But an equally important weakness of universal health coverage as a concept is that it fails to address the non-economic factors that play a significant role in determining whether women and young people can access and use the health services they need. These factors include:

• Laws and policies that restrict access, such as policies requiring parental or spousal consent or couples treatment, or laws that restrict the provision of and access to certain services, such as safe abortion.
• Social and cultural norms and practices that embody persistent gender inequalities. This can result in, for example, low immunization rates for girls or stigma and discrimination when unmarried women seek sexual health services. These norms and practices can keep women and girls from using services that are otherwise available.
• Lack of individual empowerment, information, and education, which impede women’s and adolescents’ knowledge about health and health-seeking behaviors.
• Weaknesses in health systems that may result in poor quality of care or inaccessible, inadequate, and inappropriate services. These range from resource issues such as the inequitable distribution of services between urban and rural areas and insufficient numbers of trained health care workers to systemic problems like discrimination and abuse of marginalized patients, including women, adolescents, and people who are lesbian, gay, bisexual, and transgender.
• Other social determinants of health, such as food and nutrition, security, water and sanitation, and other environmental and occupational factors that can have specific negative health consequences for women and girls, including for their sexual and reproductive health.

A draft discussion paper prepared for next week’s Global Leadership Meeting on Health acknowledges the critical gap of universal health coverage in addressing the social determinants of health and other barriers to health care. Indeed, this gap might even make universal health coverage something of a pipe dream when sexual and reproductive health is on the line. Without concomitant efforts to address these and the economic factors outlined in my previous blog, women and girls will continue to face challenges accessing and using sexual and reproductive and other critical health services and exercising their rights. The government and civil society leaders meeting next week would do well to discuss the full range of factors that can facilitate or impede people’s ability to achieve the highest attainable standard of health.

We at the International Women’s Health Coalition hope that global leaders agree to take a more holistic approach to improving health care by recommending development goals specifically for women and adolescents—two population groups who face the biggest barriers to care and whose health is critical for overall development. Such an approach would allow for focus on the particular health challenges faced by women and young people, the contextual factors that can jeopardize their health and erect barriers to care, and the specific interventions needed for both prevention and treatment of health conditions.

Universal health coverage is important, but it alone is not enough to guarantee access to health services and improve health. We need specific goals that address the diversity of barriers to care faced by women and adolescents, along with a dose of political will and resources adequate to meeting these goals.

One proposal on the table would group all these concerns under the objective of “universal health coverage.” In my two-part blog series, I will discuss why this proposal falls short when it comes to women and adolescents.

Universal health coverage is defined in the draft discussion paper for Botswana as “two inter-related components: coverage with needed health services (prevention, promotion, treatment, and rehabilitation) and coverage with financial risk protection, for everyone.” Universal health insurance is considered critical to achieving universal health coverage because of the protection it can provide against catastrophic health costs and its contribution to sustainable financing. But is it enough?

Economic barriers (“financial risk”) certainly pose formidable obstacles to women and adolescents seeking sexual and reproductive health care; universal health insurance can help to address this.  But alone, it is not sufficient. In fact, health insurance schemes may contain their own barriers to care, particularly for marginalized women and adolescents.

For example, core sexual and reproductive health services, such as family planning counseling and contraceptives and maternity care, are often excluded from benefits packages that determine what is and is not covered by insurance schemes.

Abortion services are largely excluded from coverage, despite the fact that abortion is legal (on one or more grounds) in a majority of countries worldwide. Coverage of contraceptives and sexual health services for adolescents may be likewise constrained due to political sensitivities.

The level of financial protection provided by health insurance can also vary and may not be sufficient to insulate women against economic hardship.  Women consistently experience a higher burden of out-of-pocket costs for health care services than men who have similar levels of insurance coverage, largely due to non-coverage or limits on coverage for sexual and reproductive health services. Even nominal co-pays, common in many insurance programs, may pose a significant barrier if women do not have access to or control over cash.

Concerns about confidentiality and privacy may also impede access for adolescents and women when their own insurance coverage is tied to their parents’ or spouse’s coverage.  In the United States, adolescents and young women and men enrolled as dependents under their parents’ health insurance policies often choose not to use their insurance coverage to pay for sexual and reproductive health services, for fear that their parents will receive notification that they sought such care. Women covered as dependents under their husbands’ insurance policies may likewise be hesitant to seek much-needed care, such as contraceptives or treatment for violence.

