Originally posted on the Huffington Post

A colleague on maternity leave recently sent an e-mail saying what an incredible experience pregnancy is and how she can't help thinking of the millions of women who go through it without the support we take for granted in the U.S. "Here I am focusing on tummy time and music groups; talk about perspective when you consider that more than half a million women die every year during pregnancy and childbirth because they don't have access to the simplest of health services and supplies."

by Suzanne Ehlers

The 5th Asia and Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR) is currently underway in Beijing, China. Today, I am moderating a session co-hosted by the Asia Pacific Alliance (APA) and Japan International Cooperation Agency (JICA). The session, titled Meet the Donors, explored resource mobilization and Millennium Development Goal 5 (improving maternal health) through the lens of a theme raised in the day's opening sessions: In a climate of continuing financial gloom, how is it that an intervention as cost effective as family planning and reproductive health is still having difficulty mobilizing adequate resources?

by Clive Mutunga

In spite of all of the uncertainty leading up to the Copenhagen climate talks in December, one thing is clear: Adaptation needs are the most urgent in the least developed countries. These countries are expected to feel the brunt of climate change impacts: drought, floods, extreme weather, changing disease vectors, declining agricultural production - despite having contributed the least to it. For people in countries most affected by climate change, finding and supporting adaptation strategies that strengthen people's resilience and ability to cope with the effects of changes in climate is critical. My colleague Karen Hardee and I explored these issues and how population fits in our recent study, Population and Reproductive Health in National Adaptation Programs of Action for Climate Change.

Originally posted on feministing.

When I graduated from high school in San Antonio, Texas, I can remember at least two dozen girls (out of a class of 600) pregnant or already with babies. It may seem astonishing now, but it was fairly normal in 1991: so normal, in fact, that our high school had responded with an academic track geared toward expectant and young mothers.

Based on this history, I wasn't totally shocked to learn that President Bush's abstinence-only program led to a 57 percent rise in student pregnancy in the Lone Star state.

Kirana Bammarito is PAI's Communications Intern. She is a recent graduate of American University.

August 12 will mark the tenth International Youth Day as commemorated by the United Nations. In the United States, youth triumphs and tragedies alike have occurred during the past year. November saw the exciting, social-media-driven election of President Barack Obama with July revealing the dismaying, but not surprising, report that declining teen pregnancy and STI rates either stalled or reversed during the Bush years. Rates in the South, where authorities tout abstinence and religion as perfect sex education, are of course, the highest.

Kame Westerman is PAI's Climate Change Intern. She is a current graduate student in Sustainable Development & Conservation Biology at the University of Maryland.

As an environment volunteer with the Peace Corps, I was given the task of visiting outlying villages and promoting sustainable agricultural techniques - the hope being that with increased agricultural efficiency and sustainability, there would be less need to harvest from the surrounding forests.  Yet as I quickly came to understand, sustainable agricultural techniques are a moot point if the regions' unsustainable fertility rate of just over five children per woman continues.

First published in The New Security Beat

Every day it seems the headlines bring new worries about the future of Pakistan. But among the many challenges confronting the nation--including a growing Taliban insurgency--one significant problem remains largely undiscussed: its rapidly expanding population.

Originally published in The Huffington Post

Have you seen the ads? They seem to be everywhere -- from the Washington Metro system's billboards, to the New Yorker and Roll Call.

"9 billion people to feed. A changing climate. NOW WHAT?"

While focused on biotechnology, the ad (sponsored by Monsanto) does point to a key challenge in the years ahead: namely, the need to double agricultural output by 2050 to feed a rapidly growing world.

by Suzanna Dennis & Susan Anderson

Writing from the United Nations

"I am honored to be here today to express the renewed and deep commitment of the United States Government to the goals and aspirations of the ICPD Program of Action." With these words, Margaret Pollack, head of the US Delegation to the United Nations Commission on Population and Development (CPD) ushered in a new era of US engagement on reproductive rights at the UN. The US CPD statement is another signal of the new course the Obama Administration is steering America's policy on reproductive health. Finally we are heading in the right direction again.

I have just concluded a nine day visit to Uganda to research the connections between population dynamics and development. This connection has been made by PAI and others on the global level but we have yet to discern how this plays out in individual countries. Uganda has one of the fastest growing populations in the world and 50 percent of its population is younger than 15 years old. How do you educate all these children? On paper, the intentions are very good. The government has supported free primary school for quite some time already and more than two-thirds of the population is literate. Recently, a bill that will allow free secondary education was passed by the Ugandan parliament.

