Balancing Ideals with Practice: the effect of Dutch Sexual and Reproductive Health and Rights NGOs operating in Kenya

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MSc Political Science

International Relations

Master Thesis

Balancing Ideals with Practice

The Effect of Dutch Sexual and Reproductive Health and Rights

NGOs operating in Kenya

by Jessica Antonisse

11943017

June 2020

Words: 23.338

Supervisor/Examiner:

Second Examiner:

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Abstract

This paper discusses the effect of Dutch SRHR NGOs operating in Kenya, in light of the mismatch between the Dutch and Kenyan norms and values regarding this subject. Sexual and Reproductive Health and Rights organizations have experienced increased opposition, limiting their work. As a focus subject within Dutch foreign policy, the Netherlands is outspoken on the issue. The mismatch between Dutch and Kenyan norms and values can be established in three ways. First, the mismatch between the Dutch government and the Kenyan government. This is best reflected in the different laws, where Kenya still upholds laws that prohibit abortion or LGBTQ rights, for example. The second dimension shows the mismatch between Dutch NGOs and the Kenyan population. Religious reasons and traditional practices are the main reasons for this mismatch. Lastly, there is a mismatch between Dutch and Kenyan NGOs. SRHR are experiencing a large pushback, which is reflected by Kenyan NGOs that work actively against the expansion of SRHR. Additionally, it can be argued that the work of Dutch NGOs is inherently ineffective, when the local population does not play an active role in the projects.

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Abbreviations

AIDS: Acquired Immune Deficiency Syndrome AU : African Union

BHOS: Foreign Trade and Aid (Buitenlandse Handel en Ontwikkelingssamenwerking) CSA: Centre of Adolescence

CSE: Comprehensive Sex Education DAC: Development Assistance Committee EU: European Union

FGM: Female Genital Mutilation GDP: Gross Domestic Product

HIV: Human Immunodeficiency Virus

ICDP: International Conference on Population and Development IMF: International Monetary Fund

KAPAH: Kenyan Association for the Promotion of Adolescent Health LGBTQ: Lesbian, Gay, Bisexual, Transsexual and Queer

MDGs: Millennium Development Goals MoFA: Ministry of Foreign Affairs MP: Member of Parliament

MYP: Meaningful Youth Participation

NCPD: National Council for Population and Development NGOs: Non-governmental Organizations

ODA: Official Development Aid PPP: Public Private Partnerships RH: Reproductive Health RHRN: Right Here, Right Now SAP: Structural Adjustment Program SDGs: Sustainable Development Goals SRH: Sexual and Reproductive Rights

SRHR: Sexual and Reproductive Health and Rights ToC: Theory of Change

UN: United Nations

UNDP: United Nations Development Program UNFPA: United Nations Populations Fund WB: World Bank

WHO: World Health Organization YID: Yes, I Do

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1. Introduction

The term Sexual and Reproductive Health and Rights (SRHR) was first coined at the International Conference on Population and Development in Cairo, Egypt in 1994. Recognizing the role women play in development and the specific struggles they face regarding their SRHR was a first step in making this a priority within the development aid sector. This thesis will look at the role of NGOs largely funded by the Netherlands that work on SRHR in Kenya. Dutch standards regarding this subject differ greatly from those in Kenya. Therefore, the research question of this thesis is: In what way does the mismatch between Kenyan and Dutch norms and values influence the positive effect of the work of Dutch government funded SRHR NGOs working in Kenya? In order to answer this question, several others arise. For example, what are the structures of development aid and how do these apply to the Dutch and Kenyan context? In order to see the influence of Dutch norms and values in the Kenyan context, it is important to show what actors are part of the international sphere surrounding SRHR and what their motivations are. In this way, we can start to paint a picture of the stage surrounding SRHR NGOs.

Many countries base their development policy on the Sustainable Development Goals as set by the United Nations. After years of extensive lobbying, the Millennium Development Goals started to include certain aspects of SRHR. With the 2030 Agenda for sustainable development, the issues were already more visible. The 2030 Agenda was adopted by all United Member States in 2015. With 17 goals, it shows what is necessary in order to develop our world in a sustainable way (Hill, 2013, p. 113). SRHR is directly reflected in several goals, such as goal number three: Good Health and Well-Being, four: Quality Education, and five: Gender Equality. It will however impact many other goals as well. As women are mainly targeted by lack of SRHR services, increasing their situation will decrease poverty overall. Therefore, the Dutch Ministry of Foreign Affairs, as well as many other development institutions like the UN, the European Union or the Swedish Ministry of Foreign Affairs see the improvement of SRHR as one of their top priorities (Nylund, 2017, p. 4). Especially since 2016, Dutch foreign policy focuses specifically on improving the position of women and girls. They state this as a goal seen all through their development aid programs, mostly done by NGOs. At this moment, Sexual and Reproductive Health and especially Rights, are experiencing a large pushback. Far-right wing governments are restricting the rights people have in their countries, such as in Hungary or the United States. This is also seen in the development aid carried out by these countries and has effects on the local politics surrounding these rights. Therefore, it will be interesting to see how this pushback influences the work of Dutch NGOs in Kenya.

This thesis will discuss the workings of NGOs on SRHR with use of development ethics as a theory. First, it will review the literature on development aid and the neo-colonial tendencies surrounding the

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phenomenon. Afterwards, it will discuss the concept of development ethics, with a focus on how this includes women’s rights. Lastly, it will discuss SRHR and the role NGOs play in development aid aimed at solving the issues that are part of this. In the next chapter, the research design is discussed. This thesis has used policy documents, interviews and a literature body to formulate an answer to the research question. In the fourth chapter, an overview of the situation surrounding SRHR within development aid will be given. It starts off with a review of how the different SRHR issues were slowly integrated in the work of NGOs in Kenya. The fifth chapter will discuss the framework in which these NGOs work and the role the Dutch government plays in this. In the final chapter, the mismatch between Dutch and Kenyan norms and values will be discussed. The role of NGOs and the growing opposition will show how these norms and values play a major role in the functioning of NGOs. Lastly, the effects will be discussed, thereby answering the research question.

