Survivors at a workshop in Pader, northern Uganda. Thousands of women were raped during Uganda’s civil war but there have been few government efforts to assist them. Credit: Rosebell Kagumire/IPS

By Carey L. Biron
WASHINGTON, Dec 10 2014 (IPS)

Nearly two dozen health, advocacy and faith groups are calling on President Barack Obama to take executive action clarifying that U.S. assistance can be used to fund abortion services for women and girls raped in the context of war and conflict.

The groups gathered Tuesday outside of the White House to draw attention to what they say is an ongoing misreading by politicians as well as humanitarian groups of four-decade-old legislation. That law, known as the Helms Amendment, specifies women’s health services that can be supported by U.S. overseas funding."We want to prevent these acts but also, when that violence does occur, to make sure that organisations and government agencies are providing the necessary post-rape care, including legal and social services, as well as mental and physical health services. Abortion services need to be part of that package.” -- Serra Sippel

This mis-interpretation, advocates warn, results in ongoing mental suffering, social disgrace and even additional abuse for women who have been raped.

“For over 40 years, the Helms Amendment has been applied as a complete ban on abortion care in U.S.-funded global health programmes – with no exceptions,” Purnima Mane, the president of Pathfinder International, a group that works on global sexual health issues, said in comments sent to IPS.

“The result is that Pathfinder and other U.S. government-funded agencies are unable to provide critical abortion care services to those at risk even under circumstances upheld by U.S. law and clearly allowable under the Helms Amendment. With the stroke of a pen, President Obama can change the outcome for many of these women and start to reverse more than four decades of neglect of their basic human rights and harm to their health.”

Advocates say such an executive action would be in line with both the law and broader public opinion. Indeed, on the face of it, the Helms Amendment seems to be quite clear.

The amendment bans U.S. funding from being used to “pay for the performance of abortion as a method of family planning” or to “motivate or coerce any person to practice abortions.” While the law does not specifically bar U.S. assistance being used for abortion services in the case of rape, critics have long noted that this has been the impact since the start.

“No U.S. administration has ever implemented this correctly, in terms of making exemptions in certain instances,” Serra Sippel, the president of the Center for Health and Gender Equity (CHANGE) and a key organiser of Tuesday’s demonstration, told IPS.

“This comes down to politics and the political environment in Washington. But what we need is for the president to take leadership and direct USAID” – the federal government’s main foreign assistance agency – “and the State Department to say the U.S. government is taking a stand and supporting access to abortion in these cases.”

Misinterpretation, self-censorship

Abortion has been, and remains, one of the most divisive issues in U.S. politics. By many metrics, this polarisation has only worsened with time.

This came to the cultural and political forefront in 1973, when the U.S. Supreme Court ruled in a landmark decision that a state law banning abortion (except to save the mother’s life) was unconstitutional. The ruling resulted in a lasting moral outrage among broad sections of the U.S. public, though polls suggest that a majority of those in the United States support services following rape, incest or when a mother’s life is at risk.

The Helms Amendment was among the first legislative responses to the court’s ruling, passed just months later. Since then, the amendment has resulted in a discontinuation of U.S. assistance for all abortion services in other countries.

It is important to note that these procedures remain legal in the United States, as well as in many of the countries in which U.S.-funded entities, including government departments, are operating. Humanitarian groups often feel they cannot even make abortion-related information available to women, including those raped during conflict – even if the Helms Amendment doesn’t specifically proscribe doing so.

“These restrictions, collectively, have resulted in a perception that U.S. foreign policy on abortion is more onerous than the actual law … [leading to] a pervasive atmosphere of confusion, misunderstanding and inhibition around other abortion-related activities beyond direct services,” analysis published last year by the Guttmacher Institute, a sexual health-focused think tank here, reports.

“Wittingly or unwittingly, both NGOs and U.S. officials have been transgressors and victims alike in the misinterpretation and misapplication of U.S. anti-abortion law … whether through misinterpretation or self-censorship, NGOs are needlessly refraining from providing abortion counseling or referrals.”

Global statistics on conflict-time rapes and resulting pregnancies are hard to come by. Human Rights Watch points to 2004 research carried out in Liberia, where rape was used as a weapon of war, suggesting that around 15 percent of wartime rapes led to pregnancy.

“Human rights practitioners and public health officials from Bosnia, the Democratic Republic of Congo, Colombia, and other countries at war, have collected evidence from conflict rape survivors showing both that pregnancy happens and that it has devastating consequences for women and girls,” Liesl Gerntholtz, the executive director of a Human Rights Watch’s women’s rights division, wrote Tuesday.

“They are left to continue unwanted pregnancies and bear children they often cannot care for and who are daily reminders of the brutal attacks they suffered. This, in turn, makes these children more vulnerable to stigmatization, abuse, and abandonment.”

