Last Punches: USAID Undermines Access to Contraceptives
In the waning days of the Bush Administration, the United States Agency for International Development (USAID) is undermining its own investments by pressuring several African governments to stop providing Marie Stopes International (MSI) with the contraceptives purchased by the United States.  The October 2008 decision will further jeopardize women's access to contraception, particularly in six Sub-Saharan African countries, at a time when more than 200 million women worldwide do not have access to the contraception they need. 

Women have the right to high quality health services, and the U.S. government has committed to providing them. Allowing women to go without the means to prevent pregnancies they do not want is intolerable. In the six countries in question (Ghana, Malawi, Sierra Leone, Tanzania, Uganda, and Zimbabwe) there are few alternatives. MSI provides 15 to 25 percent of the contraception nationally, and it is the only organization that reaches women living in rural areas.

Expanding the Refusal Clause:  Politics above Patients
All people deserve access to health care services and information - yet the Bush Administration is attempting to undermine that access in its last months in office.  Harmful new regulations proposed by the Administration would give certain health care providers new authority to withhold treatment, counseling, and/or medical information without regard for patient needs and rights. 

The Department of Health and Human Services (HHS) argues that the proposed regulations are consistent with three federal laws allowing health care providers to refuse-based on their religious or moral beliefs-to provide abortions, tubal ligations and/or vasectomies for their patients.  The regulations are written broadly, and could be applied to the provision of contraceptives and other health services, and beyond protecting health care professionals, they apply to every worker as well as whole health care systems and insurance plans.  The regulations go so far that patient's needs are not taken into account.

The supposed purpose of the regulations is to help clarify the law, though in reality they will create even greater ambiguity and confusion in the more than 580,000 medical facilities across the country to which these regulations would apply.   In addition, there are well-founded concerns that the regulations can be interpreted to apply to international organizations, including the United Nations and the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

After receiving more than 200,000 public comments in opposition to the proposed regulation, the HHS is supposed to take those into account before make a decision about next steps.  According to the Administration's own procedure, the decision one way or another should be made in early November.

UNFPA: The seven-year freeze
On June 26, 2008, for the seventh time, President Bush refused to release funds appropriated by Congress for the United Nations Population Fund (UNFPA)—the world's largest family planning and reproductive health provider for women.

In 2002, the President first denied UNFPA funding in the total of $34 million, citing unsubstantiated claims by an anti-family planning group that the agency supported coerced abortion and sterilization in China.  In each of the next six years, he also blocked Congressional funding intended for UNFPA, blocking a total of nearly $200 million for the agency at a time when more than half a million women die as a result of pregnancy or childbirth every year, and more than 200 million couples lack access to contraception. Four separate investigative teams-including one dispatched by the U.S. State Department-have found the Administration's charges against UNFPA to be groundless. But despite the lack of evidence, and even as outrage over the funding refusal grows among the American people, the Administration refuses to change its position, thereby denying safe motherhood services, contraceptives, fistula repair, and HIV/AIDS prevention to women in 140 developing countries worldwide. Click here for more information about the UNFPA funding freeze.  

Global Gag Rule: Stifling free speech
This Reagan-era policy, reinstated by President Bush on January 22, 2001, requires that in exchange for U.S. assistance for family planning services, foreign nongovernmental organizations (NGOs) receiving money through the United States Agency for International Development (USAID) must withhold information from women about the option of legal abortion and where to obtain safe abortion services-even if they use only their own funds to do so. Additionally, the groups cannot engage in any public debate or disseminate any information regarding the health hazards of unsafe abortion, express support for any existing laws that support safe abortion, or provide legal abortion services with non-U.S. funding. This policy stifles free speech and prevents medical professionals from offering the full range of legal, medically acceptable options to women. It is contrary to U.S. law and would be held unconstitutional if imposed on U.S.-based organizations.