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2. Theoretical Framework

The main research question that will be answered in this thesis is: In what way does the mismatch between Kenyan and Dutch norms and values influence the positive effect of the work of Dutch government funded SRHR NGOs working in Kenya? Sexual and reproductive health and rights encompass many different subjects that each come with their own level of controversy. The level of controversy is dependent on the norms and values of a community to some extent. There are many Dutch NGOs active in Kenya. These are largely funded by the Dutch government and uphold certain norms and values. These generally differ from the attitudes towards SRHR in Kenya. It will therefore be interesting to see in what way this mismatch between norms and values affects the work of Dutch NGOs in Kenya. This thesis will then go on to place the discussion of the effects of this mismatch in the broader context of development ethics. Here, the structure in which these NGOs work and the history of development aid adds to the effects of the mismatch. In order to answer the research question, the following sub questions should be addressed:

1. What is the influence of colonial history on the structure of development aid? 2. What is the role the Dutch government plays in this structure?

3. Is it ethical for Dutch NGOs to reflect their own norms and values in their work? 4. What are norms and values in the development context surrounding SRHR?

The colonial history will give us insight in the authenticity of the development structure and whether it is ethical for NGOs to impose norms and values in developing countries. In order to understand these structures, we will have to take a greater look at the role of norms and values within developing projects. The role of the Dutch government is also important, since they influence the Dutch NGOs and uphold certain standards.

In this literature review the main concepts discussed in this thesis will be presented. Firstly, I will discuss the concept of foreign aid. The development programs regarding SRHR are part of general foreign aid. Hereafter, the link with post colonialism will be made. While foreign aid now goes mainly from one state to another, critics worry that it resembles the relationship colonial powers had with their colonies. Afterwards, the concept of development ethics will be explained. The tradition of development aid has received much criticism and this section will allow us to place it in the context of global justice. In addition, SRHR will be discussed as a subject, in order to understand the concept further along the way. Here, the focus lies on the role of norms and values and what these are exactly. Lastly, the unique role of NGOs within development aid will be explained.

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2.1 Foreign Aid

Understanding the nature and structure of development aid gives us the opportunity to see how a difference in norms and values can have an impact on the effects of development aid. Therefore, it is necessary to understand how foreign aid as we know it today, has come to life. Modern programs of development aid started after World War Two. The United States helped a war torn Europe restart their economies with the so-called Marshall Plan. This plan involved giving war-torn European countries the funds to restart their economies. Not only did it have a great effect on the economy, it also helped rebuild political and social institutions in Europe. Later on, European countries tried to apply the same principles towards African countries. This, however, did not have the effect that was hoped for (Moyo, 2009, p. 40). In the literature, two main explanations are often given for why foreign aid did not develop in African countries as it did Europe. First, European countries did not have to build up their economies their economies from scratch: They had existing infrastructure that collapsed during the war and needed to be rebuilt. There were enough resources to use for European countries. During its highest point, the Marshall Plan never funded more than three per cent of the GDP of any country. The plan ran for five years. On the other hand, different African countries received as much as 15% of their GDP in the form of development aid (Moyo, 2009, p. 46). This brings us to the second difference. With the Marshall Plan, clear boundaries were set, such as that it would only last five years. The United States set clear goals for the plan and the European countries accepted the terms. Many African countries have been receiving aid continuously for the past fifty years, without a clear limit. Indeed aid is now considered a source of income for African countries (Moyo, 2009, p. 45).

After the Marshall Plan, the Development Assistance Committee (DAC) followed. They united countries in order to offer consultancy regarding Foreign Aid. Together with other agencies it later formed the Organization for Economic Cooperation and Development (OECD). In 1969, the DAC standardized foreign aid through the use of the Official Development Assistance (ODA). This measured the amount of money flowing from the DAC countries to developing countries. Next to these flows of money, private contributors still donated in the form of bilateral agreements (Niyonkuru, 2016, p. 2). ODA mainly includes financial resources or technical assistance to a list of recipient countries, to help their economy develop. Development aid on the other hand, aims to ‘save lives, alleviate suffering and maintain and protect human dignity during the aftermath of emergencies’ (OECD, 2012, p. 4). Humanitarian assistance is mostly short term and is offered by a wider range of donors, such as individuals, enterprises, NGOs, multilateral and domestic organizations and governments. Humanitarian aid that is financed by the DAC countries accounts for about 10% of the ODA (Gunnlaugsson, 2016, p. 346).

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Historically, foreign aid has suffered criticism in Africa, out of concerns that it promotes dependence on Western countries. Dependency theorists view aid as a form of exploitation and self-enrichment for donating countries (Herath, 2008, p. 820). For example, in the 1980s, conditions were tied to foreign aid. The Washington consensus introduced the Structural Adjustment Programs (SAP), in order to combat the inefficiency of the state. The conditionality placed upon the aid has been characterized as lessening the sovereignty and dignity of countries. It was argued that it was hampering the development of the state and used as a means to foster dependency (Herath, 2008, p. 821).

2.2 Neo colonial aspects of development aid

In order to understand why norms and values can have impact on the effectiveness of development aid, it is important to look at the neo-colonial aspects of development aid. The nation state has been long considered the only means to development, before other institutions such as international financial organizations (IMF, World Bank and NGOs) came to supplement that role. Globalization has changed a lot in this regard. Nevertheless, the main drive and actor of development aid remains the state. They drive the projects, within their own economic and legal framework. The role of non-governmental organization grows as that of the state declines (Niyonkuru, 2016, p. 1). African countries receive aid in many different forms: support for projects, budget support, technical assistance, debt relief, etc. Sometimes it comes in the form of grants that do not have to be paid back, other times loans with low interest rates. Contributions from the UN institutions, IMF, World Back or foreign regional banks are very common (Niyonkuru, 2016, p. 2).

Development studies have traditionally looked at the effects of colonization. During the first decade of the 21st century, some events have affected development practice extensively. More traditional stances in development studies have been critiqued because of the impact of colonization, or were validated in support of liberal democratic institutions, neoliberal-based growth policies and IMF- and World Bank-led globalization models (Kilby, 2012, p. 1001). The benefits of foreign aid in African countries have also been questioned because of the lack of result. A large amount of foreign aid that goes to developing countries is seen as wasted and only encourages unproductive consumption. Institutions do not develop, corruption plays a big role and bureaucratic failures in the developing countries are often blamed for these results (Dollar, 1998, p. 2).

