfilling this right is ensuring access to comprehensive sexual and reproductive health information and services.

 It is widely agreed that advancing reproductive rights is a pre-requisite for poverty reduction, economic empowerment of women and girls, sustainable economic growth and social stability.
Family planning itself is recognised globally as one of the most cost-effective approaches to improving maternal health and as a key driver of equitable economic development.

 Reducing unintended pregnancies supports economic development through improving education opportunities for women and girls; expanding the workforce; increasing household and community income; increasing per capital investment in education; and supporting savings across public health services.
 Restrictive legislation and policy, weak health systems, financial constraints, social norms, and geographical and physical obstacles are barriers to accessing sexual and reproductive health information, counselling and services.

In crisis and emergency contexts, these barriers are multiplied.

 Strong progress has been made in improving reproductive and maternal health outcomes over recent decades.

Despite this, global unmet need for family planning and rates of maternal mortality remain high.
Access to comprehensive, high quality reproductive healthcare would prevent almost a third of all maternal deaths.

 Many governments and donors have initiated large scale, long-term programs of work dedicated to the advancement of sexual and reproductive rights, particularly in developing countries.

Multi- agency collaboration has also lead to significant achievements in the area of reproductive health rights, particularly in relation to ensuring these rights in emergency or refugee settings.
 Australia could build on the lessons and successes of existing initiatives to develop similar programs or investments aimed at supporting improvements in women’s and girls’ sexual and reproductive health rights in the Indian Ocean – Asia Pacific region.

 Leveraging its long history of humanitarian work, Australia could also draw lessons from existing initiatives to strengthen and scale support for the delivery of reproductive health services in humanitarian and crisis situations.
 Targeted dialogue with governments in the region to support the development of policies for expanded and more equitable delivery of reproductive health services, with an emphasis on health rights and sustainable economic development, would underpin investments in this area.

1 All references, citations and additional information related to key message statements are contained within the body of the document.
1 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 About Marie Stopes International For over 30 years Marie Stopes International (MSI) has been delivering comprehensive sexual, reproductive, maternal and child healthcare.

We are a client-centred organisation that pursues innovative service delivery strategies and partnerships to ensure that women and men everywhere can access high quality reproductive health information and services.
We prevent unnecessary maternal deaths and make an impact on the lives of millions of people every year.

In 2013, more than 15 million people were using their choice of contraceptive method, supplied to them by MSI.

Our clients are at the centre of everything we do and our social business model enables us to reach them more effectively, efficiently and sustainably.
This approach employs diverse channels for service delivery, places focus on innovative and sustainable health financing, and utilises internal systems and analytical tools that are more common to the commercial sector than not-for-profit organisations.
We catalyse health markets in three ways: by improving the supply of high quality, voluntary family planning and reproductive health services; by increasing demand for services through behaviour change communication, marketing and financing; and by seeking to positively influence the underlying policy environment to encourage both.
Given our expertise in delivering sexual and reproductive healthcare within the Indian Ocean – Asia Pacific region and more broadly, MSI welcomes the opportunity to comment on the human rights issues confronting women and girls, and would be happy to provide additional information as requested.
In addressing these Terms of Reference, we have structured our submission in the following order: a) implications of reproductive rights for economic and social development; b) barriers and impediments to enhancing reproductive rights; c) achievements to date in advancing reproductive rights; and d) the effectiveness of Australian program in improving reproductive health and rights.
Sexual and reproductive health and rights Australia is party to a number of global agreements and conventions that support the sexual and reproductive health rights of women and girls.

One hundred and eighty eight countries, including Australia, recognised sexual and reproductive health rights under the 1981 Convention on the Elimination of all forms of Discrimination against Women2.
The 1994 International Conference on Population and Development Plan of Action, adopted by 179 countries 3 , and the 1995 Beijing declaration of the Fourth World Conference on Women4 further reinforced global commitments to improve sexual and reproductive health and rights.

