There are always complicated issues around mothers. Being one, having one, not having one, wanting one, losing one, not being one.

Personally, we love our mothers even when we don't. Culturally, we revere them. Globally, we say how important mothers are, but still a woman dies every minute of every day from a pregnancy-related cause. Each of those deaths is preventable and at very little expense. There's been little help for those young women -- dying to be mothers -- over the past two decades. It's not just bad, it's sinful!

Read more of Amy's second blog entry for The Huffington Post!

Last week's Earth Day celebration reminded me of the first one. As a college kid responding to the passionate calls to action punctuated by pounding music, I came away thinking that if I hadn't already decided to work for women's rights, I would choose to work on environmental causes as a career.

This came to mind recently as I bumped along a dusty road in Northern Ethiopia. I was distressed by the lack of trees and by the many young women trudging along the road bent under the weight of huge piles of branches tied to their backs. Many of them never attended school or had dropped out because of the time required to travel long distances in search of wood that their families need for cooking and heat in the winter.

Read more of Amy Coen's blog at The Huffington Post.

“Birthrates Help Keep Filipinos in Poverty” – that’s the headline of an April 21, 2008 Washington Post article highlighting the plight of a growing number of poor women in the Philippines who lack access to one of the most basic forms of health care: family planning (FP) and reproductive health services. The article, which mentions that the U.S. is scaling down its FP program in the Philippines, should be a wake-up call for policymakers about the global impact of declining FP assistance on the lives of hundreds of millions of men and women in the Philippines and other developing nations.

U.S. investments in international family planning have been one of the most successful and cost-effective ways to improve maternal and child health, ease population pressures on the environment, and help countries fight poverty. But despite the achievements of recent decades -- including an increase in use of contraceptives among married women in the developing world from 10 percent to 60 percent since 1960 and a decline in average fertility rates from about six children per woman to three children per woman -- significant needs remain. For example, only one-third of married Filipino women use modern contraceptives.

Jeffrey Locke recently joined PAI as a Legislative Policy Associate, where he will help educate policymakers and their staff about the importance of international family planning and reproductive health programs.  In this blog, he talks about why, after two years in Togo, he decided to come to Washington to work on family planning issues.  

After over two years as a community health volunteer for the Peace Corps in Togo, I don’t have a canned, thirty-second response answer to why I wanted to work on issues of international family planning.  I do, however, have a story.

As a librarian for over 30 years, I’ve seen my share of April Fools jokes. But this year’s seemed more outrageous -– and less funny -- than in previous years. A librarian at the University of California/San Francisco Medical Center sent an inquiry to staff at the Johns Hopkins University School of Public Health when she found discrepancies in POPLINE searches that included the term “abortion.” On April 1, she received the following response from Debbie Dickson at POPLINE:

Yes we did make a change in POPLINE. We recently made all abortion terms stop terms. As a federally funded project, we decided this was best for now. In addition to the terms you’re already using, you could try using ‘Fertility Control, Postconception.’ This is the broader term to our ‘abortion’ terms and most records have both in the keyword fields…

In effect, the word “abortion” was downgraded from a medical search term to the status of words such as “a” and “the.”

Our car has absolutely no business driving this rocky (small boulders, really) dirt/mud road—loaded down with four passengers, no less. A sagging bridge up ahead taunts us to attempt the crossing. But we make it across in order to reach the Palabana district rural health center, surrounded by fields of corn and pumpkins, with a few tethered goats thrown in for good measure. A mere 45 kilometers from downtown Lusaka, we could be in far off Western Province in this beautiful rural landscape.

We arrive at the center and are led to a circle of benches under the generous shade of the large acacia tree. We’re meeting with assembled village leaders and health workers to discuss the loss of the five-year sexual and reproductive health (SRH) project that ended in 2006.

“Unplanned pregnancy is feared more than HIV/AIDS among young people,” comments Nthazie Nalungwe, a striking young woman leader within Youth Vision Zambia, a sexual and reproductive health and rights (SRHR) advocacy group here in Lusaka. This comment is reflected among many young Zambian advocates, peer educators and health workers we’ve talked with, including those with organizations promoting abstinence-only. Perhaps it’s a good thing that condoms seem far more plentiful than other contraceptives in Zambia: dual protection by default.

The rainy season is coming to an end here in Zambia and the early morning sun floods the car as we pull through the front gate of Professor Nkandu Luo’s house in Lusaka to join her for breakfast. Luo is the former (and outspoken) Minister of Health who now leads two Zambian nongovernmental organizations (NGOs) tackling HIV/AIDS and women – the Society of Woman Against AIDS in Zambia (SWAAZ) and Tasintha, the only local organization focused on helping women leave commercial sex work. It is a survival strategy for many women in countries like Zambia with weak economies and high unemployment.