As a librarian for over 30 years, I’ve seen my share of April Fools jokes. But this year’s seemed more outrageous—and less funny—than in previous years. A librarian at the University of California/San Francisco Medical Center sent an inquiry to staff at the Johns Hopkins University School of Public Health when she found discrepancies in POPLINE searches that included the term “abortion.” On April 1, she received the following response from Debbie Dickson at POPLINE:

“Yes we did make a change in POPLINE. We recently made all abortion terms stop terms. As a federally funded project, we decided this was best for now. In addition to the terms you’re already using, you could try using ‘Fertility Control, Postconception.’ This is the broader term to our ‘abortion’ terms and most records have both in the keyword fields…”

In effect, the word “abortion” was downgraded from a medical search term to the status of words such as “a” and “the.”

This had to be a misguided attempt at an April Fools joke! POPLINE (POPulation information onLINE), is “the world’s largest database on reproductive health, containing citations with abstracts to scientific articles, reports, books, and unpublished reports in the field of population, family planning and related health issues.” It’s maintained by the INFO Project at the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs and is funded by USAID.

I subsequently discovered that the timing was pure coincidence, and this was no joke. Apparently, the POPLINE database includes a number of articles on abortion law reform. Years ago a decision had been made by USAID to strongly encourage its grantees to scrub their websites and publications of material offensive to the delicate sensibilities of Bush political appointees. Now the repercussions of that decision are clear; USAID has been compelled to enforce this policy of censorship. And POPLINE is feeling the long arm of the federal government reaching into its academic research collections.

Johns Hopkins is a university that openly prides itself on “securing more federal research funding than any other university.” Understandable, in the day—not so long ago—when scholarship, libraries, and federally-funded research aligned harmoniously behind the principles of free and open access to information, and of commitment to learning built on the sum of human knowledge. This setback at POPLINE represents more chipping away at these foundational principles, and—even more alarming—turns a fundamental principle of democratic governance on its head: Whereas there has always been the possibility that private sources of funding carry the risk of private bias or censorship, slant or “spin”, public funding has always presupposed protection of the free flow of information and ideas. This is fundamental to a democratic society.

Such an Orwellian act runs counter to everything I learned in history class and in my graduate library programs. How is it possible for “the world’s largest database on reproductive health” to remove the word “abortion” as a search term? What does it say about our government’s lack of respect for freedom of speech and for scientific and academic integrity? What are they afraid of, and why are users of this database not trusted to have access to comprehensive information on abortion?

Not only is Big Brother watching you, but he is afraid to let scientists, researchers, students—and even librarians—have access to honest and evidence-based information. As a librarian, I am outraged that I am being asked to sacrifice everything I learned to the altar of the Bush Administration’s ideology. Censorship is always the antithesis of freedom. Please join me in alerting the world to this latest breach of trust with the American people.

—Mary Panke, Director of Knowledge Resourcing, PAI

 

More than two months after the beginning of the new 2008 fiscal year, the White House and Congress have finally reached agreement on a massive FY 2008 omnibus spending bill. Here is a summary of the international family planning and reproductive health (FP/RH) issues within the foreign assistance provisions of the bill:

Funding—The omnibus spending bill includes $461 million for U.S. international FP/RH programs. This is the higher level that was contained in the Senate bill and represents an increase of $21 million above current levels and a more than 25 percent increase above the amount requested by the President.

Global Gag Rule—Disappointingly, the measure approved by both the House and Senate to provide an exemption from the Global Gag Rule—enabling foreign family planning organizations otherwise ineligible for U.S. FP/RH assistance to continue to receive U.S.-donated contraceptives—was dropped by congressional negotiators in the face of an unwavering veto threat from the President. Regrettably, the Senate-passed amendment to fully overturn the Gag Rule also suffered the same fate.

PAI President and CEO Amy Coen had this to say upon hearing the news:

"We commend members of Congress—on both sides of the abortion debate—for finding common ground to improve the lives of women and their children, thus reducing unintended pregnancies, abortion, and HIV infection through greater access to contraceptives. It is tragic that President Bush was unable to follow their lead. His persistent threat to veto the foreign assistance bill doomed this life-saving measure. It is unconscionable for a president to ignore the majority of the members of Congress, the majority of Americans and the best interests of millions of human beings because he is blinded by his own narrow beliefs. Today the shadow of one man darkens the lives of so many."

UNFPA—The omnibus spending bill provides a U.S. contribution to the UN Population Fund of $40 million. The overall contribution level reflects a $6 million increase about the $34 million approved by Congress in FY 2007. The UNFPA contribution still remains subject to the existing "Kemp-Kasten" restriction, which has been interpreted by the Bush administration to deny more than $150 million in funding to UNFPA for the last six years. However, the spending bill includes House-passed language requiring a Kemp-Kasten determination with six months of enactment of the bill and stipulating that the decision must be accompanied by a comprehensive analysis and the evidence used in making the determination. In addition, the bill includes a requirement that any amount withheld from UNFPA under Kemp-Kasten be reprogrammed to USAID for bilateral "family planning, maternal, and reproductive health activities."