The Millennium Development Goals (MDGs) sharpened global attention on equity, poverty reduction and measurable development outcomes, with universal access to reproductive healthcare explicit under MDG5b5.
The United Nations has explicitly defined the right to sexual and reproductive health as a fundamental part of the right to health6, and denial of reproductive rights as a form of torture7.

It is widely agreed that advancing reproductive rights is a pre-requisite for poverty reduction, equitable economic development8 and the success of other development initiatives9.

When reproductive rights are realised, women are better informed, healthier and better able to exercise individual choice.
Sexual and reproductive health rights embrace the basic right of all couples and individuals to attain the highest standard of sexual and reproductive health, to experience their sexuality free of discrimination, coercion and violence, and to decide freely the number, spacing and timing of their children.

Crucial to fulfilling this right is ensuring access to comprehensive sexual and reproductive health information and services, including voluntary family planning and safe abortion.
2 Convention on the Elimination of all forms of Discrimination against Women.

(1981) http://www.un.org/womenwatch/daw/cedaw/ 3 International Conference on Population and Development – Plan of Action.

Cairo (1994).

https://www.unfpa.org/public/global/publications/pid/1973 4 Fourth World Conference on Women (1995), Beijing Declaration http://www.un.org/womenwatch/daw/beijing/platform/ 5 MDG 5b: Achieve, by 2015, universal access to reproductive health.
6 United Nations General Assembly sixty sixth session (Aug 2011) Right of everyone to the enjoyment of the highest attainable standard of physical and mental health – Note by the Secretary General 7 United Nations General Assembly, Human Rights Council twenty second session (Feb 2013) Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez 8 Singh, S et al (2009) Adding It Up: The Costs and Benefits of Investing in Family Planning & Maternal & Newborn Health.
9 UNFPA, Human Rights and the MDGs <http://www.unfpa.org/rights/mdg.htm> 2 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 Responses to the terms of reference a) Implications for economic and social development in the region in promoting women and girls’ sexual and reproductive health and rights Family planning is recognised as one of the most cost-effective approaches to improving maternal health10,11.
Meeting global unmet need for contraception would decrease unintended pregnancies by two thirds, resulting in 79,000 fewer maternal deaths and 600,000 fewer neonatal deaths12.

Reducing unintended pregnancies, particularly among adolescents, also supports educational and employment opportunities for women.

This in turn contributes to empowering women, increasing household and community income, and increasing per capital investment in education.
A recent comparative study has illustrated that women who have access to and use family planning have around 40% more family assets than those who do not13.

Employers also benefit from a workforce that is able to access family planning services, through lower medical costs, lower employee turnover and increased productivity.
A number of countries, particularly in Asia, have demonstrated this ‘demographic dividend’ – where a growing workforce with fewer dependents can lead to huge economic growth, in some cases in the space of just one generation14.

The realisation of sexual and reproductive health and rights contributes towards the economic empowerment of women and girls, sustainable economic growth and social stability.
Investing in family planning can yield significant return on investment, supporting savings at the individual, community and national level.

Each dollar invested in family planning can save up to four dollars in health expenditure - costs that would otherwise be used for pregnancy services, delivery care and treating complications from unsafe abortion 15.

In this context, family planning is widely regarded as a key driver of equitable economic development and poverty reduction16.
Minister for Foreign Affairs and Trade, the Hon Julie Bishop has drawn particular attention to the empowerment of women and girls one of ‘the best ways to promote economic growth’.

Investing in health – including women’s health – remains a Government priority in supporting women to lead ‘healthy and productive lives’17.

MSI applauds the Government’s attention to women and girls in economic development.
In particular, we understand that improving women’s health will be a key consideration in the achievement of all three areas of focus identified within the Government’s approach to supporting women: facilitating women’s economic empowerment (giving women access to resources to enable their participation in the labour market); promoting women’s leadership (promoting decision making power at the political, business, community, or family level); and addressing sexual and gender based violence (giving women access to support networks, health services and social protection).
The Family Planning Guidelines will remain an important policy to guide Government support in addressing these issues18.

10 Family Planning and the Aid Program: Guiding Principles.

AusAID August 2009 11 Singh, S et al (2009) Adding It Up: The Costs and Benefits of Investing in Family Planning & Maternal & Newborn Health.

