Population Matters

Congress’s Responsibility to Youth

July 27th, 2012

Over the past few decades we have made a lot of progress in reducing teenage pregnancy rates and improving the reproductive health of women in the United States, but an appropriations bill that is now moving in the U.S. House of Representatives would do much to reverse that momentum.  The bill would eliminate Title X funding for family planning clinics and slash funding for comprehensive sex education programs in schools.  But to make matters worse, it would boost funding for abstinence-only education programs. Is Congress unaware that these programs have been discredited, or is it simply choosing to turn a blind eye?

Peer-reviewed, published research shows no evidence that abstinence-only programs delay sexual initiation, reduce STIs, or prevent pregnancies. While the programs include discussions of values and character building, they neglect to acknowledge the fact that many teens will become sexually active. They rarely provide information on even the most basic topics in human sexuality, such as puberty, reproductive anatomy, and sexual health. The Institute of Medicine of the National Academy of Sciences has recommended eliminating all federal, state, and local requirements mandating abstinence-only in our schools. How can we expect youth to make smart decisions about sex when we deny them the information they need to make informed choices?

According to the Guttmacher Institute, every year sees nine million new cases of STIs among 15-24 year olds, and an estimated 750,000 pregnancies and 190,000 abortions among 15-19 year olds. These statistics have grave implications: STIs can cause pelvic inflammatory disease, ectopic pregnancies, reproductive cancers, and spontaneous abortions or still births. Adolescent girls who become mothers are also less likely to complete high school. Their children may experience poorer health outcomes, lower education attainment, and higher rates of adolescent childbearing. Teen pregnancies also contribute to higher welfare costs. In 2004, public costs associated with teen birth amounted to at least $9.1 billion.

We need comprehensive sex education to lower these numbers and improve the health of our young people. Credible research proves that comprehensive sex education, or “abstinence-plus” programs as they are sometimes called, can effect positive behavioral changes and reduce STIs. Evidence shows that they increase contraception use, delay the onset of sexual activity, reduce the number of sexual partners, and curb the frequency of sexual activity. Because they recognize that many teens will become sexually active, these programs enable responsible decision-making by teaching medically accurate and age appropriate information on healthy relationships, contraception, and STIs.

Public opinion polls show parents of middle and high school students actually support a comprehensive sexuality program; 93% and 91%, respectively, believe it’s very important or somewhat important to have sex education in the school curriculum. Another 72% and 65%, respectively, believe the federal government should fund comprehensive sex education. Public support extends beyond parents to include most demographic categories: Democrats, Republicans, Independents, evangelical Christians, and, yes, even Catholics.

Sex education is an inherently sensitive issue, but we ignore at our peril the public health benefits of providing comprehensive sex education.  Promoting abstinence-only programs may make us feel more righteous, but the programs do a poor job of curbing sexual activity and preventing unintended pregnancies.  And that’s the bottom line.

We should look to Europe, where greater, easier access to sexual health information and services has resulted in better sexual health outcomes. Societal openness and pragmatic government policies have produced lower pregnancy, birth, and abortion rates, a lower percentage of the adult population diagnosed with HIV/ AIDS, and a lower incidence of STIs than in the United States.

In an effort to shift the social paradigm in this country, Advocates for Youth has a program entitled, “Rights. Respect. Responsibility.”  That’s the correct approach.  We owe it to our young people to provide them with the information they need to make informed and responsible choices.

Posted by Lucy Dicks-Mireaux, Public Policy Fellow

Congress Needs to Put the CDC’s Latest Report on its Summer Reading List

July 27th, 2012

Since Congress funds the Centers for Disease Control and Prevention (CDC), maybe it should take a moment to read the latest CDC report on unintended pregnancies and births.

According to a new report released yesterday from CDC, 37% of all live births in the United States are from pregnancies that were unintended at the time of conception. The unintended pregnancy rate, when including all pregnancy outcomes (live birth, miscarriage, still birth, and abortion), was estimated to be even higher at 50%. That means that half of all pregnancies in the United States are not intended at the time of conception.  The statistics are even more frightening when you look at unintended pregnancies among teens:  87% of all births are unintended at the time of conception.  The CDC reported a decrease in unintended births among non-Hispanic white women who were married or who were formerly married, but the growth in unintended births among unmarried women kept the overall unintended pregnancy rate unchanged.

