COVID-19 has had an unprecedented impact on sexual and reproductive health and rights (SRHR) services across the world, may it be from the health crisis itself or the consequences of the lockdown. It is estimated that the pandemic could result in an additional 49 million women with unmet need for modern contraceptives, and an additional 15 million unintended pregnancies over the course of a year. Sustained international development support will be crucial in the wake of this crisis, not just for the emergency response but also the much longer recovery period.
Soon after the COVID-19 crisis hit Europe, European donors already spoke out about the importance of including SRHR in the response to COVID-19 – clearly iterated for example in the joint press statement signed by all our European development or foreign affairs ministers - and made financial commitments to continue support to the Global south in these times of crisis. It remains to be seen however if governments will be able to keep this as a priority, and development cooperation overall, once the economic impact of COVID-19 domestically becomes more apparent and amidst a period of national recession. At the same time, the COVID-19 pandemic has impacted the way development donors prioritise and cooperate, which might impact development cooperation in ways we weren’t able to foresee. How might this crisis play out in the longer term for our governments' Official Development Assistance (ODA) and support to SRHR?
In the medium to long term, COVID-19 will most certainly affect levels of European development aid. Countries are experiencing an economic crisis and tensions which can have a negative impact on ODA levels and attitudes towards ODA. Dedicated SRHR ODA funding could be reassigned to broader COVID-19 responses or economic regeneration. Learnings can be taken from the financial crisis in 2018. This led to only minor ODA cuts in some countries, however, in others it had a huge impact. For example, in Spain, Portugal and Ireland, a move to more domestic funding and cuts in ODA were observed soon after the crisis, and ODA has not recovered since. The 2008 crisis has taught us that, if ODA and development are not high on the agenda and there is a lack of public support, it can easily become one of the hardest hit sectors during and after a financial crisis.
European countries have committed to the longstanding UN target of 0.7% ODA/Gross National Income target. This target is also part of the Addis Ababa Action Agenda on financing for development, endorsed by all Member States through the UN General Assembly, and repeatedly re-endorsed this at various development conferences. In some European countries, it is even a legal requirement. Despite this commitment, we have seen an overall negative trend of EU collective ODA/GNI (the sum of ODA from the EU Member States, still including the UK, and the part of ODA provided by the EU institutions that is not imputed to Member States). In 2019, before COVID-19 hit, the EU collective ODA/GNI represented 0.46% of EU GNI, which is down from the 2018 ratio of 0.47%. Only a few European donors are reaching the 0.7%. Hence it is important and non-negotiable that this ODA-GNI target needs to be kept.
Apart from the percentage, an economic recession might also mean a decrease in ODA volume, so the absolute volumes and figures are even more important to monitor. Development Initiatives projected that a longer-term economic recession alongside cuts from donors as budget is reallocated to domestic spending could see global ODA levels drop sharply, with a fall of US$25 billion by 2021 within the range of possibilities. Therefore, current absolute amounts should be frozen or even increased in order to address additional needs.
Apart from the risks for ODA overall, COVID-19 could also cause decreased attention to SRHR. SRHR might not be seen as ‘essential’ in times of crisis or as part of Universal Health Coverage. Even though the pandemic has in some cases closed down service delivery points, the needs remain as high, and in some cases like for SGBV, have even risen. Further, organisations providing SRHR services have found innovative ways to continue delivering care - through telemedicine and online comprehensive sexuality education for example. Hence, the funding needs remain. Up to date, some European donors have already reaffirmed their commitment to SRHR in their ODA and COVID-19 response, such as Finland, the Netherlands, Norway, Denmark and Sweden. While the EU has mentioned SRHR as an important need in the COVID-19 pandemic, SRHR is not identified as a priority in its longer-term response to the crisis, raising concerns from civil society. Other donors have yet to develop their response.
At the same time, the impact of the COVID-19 pandemics helps reinstating the importance of health systems and universal health coverage, which is expected to become more central again in development cooperation as well. Given the severity of the crisis, it is looking likely that European governments will keep investing, or even reinvesting, in health system strengthening and UHC and sustainability to address the needs of those most left behind. In this context, it will be imperative not to dilute the importance of SRHR, recognising SRHR as an essential element of these and that it needs sustained funding - as governments committed to in the 2030 Agenda and the UHC political declaration in 2019. Further, the focus of some European donors on the private sector (e.g. the EU institutions) could also lead to privatisation of basic services, or at least a stronger involvement of the private sector in health services. This is something to monitor, in order to make sure that health services remain accessible and affordable for the most marginalised, underserved and vulnerable communities.
