42. IPP Who?

Lars Peter Nissen: 00:11

Welcome to Trumanitarian. I'm your host last Peter Nissen. Sexual reproductive health services is an incredibly important and at times quite controversial issue both in development and humanitarian settings. IPPF the International Planned Parenthood Federation is one of the main networks pushing this agenda forward. And this week, my guest is Robin Drysdale, the deputy director for humanitarian programs for IPPF. She tells both a new and quite familiar story about the challenges and the priorities for the actors pushing for better access to critical services. And I think one of the things that I found really interesting and surprising was that in a sense, I think I overestimated how far we have gotten on this issue. It remains a massive challenge for the humanitarian sector to ensure that we put the spotlight on reproductive health, in our operations. And we see that as a truly life saving intervention alongside the other sectors.

I hope you enjoy this conversation. And if you do, please, don't forget to like us and follow us review us and all of that. And as a always, we are happy to hear from you with feedback and ideas for new episodes, you can reach us on info@trumanitarian.org. Enjoy the conversation.

Lars Peter Nissen: 01:38

Robin Drysdale welcome to Trumanitarian

Robin Drysdale: 01:40

Thank you, Lars. Nice to be here.

Lars Peter Nissen: 01:42

And I think we have to have full disclosure. It's the third time that we try to actually record this interview, the guards of internet have not been on our side so far, but we have been praying heavily this morning to them. So let's hope that everything will be okay, Robin. You're the, you're the deputy director for humanitarian programs in the international planned parenthood Federation. And, and maybe let's begin with the, Federation, the IPPF. I have to admit that I wasn't intimately familiar with the work of I P P. Before we, we got in touched and agreed to do this, this episode, I knew some of your members, but I actually wasn't too familiar with the Federation, a quick overview of what, what is IPPF

Robin Drysdale: 02:28

Ippfis an international Federation of sexual reproductive health and rights organizations, which are located across more than 170 countries in the world we are a global network of local organizations. And one of the key things about the IPPF global network is that all our member associations are local organizations. They're local non-government organizations that do sexual reproductive health and rights at their country level, but we are part of a global network, as we like to say, we're locally owned and globally connected. And that makes us quite unique, especially in terms of sexual reproductive health in crisis, because we are in the countries before, during and after a crisis and also the vulnerable populations that we serve at country level eight out of ten of the clients that our member associations see are classified as poor or vulnerable or marginalized in some way within their communities.

Lars Peter Nissen: 03:42

So maybe the reason that IPPF is not doesn't have that higher profile, is that really it's the members that take the, the front row. And, and those are the organizations that we engage with when we, we meet in the field. Is that fair to say

Robin Drysdale: 03:56

AB? Absolutely. And we have heard the saying that we are the largest organization in the world that no one's ever heard of, which is perhaps not the best state to be, but I think it is that because we are a Federation and it is very much about the work our member associations do. So they are the ones working at the field. They local organizations that are doing the work and our role becomes more of a technical support and a resource mobilizer,

Lars Peter Nissen: 04:29

But maybe you should have a word with your communications department,

Robin Drysdale: 04:32

Very good point. Hopefully, hopefully that is slowly changing, but yes, our communications department should perhaps do some more work.

Lars Peter Nissen: 04:44

All right. On a more serious note. Obviously the need for, for sexual reproductive health services is not, is both a issue that expands the development and, and the humanitarian field. Robin, you, you work predominantly with the humanitarian side of things. How different from your development work? What, what specific to sexual reproductive health services in an emergency? What, what are the main challenges? How do you engage with the, with the humanitarian architecture? What, what, what's it like?

Robin Drysdale: 05:17

So it is, it's really it's about really honing down the attention of what we do in an emergency, because it really becomes about critical life saving activities or humanitarian actions. So during stable times, we would our member associations deliver a whole raft of services for sexual and reproductive health. We don't deliver those during an emergency during a crisis. We don't deliver all of them. We really narrow it down to the minimum initial services package or the MIS as it's called globally, which is a globally recognized minimum standard of services, which are life saving for sexual reproductive health, maternal health. So that is about really about saving lives. So really the work in the humanitarian program is of course about supporting member associations to respond effectively with quality services during a crisis, but it is also about preparing them to do that.

