U.S. policies on sexual health care under fire globally

Posted on January 16th, 2007

Archived in Abortion & birth control, Medical ethics

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Public health experts are forcefully criticizing U.S. policy for limiting access to reproductive and sexual health care in the developing world. As some religious leaders call for a broadening of how conservative Christians respond to AIDS abroad, health experts are blaming deteriorating health in the Third World on what they see as the Bush administration’s accommodation of the concerns of religious conservatives. These developments took place as Democrats took control of both houses of Congress, raising the possibility of a shift in U.S. policy.

A recent series of articles in The Lancet, one of the world’s most prestigious medical journals, decries the effect of conservative religious beliefs on the health of the millions in the developing world who depend on international aid for medical care (see background). The six articles, published in November and December, were written by international public health experts under the auspices of the World Health Organization. In an accompanying editorial, Lancet editor Dr. Richard Horton said that U.S. policies have “utterly marginalized” sexual and reproductive health “from the global conversation about health and wellbeing.” Horton ended with a “call for action” to expand services.

President Bush took office in 2000 with the help of a religiously conservative base that has strong feelings on health policy concerning abortion, contraception and HIV/AIDS. The administration has favored an emphasis on abstinence training in programs to control AIDS, to the exclusion of needle exchange programs and health services for sex workers, which many public health experts argue are crucial to controlling the epidemic in developing countries. In September 2006, for example, Bush for the fifth time denied funding that Congress had appropriated to the United Nations Population Fund, the largest funder of reproductive health services in the world.

What’s new

The Lancet articles appeared as Democrats took control of the U.S. Congress in midterm elections, and observers say the new group of legislators will likely be more inclined to call for a shift in U.S. policies on global reproductive health.
On Nov. 17, the same day a news conference was held at the National Press Club in Washington, D.C., to publicize the Lancet series, Bush named Dr. Eric Keroack, an obstetrician-gynecologist, to head family planning services at the Department of Health and Human Services. Keroack came under criticism because he had previously worked as medical director of A Woman’s Concern, a Christian pregnancy-counseling center in Massachusetts that has called contraception “demeaning to women.” The administration defended the appointment.
On Dec. 1, World AIDS Day, the Rev. Rick Warren, author of The Purpose Driven Life and pastor of Saddleback megachurch, hosted a conference titled “Race Against Time: 2006 Global Summit on AIDS and the Church.” Speakers included Richard Feachem, executive director of the Global Fund to fight AIDS; Mark Dybul, the U.S. global AIDS coordinator, who is gay; and Sen. Barack Obama, an Illinois Democrat who supports abortion rights. Some conservative Christians criticized the inclusion of speakers who are not aligned with their teachings on abortion rights and homosexuality. Warren defended the inclusion of the speakers, saying that evangelicals cannot fight the AIDS pandemic alone.

Why it matters

Religious teachings on sex and sexuality have turned denominations into battlegrounds, but they have a more practical, immediate effect on people’s lives when they influence public health policy: They help determine what kind of medical services are available, which affects doctors’ ability to prevent or treat potentially deadly conditions.

Questions for reporters

Do religious groups or congregations in your region express views on the issues of reproductive and sexual health care? What are their views? How are they expressed?
Have evangelical congregations or leaders in your area reacted to the Warrens’ call? How?
Are religious groups in your area active on international sexual or reproductive health issues? What form does their activity take?
Have groups in your area responded to the Lancet reports?

Jump to background

National sources

GOVERNMENT

Dr. Eric Keroack is deputy assistant secretary for population affairs in the U.S. Department of Health and Human Services and directs the Office of Population Affairs in Rockville, Md. Contact 240-453-2800, opa@osophs.dhhs.gov.
The U.S. Agency for International Development is an independent federal government agency whose mission includes improving the health of citizens in foreign countries while advancing U.S. foreign policy goals. That includes family planning and HIV/AIDS. It frequently works with religious leaders in other countries. Contact 202-712-4320.
Ambassador Mark R. Dybul, a physician, serves as the United States’ global AIDS coordinator and carries out the President’s Emergency Plan for AIDS Relief (known as PEPFAR). Contact 202-663-2708, SGAC_Public_Affairs@state.gov.