On August 29, 2003, President Bush went even further, extending the Global Gag Rule to apply to foreign NGOs that receive money through the U.S. Department of State. Organizations that receive such funding serve some of the most vulnerable women in the world-refugees and migrants displaced by war and civil unrest. In FY 2004, the Senate attempted to expose the Global Gag Rule's legal exceptionalism and limits on free speech through a provision to the FY 2004 foreign operations appropriations bill.  Additional attempts to overturn and modify the Global Gag Rule have also been met with veto threats-and without the Congressional support to override the veto, the policy remains in place. Click here for more information about the Global Gag Rule, including action opportunities.

The New Litmus Test: Limiting free speech, compromising sound practices
According to a June 10, 2005 directive issued by the Bush administration, all nongovernmental organizations (NGOs) receiving US foreign assistance to address  HIV/AIDS must adopt an organizational policy "explicitly opposing prostitution."  At first blush this may seem harmless, but it stands in the way of free speech, public health practice and puts organizations in a terrible position of undermining their relationship with those they are trying to serve by reducing sex workers' vulnerability to HIV. 

This damaging "anti prostitution loyalty oath" infringes on organizations' right to free speech, and undermines global efforts to eradicate sex trafficking, work respectfully and effectively with commercial sex workers, and prevent the spread of HIV. It contradicts accepted public health practices: condemning sex workers' livelihoods presents a significant obstacle to gaining the trust necessary to reach them with education, health services, and viable economic alternatives. No concrete steps for addressing the poverty, discrimination, and powerlessness that lead to sexual exploitation are offered. Initially, this provision only applied to foreign NGOs, but the 2005 directive extended it to U.S.-based groups as well.

In separate lawsuits brought by U.S. organizations, two district courts have ruled that restricting the privately-funded speech of U.S.-based organizations is unconstitutional (DKT International v. USAID and Alliance for Open Society, Inc. v. USAID).  While a three-judge panel overturned the DKT ruling in February 2007, the other appeal is still pending.  

To avoid further rulings against the government policy, USAID and the Department of Health and Human Services (HHS) issued guidelines for HIV prevention funding recipients in the summer of 2007.  HHS has since developed these guidelines into a proposed regulation that is currently in the public comment process.  They state that U.S.-based recipients can set up affiliates with private funding that do not have an anti-prostitution policy, provided there is "adequate separation" of the recipient and affiliate.  This includes the onerous requirement of complete physical and financial separation, including "separate personnel, management, and governance."  Moreover, USAID and HHS maintain the right to determine "on a case-by-case basis...whether sufficient physical and financial separation exists."  In other words, no recipient can be completely assured that its affiliation is separate enough, because no firm standard is set by the guidance. 

In August 2008, a district court found that "the Guidelines require more separation than is reasonably necessary to satisfy the government's legitimate interest," and that "the Policy Requirement and the Guidelines...impermissibly compel speech."  Moreover, the court granted an injunction preventing the U.S. government from enforcing the prostitution pledge policy with any of the plaintiffs or their member organizations until the case is settled.  The injunction does not apply to foreign-based NGOs, who still need to comply with the anti-prostitution loyalty oath.

Beijing at 10: U.S. trying to undermine international agreement on women
In March 2005, 130 governments convened at the UN Commission on the Status of Women (CSW) to review progress on the landmark Beijing agreement on women's health and rights. Once again, the Bush Administration stood alone in trying to undermine international consensus at the United Nations. Rather than working with other countries on concrete strategies for addressing women's broad health needs and advancing women's social, economic, and political opportunities, the U.S. delegation spent a full week focused on its anti-abortion amendment to the one-page reaffirmation of Beijing. In spite of vigorous lobbying on the part of the U.S. delegation, countries of the world stood firm in rejecting the U.S. language. Eventually, the U.S. had no choice but to withdraw its amendment. This obstructionist U.S. behavior was particularly ironic given the Administration's calls for renewed international cooperation during President Bush and Secretary of State Rice's trip to Europe just weeks before the CSW. Click here for more information about the Administration's failed attempt to reinterpret the Beijing Platform for Action.

