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Shifting power and advancing equity in global reproductive health and development

We can't deal with sexual reproductive health and rights without dealing with gender inequality. So much of our programming medicalises the issue and takes away the social issues around reproductive health.
Source: Pexels.
Source: Pexels.

We need to equally invest in strategies and approaches that drive gender equality alongside sexual reproductive health and rights because that is the cornerstone of change.

This was Claire Mathonsi's call to action. As deputy executive director for the Advocacy Accelerator, she proudly represented South Africa at the International Conference on Family Planning, hosted by Thailand's Pattaya City from 14 to 17 November.

The conference has done much over the years to address the gaps in delivery in reproductive health equity for women.

"I have thoroughly enjoyed this space. It's changed over time, it's a scientific conference but there have been efforts to shift the narrative. The inclusion; the diversity is amazing. There is an amazing fabric of people committed to this issue that has inspired me," Mathonsi said.

UNFPA, the United Nations sexual and reproductive health agency, is a key partner in convening the International Conference on Family Planning, and works at every level to support access to safe, voluntary family planning.

According to the 2022 State of World Population report, global use of contraceptives has increased. Today, more than three quarters of the 1.1 billion women with a desire to limit or delay childbearing are using a modern method of contraception.

And yet there is still work to be done in advocacy for family planning and in encouraging development agencies to include the recommendations of girls and women at grassroots level in policymaking involving modern contraceptives.

Mathonsi was speaking on a panel discussion on women's reproductive health equity, where she advocated for strong, coordinated and integrated country-based advocacy as a driving force for transformation in health and development.

Transitioning to Care USA's associate vice president focusing on gender justice, she was no-holds-barred on the challenges of development work in informing best advocacy practices and African-led solutions to this end.

"Being on the frontlines of having an extremely aspirational and powerful mission and vision about driving locally driven advocacy comes with dealing with the dynamics of a development system that works on an inner colonial framework, as well as being a key pillar of neocapitalism and the way the global economic system works," Mathonsi said.

"Coming into that role and working in this space now, it is extremely difficult for Global South entities - those that are women-led and driven by feminists - to be recognised, and to have the same credence that entities in the Global North have.

"We are not seen as technical experts, because we are based in the Global South. We are always having to justify that we are as capable and as educated as entities in the Global North, and that we have the technical ability."

"There is an effort to shift that, and there have been many strides to do so. But then there are dynamics in the advocacy ecosystem that are unequal and are not just a North-South issue, Mathonsi said. "Many, many organisations operate and work on a single narrative and they exclude.[women and girls on a foundational level from championing for themselves on sexual and reproductive health and rights]."

"We're always asking ourselves how do we break silos between sectors? How do we ensure that intersectionality is seen as a key step of advocacy?"

Strategic interests trumping human rights

Dealing with power dynamics within the advocacy hierarchy itself is another challenge, Mathonsi said.

"We work a lot with grassroots advocacy systems and networks. We work with minoritised groups. There is an inequality between international non-governmental organisations (INGOs) and community-based organisations (CBOs) and we're asking: how do we get to a place where there's an understanding of inclusion?

"I am dealing with the facts of strategic interests trumping human rights. I am always having to navigate that."

When asked whether she is starting to see a paradigm shift come into play in the move towards locally driven advocacy, Mathonsi pointed out that "there are incredible allies in the Global North, and in the Global South".

"Nevertheless, 80% of writing on decolonisation comes from the Global North, 20% comes from the Global South. If you see gatherings and the spaces where conversations on reproductive health equity are being held, there's very little representation and involvement of the Global South."

Decolonisation and interrogation of power and privilege

Mathonsi does not shy away from interrogating power and privilege.

The International Conference on Family Planning is said to sport the world's largest gathering of family planning and reproductive health professionals.

And yet, said Mathonsi, many feminist and women's rights organisations - many of which do incredible work when it comes to sexual reproductive justice, family planning, sexual and reproductive health and rights - were not represented here at this conference.

"There is something ideologically different in idea and approach that we need to fix. We've got to do deeper, more insightful work, because the exclusion and hegemonies of power we're trying to disrupt are able to organise differently, and they maintain and hold power.

"So we've got to be serious about that agenda."

Mathonsi recognised that it's easier because of scale to work across demographics, but "we need to remember that demographics do not mean that you are progressive".

"We know as much as there are many progressive young people, there are also many conservative young people who are driving conservative agendas, so it's important for us to think beyond these boxes and the single narrative that people are put into.

"It's about asking ourselves what the world needs in light of where we have come from and in light of this anti-gender movement we see, because power organises differently and we see new neo-conservative alliances across the world. How do we tackle that?"

Welcoming resource partners rather than donors

She continued, "As civil society, we tend to put a lot of pressure on the one person we know within a development agency and think they can shift an entire institution, but we are in spaces, we are having conversations.

"There are shifts in funding models, which are driven by an understanding by key power holders within the system we're trying to shift and change."

We've got a long way to go, said Mathonsi.

"And it's more than having these words at conferences or having a statement where people sign on."

Coming from an ecosystem-strengthening organisation, Mathonsi reiterated the need for solidarity and action.

"I encourage people to remember when we think of development work and family planning, it is also about choice.

"The work we do is not to give people lives that look like ours, it's about lives that they know they want for themselves and they're the best people to articulate what it is that they want and what is best for themselves."


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