This week is National Women’s Health Week and given the expanded coverage that is going into effect as a result of the Affordable Care Act there’s lot to celebrate this year.  Not everyone, however, is in a celebratory mood and many are downright unhappy with the expanded coverage.

The House of Representatives celebrated this week by voting for the 37^th time to repeal the law.  Yes, that’s right:  the 37^th time.  That raises the question, “What is so bad about Obamacare?”  The ACA, after all, has been a huge victory for women’s health.  Prior to the ACA insurance companies could charge women higher premiums than men just because they were women, and could deny women coverage for preexisting conditions like breast cancer or pregnancy.  But thanks to the ACA, they cannot do that any longer.  Today, because of the ACA, 45 million women and counting have received preventative care with no co-pay.

Under the regulations approved by the Department of Health and Human Services, preventative care includes well woman exams, pap smears, mammograms, and birth control.  So what’s wrong with that?  A lot apparently, particularly the part about access to contraceptives.  In the past two years, there has been a firestorm of protest from social conservatives who insist that birth control should not be classified as preventative care.  Excuse me?  By what screwed up logic is the prevention of pregnancy not a preventative measure?  Birth control is an essential part of women’s health care and having birth control available with no co-pay takes women’s health care decisions out of the hands of politicians and insurance companies, and puts the power where it belongs: with women.

On another controversial front, the U.S. Justice Department is celebrating by appealing a federal judge’s ruling that would make Plan B, the most popular form of emergency contraception, available for anyone without a prescription. After the judge’s ruling, the Department of Health and Human Services lowered the age at which a female could obtain emergency contraception without a prescription from 17 to 15. The judge, however, insists that the age restriction should be eliminated altogether, and the Administration is appealing the decision.

Is that how we should be celebrating National Women’s Health Week?  I don’t think so.  Emergency contraception reduces the risk of pregnancy after contraceptive failure or unprotected sex up to 120 hours after, but is most effective in the first 24 hours.  It is important, therefore, that women obtain access to emergency contraception in a timely manner.  The current restrictions can lead to confusion and human error, effectively denying many women access to emergency contraception, particularly young women and those without any government- issued identification.  By making emergency contraception available over the counter to all women regardless of age it would ensure that women have better access to emergency contraception.

When it comes to women’s health, there’s a lot to celebrate this year…but the battle over women’s health rages on. Too bad.

Posted by Jennie Wetter, Director of Public Policy

On May 11th, voters in Pakistan will go to the polls for one of the country’s most important elections in decades.  With many experts warning that Pakistan’s economy could be headed for collapse, two issues related to population have emerged.  The first is population growth.  Many observers warn that Pakistan’s population growth rate, which has increased in recent years, is economically unsustainable.  The second issue, and it is related, is the status of women.  A lack of gender equity is hindering female participation in the workforce and it is also contributing to stubbornly high birth rates.

Zubeida Mustafa, a two-time winner of our Global Media Awards, has written extensively on both topics.  She is a freelance journalist who writes a weekly column for Dawn, the paper with which she worked as an assistant editor from 1975 to 2008. Dawn is Pakistan’s most widely circulated and influential English language newspaper that was founded in 1947.

In addressing the issue of population as it relates to the upcoming election, she writes, “It doesn’t take rocket science to realise that a rapidly growing population strains the resources of a country and poses a serious hurdle in the way of development strategies.”

She notes, however, that:

There are parties which do not even see a link between a fast-growing population and the failure of the government to provide health and education facilities to the people. The demographic factor drags down economic growth and resource expansion. They are the Awami National Party (quite surprising given its people-centric approach), the Jamaat-i-Islami, the PML-Q and the Jamiat Ulema-i-Islam-Fazl. The last-mentioned party’s spokesman orally confirmed the party’s lack of commitment to population issues.

