Assessing U.S. Policy in Zambia

In March, a policy research team from PAI and SIECUS traveled to Zambia to document how U.S. family planning and reproductive health and HIV/AIDS assistance and policy are playing out. Zambia was one of the original Global Gag Rule Impact Project study countries and is currently a PEPFAR focus country. Our purpose was three-fold: 1) to document the ongoing impact of the Global Gag Rule and the general state of sexual and reproductive health and rights in Zambia; 2) to examine how U.S. HIV prevention policies (abstinence-only, condoms, anti-prostitution pledge) are interpreted and implemented; and 3) to explore sexual and reproductive health and rights advocacy opportunities with Zambian NGO partners.

Overall, sexual and reproductive health and rights appears to have completely fallen off the national agenda in Zambia. The Global Gag Rule has weakened Zambia's leading NGO reproductive health provider and community-based outreach of family planning/reproductive health has collapsed. Demand for family planning is up while contraceptive stock-outs are increasingly frequent. Preliminary findings from the long-awaited 2007 Demographic and Health Survey (DHS) are due out next month and, based on comments from most interviewees, they expect to see little progress. Several NGOs noted that there's donor support for family planning and reproductive health "awareness raising" but no services or supplies to meet growing demand. Ironically, the U.S. is the largest bilateral family planning and reproductive health donor in Zambia (just shy of $6 million in fiscal year 2007) yet it is narrowly directed toward technical assistance to the public sector because of the Global Gag Rule restrictions.

HIV/AIDS is disturbingly viewed as completely separate from sexual and reproductive health and rights despite surveillance data showing women, especially young women, bearing the brunt of the epidemic—the abstinence-only message is loud and constant due to PEPFAR, reported interviewees. As we've noted in other focus countries, PEPFAR-supported abstinence and be faithful activities in Zambia appear to overwhelmingly target young girls. We encountered considerable confusion among PEPFAR grantees around condoms—what information they could provide, whether they could distribute them to young people, and so forth—and we clarified U.S. policy on the promotion and distribution of condoms for NGOs whenever possible. Zambia's National AIDS Council is developing a comprehensive HIV prevention policy that by all accounts will offer a timely and interesting contrast to current U.S. policy.

On the anti-prostitution pledge, interviewees commented that U.S. policy and programming had shifted away from sex workers and clients along major border crossings and trucking routes. "We're losing ground in addressing needs of at-risk groups, which we thought were target populations under PEPFAR," lamented government agency senior staff. That other donors and Zambian government officials view PEPFAR as operating independently (even within the universe of U.S. health assistance) and with its own political agenda came as no surprise. In Zambia as in other countries, one cannot help but tap into growing frustration among local NGOs that PEPFAR funding is far beyond their reach and in reality, is intended not for them but for U.S. NGOs. That all our talk about "capacity building" is just that, talk.

Stay tuned...PAI and SIECUS are planning a briefing on Capitol Hill to share policy research findings, as well as prepare written analyses for advocacy with both U.S. and Zambian policymakers.  Meanwhile, PAI is working on a small advocacy grant to a group of local NGOs to kick-start basic sexual and reproductive health and rights advocacy there.