So a lot of our work is really in preparedness so it is the time before crises. And of course, you never know when crises is going to set. So you could also say there we are always in preparedness phase, and that's where the nexus between humanitarian work and development work is really critical because that preparedness involves both capacity strengthening, and doing things such as simulation exercises at country level. It involves prepositioning of supplies ready to have a grab and go clinic if you will, to go to the field. And it requires partnerships at country level. So you mentioned the cluster system. So our member associations are engaged with their national coordination mechanisms very closely. And in particular, they engage with the health clusters or equivalents at country level, and also the protection clusters and gender based violence, sub clusters,

Lars Peter Nissen: 07:28

Sexual reproductive rights. It can be a really sensitive issue, both in terms of, of access to services, various services, but also the whole L G BTQ plus agenda and civil society in some of the countries we operate in tend to be fairly conservative at least parts of it in this area. How, do you deal with, with that situation that maybe the, the whole LGBTQ+ plus agenda is really not flavor of the month in some of the countries where, you operate. How, how do your partners deal with that? How do you as a Federation deal with that diversity of opinions on, on that issue? For example?

Robin Drysdale: 08:14

Yeah. So in some countries it is a challenge. Absolutely. I think part of the beauty though, of our member associations is that they are local organizations. And so they're engaged at local level and have long standing relationships with communities. And also other lo local organizations, which include networks of people who are of diverse sexual orientation and gender identity. So they, because they understand the local context they also have ideas around how best to approach some of these issues and to push forward the rights, for example, and support the rights of those who are most marginalized in their communities. It's not always easy. And absolutely it is a challenge in some countries in particular, but really our work is all about supporting the most vulnerable in, in communities and the absolute right that people have to sexual reproductive health, regardless of their ability or disability, their gender identity, their sexual orientation. So I think the context appropriate approach that our member associations are able to take because of those partnerships because of understanding the local culture because they're part of it. And also because of understanding, you know, religion and knowing who the gatekeepers are at local level, who are going to help and assist and how to get around some of those barriers that exist within the countries

Lars Peter Nissen: 09:54

We have previously on this per podcast had 42 degrees a great organization working with these issues in, the Pacific also. And it was really interesting to hear, hear them talk about their work, I guess they also somehow relate to, to the work you do?

Robin Drysdale: 10:10

Absolutely. And we have great networks that we work with in the Pacific as there's the Pacific sexual and gender identity diversity network. And we work closely with them in their country counterparts. And we partner with them both in stable times and emergencies and, try and engage and ensure for participation of people who are of diverse orientation and identity. For example, in Tonga, we spoke earlier about the Tonga response, our team that's mobilized there consists of yes, nurses, midwives from our member association. They have a representatives, of the local Tonga leitis association, which is a trans into network who is joining the core team that will go out to communities. They also have a representative of one of the disability, disabled people's organizations as part of the core team. So in those efforts to really engage with and ensure true participation of communities in all their diversity, we ensure that our teams represent those communities as well.

Lars Peter Nissen: 11:23

Now, the way you describe how you work in emergencies is that you trim down , the range of services you give to the absolute minimum. And I think, I think that is sort of the strategy we choose. We focus on the lifesaving immediately and so on. And then what's that like for you in an sort of an inter cluster inter agency setting, is there a general understanding of the importance of what you do or is it more like you guys will have to wait a little bit? We are too busy with the, with the truly life saving stuff.

Robin Drysdale: 11:52

Yes. Well, we do get that attitude and it is a, it's a constant advocacy, even within the UN to be honest around this, even though you know, the SPHERE guidelines, you know, kind of the Bible for the humanitarians recognizes it sexual reproductive health as a life saving humanitarian action recognize, and, and names, the importance of implementing the minimum initial service package for sexual reproductive health within 72 hours of a disaster occurring. As a really obvious example I like to give is: okay, we agree food, water shelter is life saving, but so is sexual reproductive health women don't stop having babies just because there's been a cyclone or an earthquake or a disaster. So, you know, and I think there was a really powerful image that came out of one of the disasters in, in the last few years we've responded to, which was in Mozambique.

