She Decides, But Who Pays?

This week, under the leadership of Belgium, the Netherlands, Sweden, and Denmark, representatives from 50-plus countries gathered in Brussels for the “She Decides” conference, raising about $190 million in pledges to support women’s reproductive and sexual health and rights around the world. This is great news, and an encouraging first step toward plugging the looming hole in global family planning financing (more on that later). But for those of us concerned about the implications of US policy change on global reproductive health, the relatively small absolute scale of the pledges (despite the wonderful generosity of the pledging countries given their size)—and the fact that some leading donors did not step up with additional funds—highlights the challenge of substituting for US financial and political leadership.

First, some background: the US has historically been (by far) the largest family planning donor, contributing about $638 million in 2015—just under half of all bilateral funding. The She Decides event follows the Trump administration’s recent reinstatement of the Mexico City Policy, also known as the “global gag rule,” which prevents the US from funding international family planning organizations that “perform or actively promote abortion as a method of family planning,” even with non-US funds. The (counterproductive) policy means that family planning giants like Marie Stopes International and the International Planned Parenthood Federation will once again get cut off from US funds. Bigger picture: it’s still unclear what percent total US family planning allocation will be affected by the new policy, but it may be significant—and the reallocation of funds away from organizations with longstanding programs and existing clientele and infrastructure will undoubtable be disruptive. Adding to the gloom and doom are recent reports that the Trump administration may request steep cuts to foreign aid. Some senators on both sides of the aisle are pushing back, but we can reasonably expect the family planning allocation to come under scrutiny—an issue I highlighted in December.

In January, within this climate, Dutch Minister for foreign Trade and Development Cooperation Lilianne Ploumen launched She Decides, a new initiative to “increase financial as well as political support for sexual health and family planning worldwide and mitigate the impact of decreased US funding to family planning.” The initiative attracted quick support from a number of European countries, and a pledging conference was organized for March 2. And that brings us to today’s pledge-a-palooza, attracting $190 million in (seemingly new?) money, including $21 million each from Sweden, Canada, and Finland; $20 million from the Bill & Melinda Gates Foundation; $10 million from founder of the Children’s Investment Fund Foundation Sir Chris Hohn; $10 million each (in already promised funds) from Belgium, Denmark, the Netherlands, and Norway, and $50 million from a private and anonymous American donor. Notably missing from the tally (despite their attendance at the conference) were Australia and the United Kingdom, which both declined to commit new money. (The United Kingdom did highlight its existing £200 million budget per year; it will also be hosting a summit this July to “secure extra funding for family planning.”)

Again: any new money is great, and badly needed—and She Decides has clearly stated its intent to “mitigate,” not reverse, the impact of US funding cuts. Nonetheless, we cannot ignore that so far, the absolute scale of commitments is but a small fraction of the US contribution (an issue that She Decides leaders acknowledged). Best I can tell, the $190 million in new commitments is a cumulative, not annual number; if 37 percent cuts to foreign aid are implemented, as has been reported, the new commitments would not even make up the gap for one year. (Of course, the cuts to family planning specifically could be even higher). This means that the family planning community, including the new pledging countries, will need to make its money go even further (see our recent report for some concrete suggestions on how). Given its size and stature, US leadership here has been absolutely essential. We may all soon be forced to come to terms with just how essential.

Getting recipient countries to invest their own funds in family planning—an essential women’s health service—needs to be top of the agenda. As I’ve previously discussed, the current situation clearly illustrates the dangers of donor dependency when women’s lives hang in the balance, and especially when one country accounts for such a big portion of total support. Donors can help mitigate the risk from the current situation, and possible policy changes in the future, by helping incentivize countries to fund these services from their own domestic budgets.

All this to say: three cheers to the pledging countries, and to the She Decides leaders for their quick and bold mobilization. But let’s temper our celebration with some realism—there’s much more still to do.

This blog has been updated to more thoroughly account for all pledges and contributions.