The new data show that “large and persistent differences are seen in unintended births by income and education.” Women with a college education have a 7% unintended pregnancy rate, while women who did not complete high school have a 35% unintended pregnancy rate.  Income was also a significant factor. Women making 400% or more over the poverty line have an unintended pregnancy rate of 9%, while women below the poverty line have an unintended pregnancy rate of 38%. Not surprisingly perhaps, 60% of women with an unintended pregnancy did not use contraception.  It’s disturbing, however, that the number one reason they gave for not using contraception was they did not think they could get pregnant. These results demonstrate that lower-income women, in particular, need comprehensive sexual education and improved access to family planning services and information.

Unfortunately, the U.S. House of Representatives did not get the CDC’s message.  Last week the House Labor, Health and Human Services, Education and Related Agencies (Labor-HHS) Appropriations Subcommittee marked up the FY2013 funding bill and slashed support for family planning and sex education in the schools.  The bill, which was passed out of the subcommittee on a largely party line vote, would almost certainly increase unintended pregnancies and births.

As approved by the Subcommittee, the 2012 funding bill would:

  • Eliminate Title X, which provides funding for family planning clinics serving low-income households;
  • Defund Planned Parenthood and any of its affiliates, unless the organizations certify that they will not perform abortions or provide any funds to any other entity that does; and
  • Provide only $20 million for evidence-based teen pregnancy prevention, $89 million below the President’s request, while providing $20 million for unproven “abstinence only” education programs.

These cuts would have a huge impact on women across the country and on the unintended pregnancy rate. More than 5 million women and men access family planning and related services every year through Title X funded clinics. According to the Guttmacher Institute, in 2008 Title X-supported centers helped prevent 973,000 unintended pregnancies, which would have resulted in 432,600 unintended births and 406,200 abortions.  Planned Parenthood clinics alone serve 1 in 5 women at some point during their lives. How does Congress expect these low-income women to access family planning services and information?

A giant cut in evidence-based teen pregnancy prevention programs would constitute a giant step back in efforts to curb unwanted teen pregnancies. Similarly, elimination of funding for Planned Parenthood and Title X family planning clinics would deny many low-income women the access they need to family planning services and information.

Tell Congress to halt the assault on contraception and reproductive health.  Ask your elected-representatives to fully fund Title X, Planned Parenthood, and the Teen Pregnancy Prevention Initiative!

Originally posted on Care2 by Jennie Wetter, Director of Public Policy on July 26, 2012.

Assault on Contraception and Reproductive Health Resumes

July 19th, 2012

The ongoing assault on contraception and reproductive health has resumed with a political vengeance. Yesterday the House Labor, Health and Human Services, Education and Related Agencies (Labor-HHS) Subcommittee of the Appropriations Committee marked up their FY2013 funding bill and they went after contraception and reproductive health in every available way.  The bill, which passed out of the subcommittee on a largely party line vote, is a senseless attack on women’s reproductive health.

The bill, if passed, would:

  • Eliminate Title X, which provides funding for family planning clinics serving low-income households;
  • Defund Planned Parenthood and any of its affiliates, unless the organizations certify that they will not perform abortions or provide any funds to any other entity that does;
  • Provide $20 million for evidence-based teen pregnancy prevention, $89 million below the President’s request, while providing $20 million for unproven “abstinence only” education programs.
  • Deny funding for the Affordable Care Act; and
  • Permit employers to deny health insurance coverage of any medical services (like birth control), if they object on grounds of religious beliefs or moral convictions.

These cuts would have a huge impact. More than 5 million women and men access family planning and related services every year through Title X funded clinics. According to the Guttmacher Institute, in 2008 Title X-supported centers helped prevent 973,000 unintended pregnancies, which would have resulted in 432,600 unintended births and 406,200 abortions.  Planned Parenthood serves 1 in 5 women at some point during their lives. Without this resource where will women turn?