And it got quite a lot of coverage, this image and it was a pregnant woman who had to give birth in a tree in Mozambique because of the the flooding, the huge cyclone that they, cyclone Edai. And there were no services and she was trapped in the tree and went into labor. And I've experienced being in teams where you've had women go into labor when you've been on a boat that you're trying to evacuate them. So these things continue and women are particularly, women and girls are particularly at risk of maternal health. Of course, newborns are at risk. Gender based violence is increased during emergency times and post emergency. So daily life continues and that realization or trying to help people understand sex does not stop during an emergency. Pregnancy does not stop birth, does not stop. And these are all critical things. And these are things that women ask for during an emergency. And they ask for mestrural hygiene support. So, you know, tampons pads, et cetera, to deal with menstrual hygiene, they don't stop menstruating during an emergency either. So these are all things that continue and need attention.

Lars Peter Nissen: 14:19

Another thing I was thinking about when I was preparing for this interview was climate change. How, do you actually see the link between sexual reproductive health service and, and climate change? What I, I mean, I have to, I'm probably sort of exposing my ignorance now, but my, my first thing was like, okay, so I guess it's about having fewer kids. But maybe, maybe that's not right. Or maybe it, it is slightly more complicated than that. Please, please enlighten me.

Robin Drysdale: 14:45

It is a lot more complicated than that. And certainly we don't promote contraception as a solution for climate crisis because really what that does is it places the responsibility and the emphasis for tackling it on those who are least responsible for contributing to it. You know, certainly climate climate change and the climate crisis. It's nowhere more evident than in the Pacific islands and in some of our countries such as Kittabus in the Pacific islands and Tuvalo in the Pacific islands. And it, there was a fantastic image of recently at COP 26 of the Tuvalu prime minister delivering an address to the COP 26 lit are standing waste deep in water because with his podium, because that's, what's happening to TIVA, and that does have an impact on sexual reproductive health. It has an impact on the availability of water, for example.

So if you don't, if you have difficulty accessing water and clean water that affects maternal health, that affects whether health services can operate it, it has harmful effects due to, you know for the young children as well and safe water affects safe pregnancy and childbirth, really the crisis, the climate crisis also has an impact in terms of the increased stresses it places on families, in terms of whether they need to relocate whole villages or communities, whether it impacts on their ability to access enough food or grow enough food. And that puts stresses, which can create an increase in gender based violence. We've also seen in some context where that the communities have had to move and they've had to relocate to lands that may not belong to them. For example, they might have to change, move islands or move areas, and then to be able to stay on that area, they might there might be some forced marriages that occur to try and form alliances with, with the communities who own that land.

So we see an increase in child marriage that occurs. So all of these sorts of pressures really do have harmful effects on sexual and reproductive reproductive health. I remember in Papa New Guinea, they had a heat wave and a, a massive drought just a year or so ago caused by the, the growing increasing impacts from El Nino, and this meant that schools and health services across three provinces in the country closed. So the entire province had no health services that were open because they had no water and people had no gardens that they, their gardens all died. So food became scarce. So you can imagine the impact that that would have. So there is definitely a link Lars with climate change. Yes.

Lars Peter Nissen: 18:04

And, and so when you engage, for example, with COP 26, what, what do your, what, what are your advocacy points? What do you, what do you actually push for?

Robin Drysdale: 18:12

Yes. Well, of course, we're trying to push for you know, the big countries to take action about this, because, you know, in the countries that we are working and people have little power to enact change, and in fact, we live and particularly in the Pacific, we work in some of the countries which are most affected. So we are, we're trying to make it really clear the impacts that this is having on people's lives. So the advocacy points are really about what climate related disasters, the impact that's having on people. And also the, from our, our perspective and particularly mine working in humanitarian programs, we have increasing number and intensity of climate related disasters, increasing number of floods, increasing number of droughts increasing intensity of cyclone and the impact that those things have on people in general and particular on sexual reproductive health and the harmful effects. This has on maternal health and on communities. So there are advocacy points that the consequences of inaction on climate change and what impact that's having globally, but particularly on community level and individual level and families, what it's having on families. So really trying to give a human to those impacts, I guess.

Lars Peter Nissen: 19:34

A as we've spoken about a couple of times sexual reproductive health is something that it's, it's always with us. It it's, it's not a development issue. It's not a humanitarian issue. It's a human issue. I mean, that is, that's a need, that's always there. How, how does that, we also talk a lot about nexus in, in the humanitarian sector. What, what is that for you? What, how, what's your specific take on that? How, how do you engage with that?

