'Everyone, everywhere, all at once' to implement the 3Zeroes agenda

Power and Participation Research Centre (PPRC) in collaboration with UNFPA launched a platform named 3Zeroes.ActionNetwork yesterday in Dhaka. 

The platform aims to influence and track national commitments and policies on ICPD (International Conference on Population and Development) action agendas: Promote safe motherhood - Empowered adolescents and youth - No to gender-based violence and child marriage - No unmet need for family planning and sexual reproductive health services. 

The three zeroes represent zero maternal deaths, zero unmet needs for family planning, and zero gender-based violence and harmful practices. The platform also aims at ending child marriage and exploitation in Bangladesh within the next decade.

At the launching ceremony, more than a dozen organisations were present, along with representatives from the government who shared their solidarity with the initiative. 

The Business Standard interviewed Dr Hossain Zillur Rahman, Executive Chairman of PPRC and Kristine Blokhus, the country director of UNFPA, on the sidelines of the event to have a better understanding of the platform. 

The Business Standard (TBS): Congratulations on launching the 3Zeroes platform. In partnership with PPRC, you want to redouble the awareness efforts, promote multi-stakeholder engagement, identify and address policy gaps in pursuit of 3Zeroes. What courses of action do you plan to achieve this target?

Kristine Blokhus (KB): I think the answer is we have to do everything all at once. We have in Bangladesh really an example of a country that has achieved an enormous amount when it comes to these issues like maternal health, gender-based violence, family planning, etc. So much was achieved. 

And now we are not seeing the same level of action anymore. It is time to think about how we take all the people with knowledge, at the grassroots, with connections and understanding of the issues, and bring them together, so that all of that energy, funding, research and data can be put together, so that everyone can use it together. 

So the answer to your question is I think we have to work at the policy level. And we have to use what we have in terms of research and data to influence good policy. 

But we also have to work at the community level. We know it is not enough to have good policy if the policy is not being implemented and the community is working the way it worked before; then we are not going to see the results. 

So that is the short answer to your question: that we have to do everything all at once and everybody needs to be involved. 

Hossain Zillur Rahman (HZR): Just to reinforce the point, two things. One is, as she said, we have made good progress, but then there was a plateauing of the progress. 

For example, bringing down maternal mortality to 70 per 100,00 live births by 2030 is the target. We are now at 163 =. We have only eight years left. The progress is slow. So this is one cause for concern where we need to redouble efforts. 

The second one is that Covid has also caused some disruption, setbacks, and some reversals.

So on both grounds, there is a need to reinforce efforts. And as she rightly said – there is a film by the way, "everywhere everything all at once" (Kristine adds with a laugh: so that's what we're gonna do) – we have to work at policy level, and energise the communities. 

And I think data is also going to be very important. Whether the progress is happening or not, we need to understand it through new innovative information. It is also important to emphasise that achieving these three zeros are also critical for SDGs. It is central. If we can achieve this, it is a huge step forward to SDGs. 

At the launching ceremony of 3Zeroes.ActionNetwork, more than a dozen organisations were present, along with representatives from the government who shared their solidarity with the initiative. Photo: UNFPA

TBS: It is already the end of 2022 and we are not far from 2030 (The SDGs were set up in 2015 by the United Nations General Assembly (UN-GA) and are intended to be achieved by 2030). 

KB: Yes. Maybe if I can add one thing to this, in the 2019 summit that we had in Nairobi, Dr Rahman was there. Many of the participants in today's event were there – which was really all about saying that we don't have a lot of time left, and we have an anniversary to celebrate at the ICPD (International Conference on Population and Development) – so where are we?  

So what I have heard is that the Bangladesh delegation was a fantastic delegation who brought a lot of energy to the table. And consultation meetings after that were really part of what has led us here. There was really a bringing together of activists, grassroots, think-tanks, CSOs. 

And that energy was brought into making some commitment for Bangladesh… how we are going to make progress on these issues that really impact peoples' lives and families. So that is what we are trying to capture here. 

TBS: What challenges, do you think, could be in your way? What are the factors that could hinder the process or slow it down?

HZR: So there's no lack of commitment… from the government, from the civil society… everyone wants progress on this. But what is holding us back or slowing down the progress? 

One is what we call the last mile challenges. There is a lot of goodwill at the top, but then the services have to reach to the bottom… the awareness efforts have to reach to the bottom.  

So these last mile challenges are very important. And that is where we often get stuck. In last mile challenges we need a better understanding of the communities… that is why she mentioned community engagement is so central. Because these last mile challenges are all about energising communities. 

We have many things and some of them are on paper also. Say committee, Upazilla committees for example. But is the committee working? Have the appropriate funds been available for the committee? 

To answer your question, I would say [again] that the last mile challenges are very important, and we have to understand this from multiple angles. 

And here there are many efforts in the same direction. So why the new network? If I understand it correctly, two words are important here: one is 'integrated'. 

It means child marriage will not come down if adolescent sexuality education hasn't been energised. Gender-based violence will not come down if these awareness efforts have not been redoubled. So this 'integrated' part is important. 

The other part is a 'big push'. As she rightly mentioned, we need speed. Progress is important but we also need progress at speed. But that is why [we need] multiple [networks]. 

KB: I very much agree with you. What we were saying at the beginning was how enormous progress was made and now it has plateaued a bit – a lot of the progress was made by doing the things that were easiest things to do. 

So we are now, not only at the last seven years, but also maybe at the most difficult years because we are doing the most difficult things now. 

