NCA will continue to develop the two global programmes on Gender Based Violence and Reproductive Health in the next Strategic period.
1. Problem analysis: Gender Based Violence
2. Methods and intervention strategies: Gender Based Violence
3. Problem analysis: Reproductive Health
4. Methods and intervention strategies: Reproductive Health
5. Strengthening civil society
6. Added value
An estimated 70% 4 of the world’s poor are women. Pregnancy and child birth is the leading cause of death for young women aged 15 to 19 years 5. Gender based violence (GBV)6 is a leading cause of death and disability of women of all ages. Violence due to gender affects women at all stages of life, from son preference, to child, early and forced marriage, Female Genital Mutilation (FGM)7, sexual violence, rape and trafficking. GBV, whether occurring at home or in society, hinders the enjoyment of a range of human rights. It is a barrier to women’s equal right to participation, citizenship, access to and control over resources, livelihood and to gender equality.
Sexual and Reproductive Health and Rights (SRHR)8 are the rights of all persons to make decisions about their sexuality and reproduction free from discrimination and violence. SRHR is part of any work to improve the right to health and the right to a life free from violence for women as well as men. Knowledge about your body, sexuality, choice of partner, consensual marriage, as well as access to contraceptives, maternal care and treatment are of special importance to young people as it influences their ability to make choices for the future. Girls are often negatively affected by the lack of access to SRHR due to discrimination and various forms of GBV. NCA has developed a position on SRHR9 based on experiences working with vulnerable people and communities with poor health status and high level of GBV. NCA believes that advocating for the inclusion of sexual rights for all is particularly crucial in times where these rights are being contested by powerful networks of conservative faith actors. Mobilising faith leaders and making use of faith-based resources to challenge social, religious and cultural norms and practices that uphold GBV and poor health have given documented results10.
Building on these lessons learned the GBV and the Reproductive Health programmes will seek to develop stronger linkages and synergies. The Reproductive Health programme will seek to improve the health situation of women of reproductive age and their children by working closely with women, men and young people in communities and strengthening the capacity of health clinics and services. The GBV programme continues with a specific focus on challenging and mobilising faith actors and communities to reduce GBV. Unwanted pregnancies, child marriage, child birth, FGM and other harmful practices all require access to adequate and affordable health services, which also need to be inclusive to the needs of the girl child and young women.
The focus of this programme is to contribute to fulfil the right to a life free from violence. Globally, one in three women and girls has been affected by GBV. The vast majority of those affected are women and girls. However, boys and young men are sometimes also affected although reporting rates are low. They also suffer from stigma and shame which can be different from that of women and girls. GBV is a crime seldom reported or punished, and perpetrators mostly face impunity. In war and conflict, sexual violence is used as a weapon of war, and other forms of GBV, like child marriage and trafficking are also increasing. Lack of prevention, protection, punishment and response mechanisms, including SRHR, represents huge challenges and key barriers to a life free from violence. Key root causes of GBV are the dominant social, cultural and religious norms, attitudes and practices condoning GBV and which support impunity. These are based on unequal gender power relations and discrimination of women in patriarchal societies. These norms underpin the lack of political will to allocate adequate measures and resources to prevent, protect, sanction and respond to GBV and to the needs of GBVs survivors. Discrimination of women and girls and stigma towards GBV survivors are sometimes even justified by religious dogma and interpretation of scripture, being The Bible or the Koran. Perpetrators of GBV are almost always men due to socialisation and gender norms; GBV is often perpetrated by people close to the survivors, such as partners, family members, community leaders, members of armed groups, and men with strong formal or informal power.
Key risk factors include the risk of threats, stigma, social isolation, violence and even killing of people involved in efforts to change dominant social norms related to GBV and gender relations.
The programme will begin any intervention with identifying which forms of GBV are common and applying gender analysis and GBV assessment tools describing how gender roles and relations work in a specific context. This includes how gender identity intersects with other identity markers such as age, class, ethnicity, religion, caste, rural/urban setting, profession, kinship, marital status, disability and sexual orientation. This will enable the GBV programme to identify groups which are particularly vulnerable to specific forms of GBV, as well as attitudes, behaviour and practices to be changed.