Finally, a lot of public investments have already been made by European donors for the development of a vaccine against COVID-19, some that has been advertised as coming from aid budgets. However, the OECD, whose Development Assistance Committee sets the rules on how ODA can be spent, have reconfirmed that donations to Coalition for Epidemic Preparedness Innovation (CEPI) and other organizations that work on research for a vaccine, cannot be counted as official development assistance. Even though investments in these projects are important, they would benefit developed countries as much as developing countries and can hence not be counted as ODA. Monitoring ODA expenditures by civil society, such as the donor accountability work of Countdown 2030 Europe, will hence remain crucial.
Both multilateral and bilateral cooperation will be paramount to advance universal access to SRHR in a post-COVID-19 world. Despite a rise in 2019, core contributions to the UN flatlined for most of the past decade and lagged behind funding for loan-giving bodies, with for example the WHO, a key player in immediate and medium-term crisis response, has already seen core funding fall by 13% between 2011 and 2018. With the USA planning to pull out of WHO, this will need even greater attention by European donors - not just in terms of ODA but also in their role as progressive actors in political ‘battles’. Further, the continuity in bilateral, government to government, cooperation is crucial - not as a one-fit-all solution, but building on existing and longer-term experience and collaborations, taking in account the established experiences and lessons learnt of CSO partners and local communities. Finally, to reach the furthest behind, the post-COVID response should include support to civil society organisations. They have been and are at the forefront of the COVID-19 response, and are also playing a watchdog role by monitoring the policy development and making the case for the most vulnerable.
Further, in responding to COVID-19 in the longer term, the experiences of and progress made with the Humanitarian-Development Nexus is key to respond to the crises. Short-term humanitarian responses alone will not address the longer-term implications of COVID-19 on people’s livelihoods and the need for ongoing support to national health systems. It demands a joined-up ‘nexus’ response. With regards to SRHR specifically, it can be an opportunity for increased attention and funding for the transition from ‘Minimal Initial Service Package’ interventions – which are the minimum, life-saving sexual and reproductive health needs that humanitarians must address at the onset of an emergency - to the comprehensive roll-out of services and SRHR programming in humanitarian settings. The traditional development- humanitarian budget divide appears to be softened when it comes to SRHR and may represent an opportunity both at programming and funding levels. It allows the allocation of development core funds to essential SRHR activities in fragile and conflict-affected countries which are eligible for development funds.
Finally, the quality of the response is as important as the quantity, and should be focused on e.g. reducing the impact on inequalities, addressing harmful gender norms and recognising the crucial role of civil society. EU Member States are at this very moment discussing the next EU budget, the ‘Multiannual Financial Framework (MFF)’, taking into account the impact of the COVID-19 crisis. The latest proposal by the European Council president Charles Michel and the current discussions between EU Member States already shed some light on the possible impact on ODA, and support for SRHR therein. The levels of ODA have been slightly decreased, compared to the level proposed before the COVID-19 crisis. In terms of content, health and gender equality are a priority, more strongly highlighted in the EU discourse. On the other hand, the role of the private sector is coming out more strongly, whereas CSOs are absent from the discourse. The EU shows a strong focus on economic recovery, with substantial additional funding for the private sector, blending facilities, etc. There is a risk that these types of shifts in ODA could lead to privatisation of public services or massive indebtment of developing countries. More work will be needed by the Member States and Civil society to maintain ODA levels but also development aid integrity, for example the provision of grants versus loans.
Other income in developing countries are projected to fall substantially as a result from COVID-19, such as domestic public resources, foreign direct investment, remittances and tourism. This will make ODA even more important in striving to achieve the Sustainable Development Goals. In response to COVID-19 and to avoid a discontinuation of support to the lowest-income countries, European governments need to continue to build broad support among the public and invest in awareness raising about the importance of international solidarity and equality, and the centrality of SRHR therein.
Words by Joke Lannoye, Countdown 2030 Europe
Photo credit: Xaume Olleros