Not only does investing in family planning services help women and men plan their lives and their families, it also saves taxpayers money. The Guttmacher Institute estimates that for every dollar invested in Title X for birth control, taxpayers save just under $4 in Medicaid costs for mother and baby just in the first year. What then will be the cost to women for not having access to birth control, early cervical and breast cancer screenings, or STI and HIV testing?

One of the more alarming provisions (after the elimination of Title X and defunding of Planned Parenthood) is the policy rider that would permit employers to deny health insurance coverage of any medical services (such as birth control) if they object on religious or moral grounds. This policy rider is virtually identical to the Blunt amendment that was defeated earlier this year in the Senate. It was offered in response to the Affordable Care Act regulation requiring health insurance companies to provide birth control without a co-pay requirement. While the Administration’s regulation does not require religious institutions to cover contraceptive services, religiously-affiliated institutions, such as hospitals and schools, would be required to do so.  If they object on religious grounds, their insurance company would be required to offer such coverage free of charge. Republicans felt this did not go far enough, and so offered this amendment to allow any employer to refuse to cover of any healthcare service, including contraception, for religious or moral reasons. This could also allow employer to deny coverage for such things as prenatal coverage for unwed mothers, cervical cancer vaccines, and HIV or other STI screenings. This was a bad amendment the first time it was offered, and it is just as bad this time.

The Labor-HHS funding bill is an all-out assault on contraception and reproductive health. Now is the time to stand up for women and their reproductive health and rights and tell Congress to halt the assault on contraception and reproductive health!

Posted by Jennie Wetter, Director of Public Policy

Making “AIDS-Free” a Reality

July 19th, 2012

In the thirty-first year of the HIV epidemic, the 29th International AIDS Conference will be held July 22-27 in Washington D.C., America’s political and AIDS capital with the highest HIV infection rate in the country. As the largest gathering of those working in the field of HIV, the conference serves to engage local leaders and stakeholders around common strategies. As suggested by this year’s theme, “Turning the Tide Together,” we may be seeing the beginning of the end of the AIDS epidemic.

We cannot put an end to HIV, however, without prioritizing women. HIV is the number one cause of death among women of reproductive age worldwide. To effectively address the epidemic, women must be at the center of global policies and programs. Women have recently overtaken men as the majority of HIV-infected individuals around the world. 52% of the total global population living with HIV is female. In sub-Saharan Africa, women 15-24 years old are eight times more likely than men to be HIV-positive. This change in the pandemic’s nature mandates a new approach.

Thankfully, global health initiatives have recently shifted their attention to maternal and reproductive health. What they need to do now is integrate family planning and reproductive health services with other HIV interventions. Far too little emphasis has been given to the role that family planning can play in combating HIV. Sexual transmission is the leading cause of infection. Of the 1800 children who become infected with HIV every day, the majority are newborns. Children under 15 account for one in every seven new infections, mostly through mother-to-child transmission. The current lack of integration causes healthcare gaps that limit the efficacy of programs.

In addition to basic antenatal and post-partum care, HIV-positive women need access to HIV testing and other prevention interventions in sexual health services. These include counseling and contraception to help them avoid unwanted pregnancies as well as safe delivery practices and available breast-milk substitutes to avoid mother-to-child transmission.

We must address HIV prevention, treatment, and care; cancer screening and treatment; maternal health care; and family planning services together. At the 2011 Commission on the Status of Women, UNAIDS Executive Director Michel Sidibé affirmed, “Research is showing that HIV may have a significant impact on maternal mortality. This tells us that we must work for a unified health approach bringing maternal and child health and HIV programs together to work to achieve their common goal.” Only when leaders join Mr. Sidibé in his thinking will we begin to make real progress towards eliminating HIV/AIDS from the global agenda.

Some have already started to work to promote the integration of HIV/AIDS and reproductive health programs in the last few years. In 2011, UNAIDS created “The Global Plan towards the Elimination of New Infections among Children and Keeping Their Mothers Alive.” The plan aims to ensure that HIV, maternal health, newborn and child health, and family planning programs work together.  That integration is crucial to achieving an “AIDS-free generation,” and we cannot afford to lose sight of it.