ICPD: Negating international agreements
At a regional planning meeting of the Economic Commission for Latin America and the Caribbean (ECLAC) in March 2004, the United States was the only one of 38 country delegations to oppose a declaration to ensure greater access to reproductive health services, greater efforts at HIV/AIDS prevention, and the protection of reproductive rights for all. The meeting was part of a series of regional reviews of the 1994 International Conference on Population and Development (ICPD) Programme of Action, a landmark agreement in which the world's governments, including the U.S., committed to comprehensive initiatives on women's health and rights. At the first regional meeting in the series—the Fifth Asian and Pacific Population Conference, held in Bangkok in December 2002—the Bush administration had made clear its radical shift in policy by refusing to reaffirm the importance of progress on women's health and rights. The U.S. delegation dominated negotiations with an agenda that ignored the health needs of women and girls over the objections of every other country present. It incorrectly claimed the terms "reproductive health services" and "reproductive rights" "promote abortion." Adhering to a narrow and unproven "abstinence-only until marriage" policy, it also tried to remove all language citing "consistent condom use" as a viable way of preventing HIV infection. In the end, the U.S. position was defeated by a vote of 32-1.

Essential Medicines: Trying to block WHO's efforts to decrease unsafe abortion
At a time when 68,000 women die annually from the consequences of unsafe abortion and countless others are left with lifelong health problems, the U.S. Department of Health and Human Services stood alone in trying to block the addition of early pregnancy termination pills to the World Health Organization's (WHO) essential medicines list. Abortion is legal under some circumstances in more than 120 countries, yet heavy restrictions and lack of access to trained providers or health care facilities still lead 19 million women to seek unsafe abortions each year. Ninety-seven percent of these abortions take place in developing countries. In an effort to address this crisis—especially in countries where the health system does not have the capacity to provide safe, surgical abortions even under circumstances when it is legal—an expert committee for the WHO unanimously approved the addition of the early pregnancy termination pills to the organization's essential medicines list. Intended for governments worldwide, the list officially recommends basic drugs doctors should have available. Most recommended additions to the list are incorporated within days of the committee's approval, but U.S. lobbying efforts stalled the process for four months, over the objections of physicians, academics, and public health leaders from around the world. The pills finally made it onto the list in July 2005.

Iraqi Women: Putting anti-feminists in charge of gender equality
On September 27, 2004, then-Secretary of State Colin Powell announced that a portion of a $10 million grant to train and educate 150 women leaders in Iraq would be awarded to the Independent Women's Forum (IWF). Co-founded by Lynne Cheney, National Review editor and former Heritage Foundation Vice President for Government Relations Kate O'Beirne, and others, the IWF is an ultra-conservative organization with an explicitly anti-feminist track record. Although the organization is supposed to be promoting equality and democracy for Iraqi women, it has in fact opposed several key efforts to promote gender equality in the United States, including the Women's Educational Equity Act, the Violence Against Women Act, and Title IX, the landmark federal law that prohibits sex discrimination in education. Internationally, IWF has opposed key provisions of the Convention on All Forms of Discrimination Against Women (CEDAW), including women's right to equal pay for equal work, paid maternity leave and child care facilities for working mothers, and minimum quotas that would ensure women's representation at all levels of government.

Adolescents: Censoring sexuality education
The Bush administration, in an alliance with Iran, Saddam Hussein's Iraq, Libya, Sudan, Syria, and the Vatican, tried to block consensus on quality sexuality education at the UN General Assembly Special Session on Children in May 2002. Success for the U.S. delegation would have prevented young people under 18 from receiving information about sexual abuse (despite increased evidence of its frequency), birth control, condoms, and reproductive health services, including HIV/AIDS prevention. The Administration favored an unproven abstinence-only approach, opposing comprehensive information and services for the millions of adolescents worldwide, many of whom are already sexually active, including through arranged early marriage or forced sexual relationships. Click here for more information on Bush administration policies affecting adolescents worldwide, including action opportunities.

