Male circumcision, which has been shown to reduce a man’s risk of contracting HIV by up to 65%, should be made available in countries highly affected by AIDS, according to the WHO and UNAIDS. Used in addition to other proven HIV prevention methods – especially those focused on protecting women – circumcision is proving to be another effective weapon to fight the spread of HIV; the latest tool in a growing arsenal of prevention methods that will face limited prevention resources due to the large abstinence-until-marriage spending requirement in PEPFAR. This earmark should be repealed to give countries that have the most to gain by promoting circumcision adequate resources with which to support this effort.

For male circumcision to make the largest impact in curbing the spread of HIV/AIDS, it must be part of a broader campaign to prevent infection. The WHO and UNAIDS have recommended that the procedure be offered in conjunction with other prevention programs, including promotion of safer sex practices and condom distribution. Because male circumcision has not been shown to be an effective protective measure for women, it is crucial that it not replace elements of prevention that are geared toward stemming the skyrocketing HIV infection rates in women. Male circumcision’s impact on HIV prevention offers exciting new possibilities for saving lives, but a procedure that can only help half of the population is not enough. It must be part of a comprehensive prevention program that empowers both men and women with the ability to protect themselves in the best ways possible.

Comprehensive, evidence-based approaches to HIV prevention are the most effective in curbing the spread of HIV, but they are also extremely hindered by the abstinence-until-marriage spending requirement in PEPFAR. By limiting the percentage of prevention funding that can be spent outside of abstinence-until-marriage programs, PEPFAR constrains countries’ ability to design programs tailored to their country needs, putting those programs most likely to work out of reach of the people who need them. As new prevention methods are discovered, including male circumcision and microbicides, the abstinence-until-marriage spending requirement forces them to compete against one another for an ever-shrinking supply of funds.

PAI urges Congress to pass the PATHWAY Act that would overturn the abstinence-until-marriage earmark in PEPFAR. When the U.S. is ready to support male circumcision and other evidence-based prevention methods – and we hope that will be soon - it must do so with adequate resources.

As we celebrate the 37th Earth Day, the world is increasingly—albeit belatedly—focusing on how to address the growing problem of human-induced climate change and the environmental destruction that contributes to it. One critical, but often overlooked, part of any comprehensive program to tackle climate change is addressing gender inequality—particularly in terms of reproductive health—in the developing world.

The interconnections between the status of women and environmental sustainability are significant. For example, more than 200 million women in poor, developing nations wish to delay or end childbearing but lack access to modern contraceptives. In countries such as Ethiopia and Pakistan, more than one-third of married couples have this “unmet need” for contraceptives. This deprivation of basic reproductive rigpopact—which often leads to larger than desired family size—takes a heavy toll on women and results in rapid population growth. As a result, the burden on the global environment and the destruction of natural resources are made even worse.

Currently the world adds 6.3 million people a month and is on track to add another 2.5 billion people by 2050. It’s important to remember that these updated projections from the United Nations assume that birth rates will decline in the developing world. If birth rates remain static, the planet could easily add 5 billion people by 2050, creating a greater and more dire strain on the environment.

A 2005 documentary produced by PAI called “Finding Balance: Forests and Family Planning in Madagascar” profiles Voahary Salama, a local organization whose innovative approach is improving women’s lives and helping ease population pressures on the environment. Considering that 38% of pregnancies worldwide are unintended, providing women with the ability to determine the timing and size of their families can make a significant impact on global population growth. With greater access to reproductive health programs and services, women will live longer, healthier lives—increasing their children’s chances of survival—and population growth rates will slow.

Tragically, despite the need and demand for voluntary family planning, U.S. funding for these programs has been cut by 41 % (adjusted for inflation) since 1995, despite the fact that the number of women of reproductive age in the developing world has increased by 275 million since 1995. To make matters worse, President Bush’s proposed budget for next year recommends another massive cut of 25%.

This Earth Day, PAI challenges governments around the world to show a commitment to reversing human-induced climate change by supporting voluntary family planning programs. The lives of women and the future of the planet are at stake.

The World Bank has a long history of supporting and strengthening reproductive health. This is why the reproductive health community was shocked last week when allegations surfaced that the World Bank’s Health, Nutrition and Population Strategy may de-prioritize the importance of family planning and reproductive health services to development progress. Certainly we heard more substantiated rumors that references to family planning were expunged from key country development strategies, Madagascar most notably. Because these initiatives are crucial to attaining the Bank’s goal of eliminating global poverty, the World Bank must maintain and reaffirm their commitment to reproductive health when they review the Health, Nutrition and Population Strategy on April 24th.