"Reproductive health has been left behind. We can’t fight HIV/AIDS unless we center it within sexual and reproductive health. The majority of those affected by and living with HIV/AIDS are women, especially young women in Zambia,” she thunders. Zambia’s draft reproductive health policy—first proposed ten years ago by Luo during her tenure leading the Ministry—remains untouched. It was never finalized nor implemented by her successors.

Yesterday the House Foreign Affairs Committee approved a bill to reauthorize the President's Emergency Plan for AIDS Relief (PEPFAR). Now the bill will move to the House floor -- as soon as next week. In the meantime, check out these news clips with more information and various perspectives on the bill.

PEPFAR Wins Money, Compromises Principle
RH Reality Check - Washington, DC, USA
The moment to improve PEPFAR based on reality and public health passed before the House Foreign Affairs Committee was ever convened. Americans frustrated with political game playing over dedicated problem solving will see this as one more reason Washington must change...

House Foreign Affairs Committee Approves PEPFAR Reauthorization Bill
Kaiser network.org - Washington, DC, USA
President Bush had called on Congress to authorize a $30 billion, five-year extension of PEPFAR. The bill also would remove a requirement that at least ...

The House Committee of Foreign Affairs is poised to mark-up a bill that will reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR) and correct the critical flaws in the existing program, which hinder its effectiveness. The new bill will provide greater access to contraceptives for HIV-positive women who desire to space and plan their births, as well as increase effectiveness and flexibility in the fight against HIV/AIDS by striking PEPFAR's restriction that mandates at least one-third of U.S. HIV/AIDS prevention funding be limited to abstinence-only programs

President Bush's proposed budget for Fiscal Year 2009, released today, would dramatically cut funding for international family planning and sexual and reproductive health programs. The proposed funding level of $327 million represents a $134 million (or 29%) cut from current levels.

This budget proposal continues a disturbing downward trend in funding for these vital health programs for women and families. Since 1995, U.S. funding for family planning programs has fallen nearly $100 million -- a 39 percent reduction when adjusted for inflation and the FY 2009 budget request would equal a nearly 60% reduction below the amount provided for these programs in FY 1995 (adjusted for inflation). These cuts have occurred despite a growing need and demand for reproductive health care in the developing world. For example, the number of women of reproductive age in the developing world alone has increased by approximately 275 million women since 1995.

Over the last 10 days it has been difficult to read about and take in the photos documenting Kenya's election debacle. While not an avid follower of Kenyan politics, I heard from friends and colleagues there that the 2007 election cycle was unlike any other.  Massive, historic change was underway and friends’ excitement leading up to the election was palpable.  Nearly every conversation inevitably turned toward the latest political news and foibles of the politicians (and their spouses). Young Kenyans seemed increasingly engaged in the electoral process – flexing their political muscle much like their American peers these days – and voter turnout was expected to be off the charts.   

What unfolded in the aftermath of Kenya’s election was impossible to fathom.  I felt numb reading news accounts of violent clashes—among ethnic groups, between government troops and slum residents—in Nairobi, Kisumu, Kisii, Eldoret, Kakamega and other towns throughout Kenya where we know people.

The haze of pollution that shrouds Mexico City, obscuring views of the mountains that surround the sprawling city, lifted on our first morning, giving us clear views of the hills that lie just outside of the city limits.  However, as soon as Michele Duryea, the Vice President of Development, and I were seated in the back of Hugo’s red “Chevy,” making our way through dense early morning traffic, my eyes began to burn.  It quickly became clear that Mexico City’s pollution is there to greet every newcomer, and that urbanization was not a subject we had to seek out; we could simply sit amidst thousands of cars, exhaust fumes and blaring horns and observe.  

On our way to the first of several meetings in our whirlwind trip to check out the many organizations that we will visit on PAI's Friends Study Tour to Mexico (in February), I was impressed by the diversity of scenery that passed by the car window:  enormous artistic sculptures, small stores with hand-painted signs, 17th century buildings, and expensive clothing stores all formed the eclectic mix.

Earlier this week, PAI staff Kate Tibone and Sarah Haddock were in New York City, attending the UN Special Session on Children. This meeting is a follow-up to review progress made in the past 5 years toward meeting the goals of the outcome document, "A World Fit for Children."

Youth participation on sexual and reproductive rights advocacy was supported by the International Women's Health Coalition's  advanced training, called "Advocacy in Practice". This training was the third in a series; the first was held at the Commission on the Status of Women (CSW) last year, in which former PAI intern, Beth Orero participated, and the second training was held a few months ago at the Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSH) in Hyderabad, India.