Robin Drysdale: 19:56

The nexus? Yes. What is this thing called nexus? We often talk, what is this thing? I think we see it as a lot of people talk about it as the overlap between development and humanitarian programs. And, and in fact, sometimes they talk about development, humanitarian, and peace nexus. But I, I don't see it as an overlap. I see it as a continuum and for us in a lot of the countries we work in, particularly in the Pacific, we are constantly moving between one and the other. So it, it's kind of a continuum of you know, during stable times, we need to work on preparedness at the same time. And then, an an event might occur that disrupts the system. So disrupts normal service delivery, that could be a flood. It could be a cyclone, it could be a volcanic eruption, like we've seen in Tonga. And then that's when the crisis response needs to come into play. But as I said earlier, because we need to be prepared for those things, the development work needs to be tied in so closely with humanitarian work so that we can be prepared, but also so that we can recover effectively and build resilience.

Lars Peter Nissen: 21:13

So, so what you're saying essentially is that you work fairly seamlessly across the nexus with, with your programming, that there's not a big tension between trying to integrate activities coming from a humanitarian box of money and activities coming from development funding?

Robin Drysdale: 21:31

I think it, we, we are optimistic and we, and we aim for seamless. I don't kow if that's, we're quite there yet LA, but we are working on it and I think we and we will continue to work on it, improve the, that kind of work across that nexus. It's not seamless sometimes that's, there is still some silos that occur and I, and sometimes that's because of the way that we are funded and the donor funding. But it's, it's really about integrating humanitarian work into all the work that we do and, and continual programs, because we don't know when stable times might be disrupted by natural disasters or manmade disasters or conflict. So preparedness needs to be a continuous effort, I think. But certainly our, as I said is because our member associations are local and they're uniquely positioned because they are they there before, during and after a disaster.

So that ability to be engaged throughout the humanitarian and development continuum is very strong. Sometimes it's, it's challenging at country level though, too, because there are silos at country level. And of course I'm sure you're aware on the international level there's silos. So you have national disaster coordination mechanisms, which might be completely different groups from the stable times kind of representations or groups that occur. So you might in a disaster, you have the cluster system more or equivalent at national level and national coordination. During stable times, there's often groups such as reproductive health committees, or you know, other committees that exist, but they're different than what happened during an emergency time yet in the smaller countries, they're often the same people. So you know, these trying to break down some of those things is really important. I think,

Lars Peter Nissen: 23:41

Where are we today in terms of the global opposition to your work? How, how does that feel? Are we moving forward? Where, where are the main stumbling blocks and what's the opposition you face?

Robin Drysdale: 23:51

Yes, sadly the global, gag rule that was in reinstated under Trump really meant that any, no maternal health or sexual reproductive health programs could speak about abortion. And that means even if it was women seeking advice about their pregnancy, even if it was women, who'd had an unsafe abortion getting care for the consequences post-abortion care if they'd had an unsafe abortion, which is as you know, huge throughout the world and, and it, and a high causes, many, many women's death throughout the world. So any organization that could, that did anything to support women around that would be defunded. So they had to sign a global gag, a gag rule which meant that they would not mention the, A-word at all, or provide any form of support to any women, even if they were post unsafe abortion and needed care for that.

If you did not sign that gag rule, then you would be defunded. So of course IPPF did not as a Federation did not sign that gag rule because signing that is signing the death of women really. And it's totally against what we believe in which is supporting women's rights. And so, because of that, we lost about 100 million funding for evidence based programs that provide comprehensive sexual and reproductive health services for millions of women, men, and young people many of those who went without services and you know, it probably meant the huge amount of negative consequences on women and girls, young people globally. In Africa, there were 31 member associations affected in south Asia. There were five affected in the Western hemisphere region at Caribbean and the US affiliated area there were nine impacted, lots of projects closed access to sexual reproductive health reduced significantly during that time.

So now under the new administration, the Biden-Harris administration, we are really working hard to undo the horrendous damage that was caused by that global gag rule over the past four years. So we've repealed it, of course, but it's only a long, it's really a long, a step on a long journey to recover and, and reestablish our relationship with the new administration and trying to work towards getting those essential health services back up and run running and trying to prepare some of that damage. So we, we are also trying to keep our consistet pressure to make sure that the global gag rule can not be weaponized in by future administrations to harm the rights of women and girls and people everywhere, and to try and permanently repeal that because really it is a blow to, to women's rights and, and to women generally, and it undermines their health.

