Analysis: Sex conflict's global effects

By OLGA PIERCE, UPI Health Business Correspondent  |  Nov. 17, 2006 at 10:46 PM
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WASHINGTON, Nov. 17 (UPI) -- The conflict between politics and reproductive health efforts -- now the subject of much controversy in the United States -- is a worldwide problem, health policy experts said Friday.

Sexual and reproductive health is "losing visibility in the international development agenda," said A. Metin Gulmezoglu, editor of a volume of the journal Lancet entirely dedicated to global reproductive health, unveiled Friday at the National Press Club.

"We believe if we are going to do advocacy it needs to be based on solid scientific evidence," he said. "Some of the things we believe turn out to be wrong."

Also on Friday, the Bush Administration came under fire for appointing Eric Keroack to head the federal Office of Population Affairs, which oversees the government's reproductive health efforts and has a budget of $283 million. Keroack, an obstetrician and gynecologist, was previously medical director of a Boston group that opposes premarital sex, abortion and contraception.

Bush has called the appointment a matter of "principles" and stressed Keroack's experience dealing with women and girls in crisis, but opponents of the appointment say it is putting ideology before science -- and women's health.

A report issued Thursday by the Government Accountability Office concluded that the $158 million Health and Human Services spends on abstinence-until-marriage programs goes to methods that have not been scientifically reviewed.

But the influence of thinking in the United States, the world's largest global health donor, extends far beyond national borders.

The first-ever global study of sexual and reproductive health, conducted by the World Health Organization, paints a picture of declining financial support, increased political interference and an overall reluctance on the part of governments to tackle threats to sexual and reproductive health.

An estimated 120 million couples worldwide who want contraceptives do not have access to them, and 80 million women have unintended pregnancies. More than half a million women die as a result of complications in pregnancy and childbirth every year, more than half of which end in abortion. Of those abortions, 19 million are unsafe and 68,000 women are killed or disabled as a result, the report says. Men and women also suffer from significant rates of sexually transmitted infections other than HIV -- those most of those diseases are preventable and curable.

At the same time, money to help those in need is drying up. Between 1995 and 2003, donor support for family planning decreased from $560 million to $460 million, though advocates say much more is needed. In Africa, for example, the report found that $70 million more is needed just to achieve the middle range of United Nations recommendations.

"If we do not address sexual and reproductive health openly and directly the toll of death and disability will remain with us for many years to come," said Paul Van Look, director of the department of reproductive health and research at WHO.

The reproductive health community, however, has struggled against increasing isolation and a loss of support in favor of more visible sexual issues like HIV, said Maurice Middleberg, vice president for public policy at the Global Health Council.

"Sexual and reproductive health has become mostly a women's issue, and that is a real problem," he said. "This needs to be seen as a human issue."

Increasing the saliency of sexual and reproductive health issues will require building lasting coalitions, he said, even with those on the more conservative side of the spectrum who support the objectives of healthy mothers and babies.

"Conservatives have sex too," he said. "They use contraception. They want women to have healthy pregnancies and healthy babies."

Political will is the crucial element needed to truly tackle the global reproductive and sexual health issues the world faces, Gulmezoglu told United Press International. "Finding political will has been difficult for a long time." As a movement, sexual health advocates are "not often good at that."

Proponents of abstinence, however, say such policy has more potential to combat problems like sexually transmitted diseases and unintended pregnancies worldwide than other approaches. The Family Research Council, a conservative group which favors abstinence-only education, points to the failure of condom and birth control distribution to make a dent in those burgeoning problems.

Abstinence Clearinghouse, of which Keroack is a member, did not respond to an interview request before press time.

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