Standing Strong - Collective Advocacy to Protect SRHR Amid Global Headwinds

PMNCH’s sixth convening of Collaborative Action Plan (CAAP) partners reflects on current realities following funding cuts, assesses emerging challenges, and enables partners to strategize on how collective action can advance women's, children's, and adolescents' Health (WCAH).The meeting occurred against a backdrop of increasing global difficulties, including reduced donor support, geopolitical instability, and the proliferation of misinformation, all of which are undermining the delivery of critical services, particularly those related to Sexual and Reproductive Health and Rights (SRHR) in the face of the reinstatement and expansion of the Global Gag Rule (GGR). 

Funding Cuts and Policy Retreats: A Complex Landscape 

“I cannot overstate the complexity of the challenge that we face within the present context. …This is something that we did confront not only in 2016, but also in years before that. But there is a complexity and a particularity of challenge that we are facing today and that is manifesting itself in a variety of ways that is important to reflect upon.” - Rajat Khosla, PMNCH Executive Director 

Rajat Khosla, PMNCH Executive Director, framed the discussion with insights from a recent survey, organized by PMNCH, with responses from over 20 countries in Africa, Latin America, and Southeast Asia, highlighting the following profound impacts of the abrupt and drastic cuts to overseas development assistance: 

1. Financial Instability: An alarming 89% of partners reported facing reduced or uncertain funding. 81% described the impact on WCAH as "moderate to severe." 
2. Programmatic Impact: Within just nine months of the global funding crisis, 62% of partners had downsized programmes, 37% had suspended activities, and 20% had closed operations entirely. 
3. Vulnerability of SRHR: Partners expressed particular concern that SRHR services were especially vulnerable, compounded by pressures on Human Resources for Health (HRH) and erosion of trust. 

Rajat Khosla highlighted additional compounding challenges: 

1. Regressive Policy Environment: This environment is intensified by the re-imposition and expansion of the GGR, which negatively impacts areas such as contraception, comprehensive sexuality education, and abortion services. 
2. New Bilateral Agreements: The emergence of direct bilateral agreements with countries under the "America First Global Health Strategy" without engagement of CSOs, risks shaping restrictive conditions for reinstatement of US foreign assistance, and potentially introducing new restrictions related to SRHR. 
3. WCAH priorities are being marginalized in ongoing prioritization process: A third major concern is that as countries are forced to prioritize within declining health budgets, WCAH is not consistently being included in core national, regional global health priorities, posing a significant risk to recent gains. 

Rajat Khosla invited CAAP coordinating partners to share how PMNCH’s support—through the CAAP initiative, the Global Leaders Network, and parliamentary engagements—can strengthen their advocacy in response to these external challenges. 

Understanding the GGR’s Effects on WCAH issues 

Timothy Banda, Policy and Legal Advisory at IPAS, provided a detailed overview of the GGR and its’ increasingly restrictive impact on SRHR programs, especially across Sub-Saharan Africa: 

1. Service Disruptions: The GGR is contributing to challenges in implementing national SRHR policies and guidelines, declines in contraceptive access and services, as well as in integrated program disruption (e.g. GBV, HIV, key population programming, community outreach) especially for the most marginalized population groups 
2. Increased Health Risks for the Most Vulnerable: The disruptions in contraceptive access, community outreach and integrated programs are linked to increases in outcomes like unintended pregnancies and incomplete abortion referrals (to name a few) with negative implications for maternal and child mortality and morbidity especially for the hardest to reach. 
3. Operational Consequences: The effects include the closure of almost 1300 clinics, stockouts, procurement interruptions, and disruptions to community outreach, youth programming, and integrated HIV/SRH, Gender-Based Violence (GBV) prevention, and key population programming. 

Weakening of Advocacy and Coalitions: A major non-service impact is self-censorship, with organizations retreating from SRHR advocacy, research, and policy reform. The financial pressures driven by the GGR are shrinking the civil society space, forcing CSOs to withdraw from policy platforms, fragmenting coalitions, limiting evidence sharing, and ultimately weakening unified advocacy for SRHR, Maternal, Newborn, and Child Health (MNCH), and adolescent health reforms. As Banda noted, "Coalitions are fragmenting." “Civil society now is drained from certain policies and platform to comply with the GGR funding restriction….. So we find that family planning alliances, those related to the ESA commitments, and youth networks are fragmented and some of them are entirely closing down and they are no longer existing.” -Timothy Banda, Policy and Legal advisor, IPAS 

Banda emphasized the following key lessons for building resilience, including: i) cross-regional/cross movement coordination and exchange, ii) mobilizing strong continental and local advocacy coalitions, iii) harmonizing messaging across the Regional Economic Communities, iv) promoting domestic resource mobilization, v) generating real-time community evidence on impact, and vi) strengthening national accountability frameworks through parliamentary champions and citizen monitoring. 