Mercifully, four major parties, the PPP, the PML-N, the Pakistan Tehreek-i-Insaf (PTI) and the Muttahida Qaumi Movement (MQM) are more progressive on the population question. The first three spell out categorically why an effective family planning programme is closely linked to the country’s development in the economic and social sectors….

The PPP and PTI are quite comprehensive in spelling out their strategy. The PTI promises to make the population welfare programme an integral part of the health policy and make quality education and modern contraceptive services available to women.

Mustafa, who has been a long-time champion of women’s rights in Pakistan, warns, however, that all the parties, as part of their population platform, need to make a clearer and stronger commitment to women’s rights, and not just for improved access to contraceptive services.  She writes that:

Some speak of educating women because educated women have fewer children on account of their better understanding of contraceptive choices. But that by itself does not change the gender priorities of parents who have a preference for sons. That will change only when women gain social acceptance and recognition.

Issues other than population will no doubt determine the final outcome of the upcoming elections, but the future of Pakistan will be determined in no small part by what future Pakistani governments do to improve contraceptive services and promote gender equity.  Let’s hope that the election results will point in the right direction.

Posted by Robert J. Walker, President

In a victory for women and women’s health, a federal judge last Friday ordered the Food and Drug Administration (FDA) to remove restrictions on women’s access to emergency contraception. U.S. District Court Judge Edward Korman ruled that the FDA must make the most popular forms of emergency contraception available over the counter and without an age restriction.  The decision overturns a policy that restricts access to emergency contraception by requiring that women under 17 obtain a prescription from a physician, and requiring women 17 and older obtain it from pharmacies or health clinics with government-issued identification.

In striking down the restrictions, the judge ruled that when Department of Health and Human Services Secretary Kathleen Sebelius stepped in to implement these restrictions it was “politically motivated, scientifically unjustified, and contrary to agency precedent.”

Emergency contraception reduces the risk of pregnancy after contraceptive failure or unprotected sex up to 120 hours after, but is most effective in the first 24 hours.  It is important, therefore, that women obtain access to emergency contraception in a timely manner.  The current restrictions often led to confusion and human error, effectively denying many women access to emergency contraception, particularly young women and those without any government- issued identification.  By making emergency contraception available over the counter to all women regardless of age it will ensure that women have better access to emergency contraception.  Costs for some women may still pose a barrier, but the court’s decision is still a resounding victory for women and women’s health.

Posted by Jennie Wetter, Director of Public Policy

Nearly 13 years ago the nations of the world came together in a bold new campaign to reduce extreme poverty and improve human well-being in the developing world.  The Millennium Development Goals (MDGs), which were launched at that time, set forth an ambitious development agenda.  Eight broad goals were set with 2015 as the target year for their completion.  The goals set forth a series of targets relating to poverty, hunger, maternal health, child health, drinking water, sanitation, housing and other development objectives.

No one should underestimate the scale of what has been achieved in the past 12 years under the banner of the MDGs.  The accomplishments, by any fair measure, are impressive, but much remains to be done.   The UN Secretary-General’s MDG Advocacy Group this week has called upon the nations of the world to redouble their efforts in the 1000 days between now and the 2015 deadline.  In a statement released by the Secretary-General’s office, the MDG advocacy group, said:

 “The Millennium Development Goals provide an urgent ‘to-do’ list to address many of humanity’s biggest and most important challenges. Since their creation, the global community has mobilized around these common goals to drive incredible progress that is improving lives around the world. More children are reaching their 5thbirthday, fewer people are living in crushing poverty, and as many girls attend primary school as boys.

While we’ve made great strides forward, our work is not done. Now is the time to build on the momentum we’ve started to reach families and communities that have been left behind. Today’s milestone is an opportunity for everyone who cares about creating a more just world to take action in support of the United Nations and the MDGs. What we do over the next 1,000 days matters to millions of people. As MDG Advocates, we are dedicated to doing everything we can to help drive further progress. Let’s seize the next 1,000 days to change lives and chart a course for a brighter future for our world.”

