Creative Consulting & Development Works

We are a research, evaluation and communications consultancy, servicing nonprofits, governments and donors with innovative solutions within the development context.

The Global Gag Rule and the Implications for Sexual and Reproductive Health

13 March 2018

Written by Jenna Joffe on behalf of Creative Consultants & Development Works

In his first week in office in 2017, United States President Donald Trump issued a memorandum to reinstate and expand the “Global Gag Rule”. He announced that he would be severing all US funding to organisations that “perform [or] actively promote abortion as a method of family planning.” This policy prevents foreign NGOs from being granted US health funding if they use funds to provide information about abortion, counsel individuals about abortion, refer them for an abortion, provide abortion services, or advocate for abortion laws. By law, federal money in the US can’t be spent on abortions, but the expansion of the Rule allowed for the ending of US grants for organisations that were in any way “pro-abortion” or that offer holistic sexual and reproductive healthcare in their own countries outside of the US. In effect, the policy applies not only to recipients of family planning funding, but also to many recipients of global health assistance provided by all US government departments or agencies.

The Rule is not only an impediment on family planning services, but given the integrated nature of these services, the policy inadvertently attacks various other public health issues, especially those affecting women and children. The US is the world’s largest source of global health financer and implementer of global health programmes. The Rule reportedly extends restrictions to an estimated $8.8 billion in US global health assistance. Beyond affecting funding support for family planning and reproductive health, the restrictions have implications for services related to maternal and child health, nutrition, HIV/AIDS , prevention and treatment of tuberculosis (TB), malaria, infectious diseases, and neglected tropical diseases.

Doctors Without Borders (MSF) have expressed concern about the effect the policy will have on women’s health and progress in global health endeavours, particularly efforts charged towards reducing maternal mortality related to unsafe abortions. According to the World Health Organisation (WHO), unsafe abortions account for approximately 13 percent of maternal deaths internationally. It is expected that the policy will create a market for backstreet abortion providers: Research indicates that 21 million women who get abortions go to illegal providers, and approximately 78 000 women die from complications. As such, the impact of the policy is potentially deadly to millions of women globally.

The Global Gag Rule has serious negative implications for women’s health and lives in South Africa, who is a major recipient of US federal funding. In 2016, 90% of the aid South Africa received allocated to healthcare was from the US (approximately 1.3 billion). Sexual reproductive health programmes sponsored by US funding will be negatively affected, including programmes funded by major donors such as PEPFAR, USAID, and the Global Fund to Fight AIDS, TB and Malaria. South Africa is one of few African countries which have liberal abortion laws. Many organisations in South Africa who provide abortion services or information, or who advocate for abortion services, now cannot apply for funding currently on offer from the US to address other related issues including gender-based violence (GBV) and HIV, despite South Africa bearing the world’s largest burden of HIV (with young women and girls disproportionately affected) and some of the highest rates of GBV. This is also despite the fact that South African women have the right to access safe and legal abortions as guaranteed by the Choice of Termination Pregnancy Act (1997). According to Sonke Gender Justice, this Act has produced significant improvements in women’s health and wellbeing. High morbidity from incomplete abortions halved between 1994 (16.5%) & 2000 (9.5%), permanent genital injuries from incomplete abortions decreased from 3.2% (1994) to 0.6% (2000), and there was a 91% reduction in deaths to women due to abortion.

Activists say a clause in the policy may allow some organisations, such as those in South Africa, potential exemption, although it still does not allow them to provide abortions. US funding guidelines state that when local laws require health workers to provide counselling and referrals for abortions, they may continue to do so without violating the policy. As such, the Rule should be null for healthcare workers in South Africa, as they are obligated to counsel and refer women under domestic laws, ethics guidelines and the Constitution. The policy cannot violate the laws of an independent state. However, Deputy Director of Public Policy for the Amfar warns that the US may still withdraw future funding from organisations and government who exercise their rights under the Rule.