To help adopt this woman-centered approach, declare your commitment and sign the women’s declaration! http://salsa.democracyinaction.org/o/1350/p/dia/action/public/?action_KEY=11068

Posted by Lucy Dicks-Mireaux, Public Policy Fellow

Zubeida Mustafa: Fighting for the Women and Children of Pakistan

July 17th, 2012

In the 33-year history of the Global Media Awards program, the Population Institute has recognized dozens of professional journalists for their coverage of family planning and reproductive health care issues. Many of them have gone on to have highly successful careers, based in part upon their continued coverage of population-related issues. One of those journalists is Zubeida Mustafa, a Pakistani journalist who retired after more than 30 years of work in 2008 as the Assistant Editor at DAWN, one of Pakistan’s most respected publications and the country’s largest English-language newspaper. She won Global Media Awards for her individual reporting in 1986 and in 2004.

In May of this year, the International Women’s Media Foundation selected Zubeida as the recipient of its Lifetime Achievement Award, calling her a “media pioneer.” As the first woman reporter at DAWN, Zubeida not only advocated for gender equality in her columns, she also helped to enact hiring policies to promote women at the newspaper.

As a reporter, Zubeida has sought to shed light on many of Pakistan’s problems, including those related to population and reproductive health. Pakistan’s current population stands at nearly 180 million, and according to the United Nations medium variant projection, this number could soar to 274 million by 2050. In a recent interview she remarked, “By not controlling our galloping birth rate, Pakistan has multiplied its problems enormously. One must view the issues of education, women’s empowerment, health and population planning holistically as they have to be addressed together.”

Zubeida believes that the low status of women in Pakistani society and a lack of political will also contribute to a low contraceptive prevalence rate (27%) and a high maternal mortality rate (260 deaths per 100,000 live births). The government and donor nations must do more, she says, to enable women to avoid unwanted or unintended pregnancies.  Such needed actions include increasing women’s access to contraception and involving men more in family planning discussions.

A lifelong champion of women’s rights, Zubeida is still writing columns and still advocating for women’s empowerment, children’s rights, education, and health care, despite her failing eyesight.

Posted by Christina Daggett, Program Associate

A World Population Day Worthy of Celebration

July 11th, 2012

Supporters of family planning have been observing July 11 as World Population Day for nearly a quarter of a century. For nearly two decades, it has been little more than an opportunity to bemoan declining donor nation support for family planning and reproductive health plans. This year, thanks to Melinda Gates, we have something to celebrate on that day. Foundations, NGOs, and donor countries, led by the United Kingdom, will come together for an international summit on family planning. Unlike most global summits these days, this is one where the actions, or at least the commitments, will speak more loudly than the words.

The sponsors of this year’s summit have set the goal of extending family planning services to another 120 million women in the developing world by 2020. If the commitments that are being made in London are sufficient to achieve that goal, it will represent a major turnaround. The number of women in the developing world of reproductive age continues to rise, but for most of the past two decades, donor nation support for family planning has been declining. As a result, international family planning assistance has been plummeting on a per capita basis. In many developing countries, particularly in sub-Sahara Africa, it has fallen by more than 50 percent.

Today, the United Nations Population Fund (UNPFA) estimates that there are 222 million women in the developing world who want to avoid a pregnancy, but who are not using a modern method of contraception. Extending family planning services to another 120 million women by 2020 won’t achieve universal access to reproductive health services, and certainly not by the 2015 target set forth in the UN’s Millennium Development Goal 5(b), but it’s worthy of hearty applause.

“Win-win” propositions in this world are hard to find these days, but giving women the power to avoid an unintended or unwanted pregnancy falls into that category. If the goal of universal access to reproductive health was achieved, and 222 million more women in the developing world began using modern contraception to space or limit their pregnancies, the impact would be transformative. The Guttmacher Institute estimates that:

• Unintended pregnancies would decline by two-thirds, from 80 million to 26 million.
• There would be 26 million fewer abortions (including 16 million fewer unsafe procedures).
• There would be 21 million fewer unplanned births.
• Seven million fewer miscarriages would occur.
• Pregnancy-related deaths would drop by 79,000. Most of this reduction (48,000) would take place in Sub-Saharan Africa, the region with the highest levels of both maternal mortality and unmet need for contraception.
• There would be 1.1 million fewer infant deaths.