Global acknowledgment

On Tuesday, the groups participating in the White House demonstration also called on President Obama to clarify that the Helms Amendment does not apply to pregnancies resulting from incest or if the mother’s life is at risk. Yet the focus of the calls remains on rape in the context of war and conflict.

Advocates say public consciousness on this issue has risen significantly over the past year and a half. To a great extent, this has been driven by the conflict in Syria and the rise of the Islamic State, as well as the ongoing violence in the Democratic Republic of the Congo (DRC), and the centrality of sexual violence in each of these.

“We know that rape has been used as a weapon of war throughout history. What’s new is the attention from governments and advocates over the past 18 months,” CHANGE’s Sippel says.

“The prevention of violence cannot stand alone. We want to prevent these acts but also, when that violence does occur, to make sure that organisations and government agencies are providing the necessary post-rape care, including legal and social services, as well as mental and physical health services. Abortion services need to be part of that package.”

The United States has been a strong global advocate against sexual violence in recent years, including with regard to conflict situations. President Obama has created the first U.S. action plan on women’s role in peace-building, a White House strategy on gender-based violence, among other actions.

Advocates say that clarifying the Helms Amendment would be the next logical step. Although the White House was unable to comment for this story, organisers of Tuesday’s rally say President Obama’s aides did meet with advocates working on sexual violence in Colombia, the DRC and elsewhere.

Edited by Kitty Stapp

The writer can be reached at cbiron@ips.org

Millions of women in Pakistan do not have access to family planning services. Credit: Zofeen Ebrahim/IPS

By Thalif Deen
UNITED NATIONS, Sep 19 2014 (IPS)

The U.N.’s post-2015 development agenda has been described as the most far-reaching and comprehensive development-related endeavour ever undertaken by the world body.

But where does population, family planning and sexual and reproductive health rights (SRHR) fit into the proposed 17 Sustainable Development Goals (SDGs), which are an integral part of that development agenda?"We must continue to fight until every individual, everywhere on this planet, is given the opportunity to live a healthy and sexual reproductive life." -- Purnima Mane, head of Pathfinder International

Of the 17, Goal 3 is aimed at “ensuring healthy lives and promoting well-being for all at all ages,” while Goal 5 calls for gender equality and the “empowerment of all women and girls.”

But when the General Assembly adopts the final list of SDGs in September 2015, how many of the proposed goals will survive and how many will fall by the wayside?

Meanwhile, SRHR will also be a key item on the agenda of a special session of the General Assembly next week commemorating the 20-year-old Programme of Action (PoA) adopted at the landmark International Conference on Population and Development (ICPD) in Cairo in 1994.

In an interview with IPS, Dr. Babatunde Osotimehin, executive director of the U.N. Population Fund (UNFPA) said, “Twenty years ago, we were able to secure commitments from governments on various aspects of poverty reduction, but more importantly the empowerment of women and girs and young people, including their reproductive rights.

“But the battle is not over,” he said.

“Today, we are on the cusp of a new development agenda, and we, as custodians of this agenda, need to locate it within the conversation of sustainable development – a people-centred agenda based on human rights is the only feasible way of achieving sustainable development,” he declared.

Purnima Mane, president and chief executive officer of Pathfinder International, told IPS, “We are delighted the final set of [proposed] SDGs contains four critical targets on SRHR: three under the health goal and one under the gender goal.”

The inclusion of a commitment to universal access to sexual and reproductive health care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes, is necessary and long overdue, she said.

“But we have not reached the finish line yet,” cautioned Mane, who oversees an annual budget of over 100 million dollars for sexual and reproductive health programmes in more than 20 developing countries.

The SDGs still need to be adopted by the General Assembly, “and we must all continue to raise our voices to ensure these SRHR targets are intact when the final version is approved,” she added.

Mane said civil society is disappointed these targets are not as ambitious or rights-based as they should be.

“And translating the written commitment into actionable steps remains a major challenge and is frequently met with resistance. We must retain our focus on these issues,” she said.

Sivananthi Thanenthiran, executive director of the Malaysia-based Asian-Pacific Resource & Research Centre for Women (ARROW) working across 17 countries in the region, told IPS it is ideal to have SRHR captured both under the gender goal as well as the health goal.

The advantages of being part of the gender goal is that the rights aspects can be more strategically addressed – because this is the area where universal commitment has been lagging – the issues of early marriage, gender-based violence, harmful practices – all of which have an impact on the sexual and reproductive health of women, she pointed out.

“The advantages of being part of the health goal is that interventions to reduce maternal mortality, increase access to contraception, reduce sexually transmitted diseases, including HIV/AIDS, are part and parcel of sound national health policies,” Thanenthiran said.

It would be useful for governments to learn from the Millennium Development Goals (MDGs) process and ensure that the new goals are not implemented in silos, she added. “Public health concerns should be addressed with a clear gender and rights framework.”