The Population Institute is proud to join with the UN’s MDGs Advocacy Group in calling for a renewed commitment to the MDGs.   In particular, much work still needs to be done on MDG 5, which seeks to reduce the maternal mortality rate by three-quarters for the period between 1990 and 2015.  While notable progress has been made in expanding antenatal care in developing countries, many women still lack access to family planning services and information.  Better access to contraceptive services could go a long ways toward lowering maternal mortality rates, particularly in countries where the prevalence of child marriage and adolescent pregnancy rates are still high.   That’s one of the reasons why the UN—in MDG 5(b)—ultimately set forth 2015 as a target year for achieving universal access to family planning and reproductive health services.

No one expects that MDG5(b) will be achieved by 2015, but that certainly does not diminish the urgency of trying to achieve universal access.   In addition to improving maternal health, expanded access to family planning is crucial to fighting severe poverty, improving food security, boosting educational attainment, and other MDG goals.

While renewing our efforts on behalf of the MDGs we also need to begin thinking about what comes next.   The UN is presently developing a set of Sustainable Development Goals (SDGs) that will either complement or replace the MDGs as the focus of international development efforts in 2015 and beyond.  Whatever happens in the next 1000 days, we can say with absolute certainty that more work will need to be done on achieving universal access to family planning and reproductive health services.

At the same time, world leaders—as part of the SDG process—will need to confront head-on the challenges posed by climate change and resource scarcity.  Now, more than ever, we need to take inventory of the Earth’s resources and their capacity for supporting continued progress on human development. We urgently require some form of resource sufficiency evaluation to determine whether we are living sustainably.  By some estimates, humanity is already using 150 percent of the planet’s supply of renewal resources.  Many scientists warn that by 2030 we will need two planets to sustain us in the long haul.  Unfortunately, we only have one planet, and it is beginning to show considerable wear and tear.

So let us wholeheartedly renew our support for the MDGs, but let us also get to work on the  development of meaningful SDGs.  Human development must not only be achieved, it must be sustained.

Posted by Robert J. Walker, president

“Violence against women weakens our communities, stunts our economies, and erodes our common values.”  – Susan Rice, US Ambassador to the United Nations

Violence against women is a worldwide epidemic. It is estimated that around the world 1 in 3 women will be physically, sexually, or otherwise abused in her lifetime. The World Bank estimates that more women between the ages of 15-44 are at risk from domestic violence and rape than from cancer, car accidents, war and malaria combined. This past year the world was shocked by high profile attacks on women from the brutal gang rape and murder of a young physiotherapy intern in India to the shooting of 15-year old Malala Yousafzai after she attended school in Pakistan and advocated for the right of other girls to do so. With the world finally galvanized to take action on violence against women ,this year’s meeting of the 57^th Commission on the Status of Women (CSW) came at a perfect time.

However, things are never quite that simple. The negotiations over the past two weeks were long and difficult with disagreements over language up unto the last day of the CSW on Friday. A small block of countries led by Iran, Russia, Syria, and the Holy See (the Vatican who has permanent observer status) fought doggedly to roll back previously agreed upon language on women’s rights arguing that they went against custom, tradition, and religion. Opponents of the draft took particular issue with references to abortion rights and language declaring that rape also includes forcible intercourse by a woman’s husband or her partner.

Fortunately, unlike last year’s CSW, opponents failed to completely derail the consensus document. Countries and NGOs supportive of women’s empowerment and women’s health fought tenaciously to form a strong and viable consensus. While they were not able to get everything they fought for, such as explicit language protecting gays and lesbians from discrimination; the final outcome document was still a victory for women around the world.

The document reaffirmed previous UN agreements, such as the Cairo Program of Action. It included strong language on promoting gender equality, women’s empowerment, and the need to stop harmful traditional practices such as female genital mutilation and child marriage.  Even with it being a particular area of contention in the negotiations the outcome document ensured women’s reproductive rights and their access to sexual and reproductive health services including access to emergency contraception and safe abortion for victims of violence.