PUBLIC HEALTH EXPERTS

Dr. Luella V. Klein is vice president of women’s health issues at the American College of Obstetricians and Gynecologists. She is also Charles Howard Candler Professor of Gynecology/Obstetrics and director of the Maternal and Infant Care Project at Emory University School of Medicine in Atlanta. Contact 404-616-3540, lklein@emory.edu.
Maurice Middleberg is vice president for public policy at the Global Health Council, which has headquarters in White River Junction, N.H., and Washington, D.C. The alliance of health care professionals, organizations, academic institutions, foundations and other entities works for “improvement and equity in global health.” Contact 202-833-5900, mmiddleberg@globalhealth.org.
Nancy Padian is executive director of the University of California-San Francisco’s Women’s Global Health Imperative, which aims to “improve the reproductive health of vulnerable women around the globe.” She is also associate director of research for the university’s Global Health Sciences, director of international programs at the university’s AIDS Research Institute, co-director of the UCSF Center for Reproductive Health Research and Policy and a professor in the departments of obstetrics, gynecology and reproductive sciences at the university. Contact 415-597-4968, npadian@globalhealth.ucsf.edu.
Dr. Allan Rosenfield is dean of the Mailman School of Public Health, the DeLamar Professor of Public Health Practice and professor of obstetrics and gynecology at Columbia University in New York City. He is co-author of Section 6 of the Lancet report, “Sexual and reproductive health for all: a call for action.” Contact 212-305-3929, rosenfield@columbia.edu.
Dr. David A. Grimes is clinical professor of obstetrics and gynecology and a fellow of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina. He co-authored Section 4 of the Lancet report, “Unsafe abortion: the preventable pandemic.” Contact 919-544-7040, dagrimes@mindspring.com.
Susheela Singh is vice president for research at the Guttmacher Institute and co-author of Section 2 of the Lancet report, “Sexual behaviour in context: a global perspective.” Contact 212-248-1111.
Joan Kaufman is director of the AIDS Public Policy Training Project at the Kennedy School of Government at Harvard University and a lecturer in social medicine at Harvard Medical School. She is also a senior scientist at Brandeis University’s Schneider Institute for Health Policy at the Heller School of Social Policy and Management. She directs the International AIDS Vaccine Initiative’s China program. Contact 617-384-8216, joan_kaufman@ksg.harvard.edu.
Michael Reich is Taro Takemi Professor of International Health Policy at Harvard University’s School of Public Health. Contact 617-495-3003, michael_reich@harvard.edu.

ADVOCATES OF LIMITING U.S. FUNDING OF GLOBAL PROGRAMS THAT INCLUDE ABORTION, CONDOMS AND/OR CONTRACEPTION

Deirdre McQuade is director of planning and information for the Pro-Life Secretariat of the United States Conference of Catholic Bishops. Contact 202-541-3070.
Richard Land is president of the Southern Baptist Convention’s Ethics and Religious Liberty Commission and a frequent commentator on issues of abortion and AIDS. Contact through Jill Martin, 615-782-8417, jmartin@erlc.com.
Dr. Byron C. Calhoun is president of the American Association of Pro Life Obstetricians and Gynecologists. He is also a member of the department of OB/Gyn, F. Edward School of Medicine at Madigan Army Medical Center. Contact 616-546-2639, byron.calhoun@nw.amedd.army.mil.
Peter L. Brandt is senior director of government and public policy at Focus on the Family. The organization favors ending U.S. government funding of the Global Fund HIV program because it gives inadequate support to abstinence programs and faith-based organizations. Contact Sonja Swiatkiewicz, 719-548-4570, culturalissues@family.org.
Raymond B. Ruddy is president of the Gerard Health Foundation in Natick, Mass., which gives $2 million annually to anti-abortion, abstinence, and HIV/AIDS prevention programs. Contact 508-655-8813.
Shepherd Smith is president and founder of the Institute for Youth Development in Washington, D.C., which promotes “risk avoidance” among youth, including sexual abstinence. Contact 703-433-1640.

