The World Bank just released Closing the Deadly Gap Between What We Know and What We Do: Investing In Women’s Reproductive Health (shown above) for Women Deliver. Its basic message is that investments in reproductive health are essential for development.
In other words, we know what works. We just need to implement and sustain proven policies, reforms and packages of interventions. The benefits of realizing reproductive health (or the costs of continued glacial progress) will be felt in women’s labor force participation, household well-being, and macroeconomics.
The real strength in this report is in applying the Bank’s World Development Report 2012 focus on improving gender equality, which they find is part and parcel to improving reproductive health. No surprise here, but they have the regression analysis to back it up. The authors write, “…measures of gender inequality are important predictors of poor reproductive health and therefore addressing these sources of inequality is critical to improving reproductive health outcomes.”
So what does this mean for programs?
- Efforts to improve the agency (or power) of women and girls through expanded education and economic opportunities, and removing legal barriers that are holding them back is essential.
- This must be done alongside improvements to the health sector—such as removing financial barriers, improving quality of services through proper incentives for health workers, and family planning programs that address the real world that women and girls navigate every day.
- All this has to be backed up by enhanced social accountability to raise awareness among communities about their rights. We need to create space for women to meaningfully engage with local governments and health care workers for better reproductive health outcomes. Most of the World Bank’s examples of social accountability were for maternal health, but there are also huge implications for improving quality of family planning services.
However, despite being all about gender, income equality, and women’s health, the report’s conceptual framework completely avoids human rights. In fact, rights are only mentioned in passing towards the end of the report. This is not surprising since it builds on Amartya Sen’s work on agency. But nowadays reproductive rights are mainstream. Even FP2020 has a Rights & Empowerment Working Group! It is time for the Bank to embrace reproductive rights and women’s rights.
Also, this economic take on people’s lives can lead to seemingly callous content: “The direct health expenditures of a maternal death were more than six times higher than those with a successful birth outcome…” Ugh. I know we need that kind of evidence for advocacy with the most stubborn policymakers, but it still makes me squirm.
This report could do better in recognizing the importance of human rights in achieving gender equality and improving reproductive health. But it puts forth a vision of empowered women and girls with access to high quality reproductive health services, and engaged communities behind them. Not bad coming from the World Bank!