Exposing the Politics of Foreign Aid, Diplomacy, and Reproductive Health: A book review of Sophie Harman’s Sick of It: The Global Fight for Women’s Health

By guest contributor Sophie Arseneault

The repercussions of colonialism are not limited to its legacies’ imprint on the framework of global health and international development assistance. It continues to breathe in the perpetual practice of maneuvering women’s bodies as a site of contested politics. It is evident in our understanding of reproduction – as both the backbone of our economic system and symbolic parallel to the resilience of a culture or people under siege, conflict, or genocide. Women’s sexual and reproductive health is strategically harnessed as an essential part of a country’s foreign policy and diplomatic agenda.

Sophie Harman’s book, Sick of It: The Global Fight for Women’s Health, critiques how the functions of the global health system have come to contradict its guiding principles and outlines a pathway forward.

Global Politics of Authoritarianism and Aid

For decades, low- and middle-income countries have turned to the ‘global north’ to anticipate an elected leader’s opposition to aid, trade, or diplomatic relations on the basis of contentious issues, such as abortion. Harman notes that had the United States taken notice of its foreign policy’s impact in the rest of the world, it could have foreseen how growing authoritarianism has been detrimental to women and their health.

Harman traces the shift in development economies between the 1980s and the early 2000s to efforts to eradicate poverty, under which the potential role and triple burden of women to deliver major aid programmes under economic austerity emerged between their commitments to their livelihood and households. Donor preferences for vertical issues in women’s health were adopted to improve maternal mortality, but without access to safe abortion and modern contraception. While the following fifteen years were marked by unprecedented funding, interventions failed to deliver cost-effective, harm reductionist, and evidence-based policies and programming.

Harman alludes to George W. Bush’s $100 billion investment in HIV/AIDS – the largest governmental commitment to any single health issue. While PEPFAR significantly scaled access to treatment, it did so without the distribution of barrier methods and delivery of comprehensive sexuality education. It was an intentional choice to omit sex workers, people who use drugs, and other key populations. More importantly, as Harman explains, it was with the aim to health-wash Bush’s War on Terror.

The concept relies on deflection and complicity, by which a means to an end argument invokes insult to criticism of a country’s political repression and human rights violations. Harman offers as an example Israel’s occupation of Palestine, and the decades it has instrumentalized Palestinian women’s health to be curtailed, controlled, or destroyed while investing in artificial insemination technologies for Israeli women.

The Exploitation of Trauma

Speaking to the prevention of sexual abuse and exploitation, Harman reflects on the use of traumatic stories to fundraise in the aid and health sector, by which we consume trauma under the guise of empowering or ceding space for the meaningful engagement of survivors. She addresses the ethics of these women being approached in their continuity of care, and how the very organizations committed to bearing witness to the suffering of vulnerable populations fail to properly safeguard the rights of their patients and health workers. In the case of the Ebola response, where abuse and exploitation were systematic, women and girls were exploited twice – first as survivors of gender-based violence; and second, as survivors whose efforts to seek support and justice become secondary to efforts to finance operational oversight and protect senior leadership. It is a classic tale of the emergency imperative, explains Harman: there is only time to respond to the crisis, regardless of how the response may create additional crises.

Data as a Tool for Exploitation

Data is critical to accountability, but it can also be employed to deny the existence or relevance of a person and by default, any inconvenient health inequities that may be specific to their social determinants of health. On the outset of the pandemic, Harman recalls the negligence to collect data as a political choice rather than a scientific one. When disaggregated data was first published, it reflected the predictions and observations of front-line workers who had known to anticipate a rise in gender-based violence because of evidence during the Ebola outbreak and in lessons learned during the HIV epidemic.

Women’s health, as Harman determines, has visibility; commitments; evidence; metrics; and strategies to ensure preventative and public health. Women continue to die from preventable causes nonetheless, for their exploitation remains a means to attain and sustain power.

Target Readership

“I have argued in this book that women’s health is at the centre of international diplomacy, foreign aid, conflict and global institution building. It is not a neutral scientific space free from politics. It is a highly politicized area, from which issues receive money, who is silenced, which dead bodies are counted and who is subject to violence, to who gets to lead and who does the front-line work.”

Harman’s book serves as a starting point in identifying the underlying diagnosis to these sick politics, analyzing the ways in which we are inhibited from principled steps towards sustainable, integrated health outcomes. By questioning who the beneficiaries are, which needs are met, and who remains on the periphery, we can nurture equity through best practices. For advocates; community and mutual aid organizers; front-line healthcare providers; gender experts and advisors; programme facilitators; and policy-makers, it entails we turn away from the colonial approaches that underlined the foundations of eugenics and forced sterilization and center women in our efforts, rather than claims of return on investment.

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