Thirty minutes outside Arusha on the way to Nairobi and then 3km along a dirt road is the Selian Lutheran Hospital. One of 20 Lutheran hospitals across the country, the Selian facility serves the primarily Maasai population in the surrounding area. This morning the PAI team visited the reproductive health (RH) unit of the hospital and learned of the important role it plays in meeting family planning needs despite the ongoing challenge of securing a consistent supply of contraceptive methods.

Ms. Florah Kyara, a nurse in the RH unit, opened a cabinet and showed us the shelf containing all of the contraceptive supplies in stock,

which was less than half full. Selian Hospital offers its clients a range of family planning methods, including condoms, three types of oral contraceptives, injectables, implants, IUDs and male and female sterilization; but only after each new client has received a complete medical examination and counseling about her contraceptive choices.

Here in lush, tranquil Arusha, Tanzania, a boisterous chorus of roosters greets you far too early in the morning as if to announce, "Welcome to the 5th African Population Conference!" Team PAI is here amidst the vast coffee and tea plantations surrounding Arusha – and under the watchful gaze of magnificent Mt. Meru – at this week-long gathering of largely African researchers, demographers, advocates and policymakers who’ve assembled to discuss family planning/reproductive health, HIV/AIDS and overall population trends in Africa.

 

Introduction: Staff from Population Action International are presenting “The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World” at several events in Europe.  Join Tyler LePard, PAI’s Media Manager, for an inside look!

After the journalist workshop, the PAI team headed for lunch with DSW (Deutsche Stiftung Weltbevolkerung). Along the way, we passed the “Memorial for the Murdered Jews of Europe” (Denkmal fur die Ermordeten Juden Europas). It’s an eerie grid made with concrete blocks of differing heights that takes up a whole city block.  The somberness of the subject contrasted sharply with children running and playing among the rows.

Our next stop after the Naguru was another innovative teen center in Kampala: the Kitebi Teenage Centre.  The Kitebi Teenage Centre sits at the end of a bumpy, winding dirt road, a bit more difficult to get to than Naguru.  However, the team of 150 volunteer staff has solved that problem by bringing their services directly into the communities they serve. 
 
Kitebi has a variety of outreach programs, all designed to reach young people who wouldn’t ordinarily go to a clinic.  Their drama team holds well-attended productions throughout Kampala where clients come for some free entertainment and are encouraged to get tested for HIV or receive counseling while they are there.  Other outreach programs target young men, including the predominantly male ranks of bora bora drivers (one of the fastest -- and most dangerous -- ways to get around Kampala is to sit on the back of a hired motorcycle where the driver, called a bora bora driver, weaves in and out of the heavy traffic to take their passengers to their destination) and bricklayers.  The Kitebi team distributes condoms in local bars and hosts sporting events where the participants can also receive HIV testing.  These programs make the prospect of counseling and testing more tolerable and convenient than expecting these men to go out of their way to visit a clinic.

 

Now that the Eastern Africa Reproductive Health Network (EARHN) meeting is closed and the group is armed with a draft strategic plan, the PAI team here in Kampala has finally had the opportunity to explore the city.  Carolyn Vogel, PAI VP of Programs, and I had a full day of meetings today to help us gain an understanding of the realities facing men, women and youth in Uganda who need of reproductive health and family planning supplies and services. 
 

Our first stop was Naguru Teenage Centre, widely recognized as one of the best equipped youth centers in Kampala.  Young people from age 10 to 24 are willing to travel for hours to utilize the services here, as evidenced by the long line of people waiting outside the building.  In fact, the clinic is so popular that they had to stop advertising their services because the numbers of clients grew overwhelming.  The center’s advocacy manager, Henry Ntala told us, “It can be so hard to see young people sitting outside, but there’s nothing to do.”  Even as Carolyn Vogel and I sat outside the center talking to Mr. Ntala, we watched dozens more women and children stream toward the center to join the ever growing line.  The number of young people needing reproductive health services and supplies seems endless.

Introduction: Staff from Population Action International are presenting “The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World” at several events in Europe. Join Tyler LePard, PAI’s Media Manager, for an inside look!

On Thursday morning, the PAI team and DSW colleagues walked to the first event through the heart of Berlin. Eastern Berlin is full of newly constructed and restored or rebuilt buildings. The past couple of decades have brought many changes to Berlin, leaving little sign of The Wall that divided the city. We walked along Friedrichstrasse and Unter den Linden (two main thoroughfares), past several embassies, the Reichstag and the Brandenburg Gate to reach the building of the Representative of the Federal State Lower Saxony for our morning event.