Abstinence Earmark—Lastly, and on a very positive note, the omnibus spending bill also contains a provision approved by both the House and Senate nullifying the "abstinence-until-marriage" earmark of bilateral HIV/AIDS prevention funding. By waiving this destructive restriction mandating at least one-third of all HIV/AIDS prevention funding be limited to abstinence-until-marriage programs, this measure will provide much-needed flexibility to the federal Office of the Global AIDS Coordinator (OGAC) in programming prevention funding in developing countries.

Tomorrow, on World AIDS Day, let's talk about sex.  80% of new HIV infections are sexually transmitted; let’s stop pretending that sex isn’t happening and start making it safer.

This World AIDS Day—and every day after—we need to talk openly and honestly about how to stop the spread of HIV.  We need to ensure that all women have the ability to make choices about their own sexual and reproductive health.  Both men and women need to have access to the contraceptive supplies they need to protect themselves.  Men, women and couples of all ages must be educated about how HIV is transmitted and how to best protect themselves: reducing the number of sexual partners, using a condom every time they have sex, and being aware of their HIV status.  We need to encourage men to be involved in their own sexual health and that of their partners.  And, HIV positive women need to have access to the tools they need to be sexually healthy and make choices about if and when to have children.

When a deadly disease such as HIV/AIDS is transmitted largely through sex, we can't afford to be shy.  We have let ideology and fear curb a global conversation about the reality of how this epidemic continues to spread, and history will judge us harshly for it.   Let’s stop this deadly trend and make sex safer for men and women around the world.  It’s World AIDS Day; let’s talk about sex.

Question: What do you do with a $100 million U.S. government program that isn’t working?  The answer; you fix it.  Abstinence and be-faithful programs for youth in the President’s Emergency Plan for AIDS Relief (PEPFAR) are not meeting the needs of sexually active and at-risk youth, according to a government-commissioned evaluation that took place in March.  Eight months later, no plan has been put into place to address these flaws—endangering the millions of young people these programs are supposed to help protect. 

 

In July, the Chairman of the House Oversight and Government Reform Committee, Henry Waxman; Chairman of the House Foreign Affairs Committee, Tom Lantos; and member of the exclusive House Appropriations Committee, Congresswoman Barbara Lee—all champions of evidence-based HIV prevention—sent a letter to Mark Dybul, US Global AIDS Coordinator at the Department of State, asking how PEPFAR planned to respond to the serious concerns raised in this report.  Dybul’s response gave no indication of a plan to address the gaps the evaluation found and offered no evidence of the effectiveness of these abstinence and be-faithful programs.  Last month, Reps. Waxman, Lantos and Lee wrote to Mark Dybul again, reiterating the need for a plan to address the shortfalls in PEPFAR’s youth programming. How many letters have to be written when people's lives and wellbeing are at stake? 

 

For every person who gains access to HIV treatment, six more become infected with this deadly disease. PEPFAR cannot afford to support anything less than sound, evidence-based prevention programs if we truly intend  to stop this epidemic.  There simply isn’t enough funding to spend $100 million on a program with harmful flaws.  While PEPFAR’s administrators write letters, young people are at risk of contracting HIV because they don’t have access to the education and supplies that they can use to protect themselves.

 

Through programs funded by PEPFAR, the U.S. has made a historic commitment to the prevention, care and treatment of HIV/AIDS.  But this financial commitment is dwarfed in size by the global need for these services.  PEPFAR has a responsibility to ensure that all their programs, including abstinence/be-faithful programs, are addressing the needs of their target audience— youth, including those who are sexually active.  If programs cannot meet this basic requirement, it’s time to find a more effective investment for U.S. dollars.

“For every person who began antiretroviral therapy in 2006, six people were newly infected,” according to a new report from the Global HIV Prevention Working Group.Without a major scale-up of HIV prevention programs, using existing prevention tools, 60 million more HIV infections are projected to occur by 2015.  The best of the best have confirmed what many knew to be true: Only by significantly ramping up HIV prevention programs can we curb the scourge of HIV/AIDS. If the world does not listen, and new HIV infections continue to grow as they are, we'll have no one to blame but ourselves.  The members of this group  are the most knowledgeable experts on HIV prevention in the world and they have rung an alarm bell that world leaders must heed in order to put an end to the HIV/AIDS epidemic. 

