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USA/Africa: Global Gag Rule Expands
AfricaFocus Bulletin
Nov 28, 2005 (051128)
(Reposted from sources cited below)
Editor's Note
The "Mexico City Policy," also known as the "Global Gag Rule"
denies U.S. funding to foreign non-governmental organizations that
work on safe abortion issues. It was reimposed by President George
W. Bush in 2001, but in 2003 the administration said that the rule
would not apply to funds for fighting HIV/AIDS. Now, according to
the Center for Health and Gender Equity, the administration is
reversing that policy in a new $193 million program in Kenya.
This move follows recent controversies over related U.S. aid policies,
including the demand that organizations pledge their opposition to
prostitution and the use of U.S. influence to stress abstinence
rather than condom use in AIDS prevention.
This AfricaFocus Bulletin contains a press release and fact sheet
from the Center for Health and Global Equity on the latest shift in
policy.
For additional background on these issues, see the Center for
Health and Gender Equity website at http://www.genderhealth.org.
Additional background on the Global Gag Rule can be found on a site
sponsored by several family planning organizations at
http://www.globalgagrule.org. For information on supporting the
restoration of funding for the UN Population Fund, withheld by the
Bush administration, visit http://www.unfpa.org and
http://www.americansforunfpa.org.
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
Bush Administration "Breaks the Promise" by Expanding Global Gag
Rule to HIV Funding On Eve of World AIDS Day
Action will further undermine HIV Prevention efforts for women and
girls, according to the Center for Health and Gender Equity
November 23, 2005
Contact: Jodi Jacobson
Center for Health and Gender Equity
http://www.genderhealth.org
Email: change@genderhealth.org
301 270-1182 office; 301 257-7897 cell
Washington, D.C. - In a stealth move intended to draw little public
notice, the Bush Administration has formally expanded the Global
Gag Rule to U.S. global AIDS funding under the President's
Emergency Plan for AIDS Relief (PEPFAR), according to the Center
for Health and Gender Equity (CHANGE). The restrictions appear as
part of a five-year, $193 million request for applications (RFA)
for HIV/AIDS prevention, treatment and care in Kenya released late
Friday, November 18th by the United States Agency for
International Development (USAID). The RFA, entitled, "HIV/AIDS
& Tuberculosis, treatment, care and support" references the gag
rule twice in stating eligibility criteria, stating that all
consortium partners must "agree, to abide by the Mexico City
Policy, the Tiahrt Amendment, and all USAID policies and
regulations."
(For a summary of the grant see
http://www.genderhealth.org/kenyagrant.php, as well as to find
links to the original RFA and related documents).
In August 2003, President Bush released an Executive Order
specifically exempting U.S. global AIDS funds from gag rule
restrictions. "The theme of World AIDS Day 2005 is 'Keep the
Promise.' In expanding the Global Gag Rule to U.S. global AIDS
funding on the eve of World AIDS Day, the Administration has
broken its own written commitment not to subject global AIDS funds
to these onerous restrictions," stated Jodi Jacobson, Executive
Director of CHANGE.
The Gag Rule, also known as the "Mexico City Policy," denies U.S.
international family planning funding to foreign non-governmental
organizations that provide safe abortion services, counseling,
referral, or information on safe abortion, advocate for changes in
abortion law in their own country, conduct research on the effects
of unsafe abortion, or otherwise work on safe abortion issues.*
The Global Gag Rule undermines efforts to prevent unintended
pregnancies in the first place by crippling family planning
programs that do so much as collect data on unsafe abortion. It
also hobbles efforts to address the toll taken on women's lives
worldwide by complications of unsafe abortion, sexually
transmitted infections, complications of labor and delivery, and
other leading causes of illness and death among women worldwide.