12 Guttmacher Institute (2012) Costs and Benefits of Investing in Contraceptive Services in the Developing World.
13 Gribble, J., Voss, M. (2009) Family Planning and Economic Well-Being: New Evidence From Bangladesh.

Population Reference Bureau 14 Bloom D, Williamson J. Demographic Transitions and Economic Miracles in Emerging Asia.

World Bank Economic Review.

1998.12:419–55.

15 Marie Stopes International Australia.

Annual Report 2012 16 Singh, S et al (2009) Adding It Up: The Costs and Benefits of Investing in Family Planning & Maternal & Newborn Health.
17 The Hon Julie Bishop, Minister for Foreign Affairs and Trade.

Opening Address – 2014 Australasian Aid and International Development Policy workshop (February 2014).

18 Family Planning and the Aid Program: Guiding Principles.
AusAID (August 2009 ) 3 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 Inquiry into the human rights of women and girls Marie Stopes International submission Info graphic 1: The power of family planning19 19 http://www.mariestopes.org.au/ 4 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 Inquiry into the human rights of women and girls Marie Stopes International submission b) Barriers and impediments to enhancing the sexual and reproductive health and rights of women and girls in the Indian Ocean – Asia Pacific region Despite global agreements on the importance of universal access to sexual and reproductive health in achieving sustainable economic development and poverty reduction, progress in this area has been slow20.
Around the world more than 222 million women have an unmet need for contraception.

In the developing world, where unmet need is greatest, this situation results in approximately 80 million unintended pregnancies and 20 million unsafe abortions each year.

Around 291,000 women will die from pregnancy-related causes, and a third of these pregnancies will have been unintended 21 .

Pregnancy is one of the leading causes of death and disability among women of reproductive age in developing nations22.
Access to comprehensive, high quality family planning would reduce pregnancy related deaths by a quarter 23 .

However, many barriers exist that impede access to sexual and reproductive health information, counselling and services.

These include restrictive legislation and policy, weak health systems, financial constraints, social norms, and geographical and physical obstacles.

For young people, and in crisis and emergency contexts, these barriers are multiplied.
By addressing existing constraints through both targeted dialogue as well as specific initiatives (see section c), there is huge opportunity for Australia to play a greater role in expanding access to sexual and reproductive health services in the Indian Ocean – Asia Pacific region.
Legislative barriers that limit the delivery of health services To expand access to services, particularly where availability of doctors is limited, the World Health Organisation (WHO) recommends the delivery of reproductive health services at the lowest level cadre of providers that is proven clinically safe.

The process of moving reproductive health services beyond doctors to clinical officers, nurses, midwives and other paramedicals is known as ‘task shifting’ or ‘task sharing’24.
In many countries however, prohibitive policies limit the delivery of certain services through lower level health cadres.

Given poor and marginalised women often access family planning and reproductive health services through informal, low-level providers 25 , these policies negatively impact women’s and communities’ ability to access reproductive health services, stifling progress towards improved health and development outcomes.
Australia could play a role in advocating global best practice to improve availability of services for poor and marginalised communities.

Experience shows that working with government to develop policy around small-scale provision of healthcare can expand access to health services.
In Uganda for example, MSI-led research demonstrating the safety and efficacy of tubal ligations (female sterilisation) performed by trained clinical officers provided a precedent for the Ministry of Health’s decision to scale up this approach and add tubal ligation to the national healthcare training curriculum26.

MSI has undertaken similar work in Ethiopia27.

20 United Nations (2013) The Millennium Development Goals Report .
To date, MDG5 – to improve maternal health – is one of the most off track of the MDGs, falling far short of its 2015 MDG targets.

21 Guttmacher Institute (2012) Costs and Benefits of Investing in Contraceptive Services in the Developing World.

22 http://www.who.int/mediacentre/factsheets/fs334/en/ 23 Guttmacher Institute (2012) Costs and Benefits of Investing in Contraceptive Services in the Developing World.

24 WHO recommendations.


(2012) Optimize MNH: Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting.

