Q&A: Steven W. Sinding of International Planned Parenthood Federation
> BY PRANAY GUPTE
Copyright © 2002 by The Earth Times. All rights reserved

Harrelson works the stadium crowd with the ease of a free- loving Why did you accept the IPPF post at this stage of your career?

For two reasons. The first and more important reason is that IPPF has been for many years the largest and most important nongovernmental organization in the population and family planning--now reproductive health--field. I wanted to conclude my career helping to strengthen--and in some sense to revitalize--this important organization which it has had rough times in recent years. At a more personal level, I have spent a career on the funding side, at USAID, at the World Bank, at the Rockefeller Foundation, but had never worked on the other side. Before I ended my career I wanted to work with a significant organization that was directly involved in the delivery of reproductive health and family planning services.

Why has IPPF had a rough time in recent years? What happened to make it go somewhat slack?

I think there are two major factors that have been at work. One is that the international development cooperation landscape has changed very considerably from the days when IPPF was created. In the early years, IPPF represented a convenient channel through which funders interested in the population and family planning field could direct their funds to the very few grassroots organizations that were actually working in the field. Donors badly needed the kind of structure that IPPF represented in order to pursue their own interests in enlarging support for population and family planning work. That changed over time. New NGOs grew up. National governments became involved in the delivery of family planning and reproductive health services. Other advocacy organizations came to the fore. IPPF found itself in a competitive environment that it never anticipated. It has responded very slowly and, I think, in many respects it has lost ground. The donors found leaner, hungrier, more efficient channels through which to direct their resources. The other reason--and perhaps it is related--is that IPPF was created for the purpose of pressing reluctant public agencies to embrace family planning. Family planning was extremely controversial in the early 1950s when IPPF was created. IPPF adopted the slogan "brave and angry" to reflect the fact that it was working in a very difficult field where passion on the part of nongovernmental groups was required to get reluctant governments to adopt policies and establish programs. That work was essentially successfully completed by the late 1960s--certainly by the mid-1970s. Thereafter, IPPF never really made the transition from advocacy on behalf of family planning to advocacy on behalf of some of the newer reproductive health issues that emerged subsequently. In other words, it was satisfied to convert itself from a brave and angry organization into a mainstream service delivery institution. As its role in service delivery diminished because governments and the other NGOs were getting more and more active and the commercial and private sectors were satisfying individuals' and couples' needs, IPPF had lost its singular role. Getting back to your original question: why did I want this job? Part of it is to return IPPF to its leadership role on advocacy, but now on behalf of new issues that have emerged.

What are these new issues that make it critical for IPPF to be revitalized?

The most obvious is HIV/AIDS. IPPF has been curiously quiet on that subject. I think that the consequence of IPPF being in the background role for much of the last two decades has been that the epidemic has spread faster and more widely that it might have had the IPPF taken a more aggressive role early on. The reason I say that is that it is still the case in many parts of the world and particularly in those parts of the world most seriously afflicted by HIV/AIDS that IPPF has a predominant capability in grassroots service delivery. In many parts of Africa, governments have no service delivery systems in place for rural health care and IPPF is in many places where no one else is. IPPF has an enormously important role to play, both as an advocacy organization and in service delivery. That is number one. Number two is adolescent reproductive health. This is very much related to the AIDS question. The age group15-25 has historically been the least well served by family planning organizations, particularly unmarried people under the age of 25, many of whom are sexually active and in need of both information and services to protect themselves from unwanted pregnancies and from sexually transmitted diseases and other reproductive health problems. It is the least well-educated and the least well protected group and therefore the one at greatest risk of HIV, other STDs and unwanted pregnancies. It is a sensitive subject in a great many cultures. Many adults in conservative countries prefer to believe that young people, more precisely unmarried young people, are not sexually active. IPPF has a critically important role to play in pressing governments to open their eyes and respond to the fact that this age group is at great risk if reproductive health information and services are not made available to them. Third is unsafe abortion. Abortion of course is an enormously sensitive subject in most of the developing world, whether because conservative religious traditions or for other reasons. Abortion is either illegal or safe abortion services are extremely limited in much of the developing world. One consequence is an epidemic of unsafe abortions as people desperate to avoid unwanted births turn to providers of unsafe abortions. IPPF has an important role to play in at least making governments aware of the health consequences of unsafe abortion and in helping governments think through all of the options available to them in admittedly very sensitive and difficult areas. So those three things--adolescence, HIV/AIDS, and abortion, and advocacy on behalf of all of them--is where IPPF needs to be in the forefront. I call them the "four A's" You could add access to reproductive health services for the most marginalized groups, and it would be "five A's."