Finally, the most marginalized women often fall through the cracks of so-called “universal” health insurance schemes for a number of reasons including lack of autonomy and decision-making power, or lack of information.  Women who are employed in the informal sector, women living in poverty, adolescent girls, and older women are often those least able to obtain good quality health insurance.

How do we make sure what is recommended at the Botswana meeting addresses these concerns?

I suggest a way forward in my next post.

Young people all over the world face a range of unique challenges to exercising their rights.  Barriers to age-appropriate health services, meaningful education, and viable livelihoods opportunities are among the most pressing impediments to youth empowerment.

The International Women’s Health Coalition is centrally concerned with the sexual and reproductive health and rights of young people.  We believe that working with both young men and women is critical to ensuring that the rights of all young people, particularly girls, are universally protected and realized. The following contribution focuses specifically on the challenges facing girls, who continue to experience systematic social, economic and political marginalization in every part of the world.

Given the global persistence of gender inequality, many of the issues disproportionately affecting young people also tend to disproportionately affect girls. In 1997, UNAIDS reported that 60% of new HIV infections in sub-Saharan Africa were among young people (aged 15-24), with a 2:1 ratio of infected girls to infected boys.  This ratio continues to grow increasingly lopsided, with girls representing 74% of new infections among young people in 2009.

Additionally, girls face extraordinarily high rates of violence.  The experience of violence, the perceived threat of violence, or the stigma associated with being a victim of violence hinder access to entitlements, opportunities for social participation, and employment.

In developing countries, 40% of girls have their first child before the age of twenty, many before the age of 18. Not only does this mean that more girls are dropping out of school, but girls are also more likely than adults to die, experience complications, or suffer chronic injuries related to childbirth. Because they have less access to contraceptives and are less sexually experienced, adolescents are more likely than adults to seek out unsafe (often late-term) abortions.  Each year, it is estimated that 2 million to 4.4 million adolescents in developing countries have abortions, 70,000 unsafe abortions are carried out, and 13% of all maternal deaths occur as a result of unsafe abortion.

Early pregnancy is often associated with child marriage, a practice which also puts girls at increased risk of HIV infection.  Female genital mutilation, infanticide, nutritional bias—these and other harmful traditional practices disproportionately affect girls, infringing on their fundamental rights and opportunities for development.

The short answer to why these inequalities exist is that girls, especially the most vulnerable girls, continue to remain invisible. Despite the aforementioned figures, policymakers have consistently masked the specific needs of girls within “male-focused and male-dominated community-based activities and generic ‘youth’ prevention initiatives, all of which widely miss the mark” (Bruce, Temin, & Hallman, 2012).  This generic youth programming disproportionately benefits boys over girls overall, but it also favors unmarried to married girls, well-connected to socially marginalized girls, urban to rural girls, girls belonging to an ethnic majority to migrant or indigenous girls, and so on.

Girls also remain invisible because of how we measure progress.  Primary education enrollment figures, for example, are based on one day of the school year; even if there were genuine parity on this particular day, these figures fail to account for the reality that girls often miss multiple days of school each week because their domestic and reproductive responsibilities take priority.  Moreover, data on young people is rarely disaggregated, resulting in measures of participation which fail to report gender, age, marital status, and other critical factors.

The disproportionate burden that girls share for maternal morbidity and mortality, the time burdens that girls shoulder, the staggering inequalities in girls’ educational outcomes—these are all reversible realities. To tackle these disparities, we need to begin by making girls visible.  We must call for the post-2015 agenda to pay particular attention to girls and the challenges that they face.  The risks facing girls are well documented and the next step is to match the research with the necessary resources.

We need to make girls visible.

Making girls visible begins with how we count them.  By properly counting girls and disaggregating data by age and gender, we can target youth programming at specific subsets of youth—like adolescent girls.  We can also measure whether programs are actually reaching the girls who are most at risk.

We need to invest in girls.

