Leak prompts fear over World Bank health policies

· Madagascan contraception targets deleted, critics say
· Managing director said to have links to Opus Dei

Sarah Boseley, health editor
Monday April 16, 2007
The Guardian

A key figure in the World Bank, said to have links to the Roman Catholic sect Opus Dei, was accused yesterday of undermining its commitment to the health of women by ordering the deletion of goals, targets and policies relating to family planning.

Juan José Daboub, the bank's managing director, ordered staff to remove all references to family planning from its country assistance programme document for Madagascar. Mr Daboub is the former finance minister of El Salvador and a member of the Arena party, which has close ties to the Catholic church.

The Guardian understands from sources close to the Africa region that specific targets relating to contraception were also deleted. The original draft committed the bank to work to increase contraception uptake from 14% as of 2004 to 20%. The final document contained no goal.

The British international development secretary, Hilary Benn, who has strongly backed efforts to improve the reproductive health of women in the developing world, said yesterday that he was very concerned. "If true, they [the reports] are extraordinary. This would be inconsistent with bank policy on reproductive health."

In the past, the World Bank has championed the sexual and reproductive rights of women, which are considered by most in international development as critical to their health, status and economic progress. There are 75m unplanned pregnancies around the world each year, a third of which end in unsafe abortions. The need for better services to enable women to protect their health has been thrown into sharp relief by the Aids epidemic.

Mr Daboub's intervention was revealed through a leaked email from the country programme coordinator at the bank, Lilia Burunciuc, who warned that the absence of family planning policies would be a problem, because Madagascar had specifically asked for them.

She writes: "By the way, one of the requests received from the MD [Mr Daboub] was to take out all references to family planning. We did that. However, this is a potential problem for us as the upcoming Health Swap [sector wide approach] includes family planning measures in response to the government's strong request for help in this area ..."

Sources within the region are concerned that other health documents may also have been tampered with. Health projects relating to Niger, Rwanda and Ethiopia are all due to reach the board shortly. High-fertility countries with Aids epidemics in Africa are particularly vulnerable to restrictions in family planning services.

Worryingly, they say, the board which contains representatives from governments including the UK, did not spot the changes to the Madagascar strategy.

Family planning organisations such as the International Planned Parenthood Federation (IPPF) are concerned that a new global health strategy which is still in draft form may also ditch reproductive health strategies. It also omits specific references to family planning. Instead, it talks about education. "Bank population and reproductive health policy advice ... will emphasise options for improving demand for reproductive health advice and services by strengthening female education, improving women's economic opportunities and reducing gender disparities," it says.

Yesterday Mr Daboub said the bank's policies had not changed in any way. A statement from the bank added: "Mr Daboub says he recognises that he is the managing director of an institution that implements policies approved by an international board of executive directors, and that his job is to execute those policies, independently of what his personal views on any particular issue may be."

Paul Wolfowitz, the bank's president, has also claimed there is no change: "I want to make it clear, personally; I think reproductive health is absolutely crucial to what I have said over and over again is a major part of the development agenda."