Motives for foreign aid have been debated extensively: while some critics take a radical view, rejecting aid as destructive for the recipient, others take a more reformist view, arguing that aid should be improved. The patterns of foreign aid show that many donating countries do so because of political and strategic considerations. For example, being a former colony of a donating country is a strong indicator. A country that is inefficient, has a closed off economy and mismanaged non-democratic rule

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but is however a colony, will receive more aid from their former colonizer than a country with a similar level of poverty, a superior policy stance, but that was not a colony. For example, Portugal spends 99,6% of their aid budget on their former colonies (Dollar, 1998, p. 7). France and the UK have given 57% and 78% respectively, of their total aid to former colonies (Dollar, 1998, p. 13). Here you can see certain trends as well. Certain donors (namely the Nordic countries) seem to respond more to the “right” incentives, such as income levels, good institutions and openness. Others (France for example) give aid to former colonies that are still tied to them by political alliances, without paying much attention to other factors (Dollar, 1998, p. 18). This includes even poverty levels or their political regime. Lastly, the United States aid policy is influenced by the receiving country’s interest in the Middle East (Dollar, 1998, p. 16).

Aid can therefore be seen as economic exploitation and ineffective, since it mostly deteriorates the existing economy. There are many different theories about why foreign aid fails to develop countries. Most of them are based on the notion that foreign aid is a short term intervention that lacks a sustainable impact. Some blame this on the economic world order, where lower developing countries are at the bottom of the chain. African political economy is a consequence of Western imposed models and ideologies (Niyonkuru, 2016, p. 2). Following the economic crisis, many donor countries had great debt. This led to more conditionality, in order to make sure the countries could pay the aid back in the end. Consequently, this caused donor countries to impose economic policy on receiving countries. This is by many criticized and seen as a neo-colonial way of using a country for your own country’s gain (Niyonkuru, 2016, p. 3). Countries become dependent on the foreign aid and often have no choice but to go along with the demands that come along with the money. Therefore, it resembles the colonial ties that were present earlier in history. Donating countries hold a power over the receiving countries.

This power imbalance, together with the conditionality placed on aid, show how the relationship still holds some aspects of the colonial time. This thus gives us insight in the ways colonial history influenced development structures. The structure in which Dutch NGOs operate in Kenya on SRHR, show this same power imbalance. This relationship will be explored further in this thesis. There is a general consensus that states that the Netherlands is a very progressive country, whereas Kenya lacks these views regarding SRHR. It is thus likely that Dutch NGOs meet a lot of resistance regarding certain topics, such as abortion or LGBTQ rights. However, Kenya does depend on the relationship with the Netherlands to a certain extend. For example, when it comes to the agricultural industry, Kenya does not want to lose their trade partner. In addition, the Netherlands donates large amounts of money on multiple topics. Therefore, it could be that there is a clear power imbalance, enlarged by the mismatch between norms and values.

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2.3 Development ethics

In order to reflect on the effects of the mismatch between norms and values, this thesis takes the concept of development ethics into account. Development ethics is a discussion of the means and ends of social and economic development. It raises questions such as: What is good or real development? How should these benefits be shared? Who decides and how? What rights of individuals should be respected and guaranteed? Looking at development ethics will help answer the question, is it ethical for NGOs to impose the norms and values of their community on another country?

The study of development ethics can be divided into two parts. First, it entails discussion about which means and ends are ethically justifiable. For example, universalists adhere to utilitarianism and Kantian philosophy, arguing that state actions are right as long as they benefit the majority of the population (Gunnlaugsson, 2016, p. 347). Second, it entails the discussion of development end or goals. This also looks at what forms of development should be advocated and which should be neglected. These scholars incorporate the postmodern relativist critique of the global development project (Gunnlaugsson, 2016, p. 347). The distinction between what forms should or should not be advocated is based on which values or assumptions are lying beneath the surface. For example, a development strategy that makes the economy grow, while impoverishing a part of the population, presupposes that this will enhance well-being in the end. The discussion is then about whether national economic growth is more important than this impoverished part of the population. Another example would be a development strategy that has a negative impact on the environment. Crocker argues that while these are different views, the central goal of development ethicists is to combat human poverty, suffering and inequalities between and within countries. Thus, development ethics assess the ends and means of local, national, regional, and global development. Many development professionals, such as national policy-makers project managers and aid donors are regularly confronted with moral questions in their work. They are looking for a good balance between moral theories of development (Crocker, 2008, p. 31).

The moral obligations of famine relief and food aid have been invoked by Peter Singer in an argument for utilitarianism. He starts off with the assumption that suffering and death from lack of food, shelter, and medical care are bad. In addition, he argues that when it is in our power to keep something from happening, without sacrificing or causing harm of equal moral importance, we morally have to do it. This does not sound very controversial, but if we were to act upon it the world around us would look very different (Singer, 1972, p. 231). We often do not act according to those two premises, because of geographical distance towards the disaster at hand, or because other people are stepping in. However, both of these reasons should not mean that we do not act (Singer, 1972, p. 232). While Singer’s argument started a debate, many have stated that development aid should entail more than famine

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relieve. Philosophers such as Nigel Dower, Onora O’Neill, and Jerome M. Segal, argued that it is not just the ethics of aid, but a more comprehensive, empirically informed, and policy relevant “ethics of Third World development” that is needed. Development ethics should draw on philosophical and moral traditions distinctive of their cultural contexts (Crocker, 2008, p. 37). Development ethicists see the field of development as a way to understand the nature, causes and consequences of development. Additionally, they assume that there is a choice in how to do development, and that some strategies are better than others. Assessing development policies is therefore an essential part of development aid. Development ethicists remind development agencies of the fact that development aid should be about supporting individuals and providing them with a better situation (Crocker, 2008, p. 42). Development is regularly seen in forms of economic growth for instance. Development ethicists would state that this causes several problems. A region can grow economically, while the inequality grows as well and many people might be worse off.