Politically, why is it important for IPPF's voice to be rejuvenated at this particular time?

IPPF is by far the largest nongovernmental organization in the world devoted to sexual and reproductive health. Even if there were no other reason for it to be more active in the advocacy sense, that one is important. It represents an independent voice of 147 member countries and it is an organization with programs in 180 countries. It is a legitimate international independent voice for these issues. The implication of your question is that it is particularly important at this moment because of the position that the US administration has taken with respect to reproductive health issues. Because of the domestic politics of abortion, the United States has taken a very restrictive position on reproductive health and rights.

You mentioned the international programs particularly the national associations and affiliates. There is a perception among donors that why not install sustained bilateral relations with these national bodies rather than go through a central funding or advocacy mechanism such as IPPF?

That is a perfectly legitimate position for the donors to take. Where IPPF affiliates have become strong, and independent and self-sustaining, there is absolutely no reason why the donors should not work directly with them. It is in many respects more efficient to do it in that way. The value added of the IPPF secretariat lies in two areas; first it has the capability of being the single voice for the federation where such advocacy matters--where the Federation wants to speak out and take a position. The London office then becomes the mouthpiece, the mechanism, through which those messages are articulated in a clear forceful coherent fashion. The second is that the secretariat should be in the position to provide technical support, and management and programmatic support, to the weaker national affiliates--and many still need this help. If the donors want to support programs in Africa, then they need to recognize that direct funding to very weak family planning affiliates in Africa will not achieve the desired. The secretariat, including the six regional offices, have an important role to play in providing technical support and strengthening those national affiliates which are still quite weak. I am not sure that in recent years how well this support function has been done, but it is a legitimate reason for donors to support a central secretariat and it is my intention to strengthen the secretariat so that it can perform that technical and programmatic support role more effectively.

What is it that IPPF can do uniquely under your stewardship that other ultilaterals or international organizations may not be able to?

Let me begin by saying that I do not think either the UNFPA or the World Bank do much by way of strengthening local institutions. They are basically funding mechanisms. They have very little capacity to directly provide program and management assistance to local organizations. To the extent they do that, they do it through contracts and grants to other organizations, either private firms or NGOs. So, I do not think the IPPF has competition from either the UNFPA or the World Bank in strengthening local NGOs. USAID is another story, along with some of the European donors. They have over time created the institutional capacity to directly assist grassroot organizations. USAID particularly does that well and has for many years. IPPF's role ought to be limited to strengthening its own affiliates. IPPF is after all a federation of largely autonomous national organizations. IPPF's role ought to be to make sure that those national organizations are capable of playing their role effectively. If the IPPF secretariat cannot ensure that its own associations are strong and effective, it really has no business existing and I do not think it is right to turn over that role to other institutions. IPPF ought to look after its own affiliates.

Given the current political climate internationally, not just in the US but also in Europe, and given the turn the economy has taken--especially the American and Japanese economies--you are really assuming stewardship of IPPF at an unenviable time, not just politically but financially as well. Since you are in a way reliant on donors, what strategy do you plan to jump-start IPPF?