According to conservative estimates by the World Health
Organization (WHO), approximately 600,000 women worldwide die each
year from complications of pregnancy and childbirth, of which at
least 78,000 women worldwide die as a result of complications of
unsafe abortion in a desperate effort to terminate unintended
pregnancies. In Kenya, where abortion is illegal, complications
of unsafe abortion are a leading killer of married women in their
twenties and thirties. The Kenya Family Planning Association lost
U.S. funding because it refused to forgo the right to discuss the
toll of unsafe abortion on the lives of women in Kenya. "Loss of
this funding has severely undermined efforts to reduce unintended
pregnancy in Kenya through expansion of voluntary family planning
as well as to prevent HIV infections in women," according to Dr.
Godwin Mzenge, Executive Director of Family Planning Association
of Kenya.
Women and girls make up 60 percent of those infected by HIV in
sub-Saharan Africa, the region hardest hit by the AIDS epidemic,
and the rate of new infections is highest among women in their
twenties and thirties in most countries of sub-Saharan Africa, and
in other "hotspots" such as India. "Given these realities, this
shift in policy goes beyond hypocrisy to sheer irresponsibility
and complete disregard for the lives and welfare of women and
girls worldwide," asserted Jacobson.
"More to the point, this move will further undermine the ability of
reproductive health, family planning and material and child health
programs to reach women and girls with life-saving information and
technologies for the prevention of HIV infection at a time when 5
lives are being lost to HIV/AIDS every year and when an
increasingly disproportionate number of those deaths are among
women, " stated Jacobson.
The application of the Global Gag Rule to HIV/AIDS funding reneges
on earlier promises by the Administration not to apply these
restrictions. In February 2003, the Administration indicated it
would expand the Global Gag Rule to all funding under the purview
of the Department of State, including HIV funding. This
announcement generated an international outcry. In a campaign led
by the Center for Health and Gender Equity, more than 145 leading
U.S. organizations from across the fields of public health, human
rights, global AIDS and reproductive health were joined by over
300 leading parliamentarians, public health practitioners, and
religious leaders from every region of the world protesting the
policy restrictions. A letter sent to the President signed by
both domestic and international leaders stated that "Rather than
saving lives, this policy will have the opposite effect: consigning
untold numbers of women and girls to infection, suffering and
premature death that could otherwise have been prevented." Even
Henry Hyde, Chair of the House International Relations Committee
and a primary author of the original global AIDS legislation
advised against applying the gag rule to HIV funding, saying "In
negotiating [global AIDS funding] with the White House, I felt it
was extremely important not to become bogged down in gag rule
politics."
In response to public pressure, President Bush issued an executive
order on August 29, 2003, stating that the Global Gag Rule "shall
not apply to foreign assistance furnished pursuant to the United
States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act
of 2003 (Public Law 108-25)." This latest move breaks that
promise. "In the face of the HIV epidemic, this policy, whether
applied formally or informally, is indefensible, unethical, and
immoral," asserted Jacobson.
Application of the Global Gag Rule will further undermine effective
prevention strategies by denying funding to those programs that are
best poised to meet the needs of the most vulnerable. Family
planning and maternal and child health programs are the "first
responders" for women and girls in the global AIDS epidemic,
trusted sources of information, education, and access to critical
commodities, such as male and female condoms, among other things,
noted Jacobson. Governments and leading donor institutions
throughout the world strongly support integrated family planning
and HIV prevention programs as the best approach to improving
public health. The World Health Organization (WHO) Global Sector
Strategy for HIV/AIDS underscores that existing family planning
programs "provide a clear entry point for the delivery of HIV/AIDS
interventions." USAID, the World Bank, the European Union and
other leading donors in every region encourage integration as a
matter of good public health practice and economic efficiency.
Under severe pressure from the extreme right in the Republican
Party and its fundamentalist Christian base in the United States,
the Administration's global AIDS policy already includes numerous
policy shifts and funding constraints that undermine effective
prevention efforts. First, there is an excessive emphasis on
abstinence-only programs to the exclusion of comprehensive
approaches that integrate abstinence-based programming with safer
sex education. Today, nearly 60 percent of funding for prevention
of sexual transmission-the single greatest factor in HIV
transmission-goes to abstinence programs in PEPFAR focus
countries. Second, the Administration has dramatically cut
funding for condom social marketing and has severely limited condom
distribution to groups at greatest risk of infection. Finally,
PEPFAR provides virtually no funding for female condoms, for
increasing women's ability to negotiate safer sex, for efforts to
stem violence and sexual coercion as a factor in transmission of
HIV, or for other programs critical to women. "What we are doing
is taking an already sub-par effort and making it worse," stated
Jacobson.