Identifying values has become an integral part of development ethics. Critiques of development strategies are therefore not uncommon, especially in regard to the role of developments strategies in reproducing social inequalities in areas like gender, impacting ecosystems unsustainably, limiting human rights, or facilitating corruption. Therefore, it is vital to identify these values and to look at their implications for development in practice. One of the values often present is that of agency. In a broad sense, this is the idea that development should not be imposed, it should be achieved freely (Drydyk, 2019, p. 146). This is also stated in the Declaration on the Right to Development, issues by the UN in 1986:

“States have the right and the duty to formulate appropriate national development policies that aim at the constant improvement of the well-being of the entire population and of all individuals, on the basis of their active, free and meaningful participation in development and in the fair distribution of the benefits resulting there from” (UN 1986, Article 2, Par. 3)

The general agreement is that worthwhile development involves agency. However, there is also disagreement as to what this means in practice. It can be interpreted in a way that states have agency, that they are sovereign. This would mean that the government has a total control on development decisions. However, free and meaningful participation is included in the statement. This would mean that people should be more involved in the development of their communities. Arguably, development should make sure people have more tools in order to shape their lives, more choice in how to do so. Agency thus has a big impact on how the development aid is structured. The idea of expanding people’s choices is especially important from a gender perspective. Denis Goulet argues that the value of ‘free participation’ must mean participation in development decision-making (Drydyk, 2019, p. 147) . Only then, they can begin to take control of their own situation. Agency then means being a

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subject that participates in development decisions (Drydyk, 2019, p. 147). For David Crocker, there are four points to analyze agency: deciding for oneself (1), for one’s own reasons (2), to perform a role that (3), contributes to making that action occur (4) (Drydyk, 2019, p. 147). Agency is closely related to accountability. The executing party has to provide all information for example, in order for people to make their own choice. When a project has expected outcomes and people do not meet those, they are also limited in their choice (Drydyk, 2019, p. 148). In addition, agency is closely related to power. The choices that are made in developing projects, limit the choices people can later make for themselves.

Lastly, I would like to mention the intersection between human rights and feminism that development ethics addresses. When focusing on developing an economy without working towards less inequality within it, one is only enhancing the male dominated power structures (Gunnlaugsson, 2016, p. 348). Therefore, feminist scholarship sees this view as limiting democracy and especially social justice in a major way (Truong, 2009, p. 5). The dominant stance towards a traditional family misinterprets the intra-family relations as well as unjust disciplinary control over the body. Progress is conceived in terms of private ownership, market principles and the rule of science in statecraft and social reforms. By sticking to a traditional family as the centre of development, many groups within society whose identity is defined by birth, such as stigmatized identities or the disabled, are ignored. Activism on this issue has brought to attention the way complex forms of poverty connect with inequality towards gender identity (Truong, 2009, p. 6). Early feminist research argued against “sexless averages” in poverty statistics. There is a need for sex-disaggregated data and indicators, to show the difference between growth of these indicators between men and women. Activism was based on the link between women and poverty, by noting the high number of female headed household among the poor, their responsibility for the household provisioning and their marginalization in development politics. Thus, development often focuses on how to make programs that would support these women. It did not however challenge the underlying gender bias that caused this difference in poverty levels (Truong, 2009, p. 9).

Starting in the 1990s, gender has become a regular topic within development policies. While analyzing situations, many organizations such as the UNDP now take gender into account. The policies however did not rally change from promoting female education and employment, leaving out issues such as reducing fertility rates (Truong, 2009, p. 18). The danger with this new focus however, was that being female could be considered the same as being poor. This led to the construction of the myth of feminization of poverty: female-headed households are the poorest of the poor Feminists have argued that aid organizations should not assume that women are especially poor, but rather it should focus on how women are particularly vulnerable to threats in the social system we live in (Nussbaum, 2004, p. 328). Yet, the focus is often on income, and how women have less of it and are dependent on the state.

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The female head of the household is seen as inadequate and therefore, their percentage of poor household is higher. However, it is often showed that women who take up the position of head of the house-hold improve the situation for themselves and their children. There is also less violence and more equal sharing of responsibilities. Thus, the big emphasis on income misses the positive effects of women leading a household. Furthermore, women experience something called the reproduction tax when they have children (Truong, 2009, p. 18). Their obligations increase and they need more time to do more work, while they miss out on time to work a paid job. Often, anti-poverty programs place a large amount of responsibility on the mothers, resulting in even more work for them (Truong, 2009, p. 18). Lastly, the focus on women as a group consequently means that all women are generalized. They are seen as a group with identical interest and desires, while this is of course not the case. This results in very general policies, that do not address the individual needs of people (Mohanty, 1984, p. 337).

Thus, this discussion gives us several preliminary answers on the question about the influence of different norms and values on the ethics of development work. In order for the development aid on SRHR to be ethical, it should do more good than it does harm. The difficulty here is that the outcome depends on your view of certain issues surrounding SRHR. Take the concept of abortion for example. The general consensus among Dutch NGO employees is that safe abortion should be a right and available to all women. In Kenya however, safe abortion is only allowed by law when the pregnant women is in danger because of the pregnancy. Having an abortion is regarded as wrong and can result in exclusion from the community. It can thus be argued that promoting the right to abortion is more harmful than helpful and thus not ethical. In reality however, the process is more complicated. For instance, it is important that women are involved in decision-making about these subjects, making sure that the local population have agency. Lastly, there are many different actors and issues involved. This thesis will go on to sketch an overview of the situation and assess whether the projects of Dutch NGOs are ethical.

2.4 Norms and values in sexual and reproductive health and rights

When discussing the influence of norms and values surrounding SRHR, it is important to see the different perspectives that are out there and what they entail. Therefore, we will first look into the definition of SRHR. Afterwards, a discussion of the term norms and values will take place. SRHR stands for Sexual and Reproductive Health and Rights and is defined as: the concept of human rights applied to sexuality and reproduction. It addresses the intersection between sexual health, sexual rights, reproductive health and reproductive rights. With this definition, it covers many topics. The main issues that development workers try to tackle are access to safe abortion, LGBT rights, access to contraceptives and Comprehensive Sex Education (CSE). Globally, these issues are covered by the

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UNPFA: United Nations Population Fund. According to the World Health Organization, it can be defined as follows:

“Sexual and reproductive health and rights encompass efforts to eliminate preventable maternal and neonatal mortality and morbidity, to ensure quality sexual and reproductive health services, including contraceptive services, and to address sexually transmitted infections (STI) and cervical cancer, violence against women and girls, and sexual and reproductive health needs of adolescents.” (Temmerman, 2014, p. 30)

The universal access to sexual and reproductive health is essential to achieve sustainable development. In addition, it is necessary that the framework speaks to the needs and aspirations of people around the world and leads to the realization of their health and human rights.