The Director General of IPPF really cannot do very much about the global development cooperation environment. So the question is how to adapt to it and make IPPF competitive in a difficult funding world. In the short term I am hoping that my former colleagues in the development cooperation business--that is the program staffs of American foundations and the large, multilateral and bilateral funding organizations--will have sufficient confidence in me that they will provide some funding to help us turn the situation around. I am not expecting the foundations to substitute for the money that comes from governments. I am hoping that foundations will provide funding in the short term that will give me some running room. IPPF's funding situation is so bad right now that without a little bit of flexible funding it will be very difficult to make the institutional changes that are required to show that the institution is effective. But over time, the answer to your question is that we can only restore IPPF to financial health if IPPF demonstrates that it is capable of doing things, whether these are in the realm of advocacy or in the realm of service delivery, that others aren't doing. Future funding will be performance based. We will have to show as a federation that we have turned ourselves around and we are really making a difference. So we need some money up front to help jump start that process and then I hope that by doing things well we will demonstrate that we are on the right track and worthy of receiving more public funds. We are not going to be able to turn the European political environment away from the right, nor in the United States, but I am hopeful that by showing that IPPF is an effective organization, particularly in the fight against AIDS, that where there is money we can more effectively compete for it.

Aren't there already too many organizations working in AIDS? Isn't there a danger of duplication and replication?

In many countries where AIDS is most severe, IPPF is one of the few organizations that is actually on the ground with the service delivery capabilities. In several African countries, for example, the IPPF affiliates have more service delivery outlets than any other organization, in fact, more than all the other organizations combined. So potentially IPPF has a hugely important role to play. These organizations that you are mentioning are largely organizations that were created to serve as funding channels but they do not have grassroots service delivery capability. The great constraint in the fight against AIDS is precisely that: lack of institutions on the ground working at the community level. Such organizations, where they do exist, are better able to provide the very limited amount of technology against HIV and AIDS that we do have. Basically, all we have is information and condoms to prevent AIDS. We have no vaccines. At a still very high cost, we can provide antiretroviral treatment, but in the absence of a vaccine, AIDS can be defeated only through behavior change. In the meantime, making sure that condoms are available, that their use is demystified so that people do not regard them as an illicit adjunct of sex outside marriage, and basic education and information to encourage behavior changes is all we have got. The limiting element is not the money at this point. The new Global Fund is just another vehicle through which the donors hope to be able to deliver money, but you cannot throw money at this problem, unless you can overcome the most severe limiting factor, which is the absence of organizations that actually can work at the community level. And there IPPF has the potential to play a very important role.

Why do you think that neither UNAIDS nor the new Global Fund for HIV/AIDS, Malaria and Tuberculosis has been terribly successful?

I think the reason that neither has been effective is the absence of strong service delivery institutions at the country level, whether government public health systems or networks of NGOs. One of the reasons Uganda has been successful is that the government turned to grassroots organizations and asked them to become active and effective in HIV prevention. And it worked. But in much of the rest of Africa the governments have been reluctant to do that, have been in denial or the grassroots organizations simply do not exist. IPPF has the potential to fill that gap and IPPF has shown historically that when it sets its mind to do something well, it can do so with the minimum of bureaucratic inefficiency. I think its track record on expanding family planning between the 50s and 60s was very good--relatively nonbureaucratic and efficient.

What do you see as your initial management objectives? You are known to be tough and hard minded, so what changes can IPPF expect from you initially?

The hallmark of effective leadership is to have a clear set of goals and a very clear strategy for achieving those goals. My first job is to get the entire IPPF, which is hundreds of volunteers around the world and the professional staff, both at the central and at the regional level--to work together to produce a unified vision and strategy. That has to be done collaboratively. One cannot articulate a full blown strategy and say here it is and buy in. The only way that people will buy in is if they feel they are participants in the process. In my first year what I will be doing is instituting a process, which in fact has already begun, of working together with staff and volunteers on the articulation of a strategy along the lines of the priorities I mentioned earlier. I actually do not think of myself, nor do I think that most people who have worked with me, think of me as being tough or hard-nosed.

I said hard-minded.

OK. Fair enough. I have always tried, whether it was USAID or at the World Bank or Rockefeller, to run an organization by articulating a clear mission for the organization and then encouraging people to make that vision or that goal a reality. My management style in fact tends to be a supportive one in which I delegate a lot to trusted colleagues. So I may be hard-minded in terms of trying to limit the number of things that IPPF commits itself to doing to a manageable number of very high priority things; making it clear that we will stick to that agenda; but then managing in a style that is both supportive and encouraging, and inclusive, to get the job done.