With such a hard fought victory let’s hope that it endures. As supporters said at the end of the CSW,  “By adopting this document, governments have made clear that discrimination and violence against women and girls has no place in the 21^st century. There is no turning back.”

Posted by Jennie Wetter, Director of Public Policy

Today is International Day for Zero Tolerance to Female Genital Mutilation/ Cutting (FGM/C). Even though FGM/C is widely recognized today as a violation of the rights of women and girls, the practice still persists. About 140 million girls and women worldwide have undergone FGM/C, with 3 million girls in Africa alone at risk of cutting every year.  That means that every single day somewhere from 6,000 to 8,000 girls are cut. The severity of the practice ranges from cutting to the total removal of the external female genitalia, but in any form it exacts an unacceptable toll on girls and women.

The World Health Organization defines FGM/C as any procedure that intentionally alters or injures female genital organs for non-medical reasons. FGM/C is mostly performed on girls between infancy and age 15 by traditional cutters who can use anything from a razor blade to scissors to broken glass. It is most common in 28 countries in Africa, mostly in the west, east and northeast, in some countries in Asia and parts of the Middle East. While there are no health benefits to FGM/C there are many ways in which it is harmful to girls and women. The harmful effects are both immediate (severe pain, shock, bleeding, and tetanus) and long-term (cysts, recurring bladder infections, infertility, increased risk of complications in childbirth, and the need for surgery).

While 20 of the 28 African countries have banned the practice of FGM/C, the laws are rarely enforced. Progress, however, is being made.  This past December the United Nations unanimously passed a resolution banning the practice of FGM/C. The resolution calls the practice harmful and a serious threat to the psychological, sexual and reproductive health of women and girls. It urges countries to condemn the practice of FGM/C and to work to eliminate the practice. It also calls on countries to enforce legislation that would protect girls from this gross violation of their human rights.

It is time to speak out for the 6,000 to 8,000 girls who are cut every day. The Population Institute is proud to join with the international community in standing up and saying it is time to make FGM/C history.

Posted by Jennie Wetter, Director of Public Policy

The Population Institute received word earlier this week that Werner Fornos had passed away at the age of 79.  Werner served as President of the Population Institute from 1982 to 2005 and while I did not know him well, I knew him well enough to know that he was greatly admired for his leadership on international family planning.  He was a tireless champion of the United Nations Population Fund (UNFPA) and did so much to grow and sustain the Population Institute.

I first met Werner at a legislative retreat hosted by the Population Institute in 1985.  At the time, I was legislative director for Rep. Morris K. Udall, a Congressional champion of international family planning.  I remember being impressed by the great passion and intensity that Werner brought to his work.  It’s what made him such a respected spokesperson on Capitol Hill and around the world.  As one of his many admirers put it, “Werner is a force of nature.”

Very few people in this world have done as much as Werner did to build popular support for international family planning assistance.  An accomplished and highly-popular speaker, he spoke to audiences around the world about population. During his tenure as President, the Population Institute played a major role in building public and Congressional support for UNFPA.  During his presidency, the Institute also played a pioneering role in using entertainment media to increase awareness and acceptance of family planning in developing countries.  Through the Population Institute’s Global Media Awards program, he gave much needed recognition to reporters, authors, editorial writers, cartoonists, and radio and television producers for their outstanding coverage of population issues.   As a member of Rotary International, he actively promoted the Rotary Action Group on Population and Development, which today is doing so much to support family planning and reproductive health in developing countries.

Although he retired from the Population Institute in 2005, he continued to lecture widely about population and remained a fearless champion of family planning and women’s empowerment.

On behalf of Bill Ryerson, our Chair and CEO, and the staff of the Population Institute, we extend our deepest sympathies to his children and grandchildren and to Moyne Gross, his life partner.  He will be missed.