In addition, population growth rates in the developing world would fall faster than expected. While world population would continue to grow for a few more decades, world population–currently 7 billion–would likely stabilize around 8 billion, instead of rising as high as 16 billion by the end of the century. Realizing that slower population trajectory would dramatically improve our chances of reducing world hunger and severe poverty. It would even contribute to lower greenhouse gas emissions and slower rates of plant and animal extinction.

So what’s the price tag for universal access to family planning? The Guttmacher Institute estimates that it would cost about $4.1 billion more a year to achieve those results. That’s an exceedingly small price to pay for healthier families and a healthier planet. The commitments being made at the London family planning summit will stop well short of that funding level, but they represent a significant down payment.

The London family planning summit is genuine cause for celebration, but it may be short-lived: the world’s single largest contributor to international family planning, the United States, may be in the process of reducing its commitment, not increasing it. Since the Obama Administration took office, U.S. support for international family planning has increased by about one-third, but a House Appropriations Subcommittee has approved a cut of nearly one-quarter for the fiscal year that begins October 1, 2012. A cutback of that size would go a long way towards negating the new commitments that are being made in London.

We can’t let that happen. We had better keep the celebration short.

Posted by Robert Walker, President

The Future Women Want

July 5th, 2012

Two weeks ago, world leaders at the Rio+20 Earth Summit in Brazil released a consensus statement titled, “The Future We Want.” For the most part, it’s an ambitious, forward looking document, but when it came to women and reproductive health it’s not altogether what women want.

Despite the strong appeals of the reproductive rights community, the final Rio document stopped short of embracing reproductive rights:  “We are committed to promote equal access of women and girls to education, basic services, economic opportunities and health care services, including addressing women’s sexual and reproductive health.”  In adopting this language, the drafters declined to “ensure” access to reproductive health services and omitted any reference to “reproductive rights.”

With considerable justification, many women’s rights’ proponents and political leaders have cited the document as a step backwards. If that is the case, where do we go from here? How do we ensure that women everywhere are able to determine freely how many children they will bear and when?  What more can we do to ensure that the sexual and reproductive health needs of adolescents are addressed?

After the Commission on Population and Development (CPD) at the United Nations in May, reproductive rights’ proponents expected more from Rio. CPD adopted a strong resolution this year in support of the sexual and reproductive health and human rights of youth and adolescents. The momentum we gained at this year’s CPD session, however, came to an abrupt halt at Rio.

As countries work to achieve sustainable growth, their leaders should acknowledge the central role that reproductive rights should play in achieving sustainable development.  One cannot happen without the other. As Dr. Musimbi Kanyoro, CEO of the Global Fund for Women, argued, “Population growth weakens our development systems, and is not going to help women or developing nations. We need to address population growth from the perspective of empowerment of women.” U.S. Secretary of State Hillary Clinton affirmed that sentiment in her remarks at Rio. Women’s empowerment is a prerequisite for any real change, and access to family planning represents one of its key components.

According to the Guttmacher Institute, 222 million women worldwide have an unmet need for contraception today. 50% of pregnancies are unplanned and 25% are unwanted. By supporting reproductive rights and working to ensure universal access to maternal care and reproductive health services, we can prevent unintended pregnancies and save lives at the same time. Doing so would promote both healthy families and a healthy planet.

Having this type of care available is essential to better health outcomes for women and their full economic participation. Women should not be marginalized any longer. As Michelle Bachelet, the Executive Director of the UN Entity for Gender Equality and the Empowerment of Women (UN Women), recently said. “The future women want is free from poverty and discrimination, with equal access to opportunities and leadership.” Those opportunities ought to include reproductive healthcare. While the Rio statement may not have fully acknowledged the future that women want, it does not mean we have to accept either defeat or their limited vision of reproductive health and rights.

Hopes for improved reproductive rights across the globe now lie with the upcoming Family Planning Summit in London, which will take place on July 11. Co-hosted by the Bill and Melinda Gates Foundation and the United Kingdom Department for International Development (DFID), it will address the increased need and demand for modern contraception and family planning services. The Summit’s goal is to raise enough in new commitments to provide an additional 120 million women with contraceptives, information, and services by 2020.