There is a perception that IPPF has in effect has lost its voice. Your personality, for those who know you well, seems to be someone who articulates things very clearly and crisply. The perception is that IPPF is a weak body led by weak leaders with weak if nonexistent voices.

You are not going to get me to announce a shake-up. I am going to reserve judgment until I am actually there and having chance get to know to get the players and make my own assessment of their strengths and weaknesses. You are also not going to get me to be overly critical of my predecessors. Perceptions be as they may, I am going to take a fresh look at the situation when I get there and make my own judgments about what is needed. I think it is true that IPPF has not been as strong a voice in the recent years as it might have been. But I am reluctant to blame just the leadership of the organization. IPPF has always been an extremely complicated institution from the governance and management standpoint. It depends for its fundamental strength on a network of volunteers. Without the volunteers, IPPF would be just another bureaucracy. With the volunteers it is truly a citizen-based and citizen-led international movement. But in citizen-based, citizen-led, highly democratic international movements sometimes they have had to sacrifice a little bit of efficiency in favor of inclusiveness. I am going to have to find my own way in dealing with that dilemma and try to capitalize on IPPF's greatest strength--which is its volunteer structure.

And how are you going to do that?

How I am going to do that is something that I cannot really anticipate until I am on the job. Whether the right people are in place to carry out the strategy that we will evolve over the next several months is a judgment that I am going to have to reserve until I have had a chance to get to know the people better and to see where our needs are greatest. I want to return to advocacy.

Advocacy is perceived as an ideological undertaking. And the perception is that advocates are a bunch of radicals. How do you plan to strengthen the concept of advocacy particularly for IPPF in the classical sense, in the most wholesome and healthy sense, and would that perhaps involve rebranding of IPPF through things like a name change?

I have given name-change question quite a lot of thought. At least at this point I am reluctant to push on that front. I think that the name Planned Parenthood actually resonates very well with most people. It is an honorable phrase. An international federation that is committed to Planned Parenthood, which is basically empowering people, I think continues to resonate well. It does not resonate well with a particular group of anti-abortion zealots in the United States and elsewhere. But I continue to believe that is a relatively small group and that for the vast majority of people the Planned Parenthood name is a positive name and I do not think I want to change it. But getting to your more fundamental point, the most effective advocacy is that which is knowledge-based and data-based. I learned when I was a graduate student that the best lobbyists were not those who went in with the shrillest voice or the toughest arm-twisting, but the ones who provided solid evidence that helped policy makers and decision makers reach a conclusion which they then could defend. When I talk about advocacy, I mean it in that sense. I mean bringing information to bear on political decisions that helps policy makers to move in the direction you want, but on the basis that makes that direction defensible. I think that IPPF has been at its most effective where it has provided policy makers with the information that millions of couples wanted access to contraception, that they wanted the ability to control their own fertility and that it was not politically dangerous to respond to that demand. The old surveys of knowledge, attitudes and practices that IPPF helped to sponsor in the 50s and 60s were instrumental in many countries in convincing policymakers that adding the provision of contraceptives to other health services was a politically acceptable and safe thing to do. By the same token today, the way to address the abortion question is not by shrilly insisting that abortion clinics should be opened up and made available everywhere, but by documenting the social and health cost of unsafe abortion by demonstrating that people will of their own volition turn to unsafe abortion if that is the only option available to them in the process putting their lives and the well-being of their families at great risk and that a humane response to that situation is to provide safe abortion, because people are going to turn to abortion anyway. That kind of dispassionate presentation of information and data seems to me to be the most powerful form of advocacy. So when I talk about advocacy, I am talking about it in the form in which IPPF has always done its best, which is by providing data and by demonstrating through its own service delivery systems what will work and what will be acceptable to the population.

Do you have any role models here?

