The World Health Organization (WHO) Executive Board on Tuesday voted to recognize the US-based Center for Reproductive Rights (CRR) as a non-state actor “in official relations” with it, in a motion carried by a narrow 17-13 margin, with four abstentions.

After multiple rounds of voting, the final vote was by way of a secret ballot.

The decision to grant WHO recognition to the Center, which supports access to sexual and reproductive health services, including abortion, was a hard-won victory for European, Asian and Latin American countries.  But the victory may be  short-lived.

Egypt, backed by a coalition of Middle Eastern and Islamic nations, as well as the 47-member WHO African Group, pledged to  “escalate” the issue to the World Health Assembly (WHA), a promise that it reaffirmed shortly after the vote in the WHO governing body, calling the vote a “politicization” of the global health body.

“We would like to repeat what we have mentioned yesterday,” said Egypt’s delegate. “That we will pursue reopening of the discussions on this agenda item within the wider quorum of the organization during the upcoming WHA”.

He added that, at the national level, the decision ” is of no weight…  we will not abide by it, and will not consider it in any means”.

“Also, we will join the Russian Federation on their query, which is ‘how could we avoid the repetition of such unpleasant situation?’.. We need the good offices of the WHO in order to avoid the politicization of this organization as it has been experienced frequently in the past few days. “

“The text that was adopted today will not be implemented in Senegal, unless it is compatible with our laws, traditions and values,” said Senegal’s delegate, echoing sentiments expressed by Yemen, Kuwait, Somalia, and other member states in the post-vote discussion. 

National context still prevails

Member states that supported the move by the 34-member governing body noted that other nations are in no way obliged to cooperate with the Center, or with any other non-state actor, which they oppose.

They stressed that the recognition was being extended solely by the WHO Secretariat, which maintains a wide network of official relations with over 200 non-state actors from civil society, industry federations and professional associations in line with a Framework for Engagement with Non-State Actors (FENSA) approved by the World Health Assembly in 2016.

The vote also awarded WHO recognition to a second non-state actor, Rare Diseases International, whose candidacy was never opposed by member states.

“The Framework of Engagement with Non State Actors (FENSA) is one of WHO normative guidelines, which has been negotiated and agreed by all member states,” The Netherlands pointed out.  “Questioning any non-state actor about its eligibility for admission into an official relationship with WHO after the organization passed the Secretariat’s criteria, undermines a great procedure and sets a harmful precedent for the future agreements.

However “the national context prevails over WHO engagements with non state actors,” she emphasized. 

FENSA framework is supposed to be neutral

The FENSA framework sets out a set of generic criteria for organizations “in official relations” to engage in collaborations with WHO, serve on technical groups and be recognized as “observers” with the right to speak at the annual WHA.

The aim of FENSA, which took years to negotiate and approve, was to create an even playing field in the much-coveted “official relations” designation that would side-step vested interests, particularly of industry or lobbying groups, that contravened WHO aims and priniciples.

Since the approval of FENSA, the handful of recommendations made by WHO each year to the Executive Board, to approve new NSA’s in official relations with WHA, or renew the terms of others, are usually just a matter of protocol, following WHO review and due diligence.

But there is growing pressure on the UN from socially conservative nations to roll back its activities on sexual and reproductive health in a period where many conservative nations still ban abortions, limit access to contraceptives and  criminalize the LGBTQI community.

Proposed WHO Recognition of Center for Reproductive Rights Provokes Storm at WHO Executive Board

As member states pointed out, the CRR has long been recognized by the UN’s Economic and Social Council (ECOSOC),  highlighting how the controversy over its recognition by WHO is a sign of the times, with intensive pushback not only in major powers such as the US and Russia, but also in international forums against the recognition of reproductive health rights long taken for granted in many societies.

Multiple votes are worrisome precedent for WHO governing body

For the EB members, themselves, the repeated votes, including by secret ballot, was yet another worrisome sign of the growing fracture between WHO member states in Europe, the Americas and Asia, which tend to identify themselves as socially and politically liberal, and developing nations in Africa as well as Russia, and the Middle East – where more conservative worldviews prevail.

The result, most member states agree, is the creeping “politicization” of global health agendas and issues. And while everyone also has a different point of view about what is political, it’s clear that it is leading to fewer decisions by consensus and more by lengthy, and often bitter, rounds of votes.

“After a record number of votes in the last week, we are alarmed by the notion that this is now becoming the default way to solve difficult issue,” said Poland’s delegate. “We would like to remind everyone that we adopted the FENSA by consensus, and we should respect it subtle equilibrium for the sake of our collective interests.

“It is essential to preserve the independent, transparent, technical and evidence based role of the World Health Organization. We highly appreciate the efforts of the direct chair and other member states in trying to find a solution we could have all subscribed to. Poland remains committed to decision-making by consensus in this organization, and rejects the notion that the voting is now mainstream. We will spare no effort in supporting effective multilateralism and fostering consensus – with all due respect for different contexts of different countries.”

New EB Chair, Matthew Wilson, who sought to strike a more consensual note after the vote, declared: “What you did was democracy, and that’s not a bad thing.”