Within SRHR different subjects are discussed, such as abortion or access to contraception. Many of these subjects differ in the level of controversy. Per community, the norms and values regarding SRHR are also very different. For example, one community can hold more value to the right to abortion, while others hold more value to their religion that prohibits abortion. In order to discuss the different norms and values of a region, we first have to establish a definition. In short, norms refer to behavior and attitudes which are considered normal, while values are things that people consider important to them. The values of a person can be seen as a reflection of their culture. The culture is what makes them stand out in between other communities. Edward B. Taylor was the first scholar to define culture in 1871, stating that culture can be seen as the complex whole that includes knowledge, belief, art, morals, law, customs and any other capabilities and habits acquired by man as a member of society. Over the years, many different definitions followed (Idang, 2015, p. 98).

Solving development problems, such as hunger, poverty rights and inclusion, is not new. All over the world, these issues are taken care of and this is done in ways that comply with a country’s culture, norms and values. However, there are also parts of the world that have these norms and values imposed on them. After the colonial period, many African countries were left with political systems they had inherited. They had not grown organically from the population itself. When addressing African norms and values we are not assuming that all African countries are the same and share the same culture. They differ greatly and each has their own language, mode of dressing and explanation for events. However, they do share underlying similarities that often stand in sharp contrast to those of other (Western) societies. African norms and values tend to differ from Western norms and values, while Western NGOs working in Africa do little to adapt their strategies to this (Malunga, 2014, p. 632).

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An example can be found in the different view on human rights, or the role of men and women in the society. Regarding human rights, the issue is not with most rights itself. However, they are based on the individuality of each person, while an African would focus on the community as a whole. An example of this can be found in the Universal Declaration of Human Rights (article 25), stating that “parents have a right to choose the kind of education that shall be given to their children” (Malunga, 2014, p. 632). In traditional African societies the family is regarded in a broader sense than in Western societies. Not only the biological parents, but the whole community is responsible for the education of all the children. Everyone that is above the age of the child has the responsibility to educate them and if they fail in this, all elderly will take the blame. Therefore, the declaration should take this into account. Also in a broader sense, where there are no individual rights, but rights for the whole community (Malunga, 2014, p. 633).

2.5 Role of NGOs in Development Aid

If traditional foreign aid (aid through states) is ineffective in actually changing the situation in developing countries, there should be an alternative. In many African countries, non-governmental organizations (NGOs) are taking up this role. They are not controlled by a state and try to fill the gaps where governments are not providing to their citizens. They can be a local organization, though most Western NGOs work in the global South. The foreign NGOs might work with local partner NGOs for capacity building. In the early 70s, NGOs were not yet capable of reacting to emergencies. However, in the 80s they had become vital in bridging the gap between the government and its citizens. The humanitarian organizations where based on philanthropies (Niyonkuru, 2016, p. 6). There are two types of NGOs that can be distinguished, namely the NGOs that provide short-term humanitarian relief and NGOs that focus on long-term development of specific issues (Yuxin, 2018 , p. 110).

The role of NGOs in development aid has been critiqued. NGOs have historically been key actors in the so-called ideological war that colonizing powers waged with their colonies. In order to control a population of a country that was colonized, the colonizers did not only need to control the political climate and economy, but also influence the ideas in that country. For instance, colonizers influenced the mental universe of the colonized and the way people perceived themselves. While even in colonial times, philanthropy was seen to be motivated by religion or compassion, it was also used to control a population (Manji, 2002, p. 570). Some organizations actively worked to suppress anti-colonial movements. An example is the Women’s Association, Maendeleo Ya Wanawake (MYWO) and the Christian Council of Kenya (CCK), that were both involved in government-funded schemes that were set up to work against black resistance (Manji, 2002, p. 570). The organizations where set up not to battle injustice, but to battle the “shortcomings” of the Africans living in Kenya. Given their large role in colonialism, it is surprising that many organizations survived after. They had to take up a new role

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and became the vessels of development aid. The NGOs that came into existence can be seen in two groups, first the missionary and charitable bodies that were present in the colonies before independence, such as MYWO and the CCK. Secondly, organizations like Oxfam Novib, Save the Children and Plan International, which had no direct involvement in the colonies before (Manji, 2002, p. 572). This last set of NGOs mostly involved organizations that had to expand from their European territory in order to survive. NGOs operate out of idealistic ideas and genuine motivation to improve the situation in African countries. However, the programs needed funding and the NGOs thus needed a marketing strategy. Here, a problem occurred. Instead of characterizing the work of NGOs as emancipating and portraying Africans as people with agency, the discourse of development showed the work as charity, technical expertise from Western countries and a deep paternalism. In the same way that racist ideologies justified colonialism, the development discourse continues to fuel the idea of social hierarchies (Manji, 2002, p. 575).

As a consequence, the debate about the efficiency and role of NGOs in development aid has been brought up. This debate has come to know two lines of argument. The first one states that NGOs should be a donor and aid provider only. The second argues that development organization should have a more active role and interfere with local policy and project implementation (McCoskey, 2012, p. 113). The role of NGOs within development aid is a unique one and differs from the role of nation states. Where international institutions set conditions for the loans and help they supply, NGOs often operate without those. They partake in the formulation, design and implementation of development projects within the developing country. This can make them more effective since they do not only offer financial assistance, but also aim to empower a less represented portion of the population (Niyonkuru, 2016, p. 7). They often have a focus on human rights, environmental protection and sustainability, fight against abuses to vulnerable people and encourage participation of the population in development processes. Bilateral donors often inject money into governments with corrupt

tendencies. By contrast, NGOs have research departments and policy makers that respond to known problems with well thought out solutions. They can do so with or without government approval, but do of course have to adhere to the local laws. For some projects, they choose to work with the

government, because it adds to their transparency and accountability. In the global south, NGOs play a big role in promoting advocacy and are part of the civil society that pressures governments and foreign donors to commit to pressing issues. Donor countries might choose to carry out their foreign aid through NGOs, because they are more trustworthy and it is clear where the money goes (Niyonkuru, 2016, p. 6).