We must invest in programming aimed specifically at girls, with an emphasis on the most at-risk populations of girls—those who engage in transactional sex, those who are forced into early marriage, those who fluently speak their native language but cannot communicate in their national language, and so on.  These programs must include the following features.

• Comprehensive Sexuality Education (CSE) must be thorough, scientifically sound, and culturally appropriate.  It should take place in a safe and healthy learning environment and it should explicitly address gender norms and gender equality.  When young people are educated about human rights, gender equality, and the role of power in relationships, they are not only equipped with the tools to negotiate their own health relationships, but they are also able to educate and influence power-brokers in their communities.
• Comprehensive services must be universally available and accessible.  This means, access to high quality sexual and reproductive health care, all forms of safe and effective contraception, safe abortion and post abortion care, maternity care, and prevention and treatment of sexually transmitted infections including HIV.
• Education is foundational to girls’ empowerment. We must ensure that all girls, no matter how poor, isolated or disadvantaged, are able to attend school regularly and without the interruption of early pregnancy, forced marriage, etc.  Education—for both girls and boys—must go beyond academics and equip young people with life skills so that they are prepared to think critically and challenge discriminatory and repressive policies and practices.
• Empowering spaces ensure girls have the opportunity to feel secure, be themselves, and plan for their safety and development.  Even if only for a few hours a week, accessing safe spaces allows girls to frame their own agendas, receive training on sexual and reproductive health and rights, and develop their social and economic capital. These participatory social spaces also foster opportunities for community-building and networking, mitigating the isolation that many girls experience.

We need to support young leaders.

We must continue to support both young women and young men to be advocates for change. Ensuring that reproductive rights are protected and promoted rests in the hands of young women and men, particularly young people throughout the global South.  Young people should be involved in all types of decision making on sexual and reproductive health and rights.  Seasoned advocates must be willing to pass the torch, share best practices, and work alongside—sometimes even be led by—a new generation of SRHR leaders.

As advocates, we can listen to one another and work in tandem to repeal legislation that legitimizes discrimination against girls and press for new protections that ensure equality of access to health services, jobs and earnings, education, property and all the rest.  Addressing the profoundly complex root causes of gender inequality (and accordingly the inequalities experienced by girls) is not a simple challenge.

As we begin to develop a tangible action plan for the post-2015 development framework, we must remain mindful that shifting the social and cultural norms that permit and promote discrimination against girls is not a simple box-ticking task. We cannot continue to view gender equality as a singular aim, but rather as both an explicit goal and an issue that needs to be mainstreamed throughout the post-2015 development agenda.

Researchers estimate that 35,000 pregnancies occur every year in Peru as a result of rape. Women and girls in this situation are faced with two options: seek an illegal abortion and risk going to jail or carry the pregnancy to term and suffer the psychological and physical trauma that go along with giving birth to your rapist’s child. Women who can prove that a pregnancy is the result of rape receive a “reduced” sentence of three months in jail (the standard prison sentence for illegal abortions in Peru is two years). Perversely, this reduced sentence does not apply to married women who are raped by their husbands, even though marital rape is a crime under Peruvian law. Doctors who perform abortions in cases of rape face up to six years in prison.

On September 28, 2012, a coalition of women’s rights groups launched a campaign to challenge this cruel violation of human rights. The campaign, Dejala Decidir (“Let her decide”), seeks to introduce a new law that decriminalizes abortion in cases of rape (currently, abortion is only permitted when the woman’s life or health is at risk). The groups, led by partners of the International Women’s Health Coalition—PROMSEX, Demus, Catholics for the Right to Decide-Peru, Manuela Ramos, CLADEM-Peru, and Flora Tristán—need to collect 60,000 valid signatures to petition Congress to consider the bill.

Photo courtesy of PROMSEX

This is no small challenge. The requirement for valid signatures means that people must be willing to provide their government ID numbers to verify their identities. This may be intimidating to many people in a country where the Catholic Church exerts a great deal of influence in the government and within communities. Consider also that many people in rural and indigenous communities—especially poor women who are disproportionately impacted by the abortion ban—do not have government IDs. Even if the campaign succeeds in obtaining 60,000 valid signatures, there is no guarantee that Congress members will risk controversy or the ire of the Catholic Church and support a change in the law.

