Reproductive Health Policy in Norway

In the May 2005 issue of RHM, Berit Austveg and I had a paper on the history of how reproductive health was improved in Norway in the 20th century and how that relates to Norway's development aid policy.¹ Policies in Norway are very much geared towards reproductive rights, including the right to induced abortion, contraceptive services and sex education. Norway also supported reproductive rights around the time of the ICPD in 1994 in Cairo. Since then, Norway has remained a large donor to multilateral reproductive health organisations such as UNFPA, while some donors have reduced their funding. The size and coverage of our bilateral support has decreased, however, and Norway's role as an international advocate for sexual and reproductive health and rights has become less visible. Further, Norway does not explicitly fund or promote any activities for prevention of mortality from unsafe abortion, though there is no policy against it either. Our RHM article called for renewed involvement of Norway in this arena.

Media uptake of our article

After the article appeared in RHM, a journalist from a daily newspaper in Norway picked it up. The paper had been running a series on development policy and policy on sexual and reproductive health and rights became one of the features in the series. The journalist referred to the RHM paper and interviewed me as well. The title of the feature accused the government of not doing its job for reproductive health.²

The article repeated the facts about Norway's good reproductive health indicators from our RHM article. It then illustrated the problem of giving so much money to multilateral agencies in the field, since many of them are afraid of dealing with sensitive issues like abortion and teenage sexuality, which therefore limits Norway's ability as an international donor to make a difference. Bilaterally, Norway supports health only in a very limited number of countries, and even then, HIV/AIDS and general health sector support feature as more important than reproductive health. This represents a real decrease in the number of countries where we can have a dialogue. The newspaper article later suggests that this lack of visibility may be due to the current Christian Democrat-led government's reluctance to talk about abortion, as the Christian Democratic party is very ambivalent about abortion rights. For example, it has not been possible to find out how NORAD, Norway's development aid agency, plans to work to achieve the Millennium Development Goal (MDG) related to reduction of maternal mortality, including abortion-related mortality.

Political response

The newspaper article triggered a response from Norways' Secretary of State for Development Aid, David Hansen, a Christian Democrat who has always been a good supporter of reproductive health within his own party. In his response, he says that he tries to listen to what we, as advisors and experts on reproductive health, have to say. But he describes Norway as still being a major donor in the field and an activist both in normative and practical interventions in sexual and reproductive health and rights. He says that despite the Christian Democratic leadership, Norway's contribution has increased in the field, and claims that our criticism, expressed in the article in RHM, is not correct. He states, rightfully, that Norway is in the lead internationally in contributions to multilateral agencies doing reproductive health work. He also says that a very recent Norwegian child and youth policy takes sexual and reproductive health into account as part of a new gender policy for development, to be finalised in 2005. That is good news!

Hansen also says that achieving the MDGs is important for Norway and that in order to reach targets related to gender equity, child mortality, maternal mortality and HIV/AIDS, it is important to give priority to sexual and reproductive health for the poor. He also says that Norway will flag sexual and reproductive health internationally in important upcoming international meetings. Also good news!

He admits that bilateral aid may be a cornerstone for success, but he wants us to see bilateral and multilateral aid as one effort in the field. As an example, he says that sexuality is a sensitive issue, and needs a culturally sensitive approach, which is what he feels UNFPA provides. But UNFPA will not accept money for work on abortion. Hansen claims that if Norway pushes the abortion or sexuality agenda too far through bilateral aid, they could be kicked out of countries. But where is his evidence of this?

All Norwegian health-related aid goes through sector support, e.g. in Mozambique and Malawi. Norway currently supports sector-wide approaches and is against earmarked funding, and therefore cannot give money to “projects” , a now perjorative label that is applied to work on sexual and reproductive health, even if the aims of those “projects” are in line with Norway's domestic priorities. Hansen does not discuss whether that means Norway cannot give money to international or national NGOs that have abortion or sexual and reproductive health and rights on their agenda. In fact, a lot of funds for NGOs in Norway go through church- or faith-based organisations, which are not known for being in the forefront of promoting sexual and reproductive health and rights. Norway does not give much, if any, support to agencies that explicitly work on these issues, like Ipas or RHM, or to organisations that promote an open-minded scientific debate like IUSSP.

Yet experience and evidence point to the need to include critical abortion documentation, critical health care access issues and a critical mass of public awareness in the poorest countries, to improve their situation. Sweden, unlike Norway, has demonstrated a capacity for and interest in doing this. I do not doubt that David Hansen is interested in improved health systems, including access to reproductive health services, and I hope we can work jointly for this goal, but we disagree somewhat on choice of strategy. He states that priorities have to be made by the health professionals in the countries in question, but policy change only happens when there is evidence of the need for change, documentation of shortcomings, demonstration of effective methods for change and sufficient political will. Norway has managed to eliminate maternal mortality almost entirely at home; maybe political pressure internationally could make this happen elsewhere. But his politician's response, as I read it, does not answer my core question: how is Norway going to ensure that the MDG of reducing maternal mortality will be achieved, including by reducing deaths from unsafe abortions.