Expansion of the Global Gag Rule comes at a time when every dollar
spent on prevention needs to be spent in the most effective way
possible to save lives. "But expansion of the Global Gag Rule is
intended to do one thing and one thing only: It is intended to
further undermine effective reproductive health and family
planning programs worldwide, a goal of the extreme right in this
country for over two decades," stated Jacobson. "The net result
will be increased rates of infection among women, and the
responsibility for this will fall squarely on the Bush
Administration policy," she continued.
To some extent, Jacobson noted, the expansion of the gag rule to
HIV funding represents a "formal admission" of what the
Administration has been doing all along--excluding family planning
and maternal and child health programs from U.S.-funded HIV
prevention efforts. Field research by CHANGE has shown that since
2003, family planning organizations in Botswana, Kenya, Namibia,
Nigeria, Tanzania, and Uganda have been outright denied funding
under PEPFAR due to confusion about the application of the Global
Gag Rule and due to the rush by this Administration to fund
"faith-based" groups, shift prevention funding to abstinence-only
programs, and otherwise undermine effective HIV and reproductive
health programs. The deterioration of basic family planning
services and their inability to respond effectively to the needs
of their clients for HIV prevention was a key concern identified
by the 22 representatives of 6 PEPFAR focus countries that attended
a meeting held by CHANGE in Kenya in September this year.
"Expansion of the Global Gag Rule to HIV funding comes at a time
when political support for the Bush Administration is waning, and
when the Administration is seeking to shore up its 'fundamentalist
base,'" noted Jacobson. "It is perhaps no surprise," noted
Jacobson, "but this decision shows just how far this
Administration will go to play politics with women's lives."
---###---
* The term "Global Gag Rule" derives from the fact that the
restriction is widely seen as violation of the constitutional right
to free speech in the United States and so, to date, has not been
applied to U.S.-based groups. The gag rule is widely seen as a
fundamental challenge to improving public health: Because it
denies funding to those organizations most effective in reducing
unintended pregnancies-and hence the need for abortion-it actually
contributes to the problems it purports to solve.
The Center for Health and Gender Equity is a U.S.-based
non-governmental organization focused on the effects of U.S.
international policies on the health and rights of women, girls,
and other vulnerable populations in Africa, Asia, and Latin
America.
New Kenyan HIV/AIDS Grant Applies Global Gag Rule to HIV Funding
Basic Facts on the Kenya Request for Applications (RFA)
November 2005
[For footnoted version see
http://www.genderhealth.org/kenyagrant.php]
Shift in Policy
In a complete shift in policy, the Bush Administration has begun
applying the Global Gag Rule to HIV funding. The restrictions
appear as part of a five-year, $193 million Request for Application
(RFA) for HIV/AIDS prevention, treatment and care in Kenya released
late Friday, November 18th by the United States Agency for
International Development (USAID). The RFA, entitled, "HIV/AIDS &
Tuberculosis, treatment, care and support" references the gag rule
twice in stating eligibility criteria, stating that all consortium
partners must "agree, to abide by the Mexico City Policy, the
Tiahrt Amendment, and all USAID policies and regulations."
Complications of unsafe abortion, pregnancy and HIV infection are
the main causes of death and illness among women in Kenya.
The new grant restrictions represent a complete abrogation of
earlier promises by the Bush Administration not to further restrict
global AIDS funding. In August 2003, President Bush released a
memorandum specifically exempting all U.S. global AIDS funds from
gag rule restrictions, stating that the Global Gag Rule .shall not
apply to foreign assistance furnished pursuant to the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003
(Public Law 108-25)..