In a funny kind of way, IPPF's own history is a good role model. IPPF more than any other single institution--possibly with the exception of the Population Council--is responsible for persuading the political leadership around the world that family planning was an important and a politically safe thing to do. The Pop Council did it with the kind of data that I mentioned earlier, although IPPF did a lot of that too. IPPF did it principally through demonstration, through opening up clinics and showing that people wanted the services that those clinics provided and that one can do this without incurring major political costs.

How do you envision an ideal relationship between the chief executive and the IPPF board?

There is a built-in tension in that relationship, which is structural--which has to be managed. It cannot be either wished or organized away. And the tension is that the board of IPPF is comprised of senior volunteers from each of the regions who themselves are the representatives of national affiliates of IPPF. In other words, they are interested parties in the allocation of resources and in the securing of resources from the Central Office. They are not in essence an independent board as one often thinks of boards of directors. They have a set of expectations of the Director-General which coalesce around the mobilization of resources and their securing of the fair share of those resources from the international funding community. Donors on the other hand have a very different set of expectations. The donors to IPPF expect that resources be allocated in the most rational way possible to achieve IPPF's overall mission. There is a natural tension between serving the expectations of those two constituencies. To the extent you do what the donors want, you are bound to incur some objections on the part of the board, because you may choose to allocate resources in a way that they do not necessarily agree with or you may choose to pursue objectives which are not necessarily the highest priority of the members of the board. On the other hand, to the extent that you try to satisfy the expectations of the board--or the Governing Council, as we call it--you run the risk of appearing to the donors to be allocating resources in an inefficient or politically motivated way. The task of the Director General is to manage that tension and the different expectations of the two principal constituencies effectively. You can never fully satisfy both sides. I think it is really important that one comes into the job recognizing that fact. The best way to handle it is to be sure that each constituency understands fully the motivations and expectations of the other.

Can you do that?

I think I can. First of all, recognizing the dilemma is a large part of being able to manage it. But beyond simply being aware of it, I think that the rest of the task is to try to be skillful in identifying and optimizing those areas in which there is agreement and working on the areas of agreement. I think that the articulation of a clear vision in which both the donors and the Governing Council are engaged and which they ultimately buy into is a large part of it. One of the reasons why I place such an emphasis on developing a process of consensus building in strategic planning is that I think it pays big dividends down the line in keeping both of these constituencies on board and supportive. I think that if everybody agrees at the outset about what we are going to do and how we are going to get there, then tensions that may arise along the line as you get into implementation are much more manageable than if people have completely different expectations at the outset.

If you were to want to produce the 15-second pitch for the organization which everybody in IPPF carries in his/her wallet--what's called the elevator pitch: get your message across in 15 seconds--how would you articulate that? What would be your elevator pitch?

It would be that the great unresolved problems in the world of reproductive health are services for young people, unsafe abortion and HIV/AIDS. That IPPF represents the largest grassroots-based organization in the world with the capability of addressing those three great unresolved challenges and that with clear focus and clear direction and strong management we will represent a very good investment of scarce resources to solve those problems.

Why are you the right leader at this time for IPPF?

It is hard for somebody who has been selected by others to answer that question. I think that it is better to address it to the people who chose me. I can tell you what they said to me when they offered me the job. I have a lot of experience. I have been in the field for 30 years and I have worked across a broad range of institutions. I have a reputation of being more than just an administrator--of being a person with some ideas--and in fact I spent the last three years as a professor and as a writer and teacher, trying to get some of my ideas down on paper and across to students. I have pretty good connections with the funding world, which at this juncture is crucial to IPPF's survival and health. But I also come with real liabilities. The preferred profile of a leader in this field today for many institutions is a woman and preferably a person younger than myself from the developing world. In that sense I am a throwback to the day when white American and European males tended to head such organizations. I think that there are many who wish that IPPF has been able to find a young dynamic woman from the developing world to lead it. I wish that had been the case. It is my hope that I will be able to attract to IPPF the kind of person who can succeed me who does represent the next generation of leadership from the developing world. I may be the right person for IPPF right now because IPPF needs a leader who is known and trusted by the funding community and who has the capability of articulating a clear vision which the organization badly needs at this moment. But I do not think I am the right leader for the next ten years. That person needs to be found, sooner rather than later.