Western NGOs often work with partner NGOs in the developing country. Here, the neo-colonial relationship can be seen in the set-up that the organizations work in. Western NGOs often have the upper hand in any negotiations between the organization and local partners. The Western NGO sets up

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the rules and determines the terms that the partnership exists in. These rules set up by Western NGOs are very similar in many cases, since they are born from a certain set of norms and values. The use of local NGOs is important, since it accounts for a greater sense of agency for the local population. As discussed earlier, this is necessary in order to make the development aid more ethical (Elbers, 2013, p. 51). The Western NGO has a larger claim to legitimacy by having this partnership and it reflects the ideal that the organization puts out, namely that they work towards greater equality. However, in practice Southern NGOs are dependable on the Western NGO in terms of funds and therefore subjective to conditions (Elbers, 2013, p. 52).

To summarize, the colonial history of development aid has influenced the structure in which it operates today. The role NGOs play is an important one that reflects the norms and values set by the society that has founded them. At the same time, these organizations reflect neo-colonial ideas and hold power over the citizens they work with. This thesis will look into these structures and reflect on the effect of Dutch NGOs working in Kenya when looking at the difference in norms and values between the countries.

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3. Research Design

This chapter describes the research that was carried out in order to answer the research question and the choices that were made regarding this. Several methods were used to carry out the research, which complement each other. The objective of the research is to see in what way different norms and values affect the outcome of the work of NGOs. It is specifically focused on Dutch NGOs operating in Kenya on the subject of SRHR. This thesis consists of two parts. First, the area that SRHR NGOs operate in will be described, as well as all the different actors in this field and how they work together. Secondly, the role of norms and values will be highlighted. This thesis will look into the effects of this mismatch in norms and values.

3.1 Research Methods

In order to answer the research question, I have used a mixed method approach. First, I studied policy documents provided by the Dutch government and different NGOs. In addition, interviews were conducted. Lastly, literature was used to link the theory to the practical outcome. In order to describe the Dutch foreign aid policy, this thesis looked at several official reports issued by the Ministry of Foreign Affairs. Policy briefs, the multi annual strategy of the embassy in Nairobi, Kenya and forms to request funding are some examples of these official documents. Leading Dutch foreign aid is the policy brief BHOS. Every four years, the Minister of Foreign Affairs issues a policy note describing the leading plans for that period. The current leading policy note is named: Investing in Perspective: Good for the World, Good for the Netherlands (Ministerie van Buitenlandse Zaken, 2018). This gives a clear overview of the intentions of the Dutch government. Not only do they reflect their proposed activities, but they highlight the intentions and thus the norms and values behind the Dutch foreign aid policy. In addition, many NGOs issue reports about their projects, what they are doing and how they are reaching their goals. These have been studied extensively in order to describe accurately how they are operating.

To gain perspective in this sector, several interviews were conducted. I had the chance to talk to employees of several NGOs based in the Netherlands. They described their work and how they are received in Kenya. An interview was conducted with Maria Codina, an employee of the Royal Tropical Institute in Amsterdam. Together with her colleagues they have build the tool Share-Net. This is a network of health professionals and policymakers that work on SRHR. Share-Net is made to spread information and organize meetings between different parties. In addition, they conduct their own research in areas that do not have any data about SRHR for themselves. In addition, Robin Smeets talked about their work at the Dutch NGO Dance4Life, that works in partnership with several other NGOs on programs in Kenya. Lastly, Juliana Jaramillio discussed her work at CHOICE for

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Youth, another Dutch NGO that is a member of the partnerships. The interviews provide insight in the bureaucratic relations between the NGOs and the Dutch government. In addition, information was gathered through an interview with a Dutch government official working in Nairobi. Johnstone Kuya works as an employee at the Dutch embassy in Nairobi. He is in charge of the communication between the embassy, the MoFA in The Hague, the Kenyan government and the different NGOs that work in Kenya. The embassy facilitates meetings between different organizations and makes sure that Dutch government officials meet with the right government officials in Kenya. The interviews have provided me with great insight in the work field of Dutch NGOs, as well as a good idea of the attitudes of Kenyan citizens and government officials.

Finally, this thesis is build up on a large body of literature. Development aid and neo-colonial structures, as well as literature about SRHR history and the current situation were used to place this research in a clear context. This qualitative research method was executed by using data from books, peer reviewed articles and reports from knowledge institutions and specialized journals.

3.2 The Case of Dutch NGOs in Kenya

In this thesis, Dutch government driven NGOs operating in Kenya are chosen as a case study .This was done very deliberately, because of Kenya’s relations with the Netherlands. The Netherlands has been involved with Kenya for over a century, where bilateral ties came into existence in the 1970s. Many programs regarding SRHR have been running for a long time, thus providing us with the opportunity to review the progress made. The ties between Dutch NGOs and Kenya are strong and the government has been working with them for a long time. The Dutch embassy in Nairobi is one of the larger posts the Netherlands has, with around 50 employees. They work together on development projects. Also, there are numerous Dutch companies active in Kenya. For a large part, these are agricultural companies. Furthermore, Kenya is one of the countries that the Netherlands marked as a focus area. It is part of the larger region that Dutch foreign policy focuses on, namely the Horn of Africa. Here, they look at different themes and women’s rights and gender equality are among them (Ministerie van Buitenlandse Zaken, 2018, p. 9). Additionally, Kenya makes for an interesting case study because it is often seen as the centre of Eastern Africa, since it has the largest economy in the region and Nairobi serves as the hub for international relations and human rights discussions.

In addition, the Dutch and Kenyan norms and values differ significantly. Therefore, it allows for a good analysis. Interesting was that the latest ICPD was organized in Nairobi. This signifies that the subject is also very present within the Kenyan community. In addition, it was recently stated Kenya would become a “middle-income” country, upgrading from a developing country by 2030 (Kuya, 2020). This would mean that the Dutch aid would become less and less and eventually be replaced by

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trade in its entirety. Many Dutch NGOs are active in Kenya and work on SRHR. Therefore, looking at Dutch NGOs operating in Kenya is an interesting case and allows us to truly see the effects of a mismatch between norms and values. Many projects have been implemented over the years and these can be studied to see the effects.