The groups see the Dejala Decidir campaign as an opportunity to build a powerful and active movement on two important but neglected issues: abortion and rape. Every signature represents at least one more person informed about the harsh realities faced by rape victims in Peru, and mobilized to change the current abortion law.

George Liendo, Director of PROMSEX, says the time is ripe for a national dialogue. “It’s not always easy to build a coalition in Peru, but there is real energy for this campaign. People across the country want to put this on the political agenda.”

Peru is not the only country in the region rethinking its draconian approach to abortion. In October 2012, the Uruguayan congress voted to decriminalize abortion in the first twelve weeks of pregnancy.

Activists in Peru have until October 2013 to collect enough signatures to ask their own Congress to act. In the meantime, we can expect a rich and lively dialogue on rape and abortion. It’s about time.

This blog was cross-posted on RH Reality Check at http://www.rhrealitycheck.org/article/2012/12/19/double-jeopardy-rape-victims-in-peru.

The last couple of days of the ICPD Global Youth Forum in Bali, Indonesia, have seen a flurry of around-the-clock activity by nearly 1,000 young people, adult allies, NGO representatives, academics, government officials, and other stakeholders from around the world. Their hard work is already paying off.

Yesterday, forum participants developed a number of “Staying Healthy” recommendations to ensure that governments prioritize programs that empower vulnerable young populations, including young women and adolescent girls, LGBTQI individuals, persons with disabilities, and young people living with HIV and AIDS. These recommendations are progressive, measurable, and based on evidence.

The journey has not always been easy. A small, but vocal, opposition made up of non-youth participants have attempted to intimidate and censor young people during this forum. Many people could easily have been intimidated into silence by this group, but thankfully the youth at the Global Forum refused to back down. There is too much at stake.

The “Staying Healthy” recommendations were developed as part of a consultative process following a lively plenary. In his speech, UNFPA Executive Director Dr. Babatunde Osotimehin encouraged young people to continue questioning the status quo, stating that young people are not only the present but the future. He discussed a number of issues impacting the sexual and reproductive health and rights of young people, including meaningful participation, gender equality, ending early and forced marriage, unintended pregnancy, maternal mortality, and the needs of both married and unmarried adolescents. Osotimehin described the process of meeting the sexual and reproductive health and human rights of young people as “A journey of 1,000 miles [that] starts with the first step.”

Indonesian Health Minister Nafsiah Mboi also spoke at the plenary and was met with rousing applause when she stated that, “We have the responsibility to fulfill and promote the health and human rights of young people,” that, “Young people need to be empowered in all aspects of their life,” and that, “It is a fundamental human right of adolescents and youth to access comprehensive sexual and reproductive health education and services.” In Indonesia, there are more than 65 million young people aged between 15 and 24 years old and only 21 percent of them have comprehensive knowledge regarding HIV/AIDS. Sexual transmission of HIV accounts for the vast proportion of new HIV infections among young people and unmarried girls cannot access contraception. Despite these facts, Mboi stated she believes that “The government has an obligation to provide education and services on sexual and reproductive health that are equitable, affordable, and accessible.” For the tens of millions of Indonesian young people in need of information, services, and protection of their human rights, we are optimistic when she says that “You can count on me, I won’t let you down.”

I am thrilled that the final consolidated “Staying Healthy” recommendations articulate a clear, comprehensive, and human-rights based vision as to where the global community needs to focus attention and resources to secure the health and human rights of all young people, and in particular the most marginalized and vulnerable which include adolescent girls and LGBTQI individuals.

These young forum participants deserve our applause for remaining steadfast that this must remain a youth-led and youth-driven process. They stood strong as did UNFPA, which made it clear in various ways that this is indeed intended to be a youth-led and youth-driven process. Displeased with the final consensus recommendations consolidated from the 15 Staying Healthy breakout sessions, the vocal minority of non-youth unconstructively confronted forum participants, after the recommendations were presented during the plenary. During my own breakout session, this same minority consistently opposed suggestions concerning individual rights, and access to safe abortion and contraception.

In contrast to this small group, many other government and non-youth forum participants from around the world stood out as great allies to the youth participants in support of this set of recommendations. The final “Staying Healthy” recommendations will be released as part of a consolidated set of recommendations including the other forum themes: “Decent Work,” “Sexuality, Family and Rights,” “Education,” and “Leadership and Meaningful Participation.” We at the International Women’s Health Coalition look forward to sharing the final recommendations with you when they are released. Stay tuned!

