on population, reproductive health & ethics

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Raleigh News and Observer, August 6, 2004

Health, in a world of trouble
U.S. family-planning restrictions are harming women and children


CHAPEL HILL -- Democratic presidential candidate John Kerry's observation that we are "all in the same boat" rings true not only domestically but also globally. We live in a time of unprecedented global interdependence, which, as we are learning in Iraq, we ignore at our peril.

Kerry and others have focused on the arrogance and unilateralism the Bush administration has displayed in the military arena, but those same attitudes are evident in numerous other areas -- many linked to global security -- and they too have reduced American credibility overseas. One area in which the administration's isolation from the rest of the international community is particularly evident is in its regard for women's health and rights. And here, the cost is not only credibility but lives.

Every year, in faraway places, approximately 550,000 of the world's poorest women die from preventable causes related to pregnancy and childbirth.

Tragically out of step with the international community, the administration's policies have undone years of U.S. global leadership in working to prevent these deaths and countless related disabilities. The adminstration's repeated refusal to release $34 million pledged to the U.N. Population Fund (UNFPA) -- which helps couples around the world plan their families and rise out of poverty and ill-health -- is one example. UNFPA estimates that restoration of U.S. funds would prevent 2 million unwanted pregnancies, 800,000 abortions, 4,700 maternal deaths and more than 77,000 infant and child deaths.

Then there's the Global Gag Rule, which prohibits foreign nongovernmental organizations that receive U.S. family-planning funds from performing or even talking about abortion, even where it's legal and even using separate money. In Kenya, to offer only one example, five clinics that served the poorest of the poor -- and offered a wide range of health care, including well-baby care -- have been forced to close as a result of a loss of U.S. funds after refusing to sign the gag rule.

In addition, the gag rule denies foreign organizations that don't agree to censor themselves about abortion access to U.S.-supplied condoms, a critical tool in preventing HIV/AIDS. Supplies of U.S-donated contraceptives have been reduced dangerously in at least 29 countries. In Zambia, where 22 percent of the population is living with HIV/AIDS (60 percent are women), the unavailability of condoms is a death sentence.

(Our organization, Ipas, was one of only two U.S.-based organizations that refused to censor its overseas partners and did not sign the Global Gag Rule, losing $2 million as a result.)

There was much optimism when President Bush announced a multi-year, multi-billion dollar pledge to help reduce the havoc wreaked by the HIV pandemic. Unfortunately, no more than 20 percent of all U.S. global AIDS funds may be spent on HIV prevention, and of those funds, a minimum of 33 percent must be spent on abstinence-until-marriage programs. The scientific literature is quite clear that comprehensive sexuality education that includes abstinence is an effective tool in disease and pregnancy prevention, but that abstinence education alone is not sufficient.

In these and other ways, the United States has failed to meet international commitments to promote women's health and rights, causing the global boat to spring a leak that endangers the lives of millions of women every year. We look forward to the day when the United States will once again be a global leader and active participant in reducing the unnecessary deaths of women and girls in the developing world. For women all over the world, the stakes have never been higher.

(Elizabeth Maguire is president and Anu Kumar is executive vice president of Ipas, a Chapel Hill-based nonprofit that promotes reproductive health in developing countries.)

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