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database on reproductive health, containing citations with abstracts to scientific articles, reports, books, and unpublished reports in the field of population, family planning and related health issues.”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.

Each year, over 600,000 children around the world are infected with HIV through mother-to-child-transmission (MTCT), totaling 2.3 million children living with HIV or AIDS today.¹ The majority of these infections is occurring in sub-Saharan Africa and are acquired from mothers during pregnancy, labor, delivery or breastfeeding.  While programs to prevent the transmission of HIV from mother-to-child (PMTCT) are invaluable, they are currently reaching only an estimated five percent of the HIV-positive population.² Instead of working in isolation, these programs should tap into the already existing network of family planning services and programs, achieving wider coverage and reaching more women, couples and infants. Preventing HIV infection among women of childbearing age and helping HIV-positive mothers avoid unintended pregnancies should be the primary emphasis of strategies to reduce MTCT.

Family Planning Prevents Primary HIV Infection In Women

Preventing primary infection in women is the first step toward preventing infections in infants. Yet, in 2006, 17.7 million women were living with HIV globally, and the proportion of women affected by the epidemic continues to increase.³ In sub-Saharan Africa, half of those living with HIV or AIDS are women, and the majority of all new HIV infections are occurring among women of childbearing age.

Women, especially young women, are at additional biological and social risk of HIV infection. Recent evidence shows that pregnant women may be at a higher risk of HIV infection than lactating women or non-pregnant, non-breastfeeding women.⁴

Male and female condoms are the only technology available for protection from sexual transmission of HIV and are thus critically important to curbing the spread of the epidemic. Family planning programs have been providing critical information, counseling and services to prevent and treat sexually transmitted infections (STIs) and promote consistent and correct condom use among women and men for over four decades. 

Family Planning Prevents Unintended Pregnancy Among Women With HIV Infection

In sub-Saharan Africa, the risk of MTCT is exacerbated by a high level of unintended pregnancy – a major cause of which is limited access to family planning services, including stock-outs of contraceptive supplies. In addition, HIV-positive women on highly active anti-retroviral therapy (HAART) may be more vulnerable to unintended pregnancy, because while HIV might suppress fertility, HAART reduces viral loads and is likely to increase fertility.⁵   In developing countries, maternal mortality is nearly double in HIV positive women than in those who are not infected.⁶

More than 200 million women in developing countries say they would prefer to avoid pregnancy but are not using any form of modern contraception. Unmet need for family planning is highest in sub-Saharan Africa (as high as 36 percent in some countries), where the HIV/AIDS epidemic is most prevalent.⁷

Recent research shows that lowering HIV infection rates among sexually active adults by 1 to 5 percent can in fact achieve the same reduction in infant HIV infections as nevirapine interventions (an antiretroviral drug).10 Not only does contraceptive use avert more HIV-positive unintended pregnancies, but it does so at a lower cost than the use of the nevirapine alone. Adding family planning services to PMTCT programs can achieve the same effect as increasing drug coverage. For the same cost, family planning services can avert nearly 30 percent more HIV-positive births than antiretroviral drugs.11

Helping HIV-positive women and couples avoid unintended pregnancies could prevent many child infections and deaths. Current levels of contraceptive use in sub-Saharan Africa, as low as they are, are already preventing an estimated 22 percent of HIV-positive births.⁸ A 2003 study found that adding family planning to PMTCT services in 14 high-prevalence countries prevented more than 150,000 unintended pregnancies. Averted child infections and deaths nearly doubled and quadrupled, respectively.⁹

A Closer Look: A Town In Eastern Uganda

In the rural town of Tororo, Uganda, a country where women have an average of more than seven children, over 90 percent of HIV-positive women who are pregnant did not wish to have more children, according to a recent study by the Centers for Disease control. Yet less than a fifth of married women who do not wish to become pregnant use contraceptives. Tragically, the HIV/AIDS rates are still rising, with 4.3 million new infections in 2006, according to the U.N. agency on AIDS (UNAIDS).

Violence against women and the spread of HIV/AIDS are inextricably linked and must be addressed together, according to a new report released by Women Won't Wait. Every woman has the “right to freedom from violence and to the highest attainable standard of health, including sexual and reproductive health and services.” PAI couldn’t agree more and urges governments and multilateral institutions to ensure that these fundamental human rigpopact are fully integrated into their approach to HIV prevention.