And then we have Covid on top of everything, which makes it more difficult. Because maybe we are taking a step back in some areas as we know that gender based violence, for example, increased a lot all around the world [during the pandemic]. So it is going to be an additional challenge. 

TBS: You have rightly mentioned the word 'implementation'. We have policies and regulations but what we lack in some places is implementation. Why is that?

KB: Yes, and also, some of that is about social norms. What they have been doing for a long time and what they perceive to be the best thing to do. It is not that the parents of the child brides are criminals. They are trying to do the best for their children. There are reasons [for them to take the decisions], perhaps economic reasons, perhaps there are other incentives that make them take that action.  

So we have to work with communities to understand why this was happening and how we address it. And I think we do know a lot because there is resources and data. Bur really filtering it down to how the people in the village behave is a challenge. It is hard to change social norms.  

TBS: Do you see a lack of implementation drive from the government or the administration side?

HZR: Some parts of the jobs cannot be done by the government alone, particularly community engagement, organising support structure etc. But certainly, things are changing. Policy gaps that were not evident 5-10 years ago, are visible now.  

For example, suppose we visited a certain Upazilla and attended an Upazilla coordination committee meeting to look at gender-based violence. The UNO, who is the person in charge, said that no budget has been allocated for doing the data registry effectively. So these are the sort of problems [that we may face from the government side.]

There is another thing that I find important.  [Looking at Kristine] As you rightly mentioned, parents or each of these decision-makers are faced with some kinds of dilemma in terms of choosing, and sometimes for example 'shall I be more concerned about the security of my young daughter and therefore I marry her off now on that concern, or shall I look at her long time education?'

Here, they need support structures in terms of awareness boosts. Because people always get a bit nervous about taking tough decisions and so they need a supportive environment.

KB: And if all the neighbours are doing something, won't you do the same? That's what social norms are all about, if you perceive that's the right way to do things.

TBS: Some of these are century-old norms that are still in practice. How do you plan to fix them? In what ways are you going to adapt?

KB: We have pretty good policies and laws. We have to work with the education system to keep girls in schools, we have to work with the health system to make services as available as possible. We need to make sure of one thing – once the girl is married we must not forget about her. Because she will eventually get pregnant. 

So it is not just preventing child marriage, it is also about looking after the girls that got married. And we need to work to empower girls, we need to work with their parents, their teachers, their school nurse and the people in their community to make them understand that the girls are really worthwhile and investing in their education is really useful for the parents. 

Once they see that value and the neighbours have that value for their education, it starts to change and it accelerates quickly. It is an investment on all of those levels. 

But also, I think it is about enabling the environment. If you have an economic downturn for example, sometimes that makes it more challenging. If things are going well, it can be easier. So there is a lot playing into this. 

What we are saying in this network is that yes it is challenging. But if we put our minds, our resources, our efforts, and our heads together, we can, and it is possible. Otherwise, it is not. 

HZR: And there are also innovations in policies that you can think about. For example, what do we have now? Mandatory education is only applied up to the primary level. One policy initiative that we are thinking about is – why not make secondary education compulsory and free for female students? That might add a big boost to ending challenges. 

As we meet mothers, they say that they want to keep their daughters in school but the school fees have gone up. There is a cost issue. 

So there is another level of policy issues. I think norm change is not easy, but [we have to realise] that norms have changed. When Bangladesh got independence, [the statistics showed] there were six children per woman. How did it come down? Because a norm change did happen. That is the spirit we all want to pursue. 

KB: It is almost unheard of. Honestly, I have been hearing about Bangladesh from wherever I was, long before I came here – its success in fertility and [reducing maternal] mortality. 

But I will give you another example where the government plays its role for the community, [which is the introduction of] the midwives. 

Just a few years ago there were zero midwives in Bangladesh. Now at the end of this year, there will be 11,000. The Bangladeshi government has created those positions at the local level for the midwives to ensure care at the local level. 

That is how they are changing the way people in the community feel about having someone skilled to help them give birth. 

So increasingly, we are going to see that women are going to give birth in a facility, as the midwives are helping them. And this helps build trust in the community that the services are good. 

TBS: About family planning and sexual and reproductive health, we feel there is some lack of openness in society. Do you see the lack of social openness as an obstacle to addressing important issues like FP and SRH in Bangladesh?  

KB: I would say Yes and No. On one hand, I don't think there is a lack of that because the family planning campaign that has existed in Bangladesh has been enormously successful. And I genuinely think if I ask a woman how many children you would like to have, she would answer two. This is one of the ways social norms have changed.  

There might be a need to ensure that everyone has access to those services. And that is where we have ways to go. 

TBS: It is still taboo to talk about SRH here, about menstrual health, and about reproductive organs. How do you think you will work on this?

KB: We have to normalise it. That is the only way. And that has to be through comprehensive sex education where young people learn that this is normal and this is my right, and I have to learn this, because that is how I make healthy choices. 

And by healthy choices, I don't mean how many children I am going to have, it is also necessary to avoid abuse. Understanding how to think about your own body and making good choices that can protect yourself. 

TBS: Now that you are launching this platform, what sort of assistance would you like to have from the government side? Because they are the biggest stakeholder in this. 

KB: It is not possible without the government.  

HZR: It is not a question of whether we need them or not, because, in every activity that we are doing, the government is present. We have already internalised the partnership with the government. And it is a multi-stakeholder approach.  Everyone, everywhere, all at once– let's end on that note.