Exemption of U.S. global AIDS funds from the Global Gag Rule4
allows those reproductive health, family planning and maternal and
child health programs that refuse to sign the Global Gag Rule to be
strong and effective partners in reaching their core client group
-
married women of reproductive age - with cost-effective,
evidence-based HIV prevention services and commodities aimed at
saving lives, as well as to provide core services, such as maternal
health care and pre-natal care, to both HIV-negative and
HIV-positive women. Married women in their twenties and thirties
represent the age-group among which new HIV infections are
spreading most rapidly throughout sub-Saharan Africa.
Many organizations have refused to sign the Global Gag Rule because
they see it as an abrogation of the rights to free speech afforded
to U.S. citizens under our constitution, and an abrogation of both
universal public health and human rights principles, especially in
countries where rates of unintended pregnancy are high, a large
share of even married women lack access to basic family planning
services and supplies, and complications of unsafe abortion are
leading killers of women in their twenties and thirties.
What the RFA says
This grant ostensibly includes reproductive health and family
planning as part of the scope of activities in the program. For
example, it says, " this Request for Applications (RFA) [is] for up
to seven Cooperative Agreements in distinct geographic areas to
provide HIV/AIDS and Tuberculosis (TB) prevention, treatment, care
and support, and to a lesser extent, reproductive health/family
planning (RH/FP), malaria, and maternal and child health (MCH)
services..
Eligibility criteria state that the grant is:
"Unrestricted (i.e., open to any type of entity above), subject to
any clarification in text field entitled "Additional Information on
Eligibility."
The section outlining .Additional Information on Eligibility.
states that applicants must:
- Apply as a consortium that includes at least one Kenyan
organization;
-
Agree, and have all consortium partners agree, to abide by the
Mexico City Policy, the Tiahrt Amendment, and all USAID policies
and regulations."
Other Eligibility Criteria include the following:
To be eligible to receive this cooperative agreement, an
organization must:
- Have successfully managed an award of at least $15 million and
five years duration or more, preferably in East Africa, have a
proven track record for accomplishing program outcomes, and have
the institutional capacity to accurately track and report program
expenditures;
-
Apply as a consortium which includes at least one Kenyan
organization
-
Demonstrate that local organizations within the consortium will
have a significant role in technical and managerial activities and
that their capacity to manage projects independently in the future
will be enhanced with a detailed plan to transfer increasing
responsibility as their capacity develops over the first 3 years of
this award; and
-
Agree, and have all consortium partners agree, to abide by the
Mexico City Policy, the Tiahrt Amendment, and all USAID policies
and regulations." The Importance of Integrated Family Planning and
HIV and AIDS Programs in Kenya:
In Kenya, where abortion is illegal, complications of unsafe
abortion are a leading killer of married women in their twenties
and thirties. The Kenya Family Planning Association lost U.S.
funding because it refused to forgo the right to discuss the toll
of unsafe abortion on the lives of women in Kenya. "Loss of this
funding has severely undermined efforts to reduce unintended
pregnancy in Kenya through expansion of voluntary family planning
as well as to prevent HIV infections in women," according to Dr.
Godwin Mzenge, Executive Director of Family Planning Association of
Kenya.
According to a 2004 report by the Kenya Medical Association, the
Kenyan chapter of the Federation of Women Lawyers, the Ministry of
Health and Ipas, some 300,000 abortions take place in Kenya every
year, causing an estimated 20,000 hospitalizations due to
complications and 2,600 deaths of women and girls.
In Kenya, an estimated 13 percent of young women ages 15-24
attending antenatal clinics are infected with HIV. Birth rates have
been declining since the late eighties, from about 7 children per
woman of reproductive age in 1989 to just under 5 children per
woman of reproductive age in 2003. However, desired family size is
lower than actual family size, at about 4 children per couple,
indicating a large unmet need for family planning. Estimates
indicate that at least 25 percent of all married women of
reproductive age want but do not have access to contraceptive
supplies and family planning services, a situation that appears to
be worsening with the erosion of funding for basic reproductive
health and family planning services, and the shift of funding,
attention, and limited health system capacity to HIV/AIDS programs
that are not integrated with, nor providers of, basic family
planning and reproductive health services.
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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