It’s the end of our third and final day at the Eastern Africa Reproductive Health Network’s (EARHN) Annual Coordination Meeting and I’m proud to report that the delegates have come to a general consensus on a draft strategic plan.  There is still refining that will be done by the EARHN Strategic Plan Drafting Team, but we walked out of the meeting this evening with a two page document that summarized three days of lengthy, passionate discussion.  This strategic plan should help EARHN focus its work and be as effective as possible.

The network decided that they needed to focus on three areas: program development and expansion (bringing their work in line with partner organizations so that work is not duplicated and EARHN can make more of an impact), advocacy and coalition building (supporting members’ ability to advocate for sexual and reproductive health and rights in their own countries) and institutional strengthening (establishing a more efficient institutional structure, developing annual workplans as well as developing a resource mobilization plan).  Of course, this brief summary just scratches the surface of the discussion and each member will return to their respective country with pages of notes about the next steps.

Introduction: Staff from Population Action International are presenting “The Shape of Things to Come: Why Age Structure Matters to a Safer, More Equitable World” ” at several events in Europe. Join Tyler LePard, PAI’s Media Manager, for an inside look!

The Population Action International team left The Hague on Wednesday morning, excited about the success of “The Shape of Things to Come” at the Peace Palace. After the panel briefing, a senior ministry official told us that he was going to use the report in a briefing for Parliament and encourage them to make demographics a key priority in development assistance and to increase funding for sexual and reproductive health programs and services. Hooray!

In the Netherlands, I was particularly impressed by the number of bicycles I saw. A couple of us in the PAI office bike to work, but it looks like everyone in the Netherlands rides bicycles. It’s an environmentally friendly way to get around – and fun too!

Bula! (hello in Fiji). I am here in Fiji, taking part in a regional advocacy training for young people from the Pacific, put on by the Youth Coalition for Sexual and Reproductive Rights, a sub-grantee of PAI's. I arrived yesterday (Tuesday) and have been very busy working with the other YC facilitators (Nino from Indonesia and Fred from Sweden) to finalize the week's agenda and develop the sessions for the training.

There are 10 participants, representing Fiji, new Zealand, Samoa, Papua New Guinea, Vanuatu and Nieu. I'll be facilitating sessions on analyzing UN texts, understanding the MDG framework, mapping international advocacy opportunities, and a session on research-based advocacy that will center on A Measure of Survival.

It is a very dedicated and knowledgeable group of young people, so I am looking forward to a productive week. The training began today, with presentations from participants on the key SRR issues in their countries and communities.

Sarah E. Haddock, Research Assistant

Our first stop on the European tour was The Netherlands.  We were invited by the World Population Fund to present “The Shape of Things to Come.”  Amy Coen, Claudia Kennedy, Tod Preston, Liz Leahy and I arrived in The Hague on December 2, met WPF staff for dinner and got ready for our events.

After the documentary screening at the Ministry Wednesday morning, we traveled to the Peace Palace, a beautiful and prestigious venue.  Before the official event began, we met with Rob Vrecken, a reporter for De Volkskrant. Each member of our PAI team contributed their expertise to the interview, highlighting key findings and recommendations from “The Shape of Things to Come” and its implications for policy, development, and security, as well as the report’s connections with other aspects of PAI’s work. 

The two-hour panel briefing began with a welcome from Frans Baneke, the Director of the World Population Fund (WPF). Claudia Kennedy (Lt. General U.S. Army Retired and PAI Board Member) introduced the report. She said, “The international development community – and organizations like WPF and PAI – have long recognized that improving the well-being of individuals aren’t just investments in people; they’re investments in creating a more peaceful and developed world.”

I’m excited to be reporting back from Kampala, Uganda, where a team from PAI is participating in the Eastern Africa Reproductive Health Network’s (EARHN) Annual Coordination meeting. This unique network consists of six member states (Uganda, Kenya, Tanzania, Ethiopia, Rwanda and Burundi) who have come together to influence policies and funding for reproductive health in their respective countries.

On our first day here, Dr. Peter Njoroge from the East African Community told a story about visiting a rural village in Tanzania where people were so desperate for contraceptives that they were using plastic baggies as condoms – even though condoms were available in the capital, they didn’t have any way to get them to the country. When I looked around the room, nearly every head was nodding knowingly. This is the sort of unbelievable story that you hear all the time in this region. Men and women throughout Eastern Africa can’t access the reproductive health supplies that stock the shelves of nearly every convenience store in the United States. EARHN is part of the effort to make stockouts like this a thing of the past.