Contribution from UNFPA, the United Nations Population Fund, to the International Development Committee’s inquiry into the inclusiveness of the Foreign, Commonwealth and Development Office’s development strategy and delivery.

Written evidence of 4 September 2023, submitted by Monica Ferro, Director of the London Representation Office, UNFPA.

UNFPA is the UN’s sexual and reproductive health agency with a mission to ensure that every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled. We support women, girls and young people in more than 150 countries, encompassing over 80% of the world’s population. Our programmes aim to achieve the "three zeros" by 2030 – zero unmet need for family planning, zero preventable maternal deaths, and zero gender-based violence (GBV) and harmful practices – and disability inclusion is a vital contributor to these transformative results.

UNFPA works to ensure persons with disabilities are leading efforts to make the world more inclusive and are championing equal rights and a life free from violence. The UNFPA Disability Inclusion Strategy puts persons with disabilities at the centre of everything UNFPA does, ensuring sexual and reproductive health and rights (SRHR) for all. Focusing on the rights of persons with disabilities also supports the achievement of the Sustainable Development Goals (SDGs), especially the principle of “leaving no one behind” (LNOB) and “reaching the furthest behind” (RFB), which is aligned with the United Nations Disability Inclusion Strategy (UNDIS) as well as UNFPA’s own Strategic Plan 2022-2025.

We value our long-standing collaboration with the Foreign, Commonwealth and Development Office (FCDO), the UK’s leadership on sexual and reproductive health and rights (SRHR) and its commitment to acting as a global leader on disability inclusion. Like the UK, UNFPA takes a human rights-based approach to disability. Through this submission, UNFPA seeks to share our approach and learnings from our flagship initiative to promote the rights and choices for women and young persons with disabilities, which may contribute to the UK’s disability-inclusive development work. In particular, we hope this evidence informs the UK’s approach to advancing SRHR and ending gender based violence (GBV) for persons with disabilities. As the International Development Committee is aware, investment in SRHR is one of the most powerful accelerators of human progress, delivering strong returns to economies and societies through lasting benefits for individuals and families.

1. The role of the UK in disability inclusion within the global humanitarian and development community.

In the UK’s Disability Inclusion and Rights Strategy 2022-2030, inclusive health was listed among six priority “intervention areas”, and UNFPA acknowledges the UK’s goal to play a leading role in promoting the sexual and reproductive health and rights (SRHR) of persons with disabilities, with a special focus on women and youth.

The SDGs provide an ambitious agenda to transform the world by 2030. Disability inclusion, gender equality, GBV prevention and response, and SRHR are explicitly recognised as integral to reducing inequality, improving access to quality education and ensuring equal rights for women, girls and young people to fulfil their potential.  Article 25 of the Convention on the Rights of Persons with Disabilities recognises that persons with disabilities have the right to the enjoyment of the highest attainable standard of health. This has strengthened disability movements, enabled transnational alliances, and resulted in the revision of discriminatory legislation.

However, major challenges remain with regards to equal access to sexual and reproductive health (SRH) services. Many women and girls with disabilities face numerous barriers to accessing sexual and reproductive health care. Persons with disabilities have typically been excluded from SRHR and their SRH needs have been neglected.

Almost one-fifth of women worldwide have a disability, and they face the most significant barriers to accessing SRHR and SRH information, education and services that are adequate, comprehensive and free of prejudice. Women with disabilities are routinely denied their right to bodily autonomy and have faced reproductive rights violations, as they experience forced or coerced sterilisation, forced contraception, denial of access to contraception, and growth attenuation and/or other forced medical procedures to control menstruation[1]. Women with disabilities are up to 10 times more likely to experience GBV. This is often compounded by disability-specific violence, including caregivers withholding or removing assistive devices or refusing to assist with daily living. In addition, support services for women experiencing violence tend not to be accessible and do not respond adequately to their specific needs.

It is within this context, the Decade of Action on the SDGs, and amid increased inequalities from the COVID-19 pandemic and the climate crisis that UNFPA believes there is scope to build on the key intervention areas stated in the FCDO’s Disability Inclusion and Rights Strategy 2022 to 2030 – specifically around inclusive health and inclusive education. Drawing from our experience, we believe the UK could further support and provide leadership on the following actions:

●        Promote and protect the bodily autonomy of persons with disabilities, with a special focus on women and young persons with disabilities. Support countries and partners to adhere to international human rights conventions and agreements that provide a framework that guarantees persons with disabilities the right to bodily autonomy.