Although the final Outcome Document “The Future We Want” (PDF) is weak overall, and in the last days of the negotiations was significantly weakened in the section dealing with the social pillar of sustainable development, women stayed the course and ensured that language around women’s and young people’s health and human rights was maintained and agreed upon as critical elements to achieve sustainable development.

Since the inter-governmental negotiations began in December 2011, feminist organizations were told by key countries, including Brazil and South Africa, that the Group of 77 (a group that represents “developing countries” in United Nations negotiations) would not break over differences of position on “controversial issues” such as gender equality and sexual and reproductive health and rights because “more important issues were at stake”.

Disappointingly, this was Brazil’s consistent position throughout the process as it sought to affirm its leadership within the Economic South and obtain gains on other issues such as the green economy and trade. Our allies remained vocal throughout the process and helped secure the language that we will use for enshrining reproductive health and human rights in future development agreements. These critical positions came from: Peru, Bolivia, Uruguay, Argentina, the United States, Iceland, Norway, Switzerland, New Zealand, Australia, Israel and Mexico.

Among other things, the Outcome Document urges governments to fully implement their previous commitments “leading to sexual and reproductive health and the promotion and protection of all human rights in this context” and emphasize the “need for the provision of universal access to reproductive health, including family planning and sexual health and the integration of reproductive health in national strategies and programmes.”

Governments also committed to “reduce maternal and child mortality and to improve the health of women, men, youth and children” by achieving “gender equality and protecting the rights of women, men and youth to have control over and decide freely and responsibly on matters related to their sexuality.” Finally, governments committed to “promote the equal access of women and girls to education, basic services, economic opportunities and health care services, including addressing women’s sexual and reproductive health, and ensuring universal access to safe, effective, affordable and acceptable modern methods of family planning”.

These words did not appear in the final document easily. Women worked day and night, through speaking with the media, taking to the streets and protesting, lobbying governments, and educating other civil society actors. to have our voices heard and hold our governments accountable.

The overall assessment by social movements and organizations that participated in the Rio+20 process is that it fell short of making any real progress and commitments for addressing pressing and critical sustainable development needs. Against the backdrop of an unwieldy process, multiple and often competing agendas, it is unsurprising that the outcome lacked content and clarity.

Moving forward as the post-2015 development discussions take shape, and if Rio+20 is to serve as an indication of how this process will unfold, it is critical that women’s and young people’s voices are heard in this process, and that social movements continue to pressure their governments to uphold their commitments to achieving sustainable development, gender equality, poverty eradication, and the realization of human rights for all.

Brazil, a country that in the past has championed women’s human rights, including reproductive rights, at the global level, has failed women in both Brazil and the world over.

During meetings to finalize the Rio+20 document, Heads of State will adopt in the next few days at Rio+20, delegates agreed on a plan short on vision and big on compromises. After three days of long, drawn-out negotiations, marked with lack of clarity about the process, a document to be signed off by heads of government was presented. Quickly gaveled through by the Brazilian chair, one after another government thanked Brazil for facilitating this document and largely expressed how this was the best they could do. By all accounts, despite the attempts to spin the outcome as a success, this document is neither “the future we want” nor what future generations deserve. In an effort to get consensus at whatever cost, Brazil forgot Rio: the vision and commitments of the Rio Earth Summit held 20 years ago.

From the start of the negotiations, gender equality and women’s human rights, including reproductive rights, have continuously been challenged by a few governments, claiming that [these] had “nothing to do with sustainable development.”

This debate continued until the last few hours of the negotiations. In the end, the text includes a re-affirmation of both the Cairo and Beijing agreements, but it falls short by failing to recognize that reproductive rights are also critical to the achievement of sustainable development. If a woman cannot decide if and when to have children and if she is not provided with the reproductive health care that is her human right, it is challenging to contribute to sustainable solutions for the planet.