In response to these concerns, World Bank President Paul Wolfowitz, stated, “I want to make it clear personally. I think reproductive health is absolutely crucial.” Family planning and reproductive health play a vital role in improving the lives of women and children, reducing poverty and curbing the spread of HIV/AIDS. In fact, the World Bank's own World Development 2007 report which cites increased access to comprehensive sex education, contraceptives and safe abortion as key factors to reduce poverty. Effective aid and donor assistance must take as its starting point tried and true development strategies, and one need look no further than the provision of family planning services within the broad spectrum of reproductive health to find such a strategy.

Here at PAI, we are heartened by Paul Wolfowitz’s statement, but we will also watch the April 24th meeting closely to make sure that actions follow these words. PAI urges the World Bank to keep reproductive health and family planning in the priority position they should occupy within the Health, Nutrition and Population Strategy. In addition, they must remain within country development strategies, which are a product of national-level stakeholder processes, particularly as the global donor community transitions from “donor-ship to country ownership.” Decisions based on anything other than facts and a strong evidence-base have no place in any global institution.

Investments in reproductive health programs and services can make countries “healthier”—more secure and peaceful, more democratic, and better able to provide for the needs of their citizens, according to a seminal new report from PAI. The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World examines the connections between demographics, reproductive health, international security, governance and other development issues. Programs that foster more balanced age structures—such as family planning, infant and maternal health, and girls’ education—must become a cornerstone of all international development assistance.

The Shape of Things to Come provides a new way of looking at the world, placing countries into one of four major age structures: very young, youthful, transitional and mature. These age structures indicate the comparative size of specific age groups relative to the population as a whole and each has its own attendant characteristics, benefits and risks associated with governance, security and economic development. It finds that countries with a more balanced age structure are more stable, democratic and highly developed.

Young people are a tremendous asset for any society, especially if they are educated, healthy, and living in a safe and equitable world. Investments in sound population and sexual and reproductive health and rigpopact policies can play a significant role in advancing global development—creating an environment where youth thrive.

Demography does not have to be destiny: Government capacity, policies and political commitment will always matter more than absolute numbers. By committing to improving women’s status in society and investing in voluntary family planning programs, nations can significantly impact the shape of things to come and build a healthier and more peaceful future for their citizens.

“I just heard of effective use of condoms, but I never knew how to use them.” These are the words of Juliet Awour, a Kenyan woman featured in PAI’s new documentary, Abstaining from Reality: U.S. Restrictions on HIV Prevention. Neither Juliet nor her boyfriend knew how to use a condom, so he took it off during sex. As a result, Juliet became pregnant and contracted HIV the first time she had sex. Her story illuminates one of the gravest problems with a U.S. HIV prevention strategy that teaches abstinence-only: What do individuals know about HIV protection when they are no longer abstinent? In Juliet’s case, not enough. The Protection Against Transmission of HIV for Women and Youth (PATHWAY) Act (H.R. 1713), reintroduced last week by Congresswoman Barbara Lee (D-CA) and Congressman Chris Shays (R-CT), is a step towards helping individuals like Juliet get the life-saving information and supplies they need. Unless Congress acts now, there will be many more Juliets.

Juliet’s story is just one example of how a lack of education can do tremendous harm. Programs that fail to educate young people—many of whom are married—about every method that can help protect them from HIV infection, including abstinence and condom use, are nothing short of irresponsible. Promoting abstinence-only over more comprehensive education is clearly preferred by the Bush administration. However, it is not an effective prevention strategy for every person in every situation. Instead of empowering women and girls with the information to protect themselves, these inadequate policies and programs are placing many lives at risk.

The PATHWAY Act would make comprehensive prevention information more widely available by eliminating the requirement in PEPFAR that one-third of all prevention funding to go toward abstinence-until-marriage programs—a policy rooted in ideology rather than reality. A recent Institute of Medicine (IOM) report agrees, “...congressional budget allocations have limited PEPFAR’s ability to tailor its activities to the local epidemic in each country and to harmonize with each country’s national plan.” U.S. prevention money would be better spent supporting comprehensive, evidence-based programs that reach more people and their evolving needs.

PAI strongly urges Congress to pass the PATHWAY Act. While we wait, more young women face insufficient knowledge about how to protect themselves from a fate all too similar to Juliet’s.