Over the last two years, the architecture of U.S. foreign assistance has undergone an unprecedented restructuring. At the same time, a congressionally-mandated commission on poverty-focused development has issued its report; a Senate staff delegation has conducted an extensive overseas fact-finding mission; and numerous nongovernmental organizations, think tanks, and presidential campaigns have issued policy prescriptions on the future of U.S. foreign aid. In all of these efforts, insufficient attention has been paid to the implications of actual and proposed changes in the U.S. foreign assistance program to the future priority and funding of family planning and reproductive health (FP/RH) care overseas-highly successful and cost-effective programs that have received U.S. government funding since the 1960s.

Country stakeholders – governments, parliamentarians and civil society – have always been challenged by a limited ability to influence decisions made at the international level. With international donors now seeking to move decision-making and ownership to the country level, we have a remarkable opportunity to establish a transparent, participatory and inclusive process. This is particularly critical to the SRHR community which, due to the often controversial nature of the work, requires institutionalized processes as well as strong, well-informed champions, to ensure that its concerns are adequately funded in development strategies.

Weak infrastructure and limited distribution systems in low-income countries complicate access to health services, especially in rural areas. Government health outlets may be relatively few and widely dispersed, and private-sector sources often favor wealthier urban areas, resulting in uneven service availability within a country. In the absence of a solid heath infrastructure, strengthening primary health care and innovative community-based health service delivery systems help provide more equitable access to health services.

HIV prevention has long been approached at the level of individual behaviors, operating to some extent under the assumption that behavior is determined by a person's conscious decisions. However, a paradigm shift toward considering the physical and social environments in which individual HIV risk behavior takes place is gradually gaining momentum. These structural factors-whether political, economic or cultural-may directly or indirectly affect an individual's ability to avoid exposure to HIV.1 The Dominican Republic offers an example of this progression from successful individual HIV behavioral interventions among sex workers, toward broader community approaches and policy initiatives.

With the largest population in Africa, Nigeria's political and economic developments reverberate across the continent. Nigeria chairs the Economic Community of West African States (ECOWAS) and is the eighth largest oil exporting country in the world. More than 40 percent of the region's gross domestic product is accounted for by Nigeria's economy, and the petroleum industry is responsible for about two-thirds of national revenue and a great deal of international interest in the country. Yet the government maintains a delicate hold on democracy, and the country has recently experienced political instability. Throughout 2006, militant rebels angry about the distribution of oil revenue have conducted a series of attacks against the industry, including kidnapping foreign workers, which resulted in the country's petroleum output dropping by 25 percent.

Whatever one's view about population as an issue, few people fervently wish the world were home to a lot more human beings than it is. Some may wonder if another Mahatma Gandhi or an Albert Einstein or a Mother Theresa missed out on being born due to the declining global birthrates of the past few decades. But most know that such a question is fundamentally unanswerable and don't stay awake at night thinking about it.

New foreign assistance strategies that aim to encourage ownership by recipients while still effectively reducing poverty are laudable. They offer the hope of increased financial support to overall global development-a bigger pie-but they also pose significant challenges to the family planning field: Will it be able to keep a slice of that pie?

A generation has passed since the onset of the HIV/AIDS pandemic. During this time, 65 million people have been infected with HIV and more than 25 million people died of AIDS. Despite the devastation, many countries, using a variety of interventions, have been successful in slowing the spread of the virus. The interventions that have been most successful are those that are congruent with the local epidemiology. With the overall HIV/AIDS epidemic being composed of a series of smaller local epidemics interconnected by space or time, a range and mix of responses in the fight against HIV/AIDS is necessary. And the relative impact of each response will always depend upon the level, stage and pattern of the epidemic in each locale. Therefore to be effective, interventions should respond to local needs.

Donor assistance for population, reproductive health and HIV/AIDS programs continues to increase, but the benchmarks used to assess performance have not changed since 1994. Those who monitor donor performance say that current assistance is not sufficient and that the benchmarks need to move upwards. This review of recent efforts to revise cost estimates for reproductive health and HIV/AIDS services concludes that $35 billion to $45 billion annually will be needed from all sources over the next few years. At the same time, further research is needed to improve the accuracy of such estimates.

Britain's recent pledge of US$15 billion to fund education in developing countries over the next ten years comes as good news for the estimated 493 million school-age children who are not enrolled in school, the majority of whom are girls. The gender gap-the difference between boys' and girls' school enrollments-is an indicator of gender equity and of a country's level of development. The gap is widest among countries in sub-Saharan Africa and a few Asian countries, including Yemen and Pakistan. Education has a profound impact on the future course of women's lives, influencing employment opportunities, earning potential and political participation. Access to quality education is also one of the best defenses against HIV infection, providing young people with the skills and knowledge to make informed decisions. Education is especially critical to HIV prevention in girls, as it reduces the power imbalances and social and financial dependencies that typically make females more vulnerable to infection. Moreover, a large body of evidence suggests that education of girls is associated with their roles in family decision-making and patterns of childbearing, resulting in improved maternal and child health, improved childhood nutrition, higher educational attainment among children, and a lower likelihood of experiencing unwanted and high-risk pregnancies.