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2. EU assistance on health in developing countries

What is the Development and Cooperation Instrument?
The main EU financing instruments for development cooperation are the European Development Fund (EDF) and the Development Cooperation Instrument (DCI). The EDF is technically outside the EU budget and it supports the collaboration with countries in Africa, the Caribbean and the Pacific. The DCI is part of the Headline IV of the EU budget, and provides bilateral support to developing countries not covered by the EDF and thematic support to all partner countries on priority themes such as human rights, democracy and good governance, inclusive and sustainable growth.

In addition to the impact assessment and the internal review of different evaluations, audit and mid-term review reports, the Commission held in 2010-2011 a public consultation on future funding for EU external action. The DCI Regulation was adopted on 11 March 2014 after ratification from the European Parliament and the European Council.

The 11th EDF for 2014-2020 will have a budget of EUR 30.5 billion. The DCI will receive an allocation of EUR 19.7 billion from the EU budget for the period 2014-2020.

Why is maternal health in developing countries an issue of concern for the EU?
This is the current situation: 287,000 women die from pregnancy or childbirth-related complications every year. Some 47,000 mothers die following unsafe abortions every year. Almost exclusively, these occur in developing countries. The EU has committed, along with other partners, to fight this unacceptable scourge.

The Millennium Development Goals (MDGs) were agreed in the year 2000 by almost 190 countries, including all 28 EU member states. They include a goal to reduce the number of maternal deaths (MDG5). It is the worst performing MDG and has not yet been reached: the target was to reduce maternal mortality by three quarters and it has not even been reduced by half until now.

The EU and its Member States have also committed to respect the sexual and reproductive rights of women in the international agreement of the International conference of Population and Development (ICPD) Programme of Action (adopted by 179 countries in 1994), which includes access to safe abortion services where they are legal.

How does the EU support developing countries on health issues?
There are different ways of channelling EU aid on health:

• Through budget support, by providing budget to the partner countries directly, to improve country ownership and sustainability of programmes.

• Through UN agencies active in the health sector and Global Health Initiatives such as the Global Fund to fight AIDS, Tuberculosis and Malaria, and the GAVI Alliance.

• Through civil society organisations (CSOs), particularly where the main target are hard-to-reach populations or operations in contexts of emergency or conflict – groups that have benefitted the least from improved health services in recent decades.

Of the EUR 3.2 billion of development funds that the EU spent between 2008 and 2012 on the health sector, EUR 1.5 billion were spent on maternal, new-born, and child-health. Specifically, EUR 87 million went to reproductive health care, EUR 17 million to family planning, and EUR 95 million to controlling sexually transmitted diseases. Contributions to the Global Fund to fight AIDS, Tuberculosis and Malaria account for another EUR 503 million.

What does the EU do specifically in the area of Sexual and Reproductive Health?
The European Commission allocated in 2012 €321 million for maternal and new born child health programmes, including reproductive health care, family planning and nutrition in developing countries.

• Commission funding is typically allocated for programmes which strengthen partner countries’ health systems, such as building and rehabilitating health care facilities, training of health personnel, providing equipment, essential medicines and supplies, as well as providing technical assistance and policy advice to Government and in support of its national health strategy.

• Support is also given to civil society organisations for work on sexual and reproductive health; providing information, education and counselling to young people, prevention of sexually transmitted diseases such as HIV/AIDS, and supporting local civil society organisations to act in these fields.

Since 2004, thanks to the European Commission:

• Almost 17 million consultations on reproductive health have taken place

• Over 7.5 million births have been attended by skilled health personnel

Why does the Commission believe that the existing framework for managing funding is the right one?
Firstly, EU Development cooperation provides comprehensive support to the entire spectrum of health services provided by partner countries. EU funding may, for instance, support building and rehabilitating health care facilities, training of health personnel, providing equipment, essential medicines and supplies as well as providing technical assistance and policy advice to governments. In helping provide safe and quality health services, including good-quality family planning, a broad range of contraceptive methods, emergency contraception and comprehensive sexual education, it contributes substantively to a reduction in the number of abortions.

Earmarking support for certain services only would prevent this comprehensive support to work effectively as it would require the partner country to re-organise its entire health service – something they may not have the means to do. Therefore, in practice, it would jeopardize the financing and support of sexual and reproductive health services in countries where abortion is legal, i.e. practically all developing countries.

Secondly, a funding ban would constrain the EU’s ability to deliver on the objectives set out in the Millennium Development Goals, particularly on MDG 5 to reduce maternal mortality by three quarters and achieve universal access to reproductive health. Despite improvements, 47,000 women still die every year as a result of unsafe abortions and the evidence from WHO is that maternal deaths and illness can be dramatically reduced by improving the safety of health services.

Thirdly, a funding ban would also conflict with the EU’s international commitment to the Programme of Action of the International Conference on Population and Development (ICPD), which was recently reconfirmed at both international and EU levels (see below extract of ICPD text) and calls for expanded and improved family planning services to eliminate the need for abortion.

NB. Section 8.25 of the ICPD programme of action states:

8.25. In no case should abortion be promoted as a method of family planning. All Governments and relevant intergovernmental and non-governmental organizations are urged to strengthen their commitment to women’s health, to deal with the health impact of unsafe abortion as a major public health concern and to reduce the recourse to abortion through expanded and improved family-planning services. Prevention of unwanted pregnancies must always be given the highest priority and every attempt should be made to eliminate the need for abortion. Women who have unwanted pregnancies should have ready access to reliable information and compassionate counselling. Any measures or changes related to abortion within the health system can only be determined at the national or local level according to the national legislative process. In circumstances where abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management of complications arising from abortion. Post-abortion counselling, education and family-planning services should be offered promptly, which will also help to avoid repeat abortions.

Does this mean that the EU promotes abortion practices?
EU health programmes do not promote abortion as a method of family planning;

On the contrary, they aim at:

• giving highest priority to the prevention of unwanted pregnancies through expanded and improved family-planning services, thus eliminating the need for abortion;

• ensuring that in circumstances where abortion is legal, such abortion is safe.

It should be noted that the EU fully respects the sovereign decisions of partner countries where health services will be provided and how they are packaged as long as they are in line with agreed human rights principles. According to the United Nations, only six countries and one state in the world prohibit abortions under all circumstances. Source: United Nations; World Abortion Policies 2013;

Is the EU controlling the use of development funds in interventions related to Sexual and Reproductive Health?
The EU contractual terms are strict to ensure that all interventions funded by EU development assistance respect the legislation of the countries where they take place. The Commission monitors the performance of projects and programmes through independent assessments and, where major difficulties are identified, the Commission ensures follow up measures. This independent monitoring is complemented by internal monitoring carried out by Delegations and by evaluation that provide important feedback on impact and results achieved. In addition, financial audits and verifications provide assurance on the legality and regularity of external aid operations.

In case of misconduct all organisations are treated equally. Information of all EU funded projects is public information and the beneficiaries of grants can be found in the database on the Commission website

This database has a search function enabling information to be obtained on a year by year basis for all grants awarded to programmes related to, for instance, reproductive health care.

1 : European Science Foundation Science Policy Briefing No. 38.
2 :