Posted by Robert J. Walker, President

It took 14 long years, but family planning advocates have won a major victory in the Philippines with the passage of the Responsible Parenthood Act, a new law providing free access to contraception and family planning services.  Despite fierce opposition from the Catholic Church and intense foot-dragging in the legislature, reproductive rights activists were able to get the reproductive health bill through both Houses and send it to the desk of President Benigno Aquino, who signed it on December 29.

Surveys in the Philippines have shown that four out of ten women in the Philippines who want to avoid a pregnancy are not using a modern method of contraception, and while condoms are available, they are very expensive.  Contraceptives, as a practical matter, are not available in most public health clinics.  As a consequence, the number of unplanned pregnancies is exceedingly high, as is the population growth rate.  In 1960, the population of the Philippines was 27 million.  Today, it is 96 million, and current projections indicate that its population could rise to 155 million by mid-century.

If this victory holds, and it may not, it would represent the biggest single advance in recent years toward the UN’s goal of ensuring that all women in the world have access to reproductive health care.  While the new law is scheduled to go into effect in mid-January, opponents of the new law are seeking to overturn it in the courts.  Let’s hope they fail.  If the new law is upheld, it will make a major contribution to preventing unplanned pregnancies, lowering the high maternal death rate, and reducing the number of unsafe abortions performed every year in the Philippines.

Congratulations to all those in the Philippines who fought for the passage of the new reproductive health law.  Let’s hope it holds.

Posted by Robert J. Walker, President

Depending upon your perspective, 2012 was either a promising year for family planning and reproductive health, or one of the worst in recent memory.  If you take a broad, global perspective, it’s clearly the former, but if you are focused on the U.S., it’s clearly the latter.

First the really good news:  on July 11, World Population Day, foundations, organizations, and leaders from several countries gathered this summer in London for a groundbreaking summit that produced major new pledges of support for international family planning assistance.  Convened by the Bill & Melinda Gates Foundation and the United Kingdom’s Department for International Development (DFID), the conference brought together representatives from developing and donor nations alike. The commitments would expand family planning services to another 120 million women in the developing world by 2020.  Reflecting this new wave of support for family planning, a growing number of leaders in the developing world pledged to step up their support for voluntary family planning.  Nigeria, Kenya, and Ethiopia, in particular, are redoubling their efforts.

Now the really bad news:  Social conservatives this year set their political sights on birth control.  Attacking contraception as morally “dangerous” and a social evil, they sought to slash funding and restrict health insurance coverage of contraceptives.  The war on contraception failed to put Planned Parenthood out of business, as some legislators vowed to do, but state budget cuts and new regulatory restrictions have taken a toll on family planning clinics serving low-income households.  In Texas alone this year more than 50 family planning clinics closed their doors after the legislature cut funding by two-thirds and barred funding for all clinics run by Planned Parenthood.

So what about 2013?  What does it portend for family planning and reproductive health? On balance, I think 2013 will be a better year.  If the major commitments that were made at the London Family Planning Summit start to be fulfilled—and there is every reason to think that they will—than we could see a gradual ramping up of family planning services in the developing world.  Much depends, however, on which direction the U.S. Congress goes with respect to funding.  At present, Congress is at a standstill over the level of support for international family planning assistance.  The House Appropriations Committee has been pushing for a 25 percent cutback, while the Senate Appropriations Committee has supported a roughly comparable increase in funding.   For the moment, funding is frozen at last year’s level ($610 million), but that could change, depending on what happens with the fiscal cliff and how the new Congress views international family planning.

Congress is also deadlocked over Title X, the federal program that supports family planning clinics here at home.  The House has sought to eliminate funding, while the Senate has fought, successfully so far, to preserve current funding levels.  I suspect, however, that the new House of Representatives will be less amenable to wiping out funding for Title X, while the new Senate will be an even stronger supporter of the program.  With any luck the Congressional war on contraception, which has never enjoyed popular support, will come to an end in 2013.  Nothing, however, is certain, particularly as Congressional caps on discretionary spending could force cutbacks in domestic and international family planning.

