Rebecca Buckwalter-Poza

Thursday January 4, 2007

American progressives’ fight for reproductive justice doesn’t begin in Tennessee‘s state legislature and end in the South Dakota ballot box. Domestic abortion bans are only one part of the ongoing international battle for reproductive freedom. But while American progressives have built an effective movement around our domestic challenges, they have not focused as much on the global reproductive health effects of American international policies.

Right now, one of the greatest threats to reproductive health worldwide is the U.S. Mexico City Policy, also known as the Global Gag Rule. The gag rule is a potent example of how dozens of nations and hundreds of thousands of women can be affected by a single presidential edict. Ronald Reagan introduced the gag rule in 1984 at a population conference in Mexico City. The policy banned funding foreign health agencies and non-governmental organizations that provided abortions or referrals for abortion. Bill Clinton overturned the gag rule when he was president, but George W. Bush reinstated it immediately after taking office in January 2001, adding bans on funding for organizations that are involved with abortion education or political activism in any way.

Alongside this policy, Bush withdrew in 2002 $34 million of foreign aid that had been earmarked for the United Nations Population Fund, the biggest provider of reproductive health services in the developing world. As of 2002, the UNPF had a $274 million budget. Using previous years as a guide, the UNFPA estimated that the funding cut would result in 2 million unwanted pregnancies, 800,000 abortions, 4,700 instances of maternal mortality, and the death of 77,000 children under five. Overturning the UNFPA funding cut and the Mexico City Policy could be the most powerful means of improving women’s health worldwide.

In Kenya, the International Planned Parenthood Federation’s refusal to comply with the Mexico City Policy criteria led to the partial or complete shutdown of five medical centers, many of which were the sole regional providers of prenatal care, mammograms, and pap smears, in addition to contraception and abortion. One such shutdown in Mathare Valley left more than 300,000 Kenyans without medical care. In the midst of the AIDS crisis, Zambian organizations were left unable to distribute contraceptives. And in Nepal, after the loss of $100,000 of funding, the central family planning clinic was forced to dismiss 60 staff members and stop providing mobile clinics. The U.S. Mexico City Policy has proven the vulnerability of international women’s health to U.S. foreign policy and funding changes.

But even if the gag rule remains in place, there is some hope for reproductive health advances in the developing world. Nations that work toward putting basic domestic infrastructure in place have suffered fewer ill effects from the UNFPA cuts than those more dependent on Western, and especially American, aid. Malaysia, for example, has been working to develop and implement initiatives targeting sexual health since 1957. Its National Plan of Action for Prevention, Control, Education, Surveillance, and Care has yielded striking results. From 1957 to 1998, Malaysia’s maternal mortality rate fell from 570 to 20 per 100,000 live births, while the country’s infant mortality rate decreased from 75 to 33 per 1,000 live births, according to the country’s Vital Registration System. In 2001, while other nations were beginning to suffer from the UNFPA funding cuts, Malaysia continued to maintain a low HIV/AIDS rate while improving maternal and infant mortality. HIV/AIDS infection remains at 0.4 percent, manageable in comparison to neighboring Thailand’s 1.4 percent

prevalence rate. Overall, from 1990 to 2005, Malaysian women’s contraceptive use rose 6.2 percent to 54.5 percent among women ages 15 to 49, and the population growth rate decreased from 2.6 to 1.9 percent.

U.S. progressives should advocate an approach to foreign aid that increases such domestic capabilities in both the public and private sectors. The United States should direct funding to government programs like Malaysia’s, and throw our weight behind initiatives like the Urban Primary Health Care Project (UPHCP) in Bangladesh, a partnership between the Bengali government, the private sector, and international NGOs. In 1997 the Bengali government, with the support of the Asian Development Bank (ADB), built health clinics in key urban centers for NGO partners. In addition to running the government-owned clinics, the NGOs such as Marie Stopes International (MSI) have provided training and seminars, created fellowships, and built government capacity to manage health care and conduct structural reform. By 2002, 14 NGOs in Bangladesh were providing reproductive health care and training. And their reach is growing. MSI, for example, increased treatment capacity from 1,000 to 600,000 patients a year once its partnership with domestic organizations began. It now operates 23 full reproductive health centers, 46 “mini-centers,” and 150 factory-based centers to serve workers.

The results have been remarkable. Maternal mortality has dropped with increasing speed. In the 12 years before 2002, maternal deaths per 100,000 live births in Bangladesh dropped from 850 to 600; in the following three years, the rate fell to 380. In May 2005, the ADB renewed its support for the strategy by granting $40 million to a second UPHCP. Joining the ADB were the U.K. Department for International Development ($25 million), the Swedish International Development Cooperation Agency ($5 million), and UNFPA ($2 million co-financed).

Progressives in the United States should focus on channeling the immense resources available to us in the form of partnerships and aid to find and nurture grassroots institutions and organizations abroad. Not only will women’s, and, as a natural corollary, men’s and children’s health improve, but the extra support for locally-run clinics and training for health care personnel will create a stable base for continued growth. Four years of well-directed aid for homegrown health services can help a nation sustain programs through eight years of aid cuts, keeping progress alive in the face of policies like the U.S. Mexico City Policy and UNFPA funding cut.