Maria Jose Alcala, director of the secretariat of the High-Level Task Force for ICPD, told IPS what so many governments and stakeholders around the world called for throughout the negotiations was simply to affirm all human rights for all individuals – and that includes SRHR.

The international community has an historic opportunity– and obligation — to move the global agenda forward, and go beyond just reaffirming agreements of 20 years ago as if the world hasn’t changed,and as if knowledge and society hasn’t evolved, she noted.

“We know, based on ample research and evidence, based on the experiences of countries around the world, as well as just plain common sense, that we will never achieve poverty eradication, equality, social justice, and sustainable development if these fundamental human rights and freedoms are sidelined or traded-off in U.N. negotiations,” Jose Alcala said.

Sexual and reproductive health and rights are a must and prerequisite for the post-2015 agenda “if we are to really leave nobody behind this time around,” she declared.

Mane told IPS, “As the head of Pathfinder, I will actively, passionately, and strongly advocate for SRHR and family planning to be recognised and aggressively pursued in the post-2015 development agenda.”

She said access to SRHR is a fundamental human right. “We must continue to fight until every individual, everywhere on this planet, is given the opportunity to live a healthy and sexual reproductive life. ”

Asked about the successes and failures of ICPD, Thanenthiran told IPS there is a need to recognise the progress so far: maternal mortality ratios and infant mortality rates have decreased, access to contraception has improved and life expectancy increased.

However, much remains to be accomplished, she added. “It is apparent from all recent reports and data that SRHR issues worldwide are issues of socio-economic inequality.”

In every country in the world, she noted, women who are poorer, less educated, or belong to marginalised groups (indigenous, disabled, ethnic minorities) suffer from undesirable sexual and reproductive health outcomes.

Compared to their better educated and wealthier sister citizens, these women and girls are more likely to have less access to contraception, have pregnancies at younger ages, have more frequent pregnancies, have more unintended pregnancies, be less able to protect themselves from HIV and other sexual transmitted diseases, suffer from poor maternal health, die in childbirth and suffer from fistula and uterine prolapse.

Hence the sexual and reproductive health and rights agenda is also the equality agenda of this century, she added.

“Governments must commit to reducing these inequalities and carry these learnings from ICPD at 20 into the post-2015 development agenda,” Thanenthiran said.

Edited by Kitty Stapp

The writer can be contacted at thalifdeen@aol.com

Most South Asian nations struggle with the twin problems of early marriage and teenage pregnancy, making it crucial to tackle both simultaneously, experts say. Credit: Zofeen Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Pakistan, Jul 11 2014 (IPS)

If 22-year-old Rashda Naureen could go back six years in time, she would never have agreed to get married at the tender age of 16.

“Looking back, I know I was not ready for marriage,” she told IPS. “How could I have been, being merely a child myself?”

With only a third-grade education, Naureen became a mother at 17 and got a divorce soon after she delivered.

According to Naureen’s mother, Perween Bibi, who works for a small daily wage as a cleaning woman in Pakistan, “I have two more daughters [in addition to two sons] and we gave Rashda away in order to have one less responsibility on our hands.”

Nearly 7.3 million teenage girls become pregnant every year -- of these, two million are aged 14 or younger.
But the opposite turned out to be true. Today Bibi and her husband, who is a private chauffeur, must now find a way to provide for their grandson in a family of seven struggling to survive.

Perhaps the most unfortunate part of the story is that Naureen’s pregnancy could easily have been avoided.

“Before marriage my best friend urged me to take contraceptive pills, but I refused to listen to her,” Naureen confessed.

“Even my husband, who had been forced to marry me by his parents, said we should wait, but I didn’t pay any heed; I thought having a child immediately would cement our relationship, and my husband would begin to love me,” she said forlornly.

Dr. Tauseef Ahmed, Pakistan country director of Pathfinder International, a non-profit organisation working to improve adolescent and youth access to sexual and reproductive health services in more than 30 countries, says that early pregnancy is not uncommon among teenage brides.

In fact, having a baby is a way of proving one’s fertility, and the values of adolescent pregnancy are “protected by women and girls themselves,” he told IPS.

According to the United Nations Population Fund (UNFPA), nearly 7.3 million teenage girls become pregnant every year — of these, two million are aged 14 or younger. Meanwhile, an estimated 70,000 adolescents in developing countries die each year from complications during pregnancy and childbirth.

The World Health Organisation (WHO) says stillbirths and newborn deaths are 50 percent more likely among infants of adolescent mothers than among mothers aged 20 to 29.

Infants who survive are more likely to have a low birth weight and be premature than those born to women in their 20s.

The problem is particularly pronounced in Pakistan, a country of 180 million people where 35 percent of married women between the ages of 25 and 49 years were wed before the age of 18, according to the latest figures in the 2012-2013 Pakistan Demographic Health Survey.