 

Countries such as Haiti and Kenya have seen early success from a scale up of their HIV prevention programs, as reported by the Prevention Working Group. Haiti has seen a drop in HIV prevalence among pregnant women (from 6% to 3.4% between 1998 and 2004). In Kenya, HIV prevalence among adults fell dramatically, from 10% in the late 1990s to 6.1% in 2005.  But, with the populations of Haiti and Kenya projected to double in 43 and 27 years, respectively, how can this progress possibly continue?

 

HIV prevention and family planning should go hand in hand. Voluntary, non-coercive family planning programs, including access to contraceptives, help HIV positive women avert unintended pregnancies, while programs that promote condom use not only reduce unintended pregnancies, they also prevent the spread of HIV and other sexually transmitted infections between sexual partners.

Tragically, however, family planning has played a diminishing role in the U.S. response to this epidemic. President Bush’s fiscal year 2008 budget request slashed international family planning assistance to Kenya and Haiti (as well as to six other PEPFAR focus countries) in half.  Meanwhile, populations are growing rapidly, HIV/AIDS continues to spread, and demand for family planning and HIV prevention and treatment programs continues to rise.

 

Ultimately, the success of our global effort to eradicate HIV/AIDS is two fold: we must scale-up prevention programs while simultaneously increasing access to family planning programs. While a stronger commitment to preventing new infections is paramount —and PAI joins the Prevention Working Group in calling for this—we will never get ahead of the race to end this deadly disease if people don’t have the tools to determine their own fertility.

 

PAI urges the U.S. and other nations to rapidly step up funding for HIV prevention and family planning programs. Ideology must be set aside in favor of heeding the warnings and advice from the experts.

Too often, it is women who make—and disproportionately bear the brunt of— reproductive health decisions on behalf of a couple.  Women are the ones who risk dying from complications in pregnancy and childbirth.  And if a mother dies, her daughters—not her sons—tend to be the ones who leave school to care for their families. Sadly, men more often hold the power in decision making, both at a personal and at a political level. PAI urges men to be the strongest allies in improving the health and well-being of women— whether as partners or politicians—by engaging in the fight to save the lives of their wives, sisters, daughters, mothers and other women in their community.

 

This year, World Population Day focused on the role of men in maternal health—emphasizing reproductive health as a goal that both men and women want and need. The role of men is crucial according to Amy Coen, President and CEO of PAI, who stated, “Women cannot win this war—a war in which they suffer poor health at the hands of inequality— without the help of their partners, husbands, and fathers.”

 

By promoting sound policy, increasing funding for reproductive health programs and making sure that these programs address the needs of both men and women, policymakers have the ability to save tens of thousands of lives and improve the quality of life for countless more women and children—and in turn, the men in their lives.

 

The involvement of men at all levels of society is critical to saving women’s lives and achieving gender equity.  Reproductive health programs must reach out to men, as well as women, if they are to be effective.  In addition, these programs must be made accessible and attractive to men and be combined with strong programs that engage men in broader issues, like preventing gender-based violence and eliminating the practice of female genital mutilation.  Reproductive health isn’t just a “woman’s issue.”  It affects the health and prosperity of every man, woman and child in the world. 

 

With further Senate action on the appropriations bill exempting contraceptives from the Global Gag Rule not likely until September, this is the perfect moment to highlight the importance of increasing access to contraceptives, which is crucial to global development and the fight against poverty.

Next year, for the first time in history, over half of the world’s population will live in urban areas, according to the U.N. report, State of World Population 2007. It is imperative that we not allow this increase in urbanization – most of which will occur in developing countries – to result in a dramatic increase in urban slums and the number of people living in poverty.

Since most of the growth in urban population is due to increased fertility, it is essential to better provide reproductive health services and to empower women through education and economic opportunity.  Janice Banaag, an eighteen-year-old mother who lives with her husband and newborn under a bridge in Manila, doesn't want to have another child until she and her husband can save more money. Tragically, planning one’s family is extremely difficult to do in Manila, where the mayor has banned contraceptives in public hospitals and health centers – making it nearly impossible for women like Janice to protect themselves from HIV/AIDS and to plan the timing of their children.

Currently, over 200 million women in the developing world wish to prevent or delay pregnancy, but lack access to modern contraceptives. If these women – many of whom live in urban slums – had the access they desire and need, they could prevent unwanted pregnancy, curb child and maternal mortality and remain free from sexually transmitted infections like HIV/AIDS, leading to longer, healthier lives. 

