PEPFAR or Making Abortion Legal and Paid With American Tax Dollars

WHA T YOU NEED T O KNOW ABOUT PEPF AR, The Glo bal Health Initiative, and Family Planning/HIV Integration those aecting amily planning/reproductive health. Subscribe to PAI’s Washington Memo at www.populationaction.org/signup. PEPFAR and the GHI: Setting the Stage for Greater RH-MCH-HIV Integration In 2008, Congress reauthorized PEPFAR or another ve years, increasing overall unding and making only a ew notable changes to the underlying law. The changes included repealing the abstinence-until- marriage spending earmark; allowing or fexibility in responding to local epidemics and strengthening prevention eorts; bolstering treatment with an increased emphasis on care and support services or people living with HIV; and linking HIV to related issues such as gender, maternal and child health, clean water and nutrition. That summer, the then-Bush Administration issued its nal PEPFAR guidance to the eld—the Fiscal Year 2009 Country Operational Plan (COP)—reaching beyond the law to explicitly state that PEPFAR unds cannot be used or amily planning, including such activities as prevention o mother-to-child transmission eorts. This was a refection o Bush Administration ideology, not the legislation passed by Congress reauthorizing P EPFAR . Described as the oundation upon which the Global Health Initiative (GHI) rests, the President’s Emergency Plan or AIDS Relie (PEPFAR) is undergoing signicant change. HIV/AIDS prevention, care and treatment remain the ocus o PEPFAR, yet the GHI mandates that PEPFAR—along with the rest o the U.S. government’s global health portolio—take a more holistic approach to meeting individuals’ primary and preventive health care needs, especially or women and girls, with amily planning/reproductive health chie among those. “We’re linking family planning, reproductive health services to our prevention efforts because they are more effective. Those needs are largely unad- dressed, and where interfaced with populations that need both, we should overlap them.” — AMBASSADOR ERIC GOOSBY, MD U.S. GLOBAL AIDS COORDINATOR, DECEMBER 2009 The purpose o this unofcial guide is to clariy current U.S. policy regarding the integration o amily planning/ reproductive health, maternal and child health, and HIV/AIDS within U.S. global health assistance. U.S. law and policy does not prohibit, restrict or otherwise discourage integration o reproductive and maternal health with HIV/AIDS. The avorable policy environment or amily planning/reproductive health and maternal-child health—in the U.S. and globally— and the reality o budget constraints, make it impera- tive that U.S.-based and local NGOs ensure health eorts are integrated, linked and sustainable to deliver services and maximize positive health outcomes. This guide seeks to help current and potential imple- menters o U.S. global health assistance better under- stand the principles underlying the GHI, especially its call or integration and coordination. It is important to note that the GHI is a work-in-progress; it is expected that the U.S. government will issue new po licy and program guidance this year and beyond. In response, PAI will issue online updates and email alerts to colleagues in the eld regarding any policy develop- ments aecting U.S. health assistance, particularly The Global Health Initiative mandates that PEPFAR take a more holistic approach to meeting individuals’ primary and preventive health care needs, especially or women and girls. ADVOCACY GUIDE