Opposition to women’s human rights per se was concentrated among a few countries, with the un-holy alliance of the Holy See and oppressive governments such as Syria and Egypt insisting on marginalizing women. And since there was so much at stake for “more important issues,” such as trade, financing for sustainable development, and the green economy, other governments in the end traded away women’s reproductive rights, giving the Vatican what it wanted in the first place. But even if reproductive rights had been reaffirmed, the lack of real commitment by the international community to eradicate poverty, address urgent environmental concerns, and to chart a clear path for implementation of sustainable development, makes it difficult for women– and for the world — to  achieve gender equality and women’s empowerment in this context.

Norway, the United States, Canada, Australia, New Zealand, Peru, Bolivia, Uruguay, Mexico, Iceland, Switzerland, Israel and many others fought to the end to retain the reference to reproductive rights and expressed disappointment that this was not incorporated in the final text. However, it is expected that they will speak of their continued commitment through their leaders during the High Level Segment that begins today.

The Brazilian failure: selling out women’s human rights in this negotiation, has not gone unnoticed. Brazilian feminists quickly mobilized and demanded an explanation from their government. In an interview with local media following the agreement on the text, the Brazilian Foreign Minister expressed disappointment that “reproductive rights” had been kept out of the document, but went on to explain that this was done out of the need to reach a compromise. Immediately following the adoption of the text, women gathered and protested at Rio Centro, the main venue for the conference, chanting “reproductive rights are not for sale”, “governments have failed women and the planet” and “women’s rights are human rights.” Finally, in a meeting with Michelle Bachelet, the head of UNWomen, and the Brazilian Minister for the Environment, Brazilian women presented their declaration to Rio+20 which fittingly ended with these words:

“We defend women’s rights to equality, autonomy and freedom in all the territories where we live, particularly in our bodies, which are our first territory.”

For now, governments attending Rio+20 have failed both territories.

Women wave scarves at Rio+20 protest. Photo courtesy of the Asia Pacific Forum on Women, Law and Development (APWLD).

Contraceptive information and services – “family planning” – form an essential part of the health services that women need throughout their lives. Any steps to increase demand for contraceptives must actively support efforts to improve comprehensive and integrated sexual and reproductive health. Contraceptives must be provided through primary healthcare, with full regard for women’s human rights and the specific needs of young and unmarried women and other groups.

Our experience, built over decades of work around the world, has taught us that the failure to take actions guided by women’s human rights – to health, to life, to live free from discrimination among others – can have devastating consequences. Policies that accept or tacitly condone forced sterilization, the coercive provision of contraceptives, and the denial of essential services to the young, poor and marginalized women that need them every day have violated, and continue to violate, women’s human rights.

Nearly twenty years ago, governments at the International Conference on Population and Development agreed that respect for women’s reproductive autonomy is the cornerstone of population policy. Any return to coercive family planning programs where quality of care and informed consent are ignored would be both shocking and retrograde. The Family Planning Summit must ensure that the clocks are not put back on women’s human rights: women’s autonomy and agency to decide freely on matters related to sexual and reproductive health without any discrimination, coercion or violence must be protected under all circumstances.

In order to expand contraceptive access with full respect for women’s human rights, we urge governments, donors and other actors supporting the Family Planning Summit to:

• Take all possible measures to ensure that this initiative is designed with quality of care and human rights at its core, so that no coercive measures are introduced in the provision of contraceptives;
• Ensure that meaningful participation by women, including young women, is built into all stages of program design and implementation to ensure that services are responsive to their needs and to prevent any human rights violations;
• Ensure that the provision of contraceptives is integrated into existing and new sexual and reproductive health services, and that a full range of contraceptive methods is offered;
• Design and implement a system for monitoring, evaluation and accountability to track and measure its impact on the human rights of women as this initiative is rolled out, and urgently make necessary corrections should violations come to light;
• Commit to tackling the existing legal and policy barriers that hinder access to contraceptive information and services, without which efforts are likely to be ineffective and exacerbate disparities in access.

In 2012, nothing less will do.

Download a PDF of this statement, along with a list of the signatories, here.

Working on the funding bill for the State Department and U.S. foreign assistance programs, today the Senate Appropriations Committee repudiated the negative action recently taken in the House.  The overall funding levels in the Senate bill for family planning and reproductive health programs were set at $700 million (an increase of about $125 million from last year’s levels – in an attempt to make up for disproportionate cuts in the past).  And, rather than seeking to defund UNFPA, as the House bill does, the Senate committee included $44.5 million for reproductive health services in more than 140 countries.