Passage of the Senate appropriations bill can help provide access to these life-saving supplies by exempting donated contraceptives from the Global Gag Rule. Since the reinstatement of the Global Gag Rule in 2001, shipments of contraceptives have been stopped to over 20 developing countries in Asia, Africa and the Middle East – the same areas that are now facing this increased urbanization.

Access to reproductive health programs and services is not only a fundamental right, it is key to eradicating poverty. PAI urges the Senate to pass the appropriations bill in its current form, providing the tools necessary for millions to rise out of poverty.

  “When you are married, you do not have the right to say ‘no’”  -- Skytt Nzambu

 

These are the words of Skytt Nzambu, a Kenyan woman who was infected with HIV by her unfaithful husband.  Tragically, Skytt is only one of an increasing number of HIV infections that are occurring within married couples, according to information reported at last week’s HIV/AIDS Implementers’ Meeting  in Rwanda.  This information highligpopact yet again the urgent need to continuously re-evaluate prevention programs as new evidence emerges in order to accurately address the needs of a constantly evolving epidemic. PEPFAR’s (the President’s Emergency Plan for AIDS Relief) ABC model, which emphasizes abstinence and provides condoms only for those “who practice high-risk behaviors,” doesn’t do a good enough job with “B” (Be faithful) to provide protection for what is increasingly becoming a “high-risk behavior” for women: sex between a husband and wife.

 

Dr. David Apuuli, director-general of the Uganda AIDS Commission, indicated that marital sex accounts for 42% of new infections in Uganda. According to Apuuli, “Studies show that a significant number of new infections through marital sex are because, over the past four years, men have increased their number of sexual partners, be it wives or girlfriends.” Sadly, it is these wives and girlfriends who are paying the ultimate price: HIV infection.

 

Vinod Mishra, director of research at Macro International, warned the attendees not to ignore these findings, saying, “It’s not about laying blame, it’s about saving lives; it’s about preventing future infections within marriage, and marriage is… the primary route of the epidemic, and the primary source of new infections in many of these countries now.” It is clear that prevention strategies that focus on abstinence and faithfulness in lieu of comprehensive, evidence-based prevention programs are not adequate to protect a woman whose husband is unfaithful.

 

The House of Representatives has taken the first step toward eradicating these flawed prevention strategies by passing H.R. 2764 , the appropriations bill that provides greater effectiveness and flexibility in the fight against HIV/AIDS by allowing the President to waive the restriction under PEPFAR that mandates at least one-third of U.S. HIV/AIDS prevention funding be limited to abstinence-until-marriage programs.  During House debate of this bill, Congressman Walberg (R-MI) mentioned that he'd met a young woman "with three children who has HIV as a result of behavior issues related specifically to a husband who was unfaithful in many, many ways.” Congresswoman McCollum (D-MN) followed up on that point and said:  "I thought it was very compelling to hear the story that was just shared on the floor by my Republican colleague about how a wife had become infected, not because of her behavior, but because of her husband's behavior."

 

Now, the Senate has their opportunity to support responsible, evidence-based HIV/AIDS prevention as they debate their own version of the appropriations bill. The language passed by the Senate Appropriations Committee contains a similar provision, which we urge the Senate to maintain to show their commitment to preventing the spread of HIV/AIDS. In addition, it also contains the provision exempting contraceptive donations from the Global Gag Rule . These two provisions will help reduce HIV infections and unintended pregnancies, including among HIV-positive women, strengthening U.S. foreign assistance and improving its ability to save the lives of women and men around the world who don’t currently have the services and supplies they need to protect themselves.

 

Population Action International celebrated an important victory for women and their families last week, as Congress passed a Foreign Operations Appropriations bill (H.R. 2764 ) that contained language correcting some of the most egregious aspects of U.S. international sexual and reproductive health policy.

 

Despite attacks by family planning and reproductive health opponents, two important provisions survived:

• An amendment put forth by Foreign Operations Chairwoman Nita Lowey (D-NY) that exempts overseas NGO family planning providers from the restrictions of the Global Gag Rule (Mexico City Policy) that cuts off the flow of U.S.-donated contraceptives and condoms.

• A provision that repeals the abstinence-only funding restrictions under PEPFAR (the President’s Emergency Plan for AIDS Relief) that require at least one-third of all U.S. HIV/AIDS prevention funding be limited to abstinence programs.

 

Three amendments that came up on the House floor were vigorously debated: the aforementioned Lowey Amendment,  the Smith-Stupak Amendment that would have nullified the Lowey Amendment, and the Pitts Amendment that would have preserved the abstinence funding restriction.

 

Some of the most powerful statements on the House floor came from Members who identify themselves as anti-abortion but understand that these changes in U.S. policy would help prevent abortion and the transmission of sexually transmitted infections, including HIV/AIDS. Both provisions were upheld with support from both Democrats and Republicans, including some Members who in the past have not been as supportive.