Geneva, Switzerland 25 Demographic and Health Surveys in Sub-Saharan African countries from 2006 and later.

26 Gordon-Maclean C, et al (2013) Safety and acceptability of tubal ligation procedures performed by trained clinical officers in rural Uganda.

International Journal of Gynecology and Obstetrics.
27 Andrews H, Corby, N (2012) Improving access to tubal ligation in Ethiopia by ‘task sharing’ services to mid-level providers.
Marie Stopes International 5 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 Inquiry into the human rights of women and girls Marie Stopes International submission Legislative barriers that prevent the delivery of health services Political and social opposition to reproductive health means that the delivery of life saving services is often hindered.
In developing countries with restrictive family planning and abortion policy, women are more likely to suffer negative health consequences associated with multiple, unplanned pregnancies, including as a result of unsafe abortion.

In these environments, abortion rates are higher and, as they are unregulated, are generally unsafe.
In contrast, countries with more liberalised family planning and abortion policy, such as Western Europe and Australia, have much higher contraceptive use and lower abortion rates.

This, coupled with access to safe abortion when needed, means that maternal morbidity and mortality in these countries are much lower28.
Australia could consider working with governments to provide expertise in developing policy that would expand access to reproductive health services, with an emphasis on health rights and sustainable economic growth.

Liberalising reproductive health policy and increasing education and acceptance of sexual and reproductive health services allows governments to regulate and ensure the provision of safe, quality services.
This improves women’s health and increases their ability to contribute to economic and development outcomes.

The recent passing into law of the Philippines Responsible Parenthood and Reproductive Health Act represents a growing recognition in the region for both the right to and benefits of expanded access to reproductive health services29.

It follows many years of advocacy and support from NGOs such as MSI, internationally, locally and at the grassroots level.
Institutional barriers and weak health systems that impede access to quality health services In many countries, the private sector provides a significant share of health service delivery, with even the poorest population segments accessing healthcare from private sources30,31.

In fact, in the nine least wealthy countries in the world, nearly half of the poorest and most marginalised people rely on private healthcare32.
We also know that the majority of poor women access reproductive and maternal health services from private sources 33 .

However, without adequate regulation, quality, cost and availability can vary.
The broad utilisation of private healthcare services presents enormous opportunity for governments and donors to work with the private sector to expand the range and reach of specialised services – in particular sexual and reproductive health services – improve quality, better integrate with public systems, improve affordability, and ultimately achieve national health, development and human rights commitments.
This is a notion supported by the World Health Organization (WHO) 34, the World Bank35, and major donors working in international development36.

Despite this, fragmented approaches to service delivery that segregate public and private sectors persist, creating redundant systems, inefficiencies, and missed opportunities for improved clinical quality.
Australia could play a greater role in expanding access to high equality and equitable reproductive health services through the private sector through targeted dialogue with governments and niche initiatives (see section c).

28 Guttmacher Institute (2012).

Facts on Induced Abortion Worldwide.

29 On 8th April 2014, the Supreme Court of the Philippines declared the Bill ‘not unconstitutional’, passing nearly all of the original Bill into Law.
30 International Finance Corporation (2008) Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives.

Washington, DC: IFC; and Montagu and Bloom (2009) The Private Sector and Health Services Delivery in the EAP Region: Background Report to UNICEF on the Role and Experiences of the Private Sector in Provision of Child Health Services.

Bangkok: UNICEF-EAP.


31 Private sector service providers include for-profit and not-for-profit; formal and informal; and small, medium and large scale service providers.

32 Zwi, A.

B.; Brugha, R.; Smith, E. (2001) Private healthcare in developing countries - If it is to work, it must start from what users need.

British Medical Journal; 323(7311):463-4 33 Demographic and Health Surveys in Sub-Saharan African countries from 2006 and later.
34 WHO (2010b) Strengthening the capacity of governments to constructively engage the private sector in providing essential health-care services.

35 Harding, A. and Preker, A.

(2003) Private Participation in health services.

Washington DC.

World Bank.