So while we can look to the New Year with renewed confidence, we cannot take anything for granted.   At the Population Institute, we never do.   To anyone who has really studied the issue, family planning may be the closest thing there is to a ‘no-brainer’, but with a volatile electorate and 80 new legislators in Congress, we have to be ever vigilant.

With 2012 winding down, I want to express my deep appreciation to all those who have supported our work over the past year.  For 43 years the Population Institute has been making a difference in Washington and around the world, but nothing that we have accomplished would have been possible without the generous support of individuals and foundations who believe in our work.

Thanks for your support, and best wishes for a happy and healthy New Year.

Posted by Robert J. Walker, President

Republican Rep. Joe Walsh, running for re-election in Illinois’s Eighth Congressional district, caused a political sensation last month when he told reporters that there should be no abortion exception for the “life of the mother” because “with modern technology and science, you can’t find one instance” in which a woman dies. Joe Walsh, ultimately, lost to Democrat Tammy Duckworth, but the abortion debate in this country is far from over.

Despite a Fox News exit poll indicating that 59 percent of voters this year believed that abortion should be legal in most cases, Walsh and other social conservatives are not about to give up on their efforts to ban abortion in all cases, including cases where the life or health of the mother is endangered.

Advances in modern medicine notwithstanding, women do die from pregnancy-related causes, particularly in cases of an ectopic pregnancy and preeclampsia. In the U.S., where abortion is constitutionally protected, most women in these life-threatening circumstances are saved by a physician-recommended abortion. But, in countries where abortion is banned or access to abortion services is severely limited, women too often do die as a result of a pregnancy.

If the Joe Walsh’s of the world want to avoid reading all the medical literature on this subject, perhaps they should pick up a copy of the Irish Times, which reported this week on the death of Savita Halappanavar (31), a dentist who died at University Hospital in Galway last month. Savita was 17 weeks pregnant when she went to the hospital experiencing back pain on October 21^st. It was determined that she was miscarrying and that the doctors would not be able to save the fetus.

Her husband recounts their ordeal to the Irish Times:

“Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.

“Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita [a Hindu] said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.

“That evening she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics.

“The next morning I said she was so sick and asked again that they just end it, but they said they couldn’t.”

At lunchtime the fetal heart had stopped and Ms Halappanavar was brought to theatre to have the womb contents removed. “When she came out she was talking okay but she was very sick. That’s the last time I spoke to her.”

At 11 pm he got a call from the hospital. “They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable. She stayed stable on Friday but by 7pm on Saturday they said her heart, kidneys and liver weren’t functioning. She was critically ill. That night, we lost her.”

This is a tragedy that should never have happened, and unfortunately it is not an isolated incident. Tragedies like this happen every day in countries where abortions are illegal or highly restricted. While abortion is constitutionally protected in the United States, states around the country have been chipping away at women’s ability to access abortion services, and the attacks are not limited to the states.  Last October the House of Representatives passed legislation (H.R. 358) that would allow hospitals that receive federal funding and who are morally opposed to abortion to refuse to treat a woman who requires an emergency abortion in order to save her life. Current law and precedent require that the hospital must give life-threatening cases whatever care is needed – including abortion care.  Thankfully, President Obama has promised to veto this bill if it ever reaches his desk, helping to ensure, for now at least, that tragedies like Savita’s death will not happen in the U.S.

So yes, Joe Walsh, women do die from pregnancy-related causes, and abortions are needed from time to time to save the life of the mother. Savita died when she so easily could have lived, and what happened to Savita could—and does—happen in medically advanced countries, particularly those that ban abortion services or severely restrict access to them.

Posted by Jennie Wetter, Director of Public Policy