3.3 Ethical Issues and Limitations

When researching social phenomena, it is important to realize the position of the human subject and the researcher. As a Dutch person, I can never fully understand the position of a Kenyan person. While trying to be as objective as possible, there will always be some bias present when discussing issues. Thus, as a Dutch student of the University of Amsterdam, I have a Western bias when discussing Kenya as a case. As with every research, this thesis also has some limitations. Some of the data used is secondary data, making it less reliable than primary data. In addition, the people that were interviewed also have their own bias. their answers they reflect their own opinions and they might not have wanted to reveal everything. They work for organizations and this gives them the incentive to make the organization look good. In addition, limitations to this research where the fact that opportunities were limited, mainly because of the outbreak of Covid-19. There was no chance to conduct fieldwork and therefore, no chance to find my own data surrounding the norms and values of the local population. In addition, several interviews that were set up were unfortunately cancelled. The staff of NGOs needed all their time for corona crisis management, which is of course very understandable. Therefore, the interviews were limited to four official interviews.

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4. SRHR in Kenya

To understand the effect of norms and values on SRHR NGOs in Kenya, it is important to understand the term and the situation surrounding this in Kenya. Therefore, I will first look at the process of SRHR as a development goal in international spheres. This will help us understand how the topic evolved and eventually how this is regarded in Kenya. Lastly, this chapter will take a look at the current status of these issues in Kenya.

4.1 Putting SRHR on the Global Agenda

A full understanding of the term SRHR requires a reflection of its definition and background. The first definitions of sexual and reproductive health were determined at the International Conference on Population and Development in Cairo, Egypt in 1994. It was stated that sexual and reproductive health and rights are a condition for all individuals to live healthy and satisfying live (Starrs, 2018, p. 2643). SRHR is a concept of human rights applied to sexuality and reproduction. It addresses the intersection between sexual health, sexual rights, reproductive health and reproductive rights. Therefore, it concerns many different topics, such as: HIV/AIDS, contraception, abortion, gender-based violence, LGBT rights, child marriage, Female Genital Mutilation, teen pregnancy and other issues. All SRHR issues have severe implications on the lives of people. It affects not only their health, but also their social and economic development. During this conference the following statement was given about SRHR: “SRHR are essential for the achievement of social justice and the national, regional and global commitments to the three pillars of sustainable development: social, economic and environmental” (ECLAC, 2013, p. 39).

SRHR remains a debated concept and knows more than one definition. During the initial attempt in at the ICPD conference in Cairo, reproductive rights were linked to human rights under international law. This shifted the focus from reducing fertility and population growth to empowering women and promoting individual choice. The right to sexual and reproductive health is seen as a part of article 12 of the International Covenant on Economic, Social and Cultural Rights: “the right to the highest attainable standard of physical and mental health.” (ECLAC, 2013, p. 2644). This right entails both freedoms and entitlements. Freedoms include the right for a person to make their own decisions concerning their bodies and their sexual and reproductive health. The entitlements coming with the right to sexual and reproductive health include unhindered access to several health facilities, goods, services and information regarding that help you to make informed choices. Freedom and bodily authority are civil rights that states are obligated to respect and recognize. Entitlements however require some state to move towards full understanding of the rights at their own pace, because of limited capacity and available funds (ECLAC, 2013, p. 2644). Therefore, the Program of Action of the

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ICPD created some common language on reproductive health and rights. Under reproductive rights it listed the following concepts: family planning, maternal health care, safe abortion where not against the law, education on sexuality and reproductive health, and prevention and appropriate treatment of infertility, reproductive tract infections, and sexually transmitted diseases, including HIV/AIDS. Reproductive rights were described by the ICPD as “the basic right of all couples and individuals to decide freely and responsibly the number, pacing and timing of their children and to have the information and means to do so.” Lastly, the ICPD defined sexual health as including “the enhancement of life and personal relations” (ECLAC, 2013, p. 2644), but it did not include the term sexual rights. The link that was now made between human rights and SRH was very important in progressing the agenda surrounding the topic, leading to a shift from family planning to individual choice and female empowerment. A major role here was played by women’s right activists and non-governmental organizations.

The level of support for different aspects of SRHR often varies, depending on the social and political context. Some aspects of SRHR are more controversial than others. The level of support can vary per government or per group of people. For example, the right to an abortion is a more sensitive subject, where opinions can differ greatly. The battle against AIDS is a more pressing subject for many parties, where there is more room for discussion and collaboration. Therefore, a common strategy is to focus on one of the four areas of SRHR to get certain aspects on the political agenda during negotiations in regions and countries. This results in different political and financial situations. An example of this would be policy makers that focus on sexual and reproductive health (SRH) services, therefore leaving out the rights that accompany this. In this way, more officials might be inclined to agree to the terms of the policies (Thijssen, 2019, p. 2). At the end of the conference, 179 countries agreed to implement the ICPD Program of Action (Oronje, 2011, p. 1).

A year after the ICPD, the agreement was reaffirmed by the Fourth World Conference on Women in Beijing, China. They defined the human rights of women to include “their right to have control over and decide freely and responsibly on matters related to their sexuality ... free of coercion, discrimination and violence”. In addition, the Beijing document affirmed that “equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behavior and its consequences.” (ECLAC, 2013, p. 2645) At this conference, and others to come hosted by the UN, there were some instances where there were disagreements on some elements of SRHR. The agreements surrounding abortion for example, already started a discussion in Cairo. This ended in a compromise, where it was decided that abortion should be provided in a safe manner wherever abortion is not against the law. In Beijing it was requested that countries that do now allow abortion legally review their laws. Sexual rights as an element has also been contested in these agreements. In

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different global and local conferences and meetings, there were discussions about what should and should not be in the agreements. Some countries chose to adopt the documents without including the term sexual rights (ECLAC, 2013, p. 2646). This was for reasons such as not wanting to endorse the rights of women and girls to bodily autonomy, the rights of adolescents to make independent decisions about sexual activity, or the acceptance of diverse sexual orientations and gender identities.