ADVOCATES OF U.S. FUNDING OF GLOBAL PROGRAMS THAT INCLUDE ABORTION, CONDOMS AND/OR CONTRACEPTION

The Center for Health and Gender Equity in Takoma Park, Md., monitors “the effects of U.S. international policies on the health and rights of women, girls, and other vulnerable populations in Africa, Asia, and Latin America.” Contact director Jodi Jacobson, 301-270-1182, change@genderhealth.org.
Family Health International is a nonprofit organization that works to improve health in more than 60 developing countries. It conducts behavioral, biomedical and health services research in support of numerous global health priorities, including contraception, reproductive health, HIV, malaria, rotavirus, and other infectious diseases, such as avian influenza. FHI also implements programs in developing countries, with an emphasis on preventing HIV infection, tuberculosis, and other illnesses, as well as in the care, support, and treatment of those already infected. For information, contact Beth Robinson, 919-405-1461.
Engender Health of New York is a nonprofit organization working to “support and strengthen reproductive health services for women and men worldwide” that has collaborated with religious organizations. Contact Beth D. Weinstein, 212-561-8087, bweinstein@engenderhealth.org.
The Park Ridge Center for Health, Faith and Ethics in Park Ridge, Ill., has done research on religion’s influence on policy-making. Contact 837-384-3507.
The Religious Institute on Sexual Morality, Justice and Healing promotes the vision of the Religious Declaration on Sexual Morality, Justice and Healing, which states a “faith-based commitment to sexual and reproductive rights, including access to voluntary contraception, abortion, and HIV/STD prevention and treatment.” It has been endorsed by 2,200 people of 35 faiths. Its director is the Rev. Debra Haffner, a Unitarian Universalist minister who holds degrees in divinity and public health. Contact haffner@religiousinstitute.org. Contact 203-840-1148.
The Religious Consultation on Population, Reproductive Health and Ethics is a multifaith organization of religious scholars interested in reproductive health and other issues. Daniel Maguire, professor of moral and theological ethics at Marquette University, is president. Contact dan@religiousconsultation.org.

Background

Read articles in the Nov. 4, 2006, Lancet series (free registration)

Other background

The Center for Public Integrity, an investigative journalism organization, published a report, “Divine Intervention: U.S. AIDS Policy Abroad.”
Read Richard Horton’s Nov. 4, 2006, Lancet editorial (free registration required).
The Center for Gender, Sexuality and Health of the Mailman School of Public Health at Columbia University has published a report titled “Global Implications of U.S. Domestic and International Policies on Sexuality.”
See a Nov. 29, 2006, Fox News story about Rick Warren defending his decision to have Sen. Barack Obama speak at an AIDS conference.
Read an Oct. 8, 2006, Boston Globe series on the growing influence of Christian groups in U.S. foreign aid.
Read “Christians and AIDS,” a Newsweek interview with Kay Warren, wife of megachurch pastor Rick Warren, and an advocate of church involvement in the fight against AIDS.
Read a May 20, 2006, Washington Post op-ed, “Where AIDS Funding Should Go.”
Read “Rift Opens Among Evangelicals on AIDS Funding,” a Religion News Service story posted June 2, 2006, by Christianity Today.

Regional sources

IN THE NORTHEAST

Margaret Farley is Gilbert L. Stark Professor of Christian Ethics at Yale Divinity School and a professor of religious studies at Yale University in New Haven, Conn. She conducts research on sexual ethics and responses to AIDS in Africa. Contact 203-432-5355, margaret.farley@yale.edu.
Marvin Ellison is Bass Professor of Christian Ethics at Bangor Theological Seminary in Maine. He studies ethics of sexuality, health care and other issues. He is a participating scholar in the Religious Consultation on Population, Reproductive Health and Ethics. Contact 207-774-5212, mellison@bts.edu.

IN THE EAST

Radhika Balakrishnan is professor of international studies and economics at Marymount Manhattan College in New York, N.Y. Her interests include ethics, sexuality and reproduction. A participating scholar with the Religious Consultation on Population, Reproductive Health and Ethics, she was formerly a program officer in New York for the Ford Foundation. Contact 212-774-4847, rbalakrishnan@mmm.edu.
Stephen Ellingson is assistant professor of sociology at Hamilton College in Clinton, N.Y., and co-editor of Religion and Sexuality in Cross-cultural Perspective (Routledge, 2002). Contact 315-859-4876, sellings@hamilton.edu.
Mala Htun is assistant professor of political science at the New School University in New York City. She wrote Sex and the State: Abortion, Divorce and the Family Under Latin American Dictatorships and Democracies (Cambridge University Press, 2004). Contact 800-523-5411, HtunM@newschool.edu.
Rosalind Petchesky is a Distinguished Professor of Political Science at Hunter College and the Graduate Center of the City University of New York and author of several books on reproductive health, including Global Prescriptions: Gendering Health and Human Rights (Zed Books, 2003). Contact 212-772-5682, rpetches@igc.org.
Visions in Action is a Washington, D.C., faith-based organization that provides abstinence and faithfulness programs and other AIDS services in Africa under a government contract. Contact director Shaun Skelton, 202-625-7402, visions@visionsinaction.org.
Catholic Medical Mission Board is a faith-based international health organization providing AIDS services in Africa under PEPFAR contract. Contact officials in New York at 212-242-7757 or 800-678-5659.