According to Show Us The Money: Is Violence Against Women on the HIV & AIDS Funding Agenda, “[r]esearch confirms that violence, and particularly intimate partner violence… is a leading factor in the increasing ‘feminization’ of the global AIDS pandemic, resulting in disproportionately higher rates of HIV infection among women and girls.” Not only are women biologically more vulnerable to HIV infection from sexual intercourse, gender inequality in many societies makes it difficult for them to negotiate condom use, refuse sex or otherwise protect themselves from HIV. Programs designed to limit violence against women and improve the status of women in society must be implemented as a key component of HIV/AIDS prevention programs.

Unfortunately, donors don’t “specifically track their programming for and funding to violence eradication efforts within their HIV&AIDS portfolio.” As a result, donors and national governments can verbally support women’s rigpopact as a component of HIV prevention programming, but there is no way to hold them accountable for actual programming initiatives. It’s time to connect the dots — and back rhetoric with money and policies.

Addressing violence against women should be a crucial part of comprehensive HIV/AIDS prevention programming. This report is a first step in monitoring funding and programming, but more regimented tracking systems are necessary. National governments and donor agencies need to be held accountable to agreed-to development objectives, which include both curbing the AIDS pandemic and promoting gender equality. Otherwise, innocent lives will continue to be lost to AIDS and violence.

This week, delegates to the U.N.’s 51st Commission on the Status of Women (CSW) will begin meeting to “evaluate progress on gender equality, identify challenges, set global standards and formulate concrete policies to promote gender equality and advancement of women worldwide.” The theme of this year’s CSW is “the elimination of all forms of discrimination and violence against the girl child,” and the outcome is expected to focus on many issues, including condemning sex selection, infanticide, and child and forced marriage. PAI urges the delegates to examine the core issues that result in these horrible acts and honor previously agreed-to international commitments. These issues are symptoms of a deep-rooted tradition of discrimination against and violence toward women—one that the Commission challenges and must help member states to overcome.

We can all agree that young girls should not be forced into marriage and infant girls should not be killed just because they aren’t boys. The more difficult task comes not from condemning these actions, but in how to change these tragic customs. These acts will only begin to be eliminated by implementing laws and programs that assure the equal status of women in society, including access to education, equal property rigpopact and economic opportunity.

A key way to raise the status of women is by improving healthcare, particularly by increasing access to sexual and reproductive health and voluntary family planning services and supplies. These services and supplies allow a woman to decide for herself if and when to have children, giving her the opportunity to stay in school longer, to protect herself from sexually transmitted infections like HIV/AIDS and to reduce the likelihood that she’ll bear a child in her teens or live in poverty. Key to the Commission’s success is relying on past agreed-to language from international conferences and their follow-up meetings, such as the 1995 Fourth World Conference on Women (Beijing), the 2005 World Summit and the 2001 World Conference Against Racism (Durban). It is imperative that delegations also consider the contributions of the youth representatives to the meeting, whether they are official delegates or NGO representatives. The decisions that are made by the Commission and resulting documents pave the way for their future, and their input and perspective are invaluable.

Taking a comprehensive, holistic approach to empowering women is crucial. In addition to condemning forced and child marriage and sex selective infanticide, providing political support and funding for gender-sensitive education and programs will help improve women's status in society and support women in taking control of their own lives.

PAI was heartened to see the Rwandan government announce a new national family planning program that will include the free distribution of contraceptives to women of child-bearing age and the teaching of comprehensive sex education in schools. Such political will is essential to getting reproductive health education and services to those who want and need them the most. However, as part of the family planning program, officials in Rwanda are apparently considering measures to limit family size to three children. PAI urges great caution in considering any incentives or disincentives when it comes to childbearing – respecting individual rigpopact is central to reproductive health programs and is especially crucial in Rwanda.

After the horrifying 1994 genocide that resulted in the death of over 800,000 Rwandans, it may be hard to believe that high birth rates and population growth could be a concern there. However, the population of Rwanda has nearly doubled since 1995 and is on track to double again in the next twenty-five years. With the average Rwandan woman bearing six children, the country’s population is growing at a pace that is overburdening the nation’s resources and almost certainly pushing Rwanda even deeper into poverty. “This constant population rise is putting a lot of pressure on the economy,” according to Francois Sekamondo of Rwanda's Ministry of Finance and Economic Planning.