Experts say one of the main reasons behind the widespread occurrence of chid marriages and early pregnancies is a lack of education.

Naureen agrees, saying her disrupted education stands out as a glaring “missing link” in her early development

Dr. Farid Midhet, who heads the USAID’s flagship Maternal and Child Health Integrated Programme (MCHIP) in Pakistan, says there is a strong link between teenage pregnancy and female illiteracy.

“Together these contribute to high infant and child mortality and morbidity, high fertility, illiteracy in general, and production of children who are a burden on society,” he told IPS.

He added that this exacerbates poverty, which in turn fuels a vicious cycle of militancy, crime and social unrest.

Pathfinder International’s Ahmed believes a strong conservative current in Pakistani society – where 97 percent of the population identifies as Muslim – also conspires against the girl child, making early marriage and adolescent pregnancy a foregone conclusion for thousands of girls.

“Early marriage and not getting permission to attend school are the two main indicators of conservative forces here,” he stressed, adding that the “fear of backlash from conservative forces” has resulted in a glaring lack of positive initiatives within the public sector to tackle the problem.

This, despite the fact that study after study has shown that countries that improve school enrollment rates for girls also see a decline in adolescent child-bearing.

Asked how to tackle the health crisis caused by teenage motherhood, Zeba Sathar, country director of the Population Council of Pakistan, answered immediately that she would first and foremost invest in girls’ education.

“Globally proven strategies include keeping adolescent girls in schools, using economic incentives and livelihood programmes, offering life skills, informing families and communities about the adverse effects of adolescent pregnancy, and mobilising them to support girls to grow and develop into women before becoming mothers,” Sathar told IPS.

A regional problem

The phenomenon is not exclusive to Pakistan, with several other countries in the region experiencing equally challenging situations.

Most South Asian nations, like Pakistan, struggle with the twin problems of early marriage and teenage pregnancy, making it crucial to tackle both simultaneously, experts say.

But this is easier said than done, as laws surrounding the ‘official’ marriage age are difficult to enforce and complicated by traditional societal values.

According to a 2013 report by the UNFPA entitled ‘Motherhood in Childhood’, India and Bangladesh remain among the countries where a girl is most likely to be married before she is 18.

Pakistan and Sri Lanka, on the other hand, show much lower rates of pregnancies among women aged 15 to 19.

The U.N. Department of Economic and Social Affairs (UNDESA)’s World Population Prospects report states that the adolescent fertility rate among women in the 15-19 age group is 87 per 1,000 women in Afghanistan, 81 in Bangladesh, 74 in Nepal, 33 in India, 27 in Pakistan, and just 17 in Sri Lanka.

India’s eastern state of Bihar had the worst score card for child marriage. Referring to a survey of more than 600,000 households conducted for India’s health ministry between 2007 and 2008, Sathar said nearly 70 percent of women in their early twenties reported having been married by the age of 18.

Bangladesh does not fare any better. One in 10 teens has had a child by the age of 15, while one in three girls gets married by the age of 15.

But numbers, according to Ahmed, do not tell the whole story.

“Early childhood marriages and fertility rates may be four times higher in Bangladesh than in Pakistan, but the former experiences higher aspirations [among women] for better education and gainful employment than Pakistan,” he stated.

Bangladesh’s Population Reference Bureau’s 2013 Data Sheet on Youth states the female labour force participation in Bangladesh is 51 percent, compared to just 20 percent in Pakistan.

Additionally, the percentage of women in secondary education in Bangladesh was 55, while in Pakistan it was just 29.

For women like Naureen, staying in school could have spared her a lifetime of pain.

“I would not have been married and become a mother at such a young age; I would have had time to think about what I was getting myself into… I would have been just a little bit wiser,” she said.

Excerpt:

A basket of condoms is passed around during International Women’s Day in Manila. Credit: Kara Santos/IPS

By Thalif Deen
UNITED NATIONS, Jul 10 2014 (IPS)

As the United Nations continues negotiations on a new set of Sustainable Development Goals (SDGs) for its post-2015 development agenda, population experts are hoping reproductive health will be given significant recognition in the final line-up of the goals later this year.

At the same time, an upcoming Special Session of the General Assembly in mid-September may further strengthen reproductive rights and the right to universal family planning."Advocates are rallying to ensure that SRHR remains as central to the next set of goals as it is to women's lives." -- Gina Sarfaty

Gina Sarfaty of the Washington-based Population Action International (PAI) told IPS, “We are at a critical juncture for sexual and reproductive health and rights (SRHR).”

As the conversation around the next set of SDGs begins to heat up, she said, “Advocates are rallying to ensure that SRHR remains as central to the next set of goals as it is to women’s lives.

