First Lady’s Trip to Africa Highlights Problems with US Policies on Health and Education
In Zambia, contact Paul Zeitz at 1-202-365-7686
From June 25 to 29, First Lady Laura Bush will travel to Senegal, Mozambique, Zambia, and Mali to visit schools and health programs. Her visit is intended to highlight US government support for health, education, and the empowerment of women.
The First Lady has spoken about the needs of women and the importance of these issues, and there is no doubt that her personal concern is genuine. However, Mrs. Bush has not simply tried to raise awareness about the seriousness of these issues; rather, she has vigorously defended abstinence-only and other policies, which so many women's organizations in Africa have criticized. [1]
The US has scored important achievements in the expansion of access to AIDS treatment and other services. Still, the stakes are very high in the battle against disease, and we must look seriously at the impact of US policy—both good and bad—in these countries.
OVERALL ISSUES:
Little new funding 2009-2013. The Bush Administration promised at the most recent G8 Summit to back the goal of universal access to all AIDS related services by 2010. Each of the countries Laura Bush will visit is trying to reach this goal and should have a national strategy in place to do this. These countries will need more US assistance, not less, over the coming years in order to reach the goal of universal access.
But, the President's recent proposal for $30 billion on AIDS was not for a doubling of current spending. As noted by other development groups, including InterAction, under his plan the US would simply carry forward over the next five years about the same amount that the US is already spending now. [2] If the US nearly flatlines spending in this way, it will leave these countries vulnerable to expanding disease threats, including to drug-resistant tuberculosis (XDR-TB). Also, the Administration has urged Congress to not increase the US contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria for 2008, even though the Fund is essential to success in fighting AIDS, TB, and malaria. [3]
Reduction in treatment. Under the Bush plan, the US would reduce the proportion of people receiving AIDS treatment through US programs from 33% of those in need to only about 17%. While it aims to get 2 million people on treatment by 2010, under the Bush plan the US would add only 500,000 people to those receiving treatment from 2009 to 2013. [4] This would be a radical scaling back of the US role in the area of AIDS treatment. UNAIDS has stated that 11 million people will need treatment by 2010, but it has warned that even this could be an underestimate by as much as 50%. [5] At least half of the people in need are women, and many need treatment to prevent transmission of HIV to their newborns.
Abstinence-only programs. A very significant proportion of US aid—at least one-third of the total budget for HIV prevention—is spent on abstinence and fidelity programs. There is no doubt that programs that result in partner reduction and faithfulness are needed; however, the US Government Accountability Office found that the US requires abstinence-until-marriage programs without requiring companion efforts to promote safer sex, and spends more on these programs than required by law. The Institute of Medicine found that it was "unable to find evidence for the position that abstinence can stand alone or that 33% is the appropriate allocation for such activities even within integrated programs." [6] One result is that programs are not familiarizing young people with condoms, breaking down stigma about condom use, or making them readily available.
Small-scale and under-funded programs for women. Programs designed to prevent and respond to gender-based violence, a major risk factor for HIV, are not well funded as discrete programs, and a lack of transparency makes it nearly impossible to determine their efficacy and impact. Married women—particularly young married women, many of whom are forced or coerced into marriage with older men by their family or the pressure of poverty—do not receive comprehensive sexuality education, but are instead told to be faithful and to rely on their husbands to do the same. Programs to address socio-cultural norms that put women at risk of HIV, such as those working to change gender norms or to secure greater legal rights and economic independence, remain small-scale, under-funded, and inconsistent.
Poorly-targeted education aid. US funding for basic education has been far too low and not well directed. The US directs most of its support through US-based NGOs. Instead, the US could direct more funds through the Fast Track Initiative's (FTI) Catalytic Fund to help countries implement sound national education plans, but the US has failed to donate to this Fund. The US is doing little to help Mali and Senegal eliminate school fees. Less than 20% of funding goes to countries with FTI-approved national education plans. Meanwhile, the President's Millennium Challenge Corporation (MCC) does very little to support access to basic education, even though education is central to economic development. [7]
PROBLEMS COUNTRY BY COUNTRYp>SENEGAL
• The First Lady will visit a primary school. The President's Africa Education Initiative (AEI) is a very small scale endeavor compared to the scale of the education challenge. It finances scholarships to cover the cost of school fees. But, education experts have urged the US work to help countries like Senegal eliminate these school fees, while helping schools upgrade school quality. The US is moving very slowly to help countries eliminate fees, and is currently only researching the issue.