Comprehensive reproductive health care, including modern contraceptives, empowers Rwandan women and men to determine the size of their families and helps prevent sexually transmitted infections, such as HIV/AIDS. The Rwandan government is calling this a “population control” program. But it is essential that it remain voluntary, placing decision-making in the hands of couples by increasing their access to family planning services. Grounding such programs in individual rigpopact – giving people comprehensive, evidence-based information and the necessary tools to determine their fertility – is the key to reaching the nearly 36% of married women in Rwanda who want to delay or prevent their next pregnancy but who aren’t currently using a modern method of family planning.

The Rwandan government’s effort to prioritize support for family planning demonstrates a dedication to improving quality of life for its citizens. By increasing access to basic reproductive health care, this program will help reduce maternal and infant mortality and aid efforts to curb hunger and poverty. Protecting human rigpopact and putting the “control” in the hands of the people themselves should remain a cornerstone in any such program. Any efforts to set strict limits on family size threaten individual choice, are counterproductive and should be rejected.

Worldwide, nearly 80 million unintended pregnancies occur each year, with over half of them ending in abortion—even in countries where the procedure is illegal. These unintended pregnancies—and resulting abortions—could be prevented if women had access to the reproductive services and supplies, including condoms and emergency contraception, they want and need to determine if and when to conceive a child. The global community must fund reproductive health programs worldwide—these supplies, services and education are crucial to improving and saving lives that might otherwise be lost to maternal mortality and unsafe abortion.

In Uganda an estimated 775,000 unintended pregnancies a year result in at least 297,000 abortions. This is despite the fact that abortion is illegal, except to save a woman’s life. Shockingly, a recent study reports that one-third of Ugandan women of reproductive age want to stop or delay pregnancy but don’t use modern contraceptives. It is tragic that the lives of these women are put at risk because they lack access to the reproductive health supplies and services that are taken for granted in other parts of the world.

Uganda is just one of many countries where women lack the knowledge or supplies necessary to make their own decisions about if and when to have a child. Over 200 million women worldwide want to avoid pregnancy, but are not using any form of modern contraception. Family planning programs providing access to modern contraceptives, disease screening and prenatal care have led to declines in maternal mortality resulting from unsafe abortion and complications from high-risk pregnancies.

But many of these programs are at risk—funding shortages, burdensome policies and the heavy and still growing number of those suffering from HIV/AIDS and other diseases have made it increasingly difficult for family planning and reproductive health programs to adequately serve the women and men they are trying to reach.

Making abortion illegal doesn’t prevent abortion from happening—but we can all agree that averting unintended pregnancy does. The good news is that increased use of contraception has been accompanied by significant declines in abortion rates in a number of countries, including Bangladesh, Bulgaria, Russia and Chile. Expanding access to voluntary family planning programs is a key—and proven—way to reduce the number of unintended pregnancies and, consequently, to reduce the incidence of abortion.

Washington, DC, January 22, 2007 – Today marks the 34th anniversary of the landmark Roe v. Wade decision legalizing women’s right to safe abortion in the United States. While the debate about the right to abortion continues to rage on here in the U.S., a number of countries are recognizing that access to safe abortion can save women’s lives. PAI hails these efforts and urges more countries to consider taking such life-saving actions.

Last May, a decision by the highest court in Colombia – where all abortions had previously been banned – legalized abortion in cases of rape or when the health of the woman or the fetus is in danger. In July, the Ethiopian Ministry of Health began allowing abortion in cases where the health of the woman or fetus is in danger, in cases of rape or incest, and in cases where a woman is physically unable to raise a child due to age or mental or physical disability. And Great Britain created the Global Safe Abortion Fund (now called the Safe Abortion Action Fund) offering NGOs grants for safe abortion advocacy, service provision or research - to help stem the damage done by the U.S.’s Global Gag Rule, which prohibits U.S. funding of any group that provides abortion services, counseling or referral.

And on February 11, Portugal will be holding a referendum on whether to decriminalize abortion; current law states that women can be jailed for up to three years for seeking an illegal abortion. With between 20,000 and 40,000 Portuguese women obtaining clandestine abortions every year, the passing of this referendum could drastically decrease the number of hospitalizations and deaths that result from septic or incomplete abortion.

Tragically, last year also witnessed the passage of Nicaragua’s total ban on abortion and the beginning of debates in the Polish Parliament to pass a constitutional amendment banning abortion. Draconian laws like these only serve to put women at an even higher risk of maternal mortality.

