Last week, experts from around the globe traveled to Washington to discuss an issue critical to the health of millions around the world—access to reproductive health supplies, notably contraceptives and condoms.  At the invitation of USAID, the Reproductive Health Supplies Coalition (RHSC) gathered to strategize how to build support for reproductive health supplies in a time when the development agenda of donors and country governments continues to expand.              

 

The RHSC is a global partnership dedicated to making essential reproductive health supplies universally available. PAI, a founding member, currently chairs the Coalition’s Resource Mobilization and Awareness Working Group, which is dedicated to achieving political support and increased funding for reproductive health supplies at the global, regional and country levels. In addition, two other working groups focus on strengthening the logistics systems for delivery of reproductive health supplies and on addressing the diverse contributors to the market for reproductive health supplies, especially the private sector.

 

Last week’s RHSC meeting brought together dozens of representatives of the Coalition’s partners among bilateral and multilateral donor agencies, international institutions and non-governmental organizations. During the meeting, the Coalition welcomed a group of representatives from countries across the Latin America and Caribbean (LAC) region, who shared their experiences with the transition toward national support for reproductive health supplies. Many of the LAC country representatives spoke of how non-governmental organizations (NGOs) had “paved the road for contraceptive access” in their countries by helping create demand, disseminating information, providing technical assistance to governments and ensuring political commitment through strong advocacy.

 

Access to reproductive health supplies—including condoms and contraceptives—can alleviate unnecessary hardship among so many in the developing world.  When men and women have access to modern contraceptives and condoms, they reduce their risk of HIV infection, unintended pregnancies, abortions and maternal mortality.  The RHSC is helping to make these life-saving supplies more readily accessible.  But the coalition cannot act alone.  While USAID is the world’s largest bilateral donor of contraceptives and condoms, the support of the U.S. government for reproductive health and contraceptives has waned.  Funding for family planning has declined by a staggering 41% (adjusted for inflation) since 1995. As Congress makes the final determinations for the FY2008 budget, including the annual appropriation for international family planning, it must support robust funding for the programs that save so many lives overseas.  Thanks to the work of partnerships such as the RHSC, we are reminded of the critical need for ongoing advocacy for the programs and supplies that make women’s lives safer and are a fundamental human right.

 

Over half a million women worldwide die every year in pregnancy or childbirth—largely from preventable causes.  In the developing world, pregnancy remains the leading killer of women in their reproductive years.  And for young girls between the age of 15 and 19, their chance of dying in childbirth is twice that of their peers in their 20’s.  In order for countries and donors to address global priorities like poverty eradication, HIV cessation, and economic growth, strong political will to improve the sexual and reproductive health of women is paramount.   

 

PAI’s new report, A Measure of Survival: Calculating Women’s Sexual and Reproductive Risk, ranks 130 developing and developed countries according to sexual and reproductive risk.  The report, released last week during the Women Deliver conference in London, illustrates the harsh reality of being a poor woman in a poor country.

 

A Measure of Survival documents the continuing stark disparities in reproductive risk between wealthy countries and poor ones.  Niger, Chad, Mali, Yemen and Ethiopia are among the countries where women are at the highest sexual and reproductive health risk. For many, a skilled attendant at childbirth can make the difference between life and death.  In Ethiopia, which has the lowest rate of births attended by a skilled health personnel, 90 to 95 percent of women deliver at home and are two or more hours away from a health facility.  Unsurprisingly, maternal death and infant mortality rates in Ethiopia are both needlessly high.

 

Overall, the number of women who die from pregnancy-related causes is over 250 times higher in developing countries than in developed countries.  Even more astonishing, these deaths are largely preventable.  In fact, voluntary family planning programs can reduce the number of maternal deaths by reducing unwanted pregnancies and preventing women from seeking often-unsafe abortion.

 

Ten years after publishing these rankings for the first time, the story still has the same grim ending: Women are dying needlessly.  We should be long past the point of measuring the well-being of women in 18th century terms—by their chance of survival.  By investing in women and their health now, we can help save lives.  Only then will we begin to measure women’s well-being in terms of the number of girls in school, the number of women in the workforce, and the number of women and children who are healthy.

“The impact [of the Global Gag Rule in Ghana] was immediate, deep and damaging,” — Matilda Owusu-Ansah of the Planned Parenthood Association of Ghana (PPAG).

 

At a heavily attended briefing in Congress last week, renowned experts Dr. Joachim Osur, of the Ipas African Alliance, and Matilda Owusu-Ansah, formally of the Planned Parenthood Association of Ghana (PPAG), addressed the damaging effects of the Global Gag Rule—highlighting the real, direct, and, more often than not, deadly impact of this policy in their respective countries.

 

According to Ms. Owusu-Ansah, PPAG, the largest provider of family planning services before imposition of the Global Gag Rule, lost all USAID family planning funding.  Within one year, their condom distribution fell by 40%.  With limited access to reproductive health supplies and services, the number of unintended pregnancies increased dramatically, as well as the number of new sexually transmitted infections. 