●        Support countries to develop national policies and laws that guarantee access to SRHR for persons with disabilities, with a special focus on women and young persons with disabilities. Countries should work to eliminate discriminatory laws that prevent persons with disabilities from exercising their reproductive rights, and prevent discriminatory actions, including unconsented sterilisation.

●        Support interventions to remove barriers to access by making SRH care and GBV facilities, communication and information accessible, affordable and safe. Health-care facilities as well as GBV service providers must be physically accessible, and the information on SRH and GBV must be provided in accessible formats. SRH and GBV service providers must guarantee accessible, available, acceptable and high quality services.

●        Support the development of interventions beyond information provision and health literacy. Promote access to maternal health, family planning and contraception and other SRH services and address barriers to the ability to seek, reach, afford and use relevant services.

●        Education is one of the main focus areas for the UK. In this regard, supporting the inclusion of comprehensive sexuality education for persons with disabilities on SRHR would be beneficial. Further development and implementation of resources for educators and advocates of high-quality, age-appropriate, accessible materials on SRH, GBV, and reproductive rights for all, including out-of-school children and youth.

●        Support efforts to strengthen data to monitor, evaluate and develop SRH and GBV services for persons with disabilities. Conducting empirical research on the SRHR of persons with disabilities, emphasising low- and middle-income countries and including more intersectional data (such as SRH among women from ethnic and minority communities) would be beneficial. Persons with disabilities must be engaged in such studies. In addition, initiatives on data literacy could be supported. Data is essential for government officials and policy makers to fulfil the rights of persons with disabilities. Understanding what, why and how data is collected is important to inform future advocacy and investment in disability data.

●        Building on lessons from the COVID-19 pandemic, the UK can support the implementation of existing international guidance on disability inclusion, SRHR, and freedom to live free from GBV.

●        Support partnerships with organisations of persons with disabilities, especially organisations of women and girls with disabilities, and practise disability-inclusive programming. Ensuring meaningful and active participation of women and girls with disabilities at all stages of programming guarantees sustainable and effective results.

2. The FCDO’s learning from other approaches and global work on disability inclusion.

UNFPA has been mainstreaming disability inclusion into all of its programming and has built a wealth of experience in this area through our global flagship programme called We Decide. This initiative promotes the rights and choices of women and young persons with disabilities and it rests on two pillars – advancing SRHR and ending GBV for persons with disabilities. The latter is an area we are rapidly growing our expertise on. We hope the information and recommendations below can contribute to the FCDO’s global work on disability inclusion.

A 2018 UNFPA study illustrated that youth and women with disabilities face multiple and overlapping challenges when it comes to accessing GBV information and services. One of the main drivers of the We Decide Programme has been for it to serve as a catalyst for UNFPA to work more systematically on disability inclusion across all of our programmes and operations, both at Headquarters and throughout the 150 countries in which we operate.

The We Decide Programme has achieved progress on disability inclusion on a global scale, including through the production of the We Decide Guidelines for promoting disability inclusive SRH and GBV services, which have been implemented in more than 70 countries since they were launched in 2018.

In the context of Covid-19, We Decide has enabled UNFPA to think of alternative ways to ensure the rights of women and young persons with disabilities are realised through the production of accessible information, with key messages on the pandemic (also see this video), and the translation and dissemination of guidelines to promote the accessibility of information and services related to COVID-19 and its interlinkages to SRHR and GBV. The programme has also supported the building and dissemination of a multisensorial exhibit, Wanted: a World for One Billion, that has served as a powerful advocacy and awareness raising tool online and in various locations, including Oslo, Helsinki, and New York.  

The We Decide programme operates around three outputs:

Output 1. Mainstreaming and targeted action: Strengthen capacity to mainstream disability inclusion and implement disability-specific interventions at all levels.

The first output focuses on a two-pronged approach: 1) mainstreaming strategies and; 2) targeted support for disability inclusion. This output seeks to strengthen capacity at global and regional levels and in selected country programmes to mainstream disability inclusion across UNFPA Strategic Plan outputs: (a) policy and accountability; (b) quality of care and services; (c) gender and social norms; (d) population change and data; (e) humanitarian action; and (f) adolescents and youth. 