Complications from unsafe abortion account for approximately 70,000 deaths a year. PAI urges governments to expand access to safe and legal abortions to women who need them and comprehensive sex education, contraceptives and counseling to all women and men in a real effort to make abortions more rare.

Saving women's lives depends on it.

Religious leaders are often among the most influential members of their communities. When they promote sound reproductive health practices and unite with health care providers, they can help make monumental strides toward ensuring reproductive health for all.

A new family planning program in Pakistan has clerics distributing contraceptives and literature on safe sex—a great example of the important role religious leaders can play in the fight against HIV/AIDS and in expanding access to reproductive health care. Armed with evidence-based information and adequate supplies, religious leaders and institutions can be a powerful ally in stemming maternal morbidity and mortality, as well as in helping prevent the spread of sexually transmitted infections, including HIV/AIDS.

Religious leaders advocating family planning are making an impact. Iran has implemented an extremely successful family planning program, issuing religious rulings that reassure patients that they are acting within the guidelines of Islam. Thailand carefully considered Buddhist values when formulating its successful promotional campaign advocating family planning and contraceptive use. And the Christian Health Association of Ghana collaborated with Pathfinder International to develop a comprehensive program that included abstinence and safe sex education, as well as condom distribution. These unique programs—from very different parts of the world—showcase the positive impact collaboration can have on expanding access to reproductive health.

The success or failure of reproductive health programs hinge on how well they are received by the community. Support from religious leaders can generate greater acceptance of programs and lead to greater success than could be achieved by family planning advocates alone.

As new discoveries in HIV prevention are made, including the use of circumcision and microbicides, the U.S. must have maximum flexibility to spend limited resources in the areas of HIV prevention that are most relevant to country demands. New discoveries are made in vain—and at considerable cost—if they cannot be funded and utilized in the countries where they can make the greatest impact.

While the end of 2006 delivered promising new research in the area of male circumcision for HIV prevention, it is in the New Year and beyond where the potential to do great things with this new research will be realized. As reported late last year, male circumcision has been shown to reduce HIV infection rates in males by roughly 50%. While this is a promising development, support for male circumcision programs could be hampered by the abstinence-until-marriage earmark in the President’s Emergency Plan for AIDS Relief (PEPFAR).

If it is determined that male circumcision should be included in HIV prevention programs—to be used in addition to other evidence-based prevention efforts—it has the potential to make a huge impact in places like sub-Saharan Africa where there is both high HIV prevalence and low male circumcision rates. However, PEPFAR support for this new prevention method would compete with limited prevention funding due to required spending for abstinence-until-marriage programs.

As 2007 gets underway, PAI urges the U.S. to overturn the abstinence-until-marriage earmark in PEPFAR and allow countries to develop HIV prevention programs that take full advantage of scientific discoveries that offer the most potential to save lives.

An estimated two million girls worldwide undergo the brutal procedure known as female genital mutilation (FGM) every year, leading to physiological, sexual and psychological effects including hemorrhage, shock, infection, sexual dysfunction and increased risk of contracting HIV. It’s a tragic human rigpopact violation, whose cultural and traditional roots run deep—making it difficult to combat. PAI has a long history of working towards the elimination of FGM—from generating awareness and action in the 80’s to funding anti-FGM projects in Mali over the past five years—but more help is desperately needed. We urge governments and communities around the world to take steps to eradicate this harmful practice once and for all.

Global eradication efforts have achieved some success, and recent events in Indonesia and Ethiopia give hope that this practice can be eliminated. Early last month, Indonesia banned all doctors and nurses from performing FGM. According to the head of the Indonesian health ministry’s family health directorate, Sri Hermiyanti, “Hurting, damaging, incising and cutting of the clitoris are not permitted under the ban, because these acts violate the reproductive rigpopact of these girls and harm their organs.” While there are no punishments in place for people who violate the ban, this is an important first step towards ending this horrific practice.

On a recent trip to Ethiopia, PAI President Amy Coen and her colleagues had the opportunity to meet Dr. Bogaletch Gebre—affectionately called “Boge”—who is spearheading a national campaign to end FGM. They participated in a rally of over 15,000, including girls, mothers, fathers and village elders, demonstrating their commitment to ending FGM in their communities.

These are just two of the ways communities are starting to figh