 

In Kenya, the effects of the Global Gag Rule have been equally detrimental. When the policy was reinstated, Dr. Osur was working for the Family Planning Association of Kenya (FPAK).  When FPAK refused to sign, they immediately lost 58% of its annual budget.  These budget cuts forced the closure of eight of FPAK’s 16 clinics, leaving 100,000 women without access to reproductive health services—including the contraceptives that would help them avoid unintended pregnancies, abortion and STIs.

 

According to the Bush administration, the Global Gag Rule was reinstated in 2001 to prevent abortions worldwide.  In reality, the effect has been quite the opposite.  In addition to creating contraceptive shortfalls and closing reproductive health clinics, Ms. Owusu-Ansah reported that PPAG saw at 50% increase in the number of women who came to their clinics for post-abortion care.  By denying access to reproductive health services and contraceptives, the number of unintended pregnancies grew, often leading to abortion.

 

Our African colleagues gave this Congressional audience a sobering wake-up call:  Women are dying from causes that, with the use of contraceptives and other family planning services, are preventable.  While Congress voted to repeal this deadly policy in the State-Foreign Operations Appropriations bill, the President is threatening to veto it, perpetuating the Russian roulette these women play with their lives each day they are denied access to family planning. Mr. President, we urge you to sign this bill.  It’s time to give reproductive health back to the hundreds of millions of women whose lives literally depend on it.

PAI’s recent study, The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World, was a hot topic in Washington last week when it drew a panel of experts to the Woodrow Wilson International Center for Scholars. The experts, including a Member of Congress and the heads of the Henry Stimson Center and the Population Reference Bureau, agreed: Demography can often be a powerful indicator for international development.

 

The Shape of Things to Come offers compelling evidence that a country’s age structure—the size of specific age groups relative to the population as a whole—has a significant impact on its stability, governance and economic development.  While young people are a tremendous asset for any society, countries with very young or youthful age structures have historically faced the greatest challenges in terms of development and stability.  Currently about sixty countries have a “very young” age structure, including Afghanistan, Ethiopia, Haiti, and nearly all of sub-Saharan Africa.  The findings of PAI’s report reaffirm that investments in education, health care and economic opportunities for young people in these countries is critical to these nations’ development.

 

Congressman Russ Carnahan (D-MO), a member of the House Foreign Affairs Committee who spoke at the Wilson Center event, described The Shape of Things to Come as a valuable resource for policymakers because it provides compelling information on how age structure and population dynamics affect development.  Congressman Carnahan urged other policymakers to use the findings of PAI’s study to highlight approaches through which developing countries with very young age structures can meet the challenges they face and help their citizens live longer and healthier lives.

 

Today, a critical opportunity to make a difference in the lives of millions of women and young people around the world exists in the annual foreign assistance (State-Foreign Operations Appropriations) bill pending before Congress and President Bush.  As passed by Congress, this bill overturns the Global Gag Rule and expands access to contraceptives in poor nations.  Such a policy shift would greatly benefit the hundreds of millions of women in developing countries who lack access to contraceptives and other basic reproductive health care. Unfortunately, President Bush has threatened to veto the entire foreign assistance bill over the life-saving, anti-Global Gag Rule provisions

 

As The Shape of Things to Come makes clear, age structure matters to development. And the good news is that demography is not destiny. More balanced age structures can be achieved through popular and effective policies backed by sufficient funding and political commitment. Most importantly, these investments in the health, education and well-being of women and young people are time-tested, cost-effective, and grounded in human rigpopact—and they can truly impact the shape of things to come around the world.

While today technically marks the first day of the government’s fiscal year, the budget is still tied up in Congress’s lengthy appropriations process. Looming over the new budget is the President’s threat to veto a number of appropriations bills because of disagreements over funding and policy issues. Among those issues he opposes are provisions in the State-Foreign Operation Appropriations (foreign assistance) bill that repeal the destructive Global Gag Rule and expand access to contraceptives in poor nations. Tragically, the President has vowed to veto the entire $34 billion foreign assistance bill— containing critical funding for HIV/AIDS prevention and treatment, humanitarian and peacekeeping programs in Darfur, and famine relief—because of these pro- family planning provisions.

For the first time in recent history, the House and Senate have united in support of the pragmatic "prevention first" policy that is favored by most Americans and backed by strong evidence. Both the House and the Senate have voted in favor of provisions that exempt contraceptives from the Global Gag Rule. Democrat and Republican Members of Congress on both sides of the abortion issue endorsed this common-sense measure, recognizing that it will save the lives of women and children and help reduce unintended pregnancies. The Senate went a step further and repealed the Gag Rule entirely.

Since the Global Gag Rule was reinstated by President Bush in 2001, shipments of U.S.-donated contraceptives have been stopped to 20 developing countries in Africa, Asia and the Middle East. In addition to this devastating impact, dozens of family planning providers in poor, developing nations have lost U.S. funding and technical assistance, forcing them to scale back services, lay off staff, and even close their clinics altogether.

The anti-Gag Rule provisions passed by Congress will bring relief to the tens of millions of poor women overseas who have been victimized by these draconian policies and who lack basic reproductive health care, including contraceptives. The President should sign these provisions into law rather than reward a small but influential group of anti-birth control extremists in his own party and jeopardize such an important bill. Mr. President, the choice is clear.