 

President Bush has vowed to veto the entire $34.2 billion foreign assistance spending bill over the new contraceptives language. This week, the Senate is expected to begin work on its version of the appropriations bill.  Indications are that they will include similar provisions on the Gag Rule and HIV/AIDS. Once the Senate completes its work on the bill in July, the bill will then go to a conference committee.  There, the House and Senate versions will be reconciled and sent to the President for his approval or veto.

 

So while there are still hurdles to overcome before these provisions can become law, we are celebrating this victory for women and their families around the world. It is a long overdue and much needed dose of common sense when it comes to U.S. assistance on family planning and HIV/AIDS.

Family planning and reproductive health supporters are on the verge of a very important show-down in the House of Representatives on the issues of access to contraceptives and abstinence-only HIV/AIDS prevention restrictions.  As early as Wednesday, June 20th, the full House may begin floor debate on the FY 2008 State-foreign operations appropriations bill, which includes the following breakthrough provisions:

• an exemption from the Global Gag Rule/Mexico City Policy (GGR) for contraceptives and condoms allowing foreign organizations otherwise ineligible for U.S.  assistance under the GGR to receive U.S. government-donated contraceptives and condoms; and
• a provision that nullifies the earmark that requires that at least one-third of bilateral HIV/AIDS prevention funding be spent on  "abstinence-until-marriage" programs.

 

In addition, the bill provides $441 million for family planning and reproductive health programs, a very slight increase over current levels but a $116 million increase above the President’s request.  The bill also furnishes a U.S. contribution of $40 million to the UN Population Fund, subject to long-standing Kemp-Kasten restrictions that has allowed President Bush to withhold U.S. funding to UNFPA for the last five years. However, new language in the bill seeks to ensure a more thorough and transparent review by the President in making his determination on whether or not to fund UNFPA.

 

Not everyone is excited about these potential policy improvements, however.  The Global Gag Rule puts women at increased risk of unintended pregnancy due to lack of modern contraceptives and services.  If clinic shelves are empty, how can women and their partners achieve their stated goal of planning their families?

 

Since the reinstatement of the Global Gag Rule in 2001, shipments of contraceptives have been stopped to 20 developing countries – a tragic consequence of a misguided policy.  In Ethiopia, clinics immediately fell short of condoms and contraceptives after passage of the Global Gag Rule.  They appealed to the government for help, but supply shipments were inconsistent and couldn’t keep up with demand.  Currently, 1 in every 14 Ethiopian women will die of pregnancy-related causes—and many of these women had not planned to become pregnant in the first place.  In Ghana, the Global Gag Rule resulted in a loss of contraceptives and funding for community health workers.  As a result, the Planned Parenthood Association of Ghana (PPAG) began treating nearly twice as many women for complications from unsafe abortion as they had the previous year, before the Gag Rule had been reinstated.  That doesn’t sound like a policy that is preventing abortion – let alone improving reproductive health in these countries.

 

Members of Congress should oppose efforts to remove the contraceptive provision and should support overturning the abstinence-only earmark, thereby demonstrating their commitment to reducing unintended pregnancies, reducing abortion, and preventing sexually transmitted infections, including HIV/AIDS. 

 

For most American women and men on both sides of the abortion debate, access to contraceptives is a basic human right. Why should that be any different for the millions of women and men in the developing world?

 With its Subcommittee on State, Foreign Operations and Related Programs’ approval of the fiscal year 2008 appropriations bill, the House of Representatives took a significant step toward grounding U.S. aid for family planning and HIV/AIDS relief in sound evidence.  The appropriations bill contains several important family planning and reproductive health provisions, including: (1) granting the president the authority to waive the abstinence-until-marriage earmark under PEPFAR that requires at least one-third of U.S. HIV/AIDS prevention funding be limited to abstinence-until-marriage programs; and (2) an exemption of U.S. contraceptives shipments to the developing world from the restrictions of the Global Gag Rule .  PAI urges Congress to approve these important changes to the destructive reproductive health policies of the Bush Administration. 

The House bill provides an overall funding level of $441 million for U.S. international family planning and reproductive health programs through the U.S. Agency for International Development (USAID).  This represents a $116 million increase above the President’s request but only a slight increase over current levels.  The bill also includes $40 million for the United Nations Population Fund (UNFPA), subject to existing Kemp-Kasten restrictions, but it requires more detailed reporting by the Bush Administration in the event that it again invokes Kemp-Kasten and withholds funds from UNFPA.  In addition, any funds withheld from UNFPA would have to be reprogrammed to bilateral Family Planning/Reproductive Health activities through USAID. 