MOZAMBIQUE:
• The First Lady will visit a malaria spraying program that relies on support from the Global Fund to Fight AIDS, TB and Malaria. Europe is the largest donor to the Global Fund, but the US contribution is also significant. The US recently agreed at the G8 Summit that the Fund should be expanded to roughly six times its current size, with the goal of providing $6 to $8 billion in grants by 2010. But, on June 19, the White House signaled its opposition to Congress regarding an increase in the US contribution to the Fund. Each year for the past five years, the President has requested that Congress dramatically reduce the US contribution. The Congress is on course to provide only two-thirds of what the Fund has requested from the US. Mozambique also urgently needs the Fund's continued resources to fight TB, including XDR-TB.
• The First Lady will take part in a discussion about women's empowerment. Among other things, US policy should be helping to ensure that women can access contraceptives if they want them, and it should be helping Mozambique address lack of access to safe abortion, as well as the factors that lead women to seek abortion. According to the Ministry of Health, unsafe abortion is the third-leading cause of death among pregnant women in the country, which has one of the highest maternal death rates worldwide. More than 40% of serious pregnancy complications treated at the central hospital in Maputo is the result of illegal abortions. And 58% of women who had an abortion did so at home, usually without help from a medical professional. [8]
ZAMBIA:
• The First Lady will visit a community center (the Mututa Center), an AIDS treatment program (Chreso Ministries), and a center for orphans and vulnerable children (Flame). In 2005, 47% of US aid for prevention of sexual transmission in Zambia was directed to promotion of abstinence and fidelity. [9] Since the median age of first sexual intercourse for girls is 16.8 years, it is imperative that teens and pre-teens become familiar and comfortable with condoms, even before becoming sexually active. This is critically important even as programs urge them to delay beginning sexual activity until they are older. However, the programs that Laura Bush will visit are not providing comprehensive sexuality education and ready access to male and female condoms. Under US rules, funding may not be used to promote the use of condoms with young people who are not already sexually active, despite the obvious need. An investigation of World Vision in Zambia, carried out by the Center for Public Integrity, stated:
Ten- to 14-year-olds receive education on the importance of future faithfulness in a marriage, while those ages 15 to 24 receive general AB messages.
The Zambia program also has a large AB component, one that in 2005 aimed to train 30 faith-based organizations to run abstinence-only programs, set up youth sport camps that would also train abstinence peer educators and train advisers to promote abstinence and faithfulness in girls' "coming of age" ceremonies, according to government documents. All in all, 23,400 youth were to be reached with abstinence and faithfulness messages.
World Vision's prevention efforts are geared overwhelmingly toward AB education, but the organization said that through ARK and other efforts, it also conducts prevention lessons for youth and others who are already sexually active, including referrals to where they can get condoms. [10]
• Because of the loss of US funding resulting from the global gag rule, the sole NGO to operate reproductive health clinics in Zambia has lost nearly 40% of its staff members, scaled back services, and ended vital community-based distribution of contraceptive supplies and health information. Abortion is technically legal but extremely difficult to obtain. A woman must first consult with and then get the approval of three physicians before she can go to one of the few facilities that perform the procedure. [11]
• Zambia is a country that is supposed to have benefited from President Bush's Women's Justice and Empowerment in Africa Initiative (WJEI). This program was announced in June 2005, but little actual work has been done under the initiative. The program is supposed to address gender-based violence with legal and judicial reforms and improve the social protection mechanisms. [12]
MALI:
• The First Lady will visit a primary school. Last year, Mali became eligible to receive education aid through the Fast Track Initiative Catalytic Fund. [13] This fund would help Mali eliminate school fees, but the US has failed to donate to the Catalytic Fund.
[1] http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=34802
[2] http://www.interaction.org/media/PEPFAR.html
[3] http://www.whitehouse.gov/omb/legislative/sap/110-1/hr2764sap-h.pdf
[4] http://www.whitehouse.gov/news/releases/2007/05/20070530-5.html
[5] http://data.unaids.org/pub/PressStatement/2007/070604_g8_en.pdf
[6] http://www.pepfarwatch.org/pubs/GAOIOMfindings.pdf
[7] http://www.results.org/website/article.asp?id=2713
[8] http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=2&DR_ID=45247
[9] http://www.genderhealth.org/pubs/ZambiaAtAGlance.pdf
[10] http://www.publicintegrity.org/aids/org.aspx?id=21
[11] www.globalgagrule.org/pdfs/case_studies/GGRcase_Zambia_2006.pdf
[12] http://www.globalaidsalliance.org/docs/Zero_Tolerance_Advocacy_Brief.doc
[13] http://www1.worldbank.org/education/efafti/documents/Catalytic%20Fund/Cairo_Status_Report_Nov06.pdf