36 Wilton Park (2008).

Public-private investment partnerships in health systems strengthening.

Conference Report.

Wilton Park UK.
Wilton Park UK.

6 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 Inquiry into the human rights of women and girls Marie Stopes International submission Multiple barriers that restrict sexual and reproductive health and rights in fragile states In times of crisis, women are more vulnerable to sexual violence and face an increased spread of sexually transmissible infections, whilst struggling to access family planning and safe childbirth services.
In emergency situations, barriers to accessing contraception increase.

People often leave their contraceptives behind when under threat from war, famine, persecution or natural disaster.

At their sites of refuge, displaced persons may struggle to obtain additional family planning supplies.
Whilst accessing contraception is made more difficult, the need for family planning is likely to increase; many women would prefer not to have children under conditions of crisis, since their newborn would be exposed to stressful – and even harrowing – circumstances.37 Significantly, women in crisis situations are often at a greater risk of unwanted pregnancy due to increased exposure to sexual violence, both as a weapon of war and through uneven power dynamics in a displacement setting.
Unsafe abortion is responsible for up to 50% of maternal deaths in refugee settings38.

Australia could leverage its long history of humanitarian work to ensure targeted support that aims to improve access to sexual and reproductive health services in humanitarian and crisis situations.

In 2014, 80 million people are projected to be in need of humanitarian assistance, of which three quarters (60 million) are women and children39.
Of women of childbearing age in crisis or refugee settings, one in five is likely to be pregnant.

The well-being and lives of these women and their babies are seriously jeopardised by loss of medical services, often within a context of suffering, ill-health and exposure to violence40.

c) Achievements to date in advancing sexual and reproductive health and rights Recent decades have seen strong progress towards improving sexual and reproductive health and rights.
In the last 20 years for example, 17 countries have reduced restrictive legislation on reproductive health services41, and global maternal mortality has declined by 47%42.

Despite this, global unmet need for family planning and rates of maternal mortality remain high.

In response, the 2012 London Summit on Family Planning brought together governments, civil society organisations, foundations, the private sector, NGOs and multilaterals to accelerate progress towards universal access to contraception.
The Summit committed to make voluntary, high quality family planning services available to an additional 120 million women and girls in the world’s poorest countries by 2020.

Australia pledged an additional AU$58 million over five years to family planning, increasing annual contributions to AU$53 million by 201643.

Many governments and donors have initiated large scale, long-term programs of work dedicated to the advancement of sexual and reproductive rights, particularly in developing countries.
Multi-agency collaboration has also lead to significant achievements in the area of reproductive health rights, particularly in relation to ensuring these rights in emergency or refugee settings.

These achievements, some of which are discussed below, provide useful, demonstrative examples of successful mechanisms or initiatives that support the advancement of women’s and girls’ sexual and reproductive health rights at scale.
Australia could build on the lessons and successes of these initiatives to develop similar programs or targeted investments aimed at supporting improvements in women’s and girls’ sexual and reproductive health rights in the Indian Ocean – Asia Pacific region.

37 IAWG, 2010, A Statement on Family Planning for Women and Girls as a Life-Saving Intervention in Humanitarian Settings 38 NFPA 1999.
“Reproductive Health for Refugees and Displaced Persons.” (New York: UNFPA) 39 Save the Children, (2014), State of the World’s Mothers Report 2014: Saving Mothers and Children in Humanitarian Crises 40 UNFPA, 2010, From Conflict and Crisis to Renewal: Generations of Change 41 Guttmacher Institute (2012).

Facts on Induced Abortion Worldwide.

42 United Nations (2013) The Millennium Development Goals Report .
43 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/67328/london-summit-family-planning-commitments.pdf 7 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 Inquiry into the human rights of women and girls Marie Stopes International submission 1) Service delivery and policy change for improved reproductive health and rights Since the launch of its Family Planning program in 1965, the United States Agency for International Development (USAID) has played a leading role in supporting access to sexual and reproductive health services for poor and marginalised people through its aid program.
Support for International Family Planning Organisations (SIFPO) is a key project under USAID’s Family Planning program.