The Global Gag Rule is also not necessarily supported by public health research. A 2011 study found that enforcement of the policy by the George W Bush administration led to an increase in abortion rates in sub-Saharan Africa, which was likely a result of decreased access to contraceptives and a consequent increase in unwanted pregnancies. A study conducted in Ghana found that, because of declines in the availability of contraceptive services as a result of the Gag Rule, both fertility and abortion rates were higher during the administrations that reinstated the Gag Rule than during non-gag rule years in rural and poor populations. The Guttmacher Institute’s report on the Global Gag Rule has stated “in reality, attempts to stop abortion through restrictive laws – or by withholding family planning aid – can never eliminate abortion, because those methods do not eliminate women’s need for abortion”. Rather, the policy results in women being left with few safe options when it comes to their reproductive health.

Two of the world’s largest family planning organisations, International Planned Parenthood Federation and Marie Stopes International have reportedly announced that they would no longer be accepting US donations. By the end of 2020, Marie Stopes estimates that the reduction in services will result in 110 000 unintended pregnancies and 32 000 unsafe abortions in Zimbabwe alone. In Kenya, Family Health Options (the local affiliate of Planned Parenthood and the country’s oldest family planning clinic) has been forced to reduce or end outreach programmes that were reaching approximately 76,000 women every year, and has had to close one of its clinics.

In little over one year into Trump’s presidency, it is too early to say with specificity what the impact of the Rule will be. However, evidence from previous Gag Rule administrations have consistently shown negative consequences for the sexual and reproductive health of women and girls. Unless the Rule is again revoked (likely by Democrats, as previous trends of change in office have indicated), recipients of US federal funding are being forced to make a difficult choice: A choice between accepting US federal funding and refusing women services and information about abortions (even in countries where this is legal and when such services are funded by other donors), or declining US funding in favour of giving women information about their reproductive health, rights and choices, but therefore forfeiting US funding for crucial non-abortion related health initiatives, including HIV, TB and GBV. It is a compromise that service providers must make carefully if they are to ensure the least impact on the communities they serve.


Trump-Pence Administration’s Neocolonial Assault on Reproductive Freedom Is Killing African Women and Girls

Trump-Pence Administration’s Neocolonial Assault on Reproductive Freedom Is Killing African Women and Girls


1 March 2018

In the past months, there have been at least 100 cases of reported sexual assault on young girls in South Africa. 87 of those cases, were reported in a primary school in Gauteng with the perpetrator being one person. Yes! One person raped 87 young girls!

Every morning, one wakes up to hear heart-breaking and saddening stories about girls being raped. What’s worse, is the fact that this heinous act is committed by their own peers, or their own teachers, their brothers, neighbours or boyfriends, and even those responsible for their protection. The problem of rape and sexual assault in South Africa is so broad and endemic that it will take a great deal more than any one public awareness campaign to solve it. Neither will it come to an end when teachers, parents and family members don’t protect the children first.

Well, I suppose if you unpack this whole campaign, one has to understand, or rather question why, rape occurs in the first instance, and then to ask why do we keep quiet about it once it has happened. We have to ask ourselves, why is this topic taboo? Why do we not bring together our young boys and girls to talk about their sexual reproductive health? Why are we so scared? I took time to think more about this topic and I realized that we probably understand rape differently. Distorted as this view is, perhaps to our perpetrators its affection, power, control. They don’t know how to partake in the act of love, and to us as women, the victims, we probably assume that is love because we were never taught about intimacy and how liberating it is supposed to be.


Rape is traumatic. One never forgets. It’s an event that can lead to suicide, depression, withdrawal, intimacy and trust issues especially in relationships. A rape victim lives with this stigma and shame, for the rest of their lives. Not only do they have constant nightmares about the event, but they have to live with the fear of being exposed to sexually transmitted diseases such as HIV/AIDS, or carry the consequences of a pregnancy as a result. It is rather easy to say that women are not coming up and saying “I have been violated’’. But it is not easy. Many women are scared, they fear that they are the cause of the rape. Our justice system is slow to act, perpetrators walk free and continue to commit these heinous crimes. The victims are imprisoned in their experiences that they have to relive each and every moment of every day.

On October 11, the world celebrated the International Day of the Girl Child and this got me thinking that if we only set aside one day to celebrate the girl child, what are we doing for the rest of the year? What are we doing to ensure that our girls and women are safe and protected? What are we doing wrong? Why are our children, sisters, mothers, aunts and grandmothers being abused in the hands of those who are supposed to protect them? How many die at the hands of their perpetrators?

