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Women’s Health, Women’s Rights, and U.S. Global Policy: Envisioning the Next Ten Years
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Women’s Health, Women’s Rights, and U.S. Global Policy: Envisioning the Next Ten Years

Ten years ago this month, the 1994 International Conference on Population and Development (ICPD) concluded with a historic agreement by more than 170 nations to promote reproductive and sexual health and rights worldwide. The ICPD Plan of Action called for greatly increased funding for family planning and HIV/AIDS prevention services, dramatic expansion of efforts to reduce unsafe abortions and maternal deaths worldwide, and the establishment of policies enabling women to exercise real choices in sex, marriage and childbearing, free from violence, coercion, and discrimination.

This was no small victory: In most countries of the world, sex and reproduction remain both highly stigmatized and highly politicized. Complications from pregnancy, unsafe abortion and HIV/AIDS are the leading killers of women aged 15 to 49 in the majority of countries worldwide. Discrimination against women and girls remains both a cause and a consequence of the lack of political will to tackle these problems. At a minimum, the ICPD Plan of Action provided a tool for civil society to hold governments and donor agencies accountable to their commitments to promote women’s rights and health.

In 1994, the United States stood out as the leader on global reproductive health issues. At the ICPD, U.S. diplomats worked to forge consensus on sensitive issues. More important, following the conference the U.S. moved to implement the ICPD Plan of Action in several concrete ways: increasing funding for international family planning programs; using U.S. bilateral and multilateral programs to address issues such as violence against women, girls’ education, and the quality of reproductive health services; expanding State Department coverage of abuses of women’s human rights; and articulating women’s rights as a central concern of U.S. foreign policy.

Ten years later, the United States, under the Bush administration, once again stands out, this time in opposition to both the spirit and letter of the very agreements it once helped to create. Measured in constant dollars, U.S. funding for international family planning under President Bush has fallen to its lowest level since 1970. Moreover, the administration is siphoning off what little money is available for family planning to fund anti-trafficking efforts and refugee crises—while claiming these programs are being funded with new dollars. President Bush has expanded the reach of the global gag rule—which denies U.S. funds to organizations that provide abortion services or counseling, or even collect data on the prevalence of abortion – and has worked hand in glove with the far right to limit both information on and access to critical reproductive health services in developing countries.

Ideology permeates even the flagship global program of the Bush administration, the President’s Emergency Plan for AIDS Relief. Funding for global AIDS programs has increased dramatically in absolute terms. But the lion’s share of funding for prevention of heterosexual transmission—the single most important factor in the spread of HIV worldwide—is being spent on abstinence-until-marriage programs, which have been discredited by research from the United States showing that such programs fail to prevent unintended pregnancy or lower the rate of infections among teens.

In sum, the Bush administration has all but abandoned the central principles of the ICPD, both at home and abroad. Given this reality, it is tempting for the U.S. global reproductive rights community to wring its collective hands, cross its fingers, and wait for better days.

There is, however, another path, and that is to learn from the success of the far right – and from some of our allies in the HIV/AIDS community – and approach our work in a new, more proactive and ambitious way.

Since at least the mid-nineties, the far right in the United States has been working doggedly to pursue a broad-ranging agenda aimed at rolling back gains on reproductive and sexual rights and health at home and abroad. While abortion is clearly the most visible issue, it is far from the only one. Far right leaders in Congress have pursued a wide-ranging agenda to limit access to contraception, comprehensive sexuality education, condoms, and other related services, information, and technologies. Their general strategy is to break broad concepts down into digestible issues accessible to the average voter (think of the partial birth abortion strategy), and build their case (albeit using misinformation, innuendo, and half-truths) to generate support for legislation and policy that undermine gains in reproductive and sexual health. They are backed by a range of far right groups that disseminate the misinformation and rally constituents in support of restrictive legislation and policies.

In a sense, it is old-fashioned politics at its best, in that the far right has created a vision that, while based on misinformation and lacking evidence, is nonetheless understood by those it seeks to reach, is often couched in terms that appeal to more moderate voters, and is backed up by consistent outreach to a base that is motivated to respond in support of its initiatives. They are proactive, focused, creative, and willing to achieve broader goals through incremental gains.

In the same vein, the U.S. global AIDS community has made incredible gains in advancing its agenda, even in a relatively difficult environment. Working alongside those from the religious community, global AIDS advocates convinced a once-reluctant President Bush to articulate a bold new program on global AIDS. Instead of “low-balling” their agenda in terms of dollars, key players in the community worked with others internationally to identify the global need, calculating the U.S. fair share in billions of dollars. They made the case for that money simultaneously to policy makers, the media, and the public, and went about cultivating motivated constituencies in a number of key states who remain at the ready to lobby their senators and congresspersons on funding and legislation at a moment’s notice. As a result, they went from having nothing, to the promise—though as yet unfulfilled—of $15 billion over five years.

What can we learn from this? In essence, the only way to “save” the ICPD—and to realize the promise of reproductive and sexual health and rights for all—is to recreate and retranslate that agreement into a bold, aggressive, but simultaneously specific agenda that can spark passion and commitment among a broader base of people in the United Sates. Reestablishing U.S. leadership on global reproductive and sexual rights—including a focus on HIV—can be achieved if we are willing, at a minimum, to do the following:

  • Create a vision of reproductive and sexual health and rights that is bold, concrete, defensible, translatable, crosses domestic and international borders, and is based both on the principles of health and of rights. It is no longer acceptable, for example, to be content with roughly the same amount of funding for international family planning appropriated last year and the year before. We need to decide what is needed and go after it aggressively.
  • Look beyond November. The only way that we can shape a meaningful agenda for the future is first to know what we want to achieve, irrespective of who is in the White House, and then set out to achieve it by being as aggressive, creative, and unapologetic about our goals on every level as the far right has been for the past ten years.
  • Engage diverse constituencies—such as the global AIDS community, women of color, immigrant populations, and others—in building common cause around issues of common concern. Work in coalition with these communities, supporting their priorities in exchange for their support of ours.
  • Respond rapidly and effectively to the misinformation spread by the far right. This requires not only media outreach, but training and mobilization of sufficient numbers of people in key Congressional districts and key states such that a broad array of individuals and organizations from different levels of civil society are engaged in promoting shared goals.
  • Be willing to raise the stakes. When the far right is angry with George Bush, they let him know it. We need to hold our own partners in Congress, the White House and elsewhere more accountable to our goals.

By taking these and other steps, the U.S. global reproductive health community can reinvent itself, revitalize its agenda, and realize long-term gains. Let’s not wait another ten years.

Jodi L. Jacobson is executive director of the Center for Health and Gender Equity.

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