IN THE SOUTHEAST

Abdullahi Ahmed An-Na’im is Charles Howard Candler Professor of Law at Emory University School of Law in Atlanta. His interests include reproductive rights and women’s rights in Islam. He is a participating scholar with the Religious Consultation on Population, Reproductive Health and Ethics. Contact 404-727-1198, aannaim@emory.edu.
World Hope International of Alexandria, Va., is a faith-based organization that has a government contract to provide abstinence and faithfulness promotion programs in Haiti. Jo Anne Lyon is executive director. Contact 888-466-4673, whi@worldhope.net.
Christine Gudorf is a professor and chairwoman of the department of religious studies at Florida International University in Miami. She is a participating scholar in the Religious Consultation on Population, Reproductive Health and Ethics. She is a contributing author of Sacred Rights: The Case for Contraception and Abortion in World Religions (Oxford University Press, 2002) and author of Body, Sex and Pleasure: Reconstructing Christian Sexual Ethics (Pilgrim 1994). Contact 305-348-2729, Christine.Gudorf@fiu.edu.

IN THE SOUTH

Riffat Hassan is a professor of humanities in religious studies at the University of Louisville and participating scholar with the Religious Consultation on Population, Reproductive Health and Ethics. Contact 502-852-6123, riffat@louisville.edu.
Michele Rivkin-Fish is associate professor of anthropology at the University of Kentucky in Lexington. She studies health and gender issues related to development. Contact 859-257-2710, mrivk2@email.uky.edu.
Dr. Jeanette H. Magnus is director of the Tulane Xavier National Center of Excellence in Women’s Health in New Orleans. Contact 504-988-6269.

IN THE MIDWEST

Nawal Ammar is a professor of justice studies at Kent State University in Warren, Ohio, and a participating scholar with the Religious Consultation on Population, Reproductive Health and Ethics. She is interested in Islamic law and reproductive health. Contact 330-847-0571, ammarn@trumball.kent.edu.
James B. Martin-Schramm is an associate professor of religion and head of the department of religion and philosophy at Luther College in Decorah, Iowa. He attended the 1994 U.N. International Conference on Population and Development as a delegate for a nongovernmental organization. He also served on the Population and Consumption Task Force of the President’s Council on Sustainable Development. He is the author of Population Perils and the Churches’ Response (World Council of Churches, 1997). His interests in Christian ethics include population policy and environmental issues. Contact 563-387-1251, marschja@luther.edu.
Ibitola Pearce is a professor of sociology and women’s and gender studies at the University of Missouri-Columbia with interests in HIV/AIDS in Africa, medical sociology and anthropology and women’s health. Contact 573-882-7265, PearceI@missouri.edu.
C. Ben Mitchell is director of the Center for Bioethics and Human Dignity, in Bannockburn, Ill., and associate professor of bioethics and contemporary culture at Trinity International University in Deerfield, Ill. He is editor of the journal Ethics & Medicine: An International Journal of Bioethics. Contact 847-317-8180, info@cbhd.org.
Christian Reformed World Relief Committee of Grand Rapids, Mich., is a grant recipient under a government contract. Its programs in Africa promote faithfulness and abstinence. Contact media relations director Beth DeGraff, 616-241-1691 or 800-55-CRWRC, degraffb@crcna.org.
Nazarene Compassionate Ministries in Kansas City, Mo., is a faith-based organization that provides abstinence and faithfulness programs and other AIDS services in Africa under a government contract. Contact 877-626-4145 ncm@nazarene.org.

IN THE SOUTHWEST

Dr. Kirtly Parker Jones is a professor of obstetrics and gynecology at the University of Utah Medical School in Salt Lake City. She teaches the ethics of reproductive medicine. Contact 801-581-3834, kirtly.jones@hsc.utah.edu.

IN THE WEST/NORTHWEST

Claire Brindis is a professor in the departments of pediatrics and obstetrics, gynecology and reproductive sciences and director of the Bixby Center for Reproductive Health Research and Policy at the University of California, San Francisco. Contact 415-502-4086, claire.brindis@ucsf.edu.
Dr. Laila Al-Marayati, an obstetrician-gynecologist, is spokeswoman and past president of the Muslim Women’s League in Los Angeles and a participating scholar in the Religious Consultation on Population, Reproductive Health and Ethics. Contact mwl@mwlusa.org.