It’s time we take our power back. It’s time we protect ourselves against such inhumane acts. So how do we start? We teach each other, we open up, we don’t judge, we accept each other and we fight for each other. We protect each other. Most importantly, we need to reach out to this upcoming generation of young men and teach them about what rape does to women and those around them. Let us work to turn something negative, hurtful and life-wrenching, to a positive thing that encourages women to stand up and do something.

Further information on rape statistics in South Africa can be found on the link below:

SONA : Youth Crime Prevention Strategy

19 February 2018

Friday 16th of February 2018 was a special day for all South Africans, as the long-awaited State of Nation Address (SONA) was delivered by the newly appointed president, Matamela Cyril Ramaphosa. As the president was delivering his speech the team at Creative Consulting & Development Works (CC&DW) embraced the following words, “During the course of this year, the community Policing Strategy will be implemented, with the aim of gaining the trust of the community and to secure their full involvement in the fight against crime. The introduction of a Youth Crime Prevention Strategy will empower and support young people to be self-sufficient and become involved in crime-fighting initiatives.”

These words were of significance as CC&DW is currently conducting an evaluation for Youth Leadership Development for Community Safety Training Intervention. This work is supported by South African-German Inclusive Violence and Crime Prevention Programme (VCP) and the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ). The Youth Crime Prevention Desks (YCPD) is implemented by the South African Police Service (SAPS), Community Policing Forums (CPF) and Department of Community Safety (DoCS) at a national and provincial level to promote community safety through the youth and the structures are based at South African Police Service stations.


The evaluation of the training programme is intended to assess the impact of the training programme in order to provide information for decision-making in terms of scalability of the approach and communicate findings to internal and external stakeholders and the wider public.

A unique component of the evaluation of the Youth Leadership Development for Community Safety Training Intervention is our use of mixed methodology with Story-boarding (SB). This creative tool is used to collect data on how the situation has changed since Youth Leaders and Mentors have been exposed to the training and mentorship programme. SB sessions are being used to identify stories of project implementation or planning, and to assess the changes that took place after the Youth Leaders attended the training in terms of implementation of knowledge and skills, confidence levels and commitments, and changes in attitudes and beliefs.

Given the high levels of crime and violence in South African homes and communities, it is vital that policy-makers, civil society and nonprofit organisations working with these issues learn what works and what doesn’t. Working with youth to promote community safety is a vital strategy to redressing violence on our streets and in our homes. This evaluation will provide decision-makers and implementers with key findings and recommendations to plan the way forward. CC&DW is privileged to have the opportunity to work on this important evaluation study, currently underway.

ASPIRES : Accelerating Strategies for Practical Innovation and Research in Economic Strengthening

13 February 2018

Creative Consulting & Development Works recently had the pleasure to complete a fascinating research study for a remarkable client, FHI360. Our research team travelled to Ingwavuma Northern Kwa-Zulu Natal, on 22nd of January 2018 to present the findings of the completed Synergy Study. The Study was Funded by America’s FHI360 and implemented by local NGO Zisize Educational Trust.

The Synergy Study is a yearlong qualitative research study to evaluate Accelerating Strategies for Practical Innovation and Research in Economic Strengthening (ASPIRES) programming designed for vulnerable youth based in disadvantaged communities. The aim of the study was to explore how psychological, behavioral, economic and social factors interact to affect HIV risk behaviors in adolescent girls and boys enrolled in the ASPIRES programme. The programme has five different components within it, and these cover different topics like, how to use and save money, how to protect yourself from HIV & AIDS, etc.

In our presentation our research team focused on the key benefits of the programme reported by the ASPIRES learners where qualitative data was collected in the field during the course of the programme throughout the year. Three key themes emerged in the self-reported benefit discussions with learners. These included ASPIRES giving the learners a sense of direction; ASPIRES taught learners about financial literacy and how to foster a culture of saving and finally ASPIRES taught the learners about self respect and how to handle themselves around other people.


