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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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