“The stakes are high, and the need for action is paramount,” cautioned Sarfaty, a Geographic Information Systems (GIS) specialist and research associate at PAI.

World population, currently at over 7.2 billion, is projected to increase by 3.7 billion people by 2100. Much of this growth will occur in developing countries, with 64 percent concentrated in just 10 countries, according to PAI.

In eight of these nations – Nigeria, Tanzania, Democratic Republic of Congo, Niger, Uganda, Ethiopia, Kenya and Zambia – an important driver of population growth is persistently high fertility.

The remaining two countries accounting for the world’s increase – India and the United States – are those with already large populations and high net migration.

The ongoing negotiations for SDGs take place against the run-up to the upcoming special session of the General Assembly commemorating the 20th anniversary of the 1994 landmark International Conference on Population and Development (ICPD) in Cairo.

The special session, to be attended by several heads of state, is scheduled to take place Sep. 22 during the 69th session of the General Assembly.

Dr. Babatunde Osotimehin, under-secretary-general and executive director of the U.N. Population Fund (UNFPA), told IPS the principles set at the ICPD in 1994 are as relevant today as they were 20 years ago.

“But we need to act strong and fast to realise the Cairo vision and achieve universal access to sexual and reproductive health and reproductive rights, including family planning,” he added.

The special session presents the perfect opportunity for governments, at the highest level, to recommit to its success and to renew their political support for actions required to fully achieve the goals and objectives of its Programme of Action and achieve sustainable development, he said.

This will also place the Cairo principles firmly in the post-2015 development agenda, said Dr. Osotimehin, a former Nigerian minister of health.

Purnima Mane, president and chief executive officer of Pathfinder International, told IPS the September meeting represents an opportunity for world leaders to assess progress made over the past 20 years against the goals and strategies developed in 1994, identify any remaining gaps in performance that require increased attention and investment, and realign their efforts moving forward.

“This is a very important session for all of us working on sexual and reproductive health since it provides a critical forum for reaffirming and unifying international commitment to ICPD goals and for making an added push to do more on areas and in countries where we are lagging,” she said.

Asked why there wasn’t a follow-up international conference, perhaps an ICPD+20 on the lines of the Rio+20 environment conference in 2012, Mane said the Cairo Programme of Action developed a very forward-looking agenda and set the bar high for the international community 20 years ago.

She said its goals are still relevant and actionable, and the agenda is unfortunately not yet finished.

“My sense is that having a follow-up conference in such an environment was seen as neither strategic nor a good use of resources,” Mane said.

The upcoming special session “is intended to heighten focus on the goals established in the 1994 Programme of Action, stimulate discussion around what we will do to complete the unfinished agenda, re-engage on commitments already made and also push for more.

“I would hope the upcoming U.N. session will highlight the need to include sexual and reproductive health and rights upfront as a core component of the Sustainable Development Goals as the Open Working Group continues to develop its proposal,” said Mane, who oversees sexual and reproductive health programmes in more than 20 developing nations on an annual budget of over 100 million dollars.

Asked about the current status of world population growth, PAI’s Sarfaty told IPS that despite the fact that mortality has declined substantially, women in sub-Saharan Africa currently have more than five children on average, representing a modest decrease from the average of 6.5 children they had in the 1950s.

Compared to Latin America and Asia, she said, a slower pace of fertility decline has characterised sub-Saharan Africa, with stalls and even reversals along the way.

Of 22 countries where recent survey data is available, 10 are transitioning towards lower childbearing while 12 are currently experiencing fertility stalls.

“Therefore, the expectation that fertility will steadily decline in Africa, as the U.N. projects, will not hold without concerted policy and programme effort,” she warned.

The polar opposite fertility scenario is happening in the high income countries with low levels of fertility.

It is estimated that 48 percent of the world’s population lives in countries where women have fewer than 2.1 children on average in their lifetimes, she pointed out.

While fertility rates in these countries may be below replacement level, their need for family planning does not disappear, she declared.

Sarfaty said family planning use continued in Iran, for example, after the government discontinued its funding of family planning programmes in an attempt to encourage higher birth rates.

In addition to being ineffective, restricting access to family planning also restricts the right of a woman to determine her family size, she added.

Meanwhile, in a report released Thursday, the United Nations said the world’s population is increasingly urban, with more than half living in urban areas today and another 2.5 billion expected by 2050.

With nearly 38 million people, Tokyo tops U.N.’s ranking of most populous cities followed by Delhi, Shanghai, Mexico City, Sao Paulo and Mumbai.

The largest urban growth will take place in India, China and Nigeria: three countries accounting for 37 per cent of the projected growth of the world’s urban population between 2014 and 2050.

By 2050, India is projected to add 404 million urban dwellers, China 292 million and Nigeria 212 million.

