Inter Press Service - June 6, 2009
Analysis by Rosemary Okello

The ICPD's Plan of Action set out several key action areas: education and literacy, reproductive health care and unmet need for contraception, maternal mortality reduction and HIV/AIDS.

But although reproductive health programmes enjoyed fresh attention and resources from donors and governments, the emergence of HIV/AIDS as a leading funding priority undermined progress.

The two became awkward bedfellows despite HIV/AIDS being a health issue that cannot be addressed effectively in isolation from sexual and reproductive health rights.

An emphasis on HIV/AIDS produced mixed results. A study published in 2008 by the International Treatment Preparedness Coalition's (ITPC) - which included field research in Uganda, Zimbabwe and Zambia - indicates that while new investment in AIDS services had many positive impacts on health systems overall, it also exposed existing weaknesses, in some cases increasing the burden on limited human resources by increasing demand and shifting governments' attention away from other health priorities.

As a result of this, many women were denied access to a full range of reproductive health services.

Says Jennifer Woodside of the International Planned Parenthood Federation (IPPF): "Those of us working in the area of reproductive health and rights missed the HIV/AIDS bus because of these hurdles where experts in the field of HIV/AIDS and us on the other hand did not make use of the linkages."

According to Woodside, the debate around the morality of reproductive health rights as envisaged by the ICPD further complicated issues such as access to family planning and constrained funding for reproductive health. "Yet family planning was meant to provide a package on reproductive health care as a way of achieving universal access to reproductive health."

The ICPD Plan of Action calls for the achievement of universal access to basic reproductive health services by 2015 and for specific measures to foster human development, with particular attention to women. But its implementation has been hindered by governments in many countries focusing on HIV/AIDS programmes for which money was more easily be accessed.

The Plan of Action further underscores reproductive health as a right, which should strengthen women's ability to take charge of their sexuality including sexual and reproductive health.

But efforts to improve access to contraception and safe abortion in line with the ICPD Plan of Action elicited international debate, with critics objecting on moral grounds to what they viewed as a licence for sexual behaviour.

In 2001, the George W. Bush administration in the United States reactivated the "gag rule" first formulated by the Reagan Administration in 1984. Also known as the Mexico City Policy the rule prevented U.S. funding for family planning that included abortion, abortion counselling and referrals services or abortion-related advocacy - even in countries where abortion is legal.

The enforcement of the rule - from 1984 until president Bill Clinton rescinded it in 1993, and again for eight years under the second President Bush - saw many family planning clinics and NGOs which provided comprehensive reproductive health care shut down.

The IPPF reported that it lost 100 million dollars in U.S funding during the latter Bush administration. Speaking during the 2015 Countdown meeting in London in 2004, the Steven Sindling, then director general of IPPF said that as a result of the 'gag rule' there was an increase of unwanted pregnancies around the world: "More deaths from pregnancy-related causes, more HIV infections and more unsafe abortions."

President Obama again rescinded the gag rule in early 2009.

According to Marcela Howell, who directs communications and marketing for the non-profit sexual and reproductive health rights organisation Advocates for Youth, the more than 1.1 billion people between the ages of 15 and 24 are bombarded with ideologies of abstinence until marriage, but have little information on how to protect themselves from unwanted pregnancies and sexually transmitted infections, including HIV and AIDS.

But for youth like Rose (not her real name), an HIV-positive 18-year-old from the Kibera slum in Kenya, the information she receives from health providers is more frustrating than useful. She complains of impractical messages on abstinence directed towards her and her peers, most of whom are sexually active; and flatly incorrect information she was given about one day having a child, given her status.

Experts warn that providing Rose and billions of women like her with access to affordable reproductive health care as well as empowering her with education about - and protection for - her rights to sexual health is necessary if the much-talked about millennium goals of reducing poverty, maternal and child mortality and attaining gender equality are to become a reality.

Many hope that the spirit of the ICPD will rise again, and women access a holistic approach to reproductive health care.

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+ AFRICA: Maximising the Benefits of AIDS Funding (http://www.aegis.org/news/ips/2009/IP090101.html)

+ U.N. Triples Allotment for Population (http://ipsnews.net/news.asp?idnews=46443)

+ Family Planning Gets Mere Sliver of Aid Pie (http://ipsnews.net/news.asp?idnews=41954)

+ UGANDA: "God Should Be So Kind That I Can Have Contraceptives" (http://www.ipsnews.net/news.asp?idnews=41947)

+ Poor Countries Footing Reproductive Bill - 2005 (http://ipsnews.net/news.asp?idnews=25477)

+ ICPD at 15: Accelerating Implementation of the Cairo Consensus (http://www.unfpa.org/icpd/15/index.cfm)

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