World leaders must not waste another opportunity at the London Family Planning Summit. It is crucial for the United States to step up and join those who are fighting for reproductive rights.

Rio+20 aimed to develop a blueprint for “the future we want,” but do we want a world in which women’s rights are neglected? Women everywhere must make their voices heard if they are going to attain the rights they need and deserve.

Posted by Lucy Dicks-Mireaux, Public Policy Fellow

What Intervention Can Save the Lives of Women, Babies and Adolescent Girls?

July 2nd, 2012

What one intervention could save the lives of 570,000 babies, 79,000 women and make a large impact on the number one killer of young women aged 15 to 19? Family planning. That’s right, investing in family planning services saves the lives of babies, women and adolescent girls around the world. With all of the rhetoric being thrown around  in the debate about birth control in the United States, it is easy to forget that birth control— Rush Limbaugh’s slander notwithstanding — is not about “sluts” and “whores;” it’s about providing services to women that save lives.

Currently, according to the Guttmacher Institute, there are 222 million women in the developing world who are said to have an “unmet need” for family planning. This means that these women want to avoid a pregnancy in the next two years, but are not using a modern contraceptive method (such as the pill or an IUD). It means that women who want to decide if, when and how many children they would like to have do not currently have the option to make those choices, and this has a profound impact on their health and their children’s health. If all of these women had their unmet need fulfilled, it would save the lives of an estimated 79,000 women per year.

On top of saving those lives, family planning gives women the ability to time and space their births, which allows for healthier babies and children. Babies who are born less than two years after a sibling are twice as likely to die as babies who are born after a three year interval.  When spaced close together, children are more likely to be stunted or undernourished. This affects not only the newborn, but also the older children.

With spacing, parents are able to give their newborn the best start in life with more time spent breastfeeding and time to plan and prepare for any subsequent children. If women were able to space their births by 36 months, it could prevent 1.8 million deaths of children under the age of 5. Spacing is also important to the health of the mother. Women who become pregnant again after less than five months are 2.5 times more likely to die from pregnancy-related causes than if they had waited 18 to 23 months.

Another area where family planning can have a measured impact is in delaying the age of first pregnancy. One factor in this is child marriage. Every year, around 10 million girls under the age of 18 are married. This often pulls girls out of school and limits their access to and information about family planning services. They are therefore more likely to have early and frequent pregnancies, both of which can have a significant impact on the health of the mother and the health of the child.

Since the girls are so young, their bodies are not fully developed and they are more at risk for a range of complications, including obstructed labor which can result in the death of the mother, baby, or both. Girls aged 15 to 19 have twice the risk of maternal death as women in their 20s, and for girls aged 10 to 14, the risk is 5 times as great.

Each year, 16 million girls between the ages of 15 and 19 give birth, leading to 50,000 pregnancy-related deaths, making it the number one cause of death for that age group.  Babies born to adolescent mothers under age 18 have a 60% higher chance of dying in their first year than those of a baby whose mother is 19 or older. Enabling young women to have access to family planning in order to delay the age their first pregnancy will lead to healthier mothers and healthier babies.

Family planning also makes economic sense. Currently, the world spends $4 billion annually on family planning services and saves, as a consequence, $5.6 billion in maternal and newborn health costs. The Guttmacher Institute reports that it would cost an additional $4.1 billion to meet the unmet need for modern contraceptives in the developing world, but doing so would save $5.7 billion in other costs, including maternal and infant care.

For all these reasons, it is imperative that the United States join with other donor countries in boosting their funding commitments at the upcoming Family Planning Summit in London on July 11.  The summit, which is being hosted by the Bill and Melinda Gates Foundation and the United Kingdom’s Department for International Development (DFID), has set the goal of expanding family planning services to an additional 120 million women in the developing world by 2020.  If that goal is to be met, the United States needs to boost its funding support, not cut it.

Make your voice heard! Tell Congress to do its part in making the goal of universal access to reproductive health services a reality and save the lives of mothers and children.

Originally posted on Care2 by Jennie Wetter, Director of Public Policy on June 28, 2012