A range of methods and specific intervention strategies will be used to best respond to the issues and actors outlined in the analysis. However, most of them will rest on three pillars:
In order to change social norms at individual, family and community level, a number of methods for sensitisation and mobilisation will be used including Community Conversation (Dialogue), Community Declarations, Behaviour Change Communication, Reflect and methods promoting positive masculinities and working with faith actors. As part of the programme NCA will support advocacy to change policies. The programme will apply methods for empowerment of girls and women to promote self confidence and agency against gender discrimination and to promote economic independency and livelihood. Built on lessons learned the programme will develop and apply new methods for engaging boys and men, including faith and community leaders. This will be achieved by promoting positive masculinities and gender equality norms that reject GBV and respect and support the rights of girls and women. A specific focus will be the mobilisation of faith-actors and religious leaders to take action against GBV and gender injustices in their communities and congregations.
Every year, 6.3 million children under the age of five and 289 00011 mothers die from causes we know how to prevent. The World Health Organisation (WHO) states that a country needs to prioritise 10 - 15 % of their national budget to health, in order to have a viable health system12. The world today is lacking 4.3 million health workers. African countries have the highest rates of diseases13, but on average spend only 1% of their budgets on health14. Access to health is therefore an issue of good governance and economic justice. Marginalised groups like people with disabilities and Indigenous Peoples (IPs) generally score lower on health indicators. Family planning, such as birth spacing and knowledge of the dangers of pregnancy for young girls, is documented as having an effect on maternal mortality.
In 2012, an estimated 80 million women in developing countries had an unintended pregnancy and at least one in four resorted to an unsafe abortion15. 600 million women in developing countries use some form of contraception, but only 1-2% use modern contraceptives with long-term effects. 200 million women and children in developing countries who do not want to become pregnant do not have access to contraceptives16.
This is first and foremost a reproductive18 health programme, which relies on an integrated approach and community mobilisation. SRHR plays a crucial role in social and economic development in all communities. However, we know that in some countries it is challenging to advocate for all these rights, especially safe and legal abortion.
In many underserved and remote communities, traditional harmful practices and beliefs combined with mistrust of the health system dissuade people from seeking health services that may exist. There is often also a lack of knowledge and trust in preventive health measures that can be carried out by the communities themselves. Governments, intergovernmental bodies and faith leaders play an important role in assuring accountability and affordability of health services to ensure human dignity. NCA will, together with other civil society organisations, give voice to women, men and communities and help monitor duty bearers in their fulfilment of their obligations to improve the lives of the poor and marginalised.
The main focus of NCA’s health work is strengthening and improving the health situation of women and children as well as among poor and marginalised people by applying an integrated approach through community mobilisation and local health clinics. NCA aims at empowering communities to serve as informed rights holders of reproductive health care and as effective advocates on their own behalf in securing essential reproductive health services through information, education and communication. Faith actors working in the health sector will be the preferred partners in the programme. Not only are they generally trusted by the communities, but data shows that faith institutions are providing 30-40% of the health services in many of NCA’s programme countries.
Three main areas of intervention are identified to ensure an integrated approach: 1) Community involvement and outreach to reduce cultural and traditional distrust in the health system; 2) Supporting and providing the structures and infrastructure for health services; and 3) Advocacy aimed at reducing structural causes of the lack of reproductive health services.
The first intervention strategy includes service provision and capacity development within and with communities, where communities are capacitated on primary and preventive health issues, such as family planning, nutrition and hygiene. The goal is to have local institutions and community based health care providers delivering highquality reproductive health services. The International Child Development Program (ICDP) will be used as a tool to strengthen the communities’ involvement and understanding of children’s and young
peoples’ needs and enhance their psychosocial development18. Community health workers and volunteers are important actors in providing information adapted to local cultures and context (health mediators). Faith and community leaders are important actors in their role as authorities in their local communities, addressing some of the challenges mentioned and particularly in acting upon harmful traditional practices and GBV. NCA has long experience in working with local communities, village health committees and health volunteers and with women’s empowerment. We will continue to strengthen these community structures.