The first output takes into account all mainstream/core areas that UNFPA’s work addresses, for example: Family Planning (FP), Fistula prevention (Output 1); Integration of SRH into Universal Health Coverage, Support for midwifery, Maternal telehealth (Output 2); Promoting gender equality, including through promotion of positive masculinities and women and girls’ agency, support for feminist movements (Output 3); The availability and utilisation of high-quality, routine facility-based SRH data (Output 4); The systemic implementation of the updated minimum initial services package, which positions FP as a life-saving intervention; SRH coordination and  information management (Output 5); and  Comprehensive Sexuality Education (CSE), young people's leadership and meaningful engagement on SRHR and gender (Output 6).

Output 2. Policy dialogue: Strengthen positioning of disability-inclusive protection and response to GBV and advancing SRHR at all levels.

This output focuses on campaigns and advocacy activities for the equal rights and opportunities of women and young persons with disabilities. It also involves the generation of innovative new data and evidence to strengthen global positioning and advocacy on disability and gender, and it calls for engagement with policymakers and legislators to address the intersections of disability, age and gender.

Output 3. Participation: Establish or strengthen innovative mechanisms and capacities for systemic engagement and participation of women and young persons with disabilities and organisations of persons with disabilities.

This output focuses on the collaboration and coordination that underlines the participation of women and young persons with disabilities. It establishes or strengthens innovative mechanisms and capacities for systemic engagement of women and young persons with disabilities and their representative organisations in GBV and SRHR policies and programmes. Within this output, the goal is to explore and develop digital and technology based innovations that can contribute towards enhancing the participation of youth and women with disabilities and increasing their access to services. 

We note that there are some parallels between these outputs and the three “enablers for inclusion” (assistive technology, strengthening organisations of persons with disabilities, empowerment of people with disabilities) outlined in the UK’s Disability Inclusion and Rights Strategy 2022-2030.

Following the positive results from UNFPA’s We Decide programme, we would encourage/believe the UK could invest in and focus on the following areas to further strengthen its work on the promotion of disability inclusive health – specifically connected to SRHR and gender equality:

1. Capacity Building

●        Establish a critical mass of trained stakeholders to provide rights-based and gender-responsive services on SRH and GBV.

●        Support a more disability-inclusive organisational culture among all partners involved.

●        Support the twin track approach, which includes mainstreaming disability in all programmes and operations, as well as targeted activities focused on disability inclusion.

2. Advocacy and Policy Dialogue

●        Strengthen positioning and policy dialogues on disability-inclusive SRHR and ending GBV.

●        Engage with policymakers to address the intersections of disability, age and gender.

3. Data and Evidence

●        Establish new and innovative data and evidence to strengthen global positioning and advocacy on disability and gender.

●        Analyse data using national surveys and census data and build Organisations of Persons with Disabilities’ data skills.

●        Increase stakeholder collaboration and integrate gender perspectives in accountability. mechanisms.

4. Innovation and Digitisation

●        Engage young persons with disabilities to take the lead in innovating for bodily autonomy and access to essential services, humanitarian and emergency aid and information and communications technology for e-health information.

●        Develop accessible and disability-inclusive digital spaces for youth advocacy.

●        Highlight the role of young persons with disabilities in formulating user-centred design and social and tech innovations to improve their social status and overcome negative attitudes and other barriers to information and services.

3. The FCDO’s progress in implementing the Committee’s previous recommendations and the commitments made at the Global Disability Summit.

Given there is limited public information on the achievement of commitments made at the first Global Disability Summit (GDS) in 2018 – with only one report released in 2021[2] after a global survey – the UK could support efforts to strengthen monitoring and accountability mechanisms to track progress made since the latest GDS in 2022. The commitments portal could be more user-friendly, display information more clearly and efficiently, and offer easily customisable options to users. Surveys to collect information on progress can also be better systematised, use an accessible electronic platform, and include a limited number of questions that can be easily analysed. Having a well functioning accountability system would bolster transparency on the commitments and allow all stakeholders to track and illustrate progress towards the main targets.

Monitoring and accountability mechanisms could also include actions to conduct annual check-ins with the different actors who made commitments. UNFPA believes the Global Disability Summits generate momentum towards advancing disability inclusion work, convening key actors to make important commitments to realise the rights of persons with disabilities. However, there is a risk that this momentum will be lost if there is not an adequate mechanism to track progress. Countries including the UK could consider providing further support to the GDS secretariat to strengthen such a mechanism, in order to ensure various actors involved follow through on their commitments. Regular check-ins could also include information on how to foster collaboration among different stakeholders, who might be working towards similar goals. We believe the UK could play a vital role in promoting stronger collaboration and synergies among actors involved, by supporting activities where this collaboration can take place.