Navigating the reproductive health field: NGO practices and projects in Malawi

Abstract

International non-governmental organisations (INGOs) play an increasingly prominent role in global health. They serve as global health advocates, participants in global health policy development, partners, and implementers of donor projects and programmes. To international health donors, INGOs are popular actors to work with. This thesis examines how INGOs navigate the aid chain and negotiate reproductive health policy and norms in a field that is politicised and tense. Based on 9 months fieldwork in Malawi, as well as in Norway and at international meetings and conferences, the thesis focuses on two international NGOs and their projects in Malawi. One project aimed to improve maternal health by reducing teenage pregnancies through interventions designed to keep girls in school and the other aimed to influence the reproductive health policy environment. The thesis explores how international NGOs manoeuvre strategically in the global landscape of institutions, financial flows, discourses, and practices that constitute the fields of ‘international development’ and global health. The thesis defines three broader shifts that to a large extent shape what INGOs can be and do. These shifts entail (1) the move from an understanding of health as a political issue to a technical issue, which makes INGOs operate in what appears as a deeply depoliticised field; (2) an increased focus on individual people detached from the society in which they ‘grow up, live, work and die’; and lastly (3) the value of what INGOs do is now spelled out in terms of the number of individuals reached rather than the need to challenge structural issues of ‘representation’, power and inequality . This study shows how the INGOs studied struggle with navigating a landscape conceptualised as technical but simultaneously highly tense and politicised. Within the bifurcated field of reproductive health, INGOs and their staff have to negotiate meaning and legitimacy for their organisations and for their political projects towards differently situated audiences (e.g. the state, other NGOs). A better understanding of these practices, and how legitimacy is negotiated, is crucial to understanding how INGOs manoeuvre in the global flow of reproductive health policy, knowledge, and norms.