CAAP Coordinating Partner Reflections: Country-level Impacts and Responses 

Levy Mkandawire, Program Manager, Amref Health Africa (“Amref”) Zambia, facilitated a discussion among CAAP coordinating partners on the GGR's impact and necessary responses, with partners sharing context-specific challenges and strategies, and indicating areas of support from PMNCH. 

i) Impact of GGR on SRHR Policies and Services 

The reinstatement and expansion of the GGR have had a direct and detrimental impact on SRHR  policies and services across multiple countries. Key impacts include: 

Service Disruption and Reduction: In Kenya, services at the county level have been disrupted, leading to gaps in family planning and integrated SRHR/HIV services, stock outs and staff layoffs. Tanzania is experiencing shortages in SRHR commodities previously supplied by the US government and a reduction in partner support.  “The effect is really felt deep down at the county level, where service delivery is actually so intense and the counties experience the immediate gaps in family planning, and reduced contraceptive options, interruptions in integrated SRHR and HIV services in which we've seen a drop and also there is a chilling effect on information sharing and referrals. So this has especially impacted rural and underserved counties that really rely heavily on the NGOs.” - Lisa Mushega, CAAP Project Lead, HENNET 

Erosion of Advocacy and Coalition Building: A major non-service impact is the fragmentation of civil society. Organizations are retreating from SRHR advocacy and policy reform due to compliance pressures and financial instability, leading to self-censorship, reduced sharing of data on these issues and a weakened unified front. Furthermore, dramatically decreased and unpredictable fundings has strained engagement. “We are yet to see the full impact of it [Global Gag Rule], but the trend is not looking very good as things stand. Now that meetings are held, there are very few partners who are participating. And then this [Global Gag Rule] will even make the situation even worse.” - Hester Nyasulu, Country Director, Amref Malawi 

ii) Impact of GGR on WCAH Health Budgets 

The GGR has exacerbated a global funding crisis, creating significant strain on national health budgets and financing for WCAH as indicated below. 

1. Funding Cuts: The starkest example is from Sierra Leone, where a U.S. funding gap analysis revealed a 77% reduction in support, leading to the cancellation of over 88 projects and a 43% cut in programmatic funding for Maternal, Newborn, and Child Health (MNCH) and family planning. This constrained fiscal scenario has underscored the importance of partnership and program integration to drive greater value for money. 
2. Increased Pressure on Domestic Resources: The funding shortfall has forced governments and partners to seek alternative financing. Ethiopia has responded by raising additional resources through its Treasury and negotiating new compacts with donors in relation to MNCH and family planning services. Similarly, Nigeria is strengthening domestic financing mechanisms like the Basic Health Care Provision Fund, and Presidential Initiative for Unlocking the Health Care Value Chain, and SWAp (sector-wide approaches) to reduce duplication and harmonize financial allocations. Additionally in Nigeria, strategic engagement and policy dialogues, facilitated by CSOs, are underway with a range of political stakeholders including legislators to galvanize their championship as advocates to support SRHR financing —especially during budget appropriation and defense “The critical issues that we all need to work on is how do we make, the dollar or whatever currency that we are using, to give us a better return or reinvestment, which is by working closely in partnership and program integration and also trying to bring in efficiency and effectiveness in everything that we are working on.” - Dr. Rahel Belete, Country Director, Clinton Health Access Initiative Ethiopia 

CAAP Partners Recommendations for PMNCH Support 

Partners identified clear areas where PMNCH support could be most impactful: 

Coalition Strengthening: Actively supporting the rebuilding and strengthening of coalitions, particularly where fragmentation is occurring due to GGR-related compliance pressures. 

Knowledge Sharing: Facilitating cross-country learning exchanges on effective strategies for navigating shrinking space and funding. 

Evidence-Based Advocacy: Supporting advocacy brief development with robust data to strengthen advocacy efforts directed at governments and alternative donors, as well as to address stigma attached to certain services like abortion. 

Communications support to increase visibility of country efforts and challenges. 

Resource Mobilization: Providing support for domestic resource mobilization, including through coordinated efforts with parliamentarians, as well as donor coordination efforts. 

Overall Highlights from CAAP Implementation 

PMNCH partners shared their overall highlights since the last CAAP peer exchange of CAAP implementation, including: 

1. Political Advocacy in Malawi: Post-election context offers new advocacy entry points; the Amref team will re-engage the new administration and Office for Manifesto Implementation on WCAH priorities. Upcoming engagements include the new Parliament’s Health, Gender, and Legal committees, and a December meeting with the health donor group on financing, potential cuts, and CSO sustainability. 
2. Coordinated Advocacy in Zambia: CAAP implementation has strengthened coordinated advocacy: convened 12+ organizations to produce an SRH/MCH policy brief, engagements underway with key ministries and MPs, partnership with the Parliamentary Health Committee to organize a public lecture on ending child marriage (gaining traditional leader commitment), and a webinar was co0hosted on Respectful Emergency Care where MPs supported expanding maternity infrastructure. 

The Necessity of Collective Action 

The consensus of the meeting was that collaborative advocacy as well as program integration are essential for protecting hard-won progress for WCAH especially SRHR. While coordination is challenging, it is essential so that everyone feels they can be part of the advocacy and accountability efforts for WCAH. PMNCH remains committed to supporting this coordination, amplifying partner priorities, and responding directly to their identified needs in these difficult times.