Lars Peter Nissen: 27:24

Yeah, it's criminal. And, and it's hard to understand how anybody can come up with a policy like that. Apart from that risk, which is there, that you may have an administration come in again. And because of, of the, the, the size of the funding from the States, of course, this has a big impact. Where, where else does the opposition come?

Robin Drysdale: 27:44

It, it depends. It it's really, there are some oppositions from, you know, some religious groups around some of the work that we do, of course because we do support rooms, right. To choose and to enable access to safe abortion care. We are trying to combat the huge amount of unsafe abortion that is occurs throughout the world. There are some countries for whom, you know, unsafe abortions, women accessing unsafe abortions is the leading cause of death of adult women in their countries. And so we see it critical to enable access to free easily accessible contraception and also safe abortion for women to maintain their health. So, you know, there are some religious groups which oppose that there are some administrations in some governments and some countries who oppose that approach because generally because of religious reasons so, you know, it's a whole, it's a range of things that there's nothing as pervasive though, as what occurred under the global gag rule, but, you know, country by country, there are certain oppositions that we faith face in need to address specific to that context.

Lars Peter Nissen: 29:10

Now, looking forward, what's the agenda for the next five, 10 years? What are you pushing for? Where, where are you trying to, to improve the situation of the population's you serve.

Robin Drysdale: 29:24

I think to continue with our efforts to try and ensure accessible affordable and appropriate you know, access to sexual reproductive health for everyone particularly those who are most marginalized in communities. So ensuring that people who are of diverse gender identity and sexual orientation have access to the sort of sexual reproductive health support that they need, because we are certainly not there yet. And that they are able to access care without discrimination and that they have the equal access that everyone does. Also the work for sexual reproductive health, for people with disabilities people with disabilities make up up to 10% of our populations. It's potentially more in some countries, many, many, many of them globally do not have the same access to sexual reproductive healthcare. And they, and sexual reproductive health and sexuality is highly stigmatized often for people with disabilities.

Yet they have the same sexual rights as we do and the reproductive rights but enabling them access firstly, to education around those rights, enabling them access to contraception, to other sexual reproductive healthcare to safe sex products, et cetera, is, you know, that is really critical to ensure that that remains. We're also at a really interesting point in history in that we have an aging population. So there are particular needs that an aging population has. So we in IPPF we try and take a life cycle cycle approach. And in that, you know, there are particular that young people have and adolescents and, and preadolescence have around sexual reproductive health and rights, but they are also ones that older people have as well. And people who are going through menopause, who are aging, who might have developed some sort of cancers, prostate cancers, cervical, et cetera.

Robin Drysdale: 31:45

So we need to look that that aging population in some countries and I'm thinking of countries such as Japan, for example, but on the flip side, we have countries that have huge young populations in the Pacific. For example, in Solomon Islands, we have mostly youthful populations. So we, you know, we need to take that whole life cycle approach. So ensuring the needs are met. So I think some of those marginalized populations as well as the different needs that people have throughout the life cycle of sexual reproductive health. And one thing that's not going away sadly, is humanitarian context. Our work will remain really, really critical because we are seeing more frequent, higher intensity range, a whole range of disasters that are occurring, and certainly the amount of conflict and protracted crises that we see that, that has not decreased. And we've only seen increases in that respect. So ensuring that people who might be displaced within their own countries or might be refugees or migrant ensuring that they can also access the care that they need.

Lars Peter Nissen: 33:03

Yeah. I'm not sure that's a very positive note to end on, but I think it's actually the right note to end on. I think we are facing in particular, as you say, in the Pacific a very difficult time because of, of climate change, as we've spoken about in this conversation sexual reproductive health is, is, it's a right. It's something that is always a need, no matter what the, the situation we're in. And I just wanna say thank you for, for coming on the show, thank you for the work you do, and all of the best of luck with, with your work going forward.

Robin Drysdale: 33:40

Thank you very much, Lars, and just a shout out to our Tonga member association who are on the ground starting to serve the women and girls in Tonga right now.