In 2000, the Millennium Development Goals (MDGs) were developed. These goals were designed by the UN, forming a plan to reduce poverty worldwide by 2015. They did not include sexual and reproductive health at all. This was out of fear that the MDGs would not be adopted at all if this was among the goals (ECLAC, 2013, p. 2646). Only in 2005, the focus on maternal and child health was introduced in the MDGs. However, it was only visible in goal 5a: reducing the maternal mortality ratio by three-quarters between 1990 and 2015. This only shows a very small aspect of SRHR (Peter S Hill, 2013, p. 113). It took seven years for advocates to add the agreement that the MDGs included universal access to reproductive health. Currently, the development agenda that is leading the policies of the UN are the Sustainable Development Goals (SDGs). This does include sexual and reproductive health and reproductive rights, but it excludes any mention of sexual rights. The agenda has 17 targets that should be completed by 2030 and have listed access to sexual and reproductive health and reproductive rights in accordance with the Cairo and Beijing agreements. (ECLAC, 2013, p. 2646). Thus, in these global agreements to develop our world and what is necessary in order to do so, SRHR was mostly excluded. This makes it clear that there is a great lack of agreement surrounding SRHR. A firm contestant of including SRHR was the United States government under the Bush Administration and several developing country governments (Thijssen, 2019, p. 3). Even though the new SDGs were a step in the rights direction, the EU recognized that they did not fully reflect all aspects of SRHR in their 2017 report on the Gender Action Plan:

“The 2030 Agenda for Sustainable Development does not cover some critical elements of the gender and human rights agenda, such as non-discrimination based on sexual orientation and gender identity, access to safe abortion care, young people and adolescents’ sexuality, diversity and intersectional inequalities. More broadly, international policy documents for the protection and advancement of SRHR, including at the EU level, do not explicitly clarify the link between gender equality and the need of structural economic and governance reforms to fully protect and promote these rights by eradicating discriminations and inequalities.” (European Commission 2018a)

In 2018, the Guttmacher-Lancet Commission launched a report with a proposal for a new definition of SRHR: “Sexual and reproductive health is a state of physical, emotional, mental and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction or infirmity” (Starrs, 2018, p. 2645). Therefore, this definition includes the barriers that laws, policies,

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the economy and social norms and values can put into place regarding SRHR. Reflecting on the comment made by the European Commission, this definition might make it possible to look at all aspects of SRHR and the circumstances that might influence these for people from all regions.

There has been a slow change in perspective on SRHR all around the world. Even though the change is significantly smaller in some areas, there has been commitment to SRHR in various consensus agreements. In Africa, Latin America and the Caribbean, Asia and Europe and Central Asia the broader term sexual and reproductive health and rights has been used and contains more progressive definitions than before. In Africa an example is the Maputo Plan of Action, in which it is described how African countries work towards the SDGs and the way SRHR is included. It describes the agreements and goals for the period of 2016 to 2030, with references to stay on track for the Agenda 2063. In this document, it is recognized that African countries have made significant steps in the development goals concerning improving maternal, newborn and child health and ensuring universal access to sexual and reproductive health services. However, it states that it did not meet the goals set and aspires to continue to reach them as set out by the SDGs (African Union Commission, 2016, p. 2). It reviews the Maputo Plan of Action 2007 – 2015 and builds onto these goals to reach comprehensive sexual and reproductive health services in Africa beyond 2015. Compared to earlier documents, the new Maputo Plan of Action contains more progressive language. For example, “safe abortion care” is mentioned as an aspect of SRHR. It is recognized that SRHR are necessary to reach, in order to develop society further and reach other SDGs.

Even though significant steps were taken during the conferences, in practice the indicators of SRHR did not improve much. Some changes have been made to policies or even laws, to ensure a framework for implementation of programs. However, SRHR are not recognized as a priority issue on the development agenda of many African countries. A consequence of this is that in most of Sub Sahara Africa maternal mortality and death remain very high, unsafe and unregulated abortion claims 22,000 lives each year, contraceptive prevalence is low, early marriages and teen pregnancy still occurs and gender inequities and violence remain high. A reason these numbers remain high is the debate between the terms SRHR and SRH at both a policy and program level. While some officials argue that rights should be included, others seize the opportunity to leave them out. This causes issues when operationalising the programs. The difference in the use of terms leaves room for interpretation and this causes opposition to carry out the work in a very minimal way. As a consequence, the objectives of the program are not met. Furthermore, an issue is implementing the policies that are universally recognized on a national level. Thus, this paragraph has made clear how SRHR evolved on the international agenda. This reflects the stance of the international community, as well as how different nations view the issues.

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4.2 Operationalising SRHR in Kenya

In order to talk about the work of Dutch SRHR NGOs operating in Kenya, it is important to understand the situation and attitudes within the African country. Sexual and reproductive health issues are tended to be neglected in many developing countries, often because of religious and cultural reasons. Therefore, international law and efforts to get governments to commit to addressing these issues are very important. While Kenya was part of many of the negotiations considering SRHR and adopted the document drafted at the Cairo conference, they chose to act on some sides while ignoring others (Oronje, 2013, p. 152).

In the early 1990s, reforms for an Adolescents Reproductive Health and Development Policy where initiated. The Centre for the Study of Adolescence (CSA) revealed high levels of teenage pregnancy and unsafe abortion in their research. A broader network was formed by the CSA, made up of medical researchers, health professionals and demographers. In 1994 a broad formal network, the Kenya Association for the Promotion of Adolescent Health (KAPAH), was set up and included government departments, program and research organizations. Since there were many medical professionals in this network, the focus was on public health arguments, including a focus on teenage pregnancy and unsafe abortion through education. The professionals realized that the number of critical cases of abortion in the hospital was very high and this could be prevented earlier on the way. Thus, they argued for the education of young people on this subject.

Since Kenyan law prohibits abortion and general attitudes are not supportive, it was not possible to cover the subject of abortion directly. Therefore, the campaign was framed to focus on the need to provide adolescents with SRH information while excluding more sensitive issues such as contraceptives and abortion services. The campaign still stirred up a lot of negative comments from political and religious leaders. They argued that such reforms would encourage young people to be more involved in sexual activities. In 1995 top religious leaders set up demonstrations and used public pronouncements to argue that providing SRH information was immoral and would teach children about sex. These arguments were backed up by the sitting President at that time, Daniel Moi and his Vice President George Saitoti (Oronje, 2013, p. 154). They blocked a parliamentary debate on a bill about Family Life Education in 1997, that would have made space for sexuality education in schools. They argued this would teach children bad manners. The President chose this route mainly to please the religious leaders, who were known to sway electoral voters. Saitoti was a member of a conservative Catholic Opus Dei and argued out of his own personal religious reasons. This is an example of how individual leaders have a great influence on the policy implementation surrounding SRHR (Oronje, 2013, p. 154).