Maternal Health Aid: Consider the Recipients

Canada's approach to aid won't be effective until we focus on the people who are getting it and what they need.

The Canadian G8 initiative to improve maternal and children’s health has thus far been a disappointment.

From the initial lack of clarity on what such an initiative might mean to the announcement that Ottawa would be reducing its foreign aid budget significantly over the next five years to the controversy over abortion, the plan has quite rightly failed to create the positive momentum that the Conservative government was hoping for.

And while some might suggest that the apparent consensus reached by the G8 development ministers in Halifax is a step in the right direction, a closer look at the results of that meeting suggests otherwise.

Based on the comments coming out of Halifax, the debate over whether access to abortion is a necessary part of any program that aims to improve maternal and children’s health in developing countries seems to be over.

Each donor country, the ministers announced, could pursue the Canadian initiative in its own way. More details are expected in Toronto in June.

And while the apparent resolution is attractive politically, it does little to ensure aid effectiveness, the true goal of any credible development assistance program. In fact, the ministers’ agreement might even hold the development agenda back.

The last 20 years have seen significant progress in our understanding of how aid works, and how it might be made most effective.

At the top of the list of best practices is a focus on the recipient states. Put simply, if the people who need the aid feel like they are responsible for the assistance that they have received, and therefore take personal responsibility for the outcomes associated with that assistance, the chance of long-term success increases dramatically.

Success is even more likely if the donor countries coordinate their aid efforts (which produced efficiencies and help to avoid unnecessary duplication) and if those efforts emphasize measurable results.

What is needed to make aid effective, then, is a collaborative, recipient-centred approach that stresses mutual accountability.

Little in how the Canadian initiative on maternal and children’s health has played out thus far meets the effectiveness criteria.

First, the initiative was announced by a donor country and then discussed in meetings that were similarly restricted to other donor states.

Second, the priority chosen has been framed publicly as a Canadian priority, not one called for by recipients in need.

Third, both Canada, with its pledge not to fund abortions, and some of the other states, whose leaders argued that there could be no maternal and child health plan without access to safe abortions, set conditions for their aid that showed a blatant disregard for recipient countries’ concerns.

By denying recipient countries the opportunity to use development assistance to provide safe access to abortion, Canada is essentially tying its aid to a set of values promoted by Ottawa.

While tied aid was a standard approach of western democracies in the past, development researchers, representing both the political left and the political right, have proven that such “assistance” is antithetical to aid effectiveness.

The Harper government is clearly aware of this research. Since it has come to office, it has not hesitated to take credit for untying Canadian aid more aggressively than any government in Canada’s history.

While the Conservatives have therefore been rightfully condemned for a hypocritical stance that suggests disregard for recipient state interests, they are not the only ones who should be ashamed.

The response of representatives from the United States and others who have insisted that there can be no plan for maternal and children’s health without funding for safe access to abortions have imposed their values – and, admittedly, their research findings – just as aggressively, and it is the aggressive imposition of donor country values that is the real problem.

When it comes to a development program’s long term sustainability, whether a recipient country is not allowed to fund, or is forced to fund, safe abortions is not the most important issue. Allowing the recipients to take ownership of the decision – and requiring them to justify it on their own terms – is.

The proposed solution coming out of the Halifax meetings could easily compound the problem. Inviting each donor country to set its own rules seems to ignore the proven benefits of donor coordination and risks inciting unnecessary duplication and other inefficiencies.

If Canada seeks to show real leadership, Prime Minister Harper should demand that the G8 development ministers go back to the negotiating table and start over.

This time, however, donor and recipient countries should meet, and the talks shouldn’t end until a recipient-driven, mutually accountable, and effectively coordinated plan is on the table.

First published in the Ottawa Citizen on May 4, 2010.