The presentation was received with great enthusiasm within the community. Teachers, Facilitators and Zisize staff contributed to the discussion and shared their appreciation in receiving the findings of the Study. What a pleasure to work with a dynamic and thoughtful community so engaged in the study. The community had a range of questions and these were answered and grounded in a practical emphasis on learning outcomes.The team also used the opportunity to encourage learners, teachers, and caregivers to continue practicing positive behaviors learnt from the programme in their communities in future.

There was a small awards ceremony that took place after findings were presented. These awards were met with great excitement by all involved. It was a very touching and encouraging moment when the attendees, and in particular the parents and caregivers of the learners, noted a positive behavior change in the learners since they had begun the programme.

There was an overwhelming appreciation towards the Creative Consulting & Development Works team who had returned to Ingwavuma to share findings and consider learnings. As this was the first time a programme of this nature had been implemented in the area a feeling of pride and achievement was evident.

Our research team are so grateful for the opportunity to have worked with such an appreciative community of learners and a truly special and supportive client, FHI360. The experience was insightful and inspired and motivated our team. We look forward to working on similar projects in future to further develop a culture of continuous innovation that can deliver better learning in financial literacy.

Thank you community of Ingwavuma and all the wonderful learners who participated in the SYNERGY study! Thank you FHI360 (Greg Guest, Amy O’Regan, Meredith McCann) – it was such a pleasure to work with each of you!  Thank you to Zisize Educational Trust and particularly Andrew Ganizani Sitima. Thank you to the entire Creative Consulting & Development Research team under the guidance of Susannah Clarke and Senior Evaluator, Leanne Adams, supported by Mkhululi Mnyaka, Itumeleng Romano, Carmen Sylvestor, our dedicated fieldworkers, and all the others who were involved in this two year study, for their sterling work on this important assignment.

To discuss your research needs kindly contact Susannah Clarke, Research & Evaluation Director, or Lindy Briginshaw, CEO of Creative Consulting & Development Works: or

More on ASPIRES:
The Accelerating Strategies for Practical Innovation and Research in Economic Strengthening (ASPIRES) project is managed by FHI 360, a non-profit human development organization. ASPIRES supports evidence-based, gender-sensitive programming to improve the economic security and well-being outcomes of vulnerable families and children, particularly those infected with or affected by HIV/AIDS, and others at high risk of acquiring HIV. ASPIRES is funded by the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR).

On the outside looking in

6 February 2018

We’re loving February for many different reasons.

This is the month when we realise time does not stand still, and the first portionof the year is gone. Inevitably those who made new years’ resolutions will pause to think about their progress with their commitment to lose weight, spend more time with friends and family, study, sleep more, drink less, quit smoking, etc.This means that February may bring some stress, disappointment, or satisfaction, depending on what we did in January.

February is also a reminder that summer in the Southern hemisphere will not last forever, and that autumn and winter will be here soon. Depending on whether you love summer or winter best, you may love or hate it that days are becoming shorter and cooler. With winter approaching, there is hope for rain in the drought-ridden Western Cape.


There is also the State of the Nation Address, on 8 February 2018. This key political event is an opportunity for the President to report on the economic and social state of the nation, and includes a review of the past year and priorities for 2018.  Given the current state of affairs this SONA is going to be decisive in determining how South Africa’s future political and economic landscape unfolds.

For those who are romantically inclined and are looking for an opportunity to make a (daring) move, February is the time. It is hard not to notice the red hearts, roses, candles teddy bears that and other items signalling Valentine’s Day on the 14th. Not everyone celebrates the day – some call it “Single Awareness Day” and others just ignore it.

Interestingly, there is no agreement on the origins of the day of love. Some say it originated from an ancient pagan festival of lust and nudity in the times of the Roman Empire; others say it morphed into a Christian celebration of St. Valentine as the Catholic Church gained ground; and an alternative explanation is that it is just an excuse to celebrate spring in February – that is in the Northern hemisphere.

So, what does all of this have to do with evaluation?

Apart from the obvious need to plan properly to make those New Year’s’ resolutions work out as intended – read Theory of Change, Theory of Action, Indicators, Targets, Timelines – there are two other things that come up: context, and values.

The importance of context is clear from the above thoughts on February – for everyone in the world it signals the approach of a new season, but depending on whether you live in the Southern or the Northern hemisphere, the approaching season will be different. The issue of context in evaluation is equally important.