In direct opposition to House action, the Senate Committee included a provision to prohibit a futurePresident from unilaterally imposing the Global Gag Rule. The amendment was offered by Senator Frank Lautenberg (D-NJ) – a stalwart supporter of reproductive rights – and passed by a vote of 18-12. Committee Democrats (with the exception of Senator Ben Nelson (D-NE), supported it and were joined by Republicans Susan Collins, Lisa Murkowski and Mark Kirk (by proxy, as he is absent from the Senate due to health issues). Please take a moment to call or email Senator Frank Lautenberg and thank him for his continued commitment to women and girls’ basic human right to access the information and services they need to promote their health and well-being.

Additional good news: the bill contains language to allow abortion services for Peace Corps volunteers in cases of rape, incest, and life endangerment of the woman.  This is progress of sorts – and if enacted would give Peace Corps volunteers the same right federal employees already have in other federal programs.

Next step is action by the full Senate – and then the House and Senate will need to work out differences between the two versions of their bills before sending to the President for signature into law.

Leaving no stone unturned, women’s health opponents are working again to eliminate funding for international family planning and reproductive health programs, as well as funding to UNFPA, the global agency that supports a breadth of reproductive health services for women in extreme poverty in more than 140 countries.  The funding bill for the State Department and foreign assistance programs around the world brought before the House Appropriations Committee on May 17 includes provisions to reinstate the Global Gag Rule as well as defund UNFPA.  As expected, the committee rejected three amendments offered by women’s health supporters to try and fix these problems in the bill.

The one surprise was that the amendment to restore funding to UNFPA, offered by Rep. Rosa DeLauro (D-CT), failed in a tie after four Republicans broke with their party line and supported the amendment.  (There are 29 Republicans on the committee and 21 Democrats.)  Her amendment was an attempt to gain support from Members that don’t support a breadth of reproductive health issues provided by UNFPA, and so would have targeted a $39 million U.S. contribution only for efforts to prevent and treat obstetric fistula, to promote the abandonment of female genital mutilation and other harmful traditional practices including child marriage, and to ensure safe childbirth and emergency obstetric care.  Who could object to meeting those health needs?  Evidently most every Republican on the committee, except for Representatives Rodney Frelinghuysen (R-NJ), Steven LaTourette (R-OH), Charles Dent (R-PA) and Cynthia Lummis (R-WY).  The amendment failed on a tie vote of 24-24.  We applaud and value the principled position taken by these members – and if you have a chance, we encourage you to share the news about their strong positions in your networks or by giving their offices a call through the capitol switchboard (202-224-3121). (Emails are only accepted from their constituents.)

In another effort to directly target at U.S. contribution to UNFPA for specific activities only, Rep. Barbara Lee (D-CA) offered an amendment stating that it would be directed to only family planning services and contraceptive supplies in low-income sub-Saharan African countries where USAID this type of assistance, specifically Burkina Faso, Central African Republic, Chad, Cote d’Ivoire, Gambia, Guinea-Bissau, Niger, Sierra Leone, and Togo.  Again, the amendment was defeated – this time by a vote of 22 to 27.

And yet one more attempt to strengthen the bill for women’s health, Rep. Nita Lowey (D-NY) offered an amendment striking the draft bill’s provision codifying the Global Gag Rule and prohibiting a U.S. contribution to the UN Population Fund (UNFPA) and replacing with language designating a $39 million contribution to UNFPA with the current restrictions on that contribution that are already in place to appease some member’s concerns about the fact that UNFPA works in China, even though its efforts there are to end coercive family planning practices.  Again, the amendment failed – this time on a vote of 23 to 27.  Thanks to the vocal support during consideration of the amendment from Reps. Jim Moran (D-VA), Sam Farr (D-CA), and Steven Rothman (D-NJ).

The base bill is problematic on the funding levels as well, including a $149 million cut to international family planning means about 8 million fewer women in developing countries would have access to contraceptives and other health needs.  This completely undermines the kinds of progress being made in reducing death from pregnancy and childbirth.