 

Overturning the abstinence-until-marriage earmark in PEPFAR would make the program more effective in curbing the spread of HIV/AIDS.  According to two congressionally mandated studies on the effectiveness of PEPFAR – from the Government Accountability Office (GAO) and the National Institute of Medicine (IOM) – this spending requirement undermines U.S. efforts to prevent new HIV infections by hindering the development of comprehensive, integrated HIV prevention programs that address vulnerabilities unique to local populations. 

 

The contraceptives provision will be crucial to meeting the ever rising demand for and shortages of contraceptives in developing nations. 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.  Increasing U.S. donations of contraceptives and condoms is essential to reducing unintended pregnancies, abortion and sexually transmitted infections such as HIV/AIDS.  Filling the unmet need for contraceptives would avert 52 million unwanted pregnancies each year, preventing an estimated 29 million abortions, 142,000 pregnancy-related deaths – and 505,000 children from losing their mothers.

 

The full Appropriations Committee will vote on June 12th, and the bill is scheduled to move quickly to the House Floor the week of June 18th.   Congress has the opportunity to save tens of thousands of lives and improve the quality of life for countless more women and children.  The House bill is a good start to ensuring that reproductive health policies – including those that address HIV prevention – are grounded in evidence and address the needs of women and their families.

PAI was thrilled to hear President Bush announce last week that he is requesting an additional 30 billion in funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) over the next five years.  This historic effort has enormous potential to save millions of lives.

To be successful, PEPFAR must coordinate with family planning and reproductive health programs, which should be fully funded—and not become a casualty of these laudable efforts to combat HIV.  And misguided policies—if allowed to continue uncorrected—are PEPFAR's fatal flaw.  For example, PEPFAR’s current prevention efforts are stymied by a spending requirement that forces one-third of all prevention funding into “abstinence-until-marriage” programs.  Only by overturning this one-size-fits-all prescription can PEPFAR live up to its potential to curb the spread of this epidemic. This is just one of the policies that need to be addressed as we move into the next phase of the U.S. response to the global AIDS pandemic.

PAI’s Vice President for Public Policy Terri Bartlett responded to President Bush’s announcement: “We welcome this news and urge Congress to take up the challenge but to take the opportunity to make PEPFAR much more effective by correcting policies on the basis of evidence, not ideology.”  By overturning the “abstinence-until-marriage” spending constraint, PEPFAR recipient "focus countries" will be better able to target how HIV/AIDS is striking their particular local populations and meet their evolving needs to protect themselves from this epidemic.

PEPFAR currently provides live-saving treatment to approximately 1.4 million people, a number that is projected to increase to 2.5 million people with this increase in funding.  However, even more lives can be saved if these treatment programs are combined with comprehensive, evidence-based prevention policies and work in concert with existing—and future—family planning and reproductive health programs.

As Congress reviews PEPFAR and prepares to take up its reauthorization, we urge them to take the time to really review the program’s prevention policies to ensure that people have access to the quality education, services and supplies necessary to protect themselves.  We have the opportunity to stop HIV/AIDS in its tracks; let's not waste it.

 As the U.S. Presidential campaign season begins to heat up, a number of advocacy groups are beginning to develop policy platforms for candidates to support and endorse in their campaigns.  The ONE Campaign, which develops these platforms for policymakers around the world on the topics of poverty and HIV/AIDS, is putting together such a document right now.  Regrettably, rumor has it that ONE’s platform will give only passing mention of one of the most effective methods of fighting poverty and hunger, curbing the spread of HIV/AIDS, and reducing child and maternal mortality: family planning and reproductive health care.

A platform that is intended to truly address the solutions to these global development concerns must stress the key intervention that is family planning and reproductive health care – particularly access to contraceptives including condoms, crucial to HIV/AIDS prevention programs. How can we expect to curb the spread of this pandemic without giving people the education, health care and tools they need to protect themselves?  How can parents pull themselves and their children out of poverty if they lack access to contraceptives that enable them to plan the size of their family based on the number of children they desire and their ability to provide for them?  How can we curb maternal and child mortality if young women are unable to delay pregnancy until they are healthy and mature enough to survive childbirth and care for a child?

Recognizing the important links between family planning and many larger development goals, such as poverty reduction, is crucial to making progress.  Bono, co-founder of ONE’s partner organization DATA (Debt. AIDS. Trade. Africa.), recognized this connection when speaking about DATA’s recent report finding shortfalls in the G8 nations’ aid to Africa.  “These statistics are not just numbers on a page, they are people begging for their lives, for two pills a day, a mother begging to immunize her children, a child begging not to become a mother at age 12,” Bono said.  When women and girls are able to prevent unwanted pregnancies and sexually transmitted infections such as HIV/AIDS, they are empowered to get an education and to live a longer, healthier life. 

