Progress on women's sexual and reproductive health and rights has always been vulnerable to political whims. U.S. foreign policy affects women overseas tremendously, yet often places women's actual well-being secondary to domestic political agendas. To assess the role and impact of current U.S. foreign assistance on maternal health, family planning and HIV/AIDS, the Center for Health and Gender Equity (CHANGE) sponsored a study tour to Ethiopia with three state legislators in July, where we met with the U.S. ambassador, U.S. development staff, national government officials, Ethiopian and international NGOs, health care providers and, most importantly, women themselves. Our strategy was to get the perspectives of key stakeholders before coming to any findings or making any recommendations.
Congress and the American people have great reason to closely monitor the impact of U.S. global health policy on women's health in Ethiopia. The U.S. is a major donor to Ethiopia, providing $900 million in foreign assistance in 2009 alone. We have been able to contribute to positive growth and development in what is one of Africa's poorest countries. The Ethiopian government is currently implementing a community health worker program that is designed to provide comprehensive, integrated health services to women and families who are among the hardest-to-reach. Our partnership with Ethiopia has led to concrete, successful outcomes, including a doubling in just five years of the percentage of women who are using contraception among those who want to avoid or delay pregnancy. It is an example of what U.S. foreign policy can accomplish.
Ethiopia is also at the crux of significant changes in U.S. foreign policy right now. It has been designated a "plus" or focus country for the Obama administration's Global Health Initiative, which will change the way U.S. foreign assistance is used. In a time when the government is under pressure to curtail spending, we have a responsibility to assure foreign assistance continues and is efficiently and effectively used. We want to be able to accomplish just as much, and more, on a global scale.
We were in Ethiopia for a week and we do not pretend to have a complete picture of all things Ethiopian, but we did see and learn a lot. What we heard was that because of Ethiopia's high rates of maternal death and illness, U.S.-funded health programs in Ethiopia should be integrated and woman-centered, meaning they should meet the actual needs of women, as expressed by women, in an accessible location. If a woman says she needs prenatal care, family planning counseling and HIV prevention or treatment, she should be able to get all those services in the same place, or with meaningful referral. It can take months of saving money and days of travel to reach a clinic in Ethiopia. We more effectively and efficiently combat maternal death and HIV/AIDS if women can access as many related services they need in that one trip. Integration of services that meet women's needs is critical.
We also found that the U.S. should increase its reproductive health and family planning funding to Ethiopia to increase access to contraceptive supplies and other reproductive health services. These services are in high demand and they are proven to tremendously improve women's lives and communities. In order to be effective and sustainable, U.S.-funded health programs should be ambitiously funded--global U.S. contributions to international family planning alone should be funded at $1 billion--and advance human rights, with the needs and perspectives of the recipients as the first priority.
Regardless of political agenda, women want access to information and services that have the potential to save their own lives. We need to pay attention to what women are telling us, instead of pushing what we might think is best. All we have to do is listen.
For more about CHANGE's study tour to Ethiopia with state legislators, view a short film about the findings and recommendations, or download CHANGE's report.