SIFPO is a US$43 million, five year project that aims to increase use of voluntary family planning services by strengthening capacity of global family planning organisations.

The project is led by MSI, in partnership with four other organisations: EngenderHealth, International Center for Research on Women, International HIV/AIDS Alliance, and Population Council.
SIFPO focuses on organisational strengthening, sustainability, quality assurance, and gender and youth focused family planning.

Between its launch at the end of 2010 and December 2013, the project has delivered 1.2 million reproductive health services across nine countries in Africa and Asia.

Other donors acknowledge the specific need for policy initiatives that create an enabling environment for the delivery of reproductive health services.
The government development agencies of both Norway (Norad) and Denmark (Danida) have allocated multi-million dollar44 support to a number of international sexual and reproductive health organisations, including MSI, to provide reproductive health services and influence policies and legislation concerning sexual and reproductive health and rights45,46.
This work focuses on reducing legal and regulatory barriers, strengthening organisational capacity to achieve policy change, and creating innovative advocacy metrics, tools and research to strengthen evidence in this area.
To support significant progress towards advancing women’s and girl’s reproductive health rights in the Indian Ocean – Asia Pacific, Australia could consider similar initiatives or programs that support a combination of organisational strengthening, direct service delivery and advocacy for reproductive health and rights organisations that have proven impact in the region.
2) Harnessing the private sector for improved reproductive health and rights Many governments recognise the importance of health service delivery through the private sector in developing countries.

In some cases, this has translated into the development of specific large scale programs aimed at improving quality, equity, efficiency and availability of services seen in the private health sector.
USAID have pioneered engagement with the private sector in improving the health of people in developing countries.
Their current flagship private sector health project, Strengthening Health Outcomes through the Private Sector (SHOPS)47, is a US$95 million, five year project that works with both non-governmental and for-profit entities to increase availability, improve quality and expand coverage of essential health products and services, particularly reproductive health services, through the private sector across Africa, Asia and Latin America.
Led by Abt Associates, the project involves five partners: MSI, Banyan Global, Jhpiego, Monitor Group and O’Hanlon Health Consulting.

Through MSI, SHOPS has supported successful, innovative approaches to improving quality and equity of services provided through private providers 48 , 49 .

Over 100,000 people have used a contraceptive provided by MSI, averting an estimated 110,000 unintended pregnancies and 15,000 unsafe abortions.
Australia could consider leveraging programs like SHOPS to develop a similar program aimed at enhancing private sector healthcare in the Indian Ocean – Asia Pacific region.

44 Australian dollar equivalent to investments originally made in Norwegian Kroner and Danish Krone.
45 http://www.norad.no/en/thematic-areas/global-health/Sexual-and-reproductive-health/family-planning 46 http://um.dk/en/danida-en/activities/annual-report-2012/theme-sexual-and-reproductive-health-and-rights/ 47 http://www.shopsproject.org/ 48 Riley, P et al.

(2011).

Mobiles for Quality Improvement Pilot in Uganda.

Bethesda, MD: SHOPS Project, Abt Associates Inc. 49 Corby, N. (2012) Using mobile finance to reimburse sexual and reproductive health vouchers in Madagascar.
MSI and USAID 8 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 Inquiry into the human rights of women and girls Marie Stopes International submission 3) Partnerships and initiatives for improved reproductive health and rights in crises In recognition of the heightened need for comprehensive sexual and reproductive health services in crisis situations, a number of partnerships and initiatives have emerged in recent years dedicated to advancing progress in this area.
This includes the establishment of the Inter-Agency Working Group on reproductive health in emergencies 50, the integration of the Minimum Initial Service Package (MISP) for reproductive health in emergency settings into the Sphere Standards51, the development of the Inter-Agency Field Manual on Reproductive Health in Crises 52 , and initiatives like RAISE 53 (Reproductive Health Access Information and Services in Emergencies) and SPRINT54 (Sexual and Reproductive Health Program in Crisis and Post-Crisis Situations), both dedicated to improving coordination, building capacity, and strengthening support through advocacy.
With new emergencies arising and protracted crises persisting, Australia is well positioned to leverage lessons from existing initiatives to strengthen and scale support for the delivery of reproductive health services in emergency settings.

