Bangkok AIDS Conference


How Bush’s policy punishes women worldwide

August 5, 2004

George Bush had given himself credit for his apparently generous PEPFAR AIDS funding programme.
But the fine print reveals the programme’s harmful effects on women’s health services.

"The fact that Bush reserves a third of all funding for pushing abstinence, has cut all United Nations funding for family planning clinics, and has attempted to undercut the Cairo Agreements, are all part of the Bush War on Women." Allie Stickney, Vice-President of International Planned Parenthood America, expressed her frustration to The Correspondent newspaper during the 15th International AIDS Conference in Bangkok, Thailand  (11-16 July 2004).

She was referring to the fact that a third of the US President's Emergency Programme for AIDS Relief (PEPFAR) prevention funds are reserved for promoting "abstinence until marriage." This restriction is "advisory" for 2004-2005 but becomes mandatory in 2006. The Bush Administration has also questioned the efficacy of condoms and removed information on condoms from the US Centers for Disease Control website.

President George W Bush reinstated the "Mexico City Policy," otherwise known as the "Global Gag Rule," on his first day in office in January 2001. The policy means that overseas NGO recipients of USAID family planning funds are unable to use their own money to provide abortion services, to advocate for changes in abortion laws, make referrals, or even to provide medical information about legal abortion services to their patients.

The policy was established by Ronald Reagan in 1984, enforced by George Bush Senior, and immediately lifted by Bill Clinton. George W Bush has since extended the Gag Rule to also cover US Department of State funding.

The law has never applied to HIV/AIDS assistance. Yet international programmes have been integrating sexual and reproductive health services with HIV/AIDS support and services for years. Bangkok conference delegates heard extensive sessions on the proven advantages of integration this week, particularly for married women in traditional societies.

The situation has enraged Dr Steven Sinding, Director-General of the International Planned Parenthood Federation (IPPF), who mentioned that the rule did not affect abortion-related activities as these had not been eligible for funding for decades.

"However, the US government remains far and away the largest single source of funding for international reproductive health programmes.” This means that youth and women can often no longer benefit from services to help them prevent unwanted pregnancies, and consequently the demand for abortions. “The cruel irony is that this policy produces more abortions, not fewer, and almost all are unsafe."

About 50 million abortions are performed around the globe every year, of which 20 million are unsafe. This has resulted in about 780,000 deaths and many more injuries and illnesses. Nearly one-sixth of all maternal deaths result from complications arising from illegal terminations.

Initially, IPPF lost US$ 12 million after the reintroduction of the Global Gag Rule, even though only 0.05% of the Federation’s total income had gone to abortion-related activities in eight out of 182 country partners. An estimated further US$ 75 million was further lost in grants and commodities promised to joint partnerships over 4-8 years. Many sexual health programmes were forced to close or scale down as they could no longer obtain donated USAID contraceptives or funding. Separating integrated services into different buildings with dedicated staff and accounting systems, usually proved unfeasible.

Three Kenyan clinics had to close so their 56,000 female clients lost health services. The IPPF further cited that in Bangladesh, 14 of their partner organisations faced closure, as did a project for marginalised youth in Lima; and a health and refugee counselling project in Georgia. In Albania, US$ 242 000 of funding for women and youth was lost, as was US$ 700 000 in Nepal, US$ 635 000 in Nigeria, US$ 50 000 in Malaysia, and US$ 3 million in Cambodia.

Allie Stickney commented that "the US does not force this choice on other governments, as politically, they just could not get away with it." However, NGOs faced a "terrible choice" on whether to accept funding or close down. Those that do accept the American conditions "feared to even speak to other NGOs, providers or partners, in case they are penalised. Thus the effect is very deep and insidious."

She continued that "Democrat candidate John Kerry has promised to immediately lift this Gag Rule if elected. But even if this happens, it would probably be a very long time before NGOs feel less fear about the whole abortion issue. That is what happened last time after Clinton lifted the Gag Rule."

Several conference speakers on gender themes have echoed the inappropriateness of such funding emphasis on abstinence. In a session entitled "Condoms, needles and negotiating skills (CNN) versus abstinence, be faithful, condoms (ABC)," a young Ugandan man stood up to proudly announce he had chosen to protect himself by abstaining from sex before marriage. Other audience members were quick to remind him that this was a far easier option for a man because he was far less likely to encounter sexual abuse or be forced into marriage with a much older, unfaithful husband.

At a later session, Kousalya Periaswamy, who started the Positive Women’s Network in India after she discovered as a 20-year-old bride that her older husband had infected her with HIV, appealed to funders. "When we ridicule abstinence, you must understand where we come from." Her story is a typical one in similar rural communities where women have no inheritance rights, lack rights education and earning opportunities, and are forced into often abusive marriages by their families for economic reasons.

"There is unlikely to be antiretrovirals where I come from for a long time", despaired one delegate, "girls will continue to be forced into marriage, and our husbands won’t consider protection – what message do I take home to women like me from this conference?" Her question was met by almost stony silence. Hopefully the Washington policymakers attending Bangkok 2004, will not only take heed of the howls of activist protest, but also hear these silences.

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