Excerpt:

Secretary-General Ban Ki-moon (centre) arrives with Babatunde Osotimehin (left), Executive Director of the UN Population Fund (UNFPA), for the opening of the 46th session of the Commission on Population and Development, Apr. 22-26, 2013. Credit: UN Photo/Eskinder Debebe

By Thalif Deen
UNITED NATIONS, Mar 12 2014 (IPS)

When the United Nations hosts one of its mega conferences – whether on population, human rights, food security or sustainable development – there is always a demand for full and active participation of often-marginalised groups, including women, civil society, indigenous peoples and youth.

But some of the world’s parliamentarians – who help implement most of the U.N.’s programmes of action through national legislation – are also battling to find their rightful place at international conferences.

This is not a shortcoming of the United Nations, say legislators, but the fault of governments that refuse to acknowledge the importance of parliamentarians in official delegations.

When the annual U.N. Commission on Population and Development (CPD) takes place in New York next month, the Asian Forum of Parliamentarians on Population and Development (AFPPD) wants all governments in the Asia-Pacific region to include “at least one parliamentarian committed to progressive population and development policy in their country’s official delegation.”

John Hyde, deputy director of AFPPD, told IPS parliamentarians are directly elected and connected to their communities.

“They can see first-hand the benefit of rights-based, evidence-based policies in improving the life of their constituents,” he said.

And they bring this relevance and commitment to their nations’ delegations, he said.

The Programme of Action (PoA) adopted at the landmark 1994 International Conference on Population and Development (ICPD) – which will be discussed at the CPD Apr. 7-11 – stressed the importance of parliamentarians, civil society and youth being involved in official delegations to the United Nations.

Confirming this, Purnima Mane, president and chief executive officer of Pathfinder International, told IPS “it is incredibly important we involve parliamentarians in development work, empowering them to appreciate and raise issues of population and development with their constituents, and gaining their support to champion global development in national policies, programmes, and budgets.”

In many countries, she pointed out, parliamentarians are already engaged in the process of monitoring their national progress on the ICPD PoA, and building political will and an enabling policy environment, and garnering needed resources for doing so.

Their example needs to be followed more vigorously around the world and inclusion of parliamentarians in national delegations is one way of recognising their role, said Mane, a former U.N. assistant secretary-general and deputy executive director of the U.N. Population Fund (UNFPA).

Hyde told IPS over a third of the Asia-Pacific nations included members of parliaments (MPs) in their delegations to the sixth Asia and Pacific Population Conference held in the Thai capital of Bangkok last year.

The Pacific nations demonstrated the value of well-prepared, engaged MPs, with Cook Islands delegate leader, health minister and AFPPD member Nandi Glassie presenting the majority outcome position on behalf of all the Pacific and a solid majority of Asian nations.

Source: ICPD Beyond 2014 Global Report

While many nations will not reveal their full delegation until just before April, many parliamentarians who contributed to APPC should be in their nations’ delegations at the CPD in New York, “hopefully with other parliamentarians embedded in delegations from the other regions of the world”, he added.

Hyde said parliamentarians from across Asia and the Pacific gathered in Chiang Mai, Thailand last month to help craft the official oral statement on priority issues that AFPPD will present during the CPD in New York.

Asked whether the CPD will also focus on the successes and failures of ICPD, Mane told IPS, “While it is difficult to predict what particular issues will see the most attention at the Commission this year, we hope for a continued focus on human rights and individual dignity, the realisation of which is a driver for all areas of development.”

“At Pathfinder, we were encouraged by, and applaud, the focus on young people and women’s empowerment found in UNFPA’s most recent review, ‘ICPD Beyond 2014 Global Report’,” she added.

Mane said she is also encouraged to see the reference to sustainability.

Without the engagement of all, including women and young people, as well as realisation of their sexual and reproductive health and rights, sustainable development will be hard to achieve in its truest sense, she said.

The upcoming session will likely touch on the successes and failures of the achievements of the ICPD agenda in the context of identifying key lessons learned “that will carry us forward for greater success in the coming decades.”

These will clearly differ by countries but the major focus needs to be on what is going to be done going forward to accelerate the momentum towards progress, Mane said.

Given that the upcoming session will certainly be shaped by the context of this year and the international focus on the Millennium Development Goals (MDGs) and what comes next, “I believe it is crucial the right to sexual and reproductive health for all people shines through as we discuss the path forward and the post-2015 global development agenda.”

She said progress has certainly been made and momentum is growing through ‘Every Woman Every Child’ and many other efforts by several bilateral partners like the U.S. Agency for International Development (USAID), national governments, philanthropic foundations, civil society and the private sector.

She said they are all working better through joint platforms, but many countries are still very much behind on equitable progress toward the MDG5 targets relating to the improvement of maternal health.

