What Congress Can Do to Restore U.S. Leadership on Global Sexual and Reproductive Health and Rights

Guttmacher Policy Review

Jesseca Boyer¹ 

关键词: developing world;    fungibility;    Global Gag Rule;    Helms Amendment;    Just the Numbers;    maternal health;    PEPFAR;    Pregnancy outcomes;    President's Emergency Plan for AIDS Relief;    U.S. International Family Planning Assistance;    UNFPA;    unintended pregnancy;    proactive policies;    United Nations;    United Nations Population Fund;    unmet need;    unplanned pregnancy;   

DOI  :  

学科分类：卫生学

来源: Guttmacher Institute

【 摘 要 】

The United States has long served a critical leadership role in advancing sexual and reproductive health and rights around the world. 1 The Trump administration—supported by social conservatives in Congress—has undermined this leadership. From making draconian funding proposals to issuing restrictive policy guidance, the Trump administration is actively undermining U.S. global health investment and the resulting progress. Congress has the power to reverse course and restore U.S. leadership—and should do so. Current Investments The United States provides critical global health assistance through bilateral and multilateral funding streams. Investment in three particular areas—family planning and reproductive health, maternal and child health, and HIV/AIDS—supports the advancement of sexual and reproductive health and rights in communities around the world. USAID family planning and reproductive health program and UNFPA. Since it began in 1965, U.S. investment in bilateral family planning and reproductive health programs through the U.S. Agency for International Development (USAID) has been critical to promoting global health and well-being. 2 Currently supporting efforts in more than 30 countries, the USAID family planning and reproductive health program increases access to voluntary family planning information, services and supplies. Beyond providing voluntary family planning, these programs include efforts to end child marriage, female genital mutilation and cutting, and other gender-based violence, as well as help countries address other cross-cutting factors that shape individual, family and community sexual and reproductive health and rights. As a result of the $607.5 million provided in fiscal year (FY) 2018 for U.S. international family planning and reproductive health assistance—the vast majority of which goes to the USAID family planning and reproductive health program—25 million women and couples received contraceptive services and supplies. 3 That, in turn, helped them avert 7.5 million unintended pregnancies, which prevented 3.2 million abortions (of which 2.1 million would have been in unsafe conditions) and 14,600 maternal deaths. Multilateral U.S. funding for family planning and reproductive health efforts through the United Nations Populations Fund (UNFPA) also plays a complementary and critical role in advancing global health and rights. UNFPA’s programming first began in 1968, and the United States played a key role in its creation. Since then, UNFPA has expanded its work to more than 150 countries. It is the world’s largest source of multilateral population assistance; its efforts often take place in humanitarian settings that are beyond the scope of USAID programming. The agency provides family planning counseling, services and supplies, as well as partnership building within communities to support adolescent health and assist people in accessing these services and achieving safer pregnancies and births. In 2017, for instance, UNFPA provided an estimated 842.5 million contraceptives, which helped prevent 13.5 million unintended pregnancies and helped avert 32,000 maternal deaths. 4,5 USAID maternal and child health program. The USAID maternal and child health (MCH) program provides global leadership to improve the health and survival of women and children in low- and middle-income countries. The USAID MCH program focuses its work in 25 priority countries, 16 of which are in Sub-Saharan Africa, a region that accounts for nearly two-thirds of maternal deaths in the world each year. 6–8 In these countries, the program supports cost-effective interventions such as vaccines; safe water, sanitation and hygiene; nutritional supplements; family planning information and counseling; postabortion care; and training for frontline health workers on basic prevention, treatment and management of maternal and child illnesses. In addition to its programmatic efforts, USAID MCH also supports identifying, testing and piloting technologies and innovations aimed at improving the lives of women and children. 9 In 2011, for instance, in partnership with other donor countries and private foundations, USAID launched Saving Lives at Birth: A Grand Challenge for Development, which has invested in more than 100 innovations, from service-delivery approaches to diagnostics. 10 In the past 10 years, USAID estimates that its MCH efforts have helped save the lives of more than five million children and 200,000 women in its priority countries. 11 The United States has committed to the goal of saving the lives of 15 million children and 600,000 women in developing countries between 2012 and 2020. The President’s Emergency Plan for AIDS Relief. The President’s Emergency Plan for AIDS Relief (PEPFAR) was established in 2003 with bipartisan support to ensure U.S. leadership for the global response to the HIV/AIDS pandemic. 12 PEPFAR supports global HIV/AIDS prevention, treatment and care, and the strengthening of health systems through bilateral and multilateral programs. PEPFAR programming has helped save more than 16 million lives in more than 50 countries to date. 13 By the end of 2017, PEPFAR had supported HIV testing for 85.5 million people, voluntary medical male circumcision services for 15.2 million men and boys, antiretroviral treatment for 13.3 million people and training for 250,000 new health care workers. 13,14 In 2014, PEPFAR prevention efforts expanded with a new public-private partnership. The goal of the partnership is to build upon evidence-based approaches and support innovative ideas to reduce HIV infection rates among adolescent girls and young women in areas of Sub-Saharan Africa with the highest country rates of HIV. 15 The DREAMS Initiative—Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe—has reached 2.5 million young women aged 15–24 to date, supporting comprehensive HIV prevention such as testing and counseling, condom promotion and provision, and pre-exposure prophylaxis, as well as broader structural interventions, including school-based HIV and violence prevention, youth-friendly sexual and reproductive health services, and community mobilization. 16 According to a 2017 analysis, 65% of the communities or districts with the highest HIV burden in the 10 DREAMS countries have reduced new HIV diagnoses among young women by at least 25% since the program began. 17 Last year, five more countries incorporated DREAMS-like activities into their respective PEPFAR country operational plans. Strengthening Investments Congress has the funding, legislative and oversight authority to ensure that the United States does not cede its leadership role in supporting sexual and reproductive health and rights around the world. Beyond protecting existing efforts, Congress should make crucial investments and pursue course corrections. Increase U.S. funding to support global sexual and reproductive health and rights. For all of the important progress that U.S. investments have helped make possible, the work is far from over. Far too many people still have unintended pregnancies that could be avoided, acquire STIs that could be prevented or treated, and experience complications related to pregnancy and childbirth that could be averted or better managed. Every day, 400 infants are newly infected with HIV and more than 800 women—one woman every two minutes—die from largely preventable pregnancy- and childbirth-related complications. 18,19 And in developing regions, 214 million women who want to avoid pregnancy for at least two years are not using a modern contraceptive method. 20 These examples demonstrate how much work remains to support global sexual and reproductive health and rights. The United States cannot help reduce unmet health needs around the world without robust investment in key global health programs. Yet President Trump proposed a complete elimination of the USAID family planning and reproductive health program in his first budget, for FY 2018, a proposal that gained no traction in Congress. 21 His most recent budget, for FY 2019, proposed a roughly 50% funding cut to $302 million that, if enacted, could have severe negative impacts, such as 12.7 million fewer women and couples receiving contraceptive services and supplies and 7,300 more maternal deaths in developing regions (see figure 1). 22 Conversely, for every additional $10 million of U.S. investment in foreign family planning and reproductive health assistance per year in developing regions, an estimated 416,000 additional women and couples would receive contraceptive services and supplies and there would be 124,000 fewer unintended pregnancies, 53,000 fewer abortions (35,000 of which would have been provided in unsafe conditions), and 240 fewer maternal deaths. 3

【 授权许可】

Unknown