It is also clear that where we “stand”, or in other words, our own perspectives and situation has an influence on what we think about February. Similarly, in evaluation, every evaluator has a position, like it or not. As evaluators we give careful consideration to many aspects and variables, but are we conscious enough of how our own background, position in society, gender, age, preferences – the list can continue endlessly – shape how we engage with an evaluation, right from the time when we read the Terms of Reference).

February is a reminder that it is a good idea for evaluators to pause, stand back, do some introspection, and check our assumptions, biases and filters. As evaluators, we need to make sound judgements about the projects and programmes we evaluate, and we cannot take that responsibility lightly. This said, we also have to be conscious that finding the truth is not as simple as it seems. Who we are, where we come from, what we value, and what we want from the future may influence us profoundly in our work, particularly in qualitative inquiry, where “the human being is the instrument of data collection” (Patton, 2002: 51).

Patton proposes that the social scientists need to “carefully reflect on, deal with, and report potential sources of bias and error” in addition to other ways[1] to ensure that high-quality qualitative data, which is trustworthy, and fair to the phenomenon and/or the people being studied. If not, our work will be worthless.        

Bias can occur at any stage of research, even when we decide what to study/evaluate, or how the research questions are formulated. Even in research where rigorous quantitative data is collected, bias and distortion can occur. For example, measurement bias happens when values are produced that “systematically differ from the true value in some way… one of the things that might contribute to response bias is the appearance or behaviour of the person asking the question, the group or organisation conducting the study, and the tendency for people not to be completely honest when asking about illegal behaviour or unpopular beliefs.” (Peck, Olden, Devore, 2012: 38)

Without elaborating on all the potential sources of bias, it should be mentioned that social theory is steeped in values, embedded in the context and culture from where they emanate. Some argue that “researchers must be unbiased” (Weber 1949 in Neuman, 2003: 497), while the idea of value-free research is disputed as being “a value in favour of ‘value free’”, and that it is used to disguise or hide scientists and professionals’ own values (Gouldner, 1976) in Neuman, 2003: 497).

Realising that it is virtually impossible to be totally value-free, Gouldner recommended that researchers make their own values explicit, and saw value in how researchers’ own values can motivate them to make a meaningful contribution: “The researcher who is motivated by a strong moral desire to effect change need not invalidate good research practice” (Neuman, 20013: 497).

Another suggestion comes from Patton (2002: 51), who says that credible research requires a “stance of neutrality” regarding the phenomenon being studied. This means that the researcher does not attempt to prove any perspective, or does not attempt to arrive at “predisposed truths”, but has the intention to understand what is being studied, with all its complexities and the multiple perspectives related to the phenomenon.

Perhaps the proposition that social researchers should “adopt a relational position – a position apart from any specific social group, yet in touch with all groups” should be considered (Mannheim, 1936 in Neuman, 2003: 497 – 498).  A relational position requires social researchers to be somewhat detached, or marginal in society, albeit with “connections with all parts of society, even parts that are often overlooked or hidden.” Roughly translated in plain language, this could mean “on the outside looking in”.

In the diverse South African society, where all are affected and influenced in some way by the history of the country, and where many issues are highly politicised, it is particularly relevant for researchers and evaluators to engage in discussions on values, and positioning, and perhaps to define what “relational positioning” means in the South African context, and what we can contribute to society through our unique positioning. This discussion could be useful to interrogate the potential contribution of social research, and particularly evaluation, in an evidence-based policy environment.    

  But before we start with this serious and important discussion – enjoy February, and happy Valentine’s day.

Fia van Rensburg is a Senior Evaluator at Creative Consulting & Development Works



Neuman, W.L. 2003. Social Research Methods. Qualitative and Quantitative Approaches. 5th Edition. Pearson Education. Boston.

Patton, M. Q. 2002. Qualitative Research & Evaluation Methods. 3rd Edition. Sage Publications. London.

Peck, R., Olsen, C. & Devore, J. 2012. Introduction to Statistics & Data Analysis. 4th Edition. Brooks/Cole. Australia.  

[1] Systematic data collection procedures, rigorous training, multiple data sources, triangulation, external reviews etc.