The second intervention strategy includes development of human resources: education of health staff (nurses, community health workers), mechanisms for retention of staff and professional ethics of staff. It further includes construction of local health clinics (with community involvement), maternal homes nearby these, health education facilities, and health information systems that ensure the recording of health visits, patients and referral systems.
The third intervention strategy includes strengthening local communities and partners to advocate towards governments in order to increase the percentage of budgets prioritised towards reproductive health, as well as budget monitoring to ensure that the funds are spent according to plan. Furthermore, monitoring of budgets and expenditures matched with the provision of primary health care will take place at the local level. Examples of advocacy can be contributions in public hearings and input to Government White Papers. This advocacy work can be carried out at the national as well as local level.
Working on budget monitoring will be the main strategy to improve access to health services for local communities, including GBV survivors. Holding governments accountable for delivering health services to rural and urban communities must be a priority. NCA will strengthen the capacity of health committees to become aware of and take responsibility for their own health. NCA will seek to enable health committees to collaborate with professional lobby organisations as a means of engaging with governments.
Faith actors and religious leaders are often well positioned to utilise their legitimacy and authority to promote moral and social norms, attitudes and practices, also on sensitive issues like sexuality, reproduction and other issues related to the body and gender norms. NCA’s main role is to challenge and accompany faith actors in engaging and take action against all forms of GBV within their own faith institutions, in communities and through advocacy towards duty bearers. NCA will also challenge and accompany our partners in increasing their knowledge and engaging in reflections on SRHR and other human rights and support gender justice from a faith perspective. Resources and minimum standards on how to effectively work towards a reduction of GBV will be provided. NCA will broker linkages between faith actors and other relevant stakeholders such as women’s organisations, civil society organisations, donors and governments. An important role for NCA is also to provide opportunities for faith actors, in cooperation with other ACT agencies, to participate in networks and advocacy related events and campaigns at various levels. NCA will continue to bring alternative voices from faith actors, including female faith leaders and women in faith, to the table in order to further strengthen women’s networks within faith structures, and to facilitate women’s participation inside their own decision making structures.
Religious leaders are important actors in advocacy, enabling and protecting space for dialogue to take place at a community level. Religious leaders and church health actors also play an important role at a national level to advocate and coordinate for health services for poor and marginalised people and for GBV survivors. However, in some contexts, the space for working on women’s rights issues is very limited and those who lobby for them can be at risk. Persons and organisations identified as particularly at risk will be provided training and accompaniment to ensure risk mitigation.
NCA and its partners have considerable experience in working to reduce many forms of GBV as well as promoting gender equality and the right to reproductive health. Innovative strategies have been applied, such as the mobilisation of faith actors, to break the silence on GBV and promoting theological reflections on sensitive issues related to dominant social norms. Given NCA’s faith-based identity, the organisation is well positioned to make use of faith-based resources in mobilising faith actors and religious leaders.
Faith actors and religious leaders – women and men – are potentially powerful actors to partner with due to their legitimacy, moral authority and outreach. Faith actors and religious leaders are often widely listened to in their societies, both by people and decision-makers. As attitudes, norms, cultural and sometimes religious traditions are key root causes upholding harmful practices and GBV, faith actors may significantly contribute to creating social change by increasing their knowledge of human rights and contributing to positive engagement for women’s rights. On the other hand, faith institutions are often based on patriarchal structures, often denying women positions to influence decisions. Faith actors can be important gatekeepers for change, and they have a moral responsibility to speak out against all forms of violence, including GBV.
Both religious and traditional leaders may have great influence in upholding as well as changing traditional roles and practices and improving women’s health. NCA will scale up proven best practices and established collaboration with faith actors. Due to long-term partnerships and established trust, NCA is well positioned to challenge leaders and power structures within faith structures that may support or uphold harmful health practices.
As a global health actor, NCA has been approached on multiple occasions to play a role internationally to specifically engage faith actors and religious leaders to promote reproductive health. NCA will leverage cooperation with health education institutions in Norway to provide professional health support to our partners.