50 http://iawg.net/ 51 http://misp.rhrc.org/ 52 http://www.iawg.net/resources/field_manual.html 53 http://www.raiseinitiative.org/home/ 54 http://www.ippf.org/resource/SPRINTing-towards-change-sex-and-pregnancies-emergencies.

SPRINT is an Australian aid initiative.


9 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 d) The effectiveness of Australian programs to support efforts to improve the sexual and reproductive health and rights of women and girls Attention to program effectiveness is essential for ensuring high impact, sustainable health and rights outcomes for women and girls.
Aid effectiveness has been a key focus of Australia’s aid program, and remains so under the current Government.

Minister Bishop’s ‘new paradigm in development assistance’ presents a strong focus on results from investments and value for money55.
Family planning is one of the most cost-effective approaches to improving maternal health 56 , empowering women and promoting sustainable economic development57.The Australian Government already supports organisations with proven track records in implementing high impact and cost- effective reproductive health programs.
MSI receives funding bilaterally and through the Australian NGO Cooperation Program (ANCP) to deliver and build capacity in reproductive health services in Timor-Leste, Papua New Guinea, Cambodia, Nepal, The Philippines, Viet Nam, Kenya and Tanzania.

We are also subcontracted through mechanisms supported by Australian aid for service delivery and capacity building.
To maximise economy, efficiency, and effectiveness of Australian investment in this area, the Government could consider supporting a large scale, multi-country program of work dedicated to advancing the sexual and reproductive health and rights of women and girls in the Indian Ocean – Asia Pacific region.

Existing Australian initiatives provide useful lessons that could inform effective programming in this area.
The Australia Africa Community Engagement Scheme (AACES), for example, couples a strong emphasis on service delivery for poor and marginalised communities with policy change to maximise sustainability of impact58.

This focus ensures that the outcomes of AACES are embedded in a framework of improving the rights of the poorest communities.

The program’s emphasis on value for money has also enabled AACES to demonstrate effectiveness in multiple ways.
Initiatives such as USAID’s SIFPO and SHOPs, as well as Norwegian and Danish policy programs offer substantial opportunity to leverage best practice approaches to improving sexual and reproductive health and rights, particularly in terms of combining service delivery, organisational strengthening and policy support in a single program of work.

Australia could build on the lessons and successes of existing programs that have proven impact and are cost-effective.
A large scale program could offer considerable value for money on Australian investment, would support Australia in meeting global commitments, and would catalyse the health rights of women and girls in the region.

To scale and strengthen support for the sexual and reproductive health and rights of women and girls in humanitarian settings, Australia could draw lessons from existing initiatives, such as RAISE and SPRINT, to help ensure effectiveness and impact from investment in this area.
55 The Hon Julie Bishop, Minister for Foreign Affairs and Trade.

A new paradigm in development assistance – harnessing the private sector.

Parliament of Victoria (29th April 2014) 56 Family Planning and the Aid Program: Guiding Principles.

AusAID August 2009 57 Singh, S et al (2009) Adding It Up: The Costs and Benefits of Investing in Family Planning & Maternal & Newborn Health.

58 AACES is one of the largest Australian Government programs of funding for Australian NGOs in Africa.
AACES is being implemented across 11 African countries over five years (2011-2016), through 10 Australian NGOs and their local partners.

Under AACES, MSI provides reproductive healthcare to marginalised communities in Kenya and Tanzania, works to support improvements in reproductive health policy and programming, and aim to raise Australian public awareness of reproductive health rights and development issues in Africa.
10 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40 Marie Stopes International GPO Box 3308, Melbourne VIC, 3001, Australia t: +61 3 9658 7500 e: info@mariestopes.org.au w: www.mariestopes.org.au Marie Stopes International delivers quality family planning and reproductive healthcare to millions of the world’s poorest and most vulnerable women.

11 Human rights issues confronting women and girls in the Indian Ocean – Asia Pacific regionSubmission 40