Time to abolish Gag Rule says population agency

Posted: 22 January 2009

Author: John Rowley

In a well-timed report, a leading US pressure group has called for a radical change in US funding for reproductive health and family planning in the 15 focus countries now receiving help with HIV/AIDS under the President's Emergency Relief for AIDS Plan (PEPFAR).

Since 2004, this plan has more than doubled foreign assistance to fight HIV/AIDS in the programme's fifteen focus countries in Africa, the Caribbean and Asia, says Population Action International. But at the same time the relatively small funds for reproductive health/family planning have actually fallen, so that they now make up less than 2 per cent of the President's request for HIV work.

It now wants to see a big increase US funding for international family planning and reproductive health to improve HIV prevention efforts for women and their children, and to reduce unintended pregnancies, especially among HIV-positive women.

It also demands the removal of the Global Gag Rule, the "abstinence earmark" and the "loyalty oath" which greatly limit access to the best available HIV/AIDS, family planning and reproductive health services for women and their families.

(The Global Gag Rule denies foreign organizations which receive family planning assistance from the United States the right to use their own non-US funds to provide legal abortion, counselling or referral for abortion. It also prevents them from lobbying for the legalization of abortion in their country. The "abstinence-until-marriage" earmark requires one third of all HIV prevention funding to promote abstinence as the lead HIV prevention strategy. The "Loyalty Oath/Prostitution Pledge" requires all groups receiving PEPFAR funds sign a pledge opposing prostitution.)

Unintended pregnancy

Population Action points out that the 33 million people now living with the disease worldwide, and the 2.5 million more infected each year, face many economic, social and psychological needs that are not met directly through the emergency relief plan. Women face the risk of unintended pregnancy and the need for access to family planning remains high in most PEPFAR countries.

In their most recent report to Congress, the Office of the Global AIDS Coordinator (OGAC) stressed the importance of voluntary family planning and reproductive health programmes in preventing HIV. Such programmes also supported those living with the disease, they prevented mother-to-child transmission, and they helped to prevent HIV transmission among couples where one partner is HIV-positive.

Such services also provide opportunities to educate women about HIV prevention, including the correct use of male and female condoms - the only technologies currently available to prevent HIV. They help women to space their children, and improve their health, says OGAC. It supports 'wrap around' funding for programmes that will help AIDS affected people, such as nutrition and family planning/reproductive health, but which cannot at the moment be funded directly by PEPFAR.

Married women with unmet need for FP and women living with HIV/AIDS in Ethiopia (thousands)
Married women with unmet need for FP and women living with HIV/AIDS in Ethiopia (thousands)
Married women with unmet need for FP and women living with HIV/AIDS in Ethiopia (thousands).
There is a common misperception that such 'wrap around' funding has grown, says Population Action, but, in reality, it has stagnated. The President's funding request for HIV programmes in the 15 focus countries increased 125 per cent in just two years over the 2006 allocated level. However, the funding request for family planning and reproductive health fell by 11 per cent. Furthermore, the sheer scale of HIV funding in the focus countries ($3.6 billion requested for 2008), dwarfs the reproductive health/family planning funding ($67.5 million requested for 2008, less than 2 per cent the amount requested for HIV programming).

Ethiopian need

Among the countries affected by this is Ethiopia which saw a 24 per cent drop in family planning and reproductive health funding between the 2006 allocation and 2008 request. Yet, the average Ethiopian woman will give birth 5.4 times in her lifetime, and 33.4 per cent of married women wish to limit or space childbearing, but cannot find the means to do so. The 2008 request for such funding in Ethiopia is $15 million, compared to $409 million to address Ethiopia's HIV epidemic.

U.S. FP/RH and HIV Funding for Ethiopia
U.S. FP/RH and HIV Funding for Ethiopia
U.S. FP/RH and HIV Funding for Ethiopia, Allocated 2003-2006, Requested 2007-2008
"Far more funding is needed to help women meet their reproductive intensions in order to promote their wellbeing and rights, regardless of HIV status" says the report. It will be interesting to see how long it will take President Obama to correct his predecessor's skewed approach to this urgent problem.

Note: Focus countries include Botswana, Côte d'Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia in Africa; Guyana and Haiti in Latin America; and Vietnam in Asia.

The full report may be seen at www.populationaction.org