In light of these truths, why would ONE want to promote a presidential campaign platform on poverty and HIV/AIDS that’s lacking legitimate discussion of the need for family planning and reproductive health care, including access to condoms? We must have heard wrong.

Maternal and infant mortality have declined in Egypt, Indonesia, Bangladesh, Nepal and the Philippines according to a new report released by Save the Children. Much of this good news can be attributed to access to family planning services which give women the ability to space their children at healthy intervals and plan the size of their families. The successes of these five countries show how crucial financial and political commitments to family planning are to curbing child mortality, as well as meeting other development goals.

Egypt’s remarkable 68 percent reduction in child deaths in the last 15 years puts the nation right on track to meet Millennium Development Goal 4 (reducing child mortality by two-thirds by 2015) . After hosting the International Conference on Population and Development in 1994, Egypt committed itself to investing in the health of mothers and children. The country aimed to reduce child mortality, reduce the fertility rate and to improve pregnancy outcomes. Through public health initiatives that provided healthcare for pregnant women and improved access to family planning education and services - including contraceptives - the fertility rate has declined from 4.3 to 3.1 births per woman, contraceptive use has increased to nearly 60 percent and child mortality has declined significantly.

“Voluntary family planning has been estimated to prevent one-fourth of maternal deaths by helping women delay early pregnancy and childbirth, prevent closely spaced births and reduce the risk of HIV transmission,” according to the report. In addition, “[i]nfants spaced more than three years apart are more than three times as likely to survive as infants both less than one-and-a-half years apart.” Considering that each year ten million children under five die - primarily from preventable causes and in poor countries - as well as an additional half a million mothers who die in childbirth or pregnancy, it is clear that family planning must remain on the forefront of any development agenda.

Unfortunately, for over a decade, U.S. support for these life saving programs has steadily declined. The U.S. has cut funding for international family planning by 41% (adjusted for inflation) since 1995, despite family planning’s proven track record of reducing maternal and child mortality. Political and financial support for international family planning must be central to global efforts to save the lives of women and children. The evidence is mounting; now we must act.

As the HIV/AIDS epidemic increasingly affects women, it is more important than ever that HIV/AIDS programs coordinate with and complement family planning and reproductive health programs.  The question is: How can this be done most effectively?

In the United States, both the President’s Emergency Plan for AIDS Relief (PEPFAR) and international family planning funds are subject to severe and hampering restrictions further limiting the flexibility of these funds to address women in need.  The Global Gag Rule denies foreign organizations receiving U.S. family planning assistance the right to use their own non-U.S. funds to provide legal abortion, counsel or refer for abortion, or lobby for the legalization of abortion in their country.  The Prostitution Pledge requires all groups receiving PEPFAR funds sign a pledge opposing prostitution.  The abstinence-until-marriage earmark in PEPFAR requires one third of all prevention funding to go toward abstinence-until-marriage programs.  The myriad of rules and regulations on both PEPFAR and family planning funding hurt the very people that these programs are supposed to be helping.

Until these harmful restrictions are repealed, it is important to understand and work within the existing policy framework in order to provide the most efficient and effective reproductive health services possible.  Since in the US policies follow the provision of services, PAI urges that  programs funded by the US  formally coordinate their services so that woman benefit while we work to remove the harmful restrictions that hamper these programs. In addition, we urge country governments and other funding sources to continue to work to make prevention programs as strong as possible.  It is crucial that these programs do not adopt the restrictions that hamper U.S. funding.

Coordination of PEPFAR and family planning requires funding for both.  However, as we discussed here last week, despite international family planning’s successful track record, there has been a 41% drop in assistance since 1995 (adjusted for inflation).  In fact, the U.S. no longer funds any family planning at all in five PEPFAR focus countries: Botswana, Cote D’Ivoire, Guyana, Namibia, and Vietnam.  This devastating oversight prevents women around the world from accessing high quality, U.S.-supported reproductive health programs and services, hindering PEPFAR’s fight against the spread of HIV.

As Ambassador Mark Dybul, U.S. Global AIDS Coordinator, stated to the House Committee on Foreign Affairs last month, “HIV/AIDS does not exist in a vacuum. It is inextricably tied to other threats to public health, and it has ramifications for a wide range of development-related issues.”  By working together, international family planning and PEPFAR can improve the lives of women and families around the world.  But, without U.S. resources for family planning, PEPFAR is losing the fight against the spread of HIV—and women are the ones who pay the ultimate price.