U.S. Clout Raises Worries for World Health Agency

(WOMENSENEWS)–Some women’s and global health experts are beginning to question whether Dr. Margaret Chan, the new director-general of the World Health Organization, can stand up to the historical interference from its biggest donor, the United States. The Bush administration has been pushing a pro-abstinence, anti-abortion agenda at WHO and has cut its funding for comprehensive sexual and reproductive health services worldwide.

“The U.S. has pressured WHO behind the scenes not to address unsafe abortions and to remove references to sexual and reproductive rights,” says Jodi Jacobson, executive director of Center for Health and Gender Equity in Takoma Park, Md.

When Chan in early February appeared to side with the U.S. position against giving developing countries easy access to cheap generic drugs, skeptics wondered whether it was a sign that Chan might follow the U.S. lead on other issues as well.

“Chan’s stance on generic drugs does not make me confident that she will be able to stand up to Washington on sexual and reproductive health issues,” said Jacobson.

Chan declined through her office to be interviewed for this story.

But in a Jan. 4 address to WHO staff from the organization’s headquarters in Geneva, Chan announced that improving women’s health would be one of her top two priorities.

“Women are a vulnerable group because of the work they do, their care-giving role, the risks they face during pregnancy and childbirth and their low status in some societies,” Chan told her staff.

‘Public Commitment to Women’

“Dr. Chan is the first director-general to make such a public commitment to women,” said Adrienne Germain, president of the International Women’s Health Coalition in New York City. “She has the potential to raise the profile of women’s health issues through her leadership.”

Germain added that WHO has in the past failed to give women’s health issues the resources and attention they need. For the 2004-2005 biennial budget, totaling $2.8 billion, $15 million was allocated for women’s health. Another $39 million was allocated to making pregnancy safer.

“That’s a drop in the bucket compared to what’s needed,” said Germain. According to a 2000 WHO report, $9 billion a year is necessary to reduce maternal mortality and increase access to health care services for the millions of pregnant women facing life-threatening complications.

Sexual and reproductive health worldwide is either stagnating or in decline, according to a global study published in the British medical journal the Lancet last November. This year, an estimated 529,000 women, most of them in developing countries, will die during pregnancy or childbirth from largely preventable causes. Another 68,000 women will die from unsafe abortions. Almost a quarter-million women will die from cervical cancer.

The same study pointed out that international aid for family planning fell to $460 million in 2003 from $560 million in 1995.

Gag Rule Reinstated in 2001

When George Bush took office in January 2001, he reinstated the Mexico City Policy, also called the global gag rule, which prohibits U.S. aid to foreign nongovernmental organizations that provide any abortion-related information or services, even if those services are funded with other money.

“Local NGOs have lost crucial money, technical assistance and access to contraceptive supplies as a result,” said Wendy Turnbull, a policy and research associate with the Washington-based Population Action International.

At WHO, the United States has also delayed the approval of lists of essential medicines because some of the medicines could be used to induce abortion. These lists serve as guidelines for what drugs countries should have available for their populations.

In January, the 34-member executive board of WHO adopted a strategy on gender, women and health that calls for enhancing the organization’s capacity for analyzing gender differences in health services and outcomes and integrating gender considerations into all areas of work. The strategy has been developed over the past 15 years and was on the agenda before Chan’s appointment.

Germain reported that the U.S. delegation at the meeting opposed a robust endorsement of the strategy. In the end it was “recognized” but not “endorsed” by the executive committee. Such wording can impact how seriously the resolution will be considered by the World Health Assembly, WHO’s governing body, when it votes on whether to adopt the strategy at its next meeting in May.

Chan is accountable to the World Health Assembly, which makes the organization’s policy decisions and is made up of ministers of health from the 193 member states. While member dues accounted for $880 million in the 2004-2005 biennial budget, voluntary contributions added up to over $1.9 billion. The United States is the biggest WHO donor, giving $170 million in member fees and an additional $226 million in voluntary contributions during the 2004-2005 financial year.

Appointment Signals Scientific Commitment

Ruth Levine, global health director at the Washington-based Center for Global Development, expressed optimism that under Chan–a former director of health in Hong Kong, where she tackled both SARS and avian flu–WHO will be guided by science and evidence. “Dr. Chan’s appointment is a positive sign that high value is being placed on technical expertise,” she said.

Yet many observers were alarmed by Chan’s statements on Feb. 1. While visiting Thailand’s National Health Security Office, Chan sparked an outcry from activists and public health experts when she cautioned the country against licensing cheaper generic drugs. Her comments were seen by some as a sign of capitulation to the pharmaceutical industry and its most vocal supporter, the United States.

U.S. interference with WHO came under scrutiny in January 2006 when the organization’s top official in Thailand, Dr. William Aldis, was demoted after arguing in an editorial that a U.S.-Thai free trade agreement would undermine Thai access to cheap AIDS drugs.

Each year since 2001, the White House has requested higher levels of bilateral aid for HIV-AIDS while seeking to cut funding for maternal and child health. The fiscal 2008 budget request submitted to Congress by the White House on Feb. 5 proposes $5.4 billion for HIV-AIDS and $345.6 million for maternal and child health. The White House is also asking for a 25 percent funding cut for family planning programs. Congress is expected to appropriate more funding for these programs than requested, as it has done regularly in past years.

Rep. Nita Lowey, D-N.Y., introduced the Global Democracy Promotion Act on Jan. 22, which seeks to repeal the so-called gag rule. Rep. Barbara Lee, D-Calif., will introduce the Pathways Act, which would remove the earmark for abstinence programs on anti-AIDS funding, during the week of Feb. 12.

Both of these bills have been introduced in previous years and have not been passed. Despite a new Democratic-controlled Congress, activists are doubtful this year will be different.

“The focus is on Iraq and fiscal responsibility,” said Jacobson. “Many of the newly elected Democrats are middle of the road on social issues and might not want to take on anything controversial.”

“The reality is that there are not enough votes to override a presidential veto on any congressional attempt to repeal the gag rule,” said Turnbull.

Bojana Stoparic is a freelance writer based in New York.

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