Indigenous women hauling water in Chiapas, Mexico. Credit: Mauricio Ramos/IPS

By Purnima Mane
WASHINGTON, Aug 6 2013 (IPS)

In the last decade, several countries in the Latin America and Caribbean (LAC) region have had the opportunity to experience economic growth and establish redistributive fiscal policies aimed at reducing poverty, reducing inequality and improving the coverage and quality of health, education and social protection services.

And yet significant gaps exist in the area of reproductive health and rights, both between countries and as a whole, when it comes to some of the key objectives of the Cairo Programme of Action.

Let us take one of the basic indicators of reproductive health, the maternal mortality ratio. The decline overall in the region is not enough to guarantee the achievement of the target set for 2015.

The average maternal mortality rate in LAC is 80 maternal deaths per 100,000 live births, according to estimates by WHO, UNFPA, UNICEF and World Bank, 2011. Moreover, there are significant inequities between countries.

For example, the estimated maternal mortality rate in Uruguay was 29 deaths per 100,000 live births in 2010, while it was 120 in Guatemala; Haiti exhibits the highest ratio in the region, with 350 maternal deaths per 100,000 live births.

A significant proportion of maternal deaths are caused by unsafe abortions, which represent a serious public health concern in the region.

In 2008, the annual rate of unsafe abortion estimated for the region was 31 abortions per 1,000 women aged 15-44. In 2008, 12 percent of all maternal deaths in Latin America and the Caribbean (1,100 in total) were due to unsafe abortions, according to the World Health Organisation.

Abortion is only legal in six countries, and together, these countries account for less than five percent of the region’s women aged 15-44. (Guttmacher Institute, 2012).

In addition to the discrepancies noted in regard to maternal mortality and access to safe abortion between countries, there are also intra-country disparities.

For example, while the total fertility rate has reduced considerably, in Bolivia (DHS, 2008), the total fertility rate of women with no education was 6.1 compared to 1.9 for women with higher education, and the urban-rural difference is 2.8 to 4.9, respectively; in Panama, maternal mortality is five times higher among indigenous women.

What is even more tragic is that Latin America and the Caribbean has the second highest rate of adolescent pregnancy in the world, with approximately 70 live births per 1,000 women aged 15-19. On an average, 38 percent of women in the region become pregnant before they reach the age of 20 and nearly 20 percent of live births in the region are by adolescent mothers.

The conclusion is clear: universal access to reproductive health is still far from being a reality in the LAC region.

Looking specifically at the seven components of the programme of action, the LAC countries have achieved much higher rates of contraceptive prevalence than Africa or Asia as a whole.

For example, in 2012, the average contraceptive prevalence rate (CPR) among married women in Africa was only 26 percent and 47 percent in Asia (excluding China); in Latin America and the Caribbean it was as high as 67 percent of married women [Population Reference Bureau].

As I said before, the LAC countries have brought down their collective maternal mortality rate to 80 deaths per 100,000 live births – a striking improvement over the Sub-Saharan African average of 500 per 100,000 live births and the South Asian average of 220 per 100,000 live births (UNICEF, 2010).

However, in other key areas of the Programme such as expression of and protection for sexual and reproductive rights including access to safe abortion, post-abortion care, and expression of gender identity or sexual orientation, the LAC region continues to be challenged.

The reasons for the progress in this region were mentioned earlier – development as a whole, higher rates of education and access to contraception have helped considerably.

Let us not forget however, that the lack of progress in ensuring reproductive rights and access to safe abortion in particular comes from the fact that a large number of LAC countries stated formal reservations to many of the rights components in the Programme of Action, including concern over abortion, a national belief and/or laws asserting a need to protect life from the moment of conception, and concern over alternate expressions of family beyond that of formal marriage between a man and a woman.

In contrast, while several other countries in other regions expressed similar reservations (notably many Islamic and Catholic countries), only one African and one Asian country (Djibouti and Philippines) presented formal reservations to this effect. These reservations have continued to hamper progress in these areas and produced the situation we see today in this region.

Purnima Mane, PhD, is President and Chief Executive Officer of Pathfinder International, a global leader in sexual and reproductive health.

The Supreme Court overturned a mandate that certain organisations receiving HIV/AIDS funding state their opposition to prostitution. Credit: Bigstock

By Carey L. Biron
WASHINGTON, Jun 20 2013 (IPS)

The U.S. Supreme Court on Thursday overturned a decade-long practise under which the government linked global HIV/AIDS funding to a controversial requirement that organisations explicitly state their opposition to prostitution.

The court’s decision to overturn the mandate surprised many observers, with the 6-2 ruling now being lauded as a major victory by a broad coalition of global health, women’s rights and free speech advocacy groups.

“We are surprised but very happy to hear how the decision came down,” Crystal DeBoise, co-director of the Sex Workers Project at the Urban Justice Centre, a New York advocacy group, told IPS.