CEDAW: Putting the brakes on women's rights
After the Bush administration notified the Senate Committee on Foreign Relations in 2002 that ratification of the Convention to Eliminate All Forms of Discrimination Against Women (CEDAW) was "generally desirable and should be approved," momentum to ratify it grew. But when the radical Right complained that the treaty would undermine women's femininity, the Bush administration tried to put the brakes on, informing the Committee that a new, "careful review is appropriate and necessary" and asking that it wait to vote until a review was complete. The Committee nevertheless voted 12-7 to send CEDAW to the full Senate for ratification on July 30, 2002, though the full Senate did not vote on CEDAW—leaving the treaty yet to be ratified. Five years later, the administration's 2007 treaty priority list sent to the Senate Foreign Relations Committee lists CEDAW as a treaty "on which the Administration does not support Senate action at this time."

Conference on HIV/AIDS: Stifling medical views on combating HIV
A top Department of Health and Human Services (HHS) official imposed strict quotas on the number of U.S. government scientists permitted to attend the 2004 International AIDS Conference, cutting U.S. funding by 85 percent since the last international AIDS conference and prohibiting researchers from using their own research funds to participate. The prohibition meant that even though the majority of Americans support U.S. efforts to stop HIV/AIDS overseas, only a fraction of the government scientists whose research papers were accepted for presentation were allowed to share their findings with scientists from the regions of the globe most devastated by HIV. This resulted in the cancellation of over 40 presentations on such topics as preventing HIV infection, countering the stigma of AIDS, and monitoring for HIV resistance. An HHS official said that the decision to restrict the number of U.S. government participants came "as a result of the treatment [HHS] Secretary [Tommy Thompson] received in Barcelona…" at a 2002 conference on HIV/AIDS when a handful of AIDS activists demonstrated against U.S. government policies. Why scientists were blamed is still unclear.

Lone Voice of Dissent: Opposing the right to health
During an April 2004 meeting of the UN Commission on Human Rights (UNCHR), the Bush administration repeatedly tried-and failed-to weaken a unanimous resolution on the right to health, and was eventually isolated by a 52-1 vote. The administration also tried to delete the word "services" from the phrase "health care services," claiming that "services" was a code word for "abortion"—an assertion rejected by a vote of 50-2. This was the third meeting since 2003 that the U.S. delegation stood alone in opposing the right to health. At the UN General Assembly in November 2003, the U.S. delegation forced a vote on the universal right to health, and was the only country to oppose it-by a vote of 166-1. The Bush administration took a similar position at the 2003 meeting of the UNCHR in Geneva. Of the 43 countries in attendance, only the U.S. delegation opposed a resolution urging countries to enhance their efforts to eliminate discrimination in health care, prevent violence, promote sexual and reproductive health, take steps to protect the fundamental right to health for their own citizens, and assist developing countries in achieving higher standards of health.

Refugee Women: Denying critical services
In August 2003 the Bush administration officially withdrew funding for a consortium of eight nongovernmental organizations serving refugee women—one of the world's most vulnerable and disenfranchised populations. Since 1995 the consortium has been working, with U.S. government support, to deliver emergency obstetric care, HIV/AIDS prevention services, emergency contraception, and education to prevent violence against women in such war-torn countries as the Democratic Republic of Congo, Rwanda, and Eritrea. But in October 2002 the Bush administration put a hold on U.S. funding because of unclear and unstated concerns about one member of the consortium, Marie Stopes International. In August 2003, the Administration presented the consortium with an ultimatum-drop Marie Stopes International or relinquish all U.S. support. Recognizing that the joint activities of all the members were crucial to quality care, the consortium chose to decline U.S. funding. By blocking these funds, the Bush administration has undermined a concerted effort in the most difficult conditions to prevent the spread of disease, allow women to give birth safely, and deliver care to survivors of rape.

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