Women's Enews, February 13, 2007
U.S. Clout Raises Worries for World Health
The new director of the World Health Organization has made maternal
and reproductive health issues a top priority for the global health
agency. But critics say that U.S. policies hinder those efforts
and funding still falls short of ambitions.
By Bojana Stoparic
(WOMENSENEWS)--Some women's and global health
experts are beginning to question whether Dr. Margaret Chan, the
new director-general of the World Health Organization, can stand
up to the historical interference from its biggest donor, the
United States. The Bush administration has been pushing a pro-abstinence,
anti-abortion agenda at WHO and has cut its funding for comprehensive
sexual and reproductive health services worldwide.
"The U.S. has pressured WHO behind
the scenes not to address unsafe abortions and to remove references
to sexual and reproductive rights," says Jodi Jacobson, executive
director of Center for Health and Gender Equity in Takoma Park,
When Chan in early February appeared to
side with the U.S. position against giving developing countries
easy access to cheap generic drugs, skeptics wondered whether
it was a sign that Chan might follow the U.S. lead on other issues
"Chan's stance on generic drugs does
not make me confident that she will be able to stand up to Washington
on sexual and reproductive health issues," said Jacobson.
Chan declined through her office to be interviewed
for this story.
But in a Jan. 4 address to WHO staff from
the organization's headquarters in Geneva, Chan announced that
improving women's health would be one of her top two priorities.
"Women are a vulnerable group because
of the work they do, their care-giving role, the risks they face
during pregnancy and childbirth and their low status in some societies,"
Chan told her staff.
'Public Commitment to Women'
"Dr. Chan is the first director-general
to make such a public commitment to women," said Adrienne
Germain, president of the International Women's Health Coalition
in New York City. "She has the potential to raise the profile
of women's health issues through her leadership."
Germain added that WHO has in the past failed
to give women's health issues the resources and attention they
need. For the 2004-2005 biennial budget, totaling $2.8 billion,
$15 million was allocated for women's health. Another $39 million
was allocated to making pregnancy safer.
"That's a drop in the bucket compared
to what's needed," said Germain. According to a 2000 WHO
report, $9 billion a year is necessary to reduce maternal mortality
and increase access to health care services for the millions of
pregnant women facing life-threatening complications.
Sexual and reproductive health worldwide
is either stagnating or in decline, according to a global study
published in the British medical journal the Lancet last November.
This year, an estimated 529,000 women, most of them in developing
countries, will die during pregnancy or childbirth from largely
preventable causes. Another 68,000 women will die from unsafe
abortions. Almost a quarter-million women will die from cervical
The same study pointed out that international
aid for family planning fell to $460 million in 2003 from $560
million in 1995.
Gag Rule Reinstated in 2001
When George Bush took office in January
2001, he reinstated the Mexico City Policy, also called the global
gag rule, which prohibits U.S. aid to foreign nongovernmental
organizations that provide any abortion-related information or
services, even if those services are funded with other money.
"Local NGOs have lost crucial money,
technical assistance and access to contraceptive supplies as a
result," said Wendy Turnbull, a policy and research associate
with the Washington-based Population Action International.
At WHO, the United States has also delayed
the approval of lists of essential medicines because some of the
medicines could be used to induce abortion. These lists serve
as guidelines for what drugs countries should have available for
In January, the 34-member executive board
of WHO adopted a strategy on gender, women and health that calls
for enhancing the organization's capacity for analyzing gender
differences in health services and outcomes and integrating gender
considerations into all areas of work. The strategy has been developed
over the past 15 years and was on the agenda before Chan's appointment.
Germain reported that the U.S. delegation
at the meeting opposed a robust endorsement of the strategy. In
the end it was "recognized" but not "endorsed"
by the executive committee. Such wording can impact how seriously
the resolution will be considered by the World Health Assembly,
WHO's governing body, when it votes on whether to adopt the strategy
at its next meeting in May.
Chan is accountable to the World Health
Assembly, which makes the organization's policy decisions and
is made up of ministers of health from the 193 member states.
While member dues accounted for $880 million in the 2004-2005
biennial budget, voluntary contributions added up to over $1.9
billion. The United States is the biggest WHO donor, giving $170
million in member fees and an additional $226 million in voluntary
contributions during the 2004-2005 financial year.
Appointment Signals Scientific Commitment
Ruth Levine, global health director at the
Washington-based Center for Global Development, expressed optimism
that under Chan--a former director of health in Hong Kong, where
she tackled both SARS and avian flu--WHO will be guided by science
and evidence. "Dr. Chan's appointment is a positive sign
that high value is being placed on technical expertise,"
Yet many observers were alarmed by Chan's
statements on Feb. 1. While visiting Thailand's National Health
Security Office, Chan sparked an outcry from activists and public
health experts when she cautioned the country against licensing
cheaper generic drugs. Her comments were seen by some as a sign
of capitulation to the pharmaceutical industry and its most vocal
supporter, the United States.
U.S. interference with WHO came under scrutiny
in January 2006 when the organization's top official in Thailand,
Dr. William Aldis, was demoted after arguing in an editorial that
a U.S.-Thai free trade agreement would undermine Thai access to
cheap AIDS drugs.
Each year since 2001, the White House has
requested higher levels of bilateral aid for HIV-AIDS while seeking
to cut funding for maternal and child health. The fiscal 2008
budget request submitted to Congress by the White House on Feb.
5 proposes $5.4 billion for HIV-AIDS and $345.6 million for maternal
and child health. The White House is also asking for a 25 percent
funding cut for family planning programs. Congress is expected
to appropriate more funding for these programs than requested,
as it has done regularly in past years.
Rep. Nita Lowey, D-N.Y., introduced the
Global Democracy Promotion Act on Jan. 22, which seeks to repeal
the so-called gag rule. Rep. Barbara Lee, D-Calif., will introduce
the Pathways Act, which would remove the earmark for abstinence
programs on anti-AIDS funding, during the week of Feb. 12.
Both of these bills have been introduced
in previous years and have not been passed. Despite a new Democratic-controlled
Congress, activists are doubtful this year will be different.
"The focus is on Iraq and fiscal responsibility,"
said Jacobson. "Many of the newly elected Democrats are middle
of the road on social issues and might not want to take on anything
"The reality is that there are not
enough votes to override a presidential veto on any congressional
attempt to repeal the gag rule," said Turnbull.
Bojana Stoparic is a freelance writer
based in New York.
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