“This is a very good progression for the human rights of sex workers and will be a positive development for organisations that are best situated to meet the needs of sex workers and other people who have social and health risks,” DeBoise said.

“Hopefully this indicates that we’re moving in the direction of serving the most vulnerable members of our societies better and more efficiently.”

The anti-prostitution mandate has been part of U.S. policy since 2003, enacted as part of the President’s Emergency Plan for AIDS Relief (PEPFAR). That programme, focused particularly on Africa, offered the largest ever commitments to fight HIV and AIDS.

In the decade since it was enacted, PEPFAR has made available almost 46 billion dollars for HIV/AIDS programmes, according to official figures, directly providing antiretroviral medicines to more than five million people. For this and next year, President Barack Obama has requested another 13 billion dollars.

Yet from the start, Congress wrote the legislation in such a way that any organisation receiving PEPFAR funding would need to explicitly state its opposition to prostitution. Since then, experts from the health community have warned that such a policy runs counter to the aim of wiping out the HIV/AIDS epidemic.

“This policy didn’t emerge from within the public health field, but rather arose when some U.S. legislators saw an opportunity, through PEPFAR, to insert and enforce an ideological purity about sex work,” Serra Sippel, president of the Centre for Health and Gender Equity (CHANGE), a Washington advocacy group, told IPS.

“That was disturbing in part because it’s not a public health intervention to silence people or require organisations to adopt a specific viewpoint of some legislators.”

Building trust

The U.S. government has always explained the anti-prostitution oath by stating that stamping out sex work is a central component of the country’s broader anti-HIV policy. Civil society has also been split on this issue, with some groups – particularly anti-trafficking organisations – supporting the pledge in some way (several such groups contacted by IPS were unable to respond by deadline).

Still, many critics on the ground have for years warned that the oath stood in the way of the independent thinking necessary to find an end to the HIV epidemic. In particular, it distanced health workers from sex workers.

“It’s considered a best practise in public health to build trust among sex workers and to work to end the stigma and discrimination that fuel the epidemic,” Sippel said.

She noted that forcing an organisation like Pathfinder International – a sexual health advocacy and implementing group, and one of the lead plaintiffs in the Supreme Court case – to sign the pledge essentially pushed the organisation to adopt policy stating that it opposed the very people it was supposed to serve."We signed the pledge, knowing that we would wilfully ignore it."
-- Kevin Frost

“There’s no question that the programmatic goal of ending prostitution comes into conflict with the programmatic goal of trying to end HIV infection,” Kevin Frost, CEO of amfAR, the Foundation for AIDS Research, told IPS. “You end up making it exponentially more difficult to reach and built trust with the kind of individuals who are on the front lines of this issue.”

Such contortions led Frost’s organisation to sign the pledge and then continue to do what it thought best.

“Like many, our hand was forced into signing the prostitution pledge, even though we felt from the beginning that this was bad both policy-wise and programmatically and would have a negative impact on our ability to reach the population that needed the kind of services we offer the most – commercial sex workers,” Frost noted.

“So we signed the pledge, knowing that we would wilfully ignore it. We discussed the policy at the board level and signed on, but did so with objection.”

Still law

Thursday’s court decision hinges on a view of the anti-prostitution oath as infringing on free speech, as guaranteed by the U.S. Constitution’s first amendment.

“The [oath] requirement mandates that recipients of federal funds explicitly agree with the Government’s policy to oppose prostitution,” Chief Justice John Roberts wrote for the majority. “The First Amendment, however, ‘prohibits the government from telling people what they must say.'”

Given the polarised nature of sex work in the United States, the case before the court had been specifically tailored to deal solely with this free speech context. As such, the court did not weigh in on the merits of arguments or policies regarding sex work more generally.

Nor did the decision actually strike down the prostitution oath. Rather, it found that the oath infringed on the free speech of the organisations that were directly party to the court case.

More broadly, the case’s interpretation will affect only U.S., rather than international, groups receiving PEPFAR funding. Yet amfAR’s Frost noted that the majority of groups that receive PEPFAR funding are based in the United States and that the programme’s ability to enforce diktat for international organisations is limited.

Still, with the oath still on the books even after Thursday’s decision, the impetus will now come down to how President Obama’s administration proceeds. To date, administration officials have refused to discuss their view of the oath, given that it has been the subject of legal proceedings since Obama took office.

“This is not over – it’s an important milestone in defeating this policy, but the work needs to continue to make sure it’s not applied in a negative way to groups on the ground,” CHANGE’s Sippel said.

“This decision now gives us an opportunity to look at specific instances where U.S. funding can engage sex workers on a more critical agenda,” Sippel added. “Globally, we’re making a lot of progress on HIV/AIDS, particularly in looking at this from a public health and human rights perspective.

“This case now helps us continue to move the conversation in that direction.”