Study gives U.S.a 'C' grade for reproductive health

In a comprehensive study released today by Population Action International (PAI) - an independent policy and research organization based in Washington, D.C. - the United States ranks 16th and receives a "C" on a list of 21 donor countries graded according to their financial and political support for international reproductive health and population programs. Leading U.S. allies the United Kingdom, Canada and Japan rank 7th, 10th and 13th, respectively. The Netherlands, Denmark and Norway top the list; Spain, Austria and Portugal occupy the last three slots.

The new PAI study, Progress and Promises: Trends in International Assistance for Reproductive Health and Population, details recent developments in international policy and funding, profiles 21 donor countries, and grades each of them on their contributions toward the goal of universal access to basic reproductive health care by 2015 - the goal agreed to by 179 nations at the International Conference on Population and Development (ICPD) in 1994. The study also addresses donors" growing focus on HIV/AIDS and the importance of linking HIV/AIDS services with other aspects of sexual and reproductive health care.

Donor countries - including the United States - agreed to provide one-third of the annual costs to implement the 20-year ICPD Programme of Action, estimated to reach US$18.5 billion in 2005. But despite the largest increase in funding ever recorded, from $1.7 billion in 2001 to $2.3 billion in 2002, a three-fold increase in funding would still be required to stay on schedule to fulfill these commitments. Even with such an increase, the cost would be less than three pennies a day per person in the world's wealthiest countries, about what it takes to buy a single movie ticket each year.

"Hundreds of millions of women in the developing world still lack access to basic reproductive health care - including family planning and HIV/AIDS prevention and treatment services," says PAI President Amy Coen. According to Coen, improving access to reproductive health care does more than enable women to make their own decisions about fertility. "The best kept secret is that when women are supported by investments in family planning and related programs, families are lifted out of poverty." But fulfilling commitments requires more than monetary investments. Coen also states, "Money matters and policies count. It's not simply about money; it's about money wisely invested and the policies needed to support those investments. Good policies get good results."

According to the study, the United States leads donor countries in funding for international reproductive health and population efforts, including HIV/AIDS, with aid of $963 million in 2002. When the size of the U.S. economy is accounted for, however, the U.S. falls to 11th place. The U.S. does even worse when it comes to overall development assistance, devoting only.13 percent of its gross national income in 2002, in stark contrast to the Netherlands' .81 percent of GNI.

In terms of policy, the Bush administration has undermined key international reproductive health programs, such as family planning, in which the United States has been a leader for more than 30 years. The administration re-imposed the Mexico City Policy (also known as the Global Gag Rule) in 2001, which led to the defunding of the International Planned Parenthood Federation (IPPF) and the closure of desperately needed clinics in developing countries. In 2002, the administration withdrew funding from UNFPA (the UN Population Fund), which supports family planning in more than 140 countries. Over the past two years, the administration also attempted to thwart efforts to reaffirm the 1994 ICPD Programme of Action by demanding that previously negotiated language on reproductive health be redefined during UN-sponsored regional meetings.

"The United States is chipping away its own legacy of enabling vulnerable women to build strong families. Even though it continues to be the largest bilateral donor to international reproductive health and population programs, past successes are being dismantled," says Coen.

With the recent re-election of George W. Bush as U.S. president, and increased conservative majorities now in both houses of Congress, policy restrictions and uncertainties about funding are expected to continue at least through mid-term congressional elections in 2006.

Progress and Promises notes that most donors have stepped up their financial support for the fight against HIV/AIDS. The United States has done the same, but rigid program guidelines hinder efforts in the field to link or integrate HIV/AIDS services with other aspects of reproductive health care. U.S. HIV/AIDS efforts are also undercut by its increasing promotion of abstinence-only approaches. "The HIV/AIDS pandemic is finally getting some long-needed attention from the international donor community," says Sally Ethelston, lead author of the new report and a vice president at PAI. "The challenge now is to ensure that, wherever possible, HIV/AIDS efforts help strengthen overall health services - including in reproductive health - and vice versa. This is because winning the war against AIDS cannot, by itself, guarantee a world in which women and men can make decisions about sex and reproduction in good health, with hope rather than fear."

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