Last week in Seattle, we hosted Afganhistan's deputy minister for health, who came to talk about his efforts to rebuild the health infrastructure in his war-torn country and how we might help. His efforts are based on the understanding that improved access to family planning and modern forms of contraception are vital to better health.

These are all reproductive health initiatives. Ultimately, these activities will also help improve women's status and ensure basic human rights for women and adolescents.

As the most powerful nation on the planet, the United States is well positioned to lead the way to a healthier future. And if decision makers base their approach on established facts and documented needs, we could achieve a tremendous impact by helping communities provide needed information and services.

But to the detriment of our global community, some key decision makers are ignoring the realities of poor reproductive health. Based on ideology, the Bush administration is actively taking positions and issuing policies that undermine global efforts to meet women's reproductive health needs. By doing so, these actions also interfere with programs aimed at slowing the spread of the HIV/AIDS pandemic among women -- and, consequently, among their children and partners.

On World AIDS Day, the World Health Organization and the Joint United Nations Programme on HIV and AIDS (UNAIDS) reported that women now account for half of all the people living with AIDS. Soon, more women than men will be living with AIDS, most of them in the developing world, where 95 percent of new HIV infections occur.

Along with the HIV/AIDS pandemic, a host of public health issues is challenging the future of entire regions. The statistics are grim:

Each year, 80 million pregnancies are unintended. Of these, 50 million end in abortion, with 20 million abortions carried out in countries where they are currently illegal.

More than 500,000 women die from pregnancy or childbirth-related causes (including unsafe abortions) every year; 99 percent of these deaths occur in developing countries.

Worldwide, 350 million couples lack access to a modern method of family planning. An estimated 150 million women in developing countries want to plan their families but cannot use contraception because they lack access to services or the services are so poor.

Of the overall disease burden facing women in their reproductive years, 20 percent is associated with sex and reproduction. In sub-Saharan Africa, the figure is 40 percent.

In 1994, global decision makers took an unprecedented step forward for the well being of the world's women and children. At the International Conference for Population and Development (ICPD), 179 countries -- including the United States -- ratified the Program of Action, a 20-year plan to promote sustained economic growth in the context of sustainable development in all countries.

The participants recognized the vital role that women play in successful economic development. As a result, the Program of Action includes a focus on expanding the availability and quality of contraceptive information and services. It also addresses a broader range of reproductive health issues, including prevention of HIV and sexually transmitted infections.

At a conference in Bangkok last week, representatives from more than 30 countries came together to develop a plan that includes recommendations aimed at furthering the ICPD Program of Action. The U.S. representative, however, attempted to remove all references to "reproductive rights" and "reproductive health services." The conference participants took the unusual step of voting on two chapters of the plan, and the United States was outvoted 31-1 and 32-1, with two countries abstaining. Later, the United States finally agreed to the plan but attached a set of concerns in a separate document.

Clearly, groups with significant influence within the administration are seeking to undermine women's access to reproductive health. As part of these efforts, however, some are also questioning the safety of well-accepted methods of family planning such as oral contraceptives. Many claim that IUDs, emergency contraception, and other hormonal contraceptives cause abortion -- despite a wealth of scientific evidence that has led the American Medical Association, the American College of Obstetricians and Gynecologists and other groups to conclude that these assertions are absolutely false.

At best, by undermining reproductive health, the administration will quite likely increase the chances that many women will face unintended pregnancies. At worst, these actions will help foster the spread of HIV/AIDS and other sexually transmitted infections, as well as the huge emotional and financial costs that they entail.

The evidence is clear. When women and men have access to voluntary and affordable reproductive health services, abortion rates go down. Conversely, a lack of reproductive health services -- particularly in developing countries -- is directly correlated with the spread of AIDS as well as high rates of maternal and child mortality.

Moreover, there is a strong correlation between adequate reproductive health services and the elimination of poverty. Just a few weeks ago, the United Nations Population Fund reported that the countries that have expanded women's access to reproductive health services and education have significantly reduced rates of poverty.

It makes sense. A large percentage of the women in developing countries are sick and dying from complications due to poor reproductive health or inadequate access to reproductive health services. Women facing reproductive health challenges are neither able to increase their level of education nor contribute to economic development or the prosperity of their family.

The Bush administration has set a political course that will restrict life-saving reproductive health services from reaching those who need it most. In so doing, our nation is compounding the tragic circumstances of women in the poorest parts of the world. We encourage everyone who is concerned about the health and rights of women to speak up about the current policy directions of our administration, and to resist efforts to misconstrue the truth about reproductive health.

REPRODUCTIVE HEALTH DEFINED

Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility that are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.

In line with the above definition of reproductive health, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well being by preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counseling and care related to reproduction and sexually transmitted diseases.

-- Source: Program of Action, International Conference on Population and Development, Cairo, 1994

Jacqueline Sherris, Ph.D., is director of the Reproductive Health Strategic Program and Christopher Elias, MD, MPH, is president of PATH, a Seattle-based international non-profit that focuses on improving reproductive health, increasing the availability of vaccines and immunizations and improving maternal and child health in developing countries. www.path.org

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