Will the GHI Guarantee the Sexual and Reproductive Rights of Women and Girls?
07/21/2010
Serra Sippel, president of Center for Health and Gender Equity, says advocates must work to make it happen
The world's foremost HIV activists, advocates, policy-makers and health professionals are gathered in Vienna to answer one question: After nearly three decades of fighting HIV and AIDS, why is the virus still gaining ground? We know how to prevent HIV; we know how to treat it, why are we still choking on its dust? We are long overdue for a revised approach to this global health crisis.
We may have heard that in President Obama's Global Health Initiative (GHI). The GHI, as proposed by the U.S. administration, looks at the people who are affected by HIV and AIDS and treats them as complete beings. It seeks to build on the U.S. global AIDS response - the President's Emergency Plan for AIDS Relief (PEPFAR) - to broaden and integrate health interventions. It insists on a woman- and girl-centered approach because it recognizes that no global health plan will be effective until it addresses gender inequality and the disparate needs and conditions of women and girls. It is country-led, recognizing the critical role of civil society and national governments in guaranteeing accessible health services that meet the needs of every person. It is comprehensive and integrated linking HIV and AIDS, family planning, maternal and child health, malaria, tuberculosis and neglected tropical diseases, because these issues do not exist separately from each other - HIV contributed to 60,000 maternal deaths alone in 2008.
The GHI views people holistically, and recognizes the problems with segregating health interventions. For example, when I visited Botswana in 2008, the country received US global AIDS funding, but not family planning funding - a PEPFAR-funded program focused on women living with HIV who were pregnant without including information or services for voluntary family planning. Similarly, an HIV-testing program offered no family planning or maternal health counseling, even though many clients were sexually active.
While the mandate of these programs is HIV and AIDS, the realities and concerns of women and their reproductive health needs and decision-making were not taken into account. These programs only addressed one aspect of their lives - not taking into account barriers women face in accessing reproductive health care such as rape, stigma faced by pregnant women living with HIV, and lack of knowledge about family planning, especially among young people - missing opportunities to help reduce risk of illness and death related to sex and reproduction.
The GHI addresses those factors. That is one of its strengths.
It is not, however, without weaknesses. The GHI, and all U.S. global health programs, remains handicapped by discriminatory funding and policy restrictions. We have to look at these restrictions and who they benefit - if the answer is policy-makers, we're doing something wrong.
The U.S. continues to support abstinence and be faithful-only (AB-only) programs even though the Obama Administration has stated its support for comprehensive prevention programs that include female and male condom information and distribution. AB-only programs are not required to include such information, and we know that doesn't work.
To be successful, the GHI must address unsafe abortion, a major cause of maternal death. In Ethiopia, a third of maternal deaths are due to unsafe abortion. Although Ethiopia decriminalized abortion in cases of rape, incest and the life of the mother, safe, legal abortions are largely inaccessible. Because of funding restrictions imposed by the U.S. Congress, health organizations receiving U.S. foreign assistance cannot use U.S. funding to provide safe abortions that are legal under both Ethiopia and U.S. laws.
We have to talk about sex work. The Obama administration has done nothing about the anti-prostitution loyalty oath, which requires organizations receiving U.S. HIV/AIDS funding to adopt a policy opposing prostitution. The policy is a proven barrier to female, male and transgender sex workers - some of the populations most at risk of HIV - for receiving HIV education, prevention and treatment - another example of a policy that is Washington-led, not country-led, harming the end-user and violating human rights.
To overcome these obstacles to successful implementation of the GHI, advocates from the U.S. and global South must work together to remove these barriers.
And while we must bring an end to siloed health and development programming, the advocacy and funding communities must also become integrated. We must find our shared vision of a world without poverty and a guarantee of human rights - including sexual and reproductive rights.
Women ARISE has already begun to break down the siloes at Vienna by bringing together women's rights advocates from the global North and South - women advocating for the rights of women living with HIV, sex workers, drug users, young women, old women, lesbians, care givers - all women united around sexual and reproductive rights, creating a powerful force for change.
Smart U.S. foreign policy and investments must uphold sexual and reproductive rights and integrate HIV and AIDS, family planning and maternal and child health. Smart advocacy must break down barriers across health and human rights to demand accountability of funders and ourselves. An integrated U.S. global health policy and united advocacy community might just be the missing ingredients.
Serra Sippel is president of the Center for Health and Gender Equity and a member of Women ARISE.
Thank you. You couldn’t have wrapped up all of the current policy issues more succinctly. As you note, the difficulty will be getting donors and governments to let go of restrictions and separate reporting structures and to allow primary health care systems to address these problems in a patient-centered manner.
— Lewis Holmes on 2010-07-23
A helpful description of GHI’s strengths and weaknesses, thanks Serra!
— Porter McConnell on 2010-07-25