Memo to the President-Elect: Improve Reproductive Health to Strengthen Foreign Aid

The U.S. Congress has put reforming the 40-year-old Foreign Assistance Act high on their agenda for next year.  If done correctly, it can help ensure that our aid to other nations is responsive to local needs, is effective and has long-lasting impact. This will be one of the most important global challenges for the next Congress, and for President-elect Barack Obama.

Though we don't know his specific stance on foreign aid reform, Senator Obama has indicated that he supports strengthening U.S. foreign assistance in his campaign platform. It states that his administration will "embrace the Millennium Development Goal of cutting extreme poverty around the world in half by 2015" and "help the world's weakest states to build healthy and educated communities, reduce poverty, develop markets and generate wealth."

To truly strengthen international development, President-elect Obama and the new Congress will need to focus reform efforts on improving impact on the ground and putting the needs and lives of people at the center. Because of the politicalization of so many areas of aid, one of their most difficult tasks will be to agree on program priorities in a revised Foreign Assistance Act.  

With over thirty years of experience working hand-in-hand with local organizations to improve communities, the Centre for Development and Population Activities (CEDPA) has a number of specific recommendations that would go a long way to make aid more effective.  Chief among these is the need to recognize the linkages between sustainable development, women's empowerment and gender equality, and health, including reproductive health.

Decades of research from the United Nations, the World Bank and others show that greater investments in women's empowerment and gender equality reduces poverty and improves governance. A reformed U.S. foreign aid system must reflect this consensus, and do a better job of using gender analysis at all levels of planning and implementation, and provide dedicated resources.

It is difficult to talk about women's empowerment without addressing their reproductive health needs. Pregnancy-related complications are among the greatest killers of women of reproductive age in developing countries. Despite the fact that more than a half a million women die each year in pregnancy and childbirth, and that maternal mortality could drop by 25-35% if family planning methods were available for the estimated 137 million women in the developing world without access to these services (according to the Guttmacher Institute), too often U.S. domestic politics trump the realities faced by millions of women living in developing countries.

Most of the rest of the world supports investments in reproductive health through decades of global agreements--including most recently the Millennium Development Goals. President-elect Obama and Congress should join this global consensus and integrate the reproductive health needs of women and girls into their foreign aid reform plans.

CEDPA's experience on the ground gives us firsthand knowledge that reproductive health programs are cost-effective and have broad and sustainable development impact.  In Nigeria, for example, CEDPA has worked since 1985 to empower women and their families to improve reproductive health and reduce maternal mortality. Nigerian women have a 1 in 18 lifetime risk of dying in childbirth, among the highest in the world.

One of our recent efforts, the "Kyautatawa Iyali" (Family Welfare) project, educates families about reproductive health and provides community-based family planning services in the largely Muslim northern Nigerian states of Bauchi, Kano and Plateau. CEDPA's program works closely with religious and community leaders, who we find recognize the benefits of family planning for improved health and the necessity to address the reproductive health needs of young people.

A hallmark of the Family Welfare program is the door-to-door delivery of  information and services to families. Teams of community health extension workers go from house to house, talking to men and women, old and young, about the importance of family planning and reproductive health care for the well-being of women and families. Often, male and female workers go out together so they can talk with both husbands and wives about their health concerns.

To date, CEDPA and its partners have reached more than 500,000 people directly with family planning services, and many millions of men and women with educational information through interpersonal talks, home visits, mass media, and public events and rallies. The program will continue through 2010, with special attention to building the capacity of CEDPA's local partners so that each can carry on the important work of improving family health-and saving the lives of mothers and their children long after the project formally ends.

The Family Welfare program in Nigeria is an example of a development program that strengthens and empowers communities to take responsibility for the well-being of their families. We must recognize that to be truly effective, communities must be supported by a policy environment and a governance structure that allows them to exercise their responsibilities and their rights to improved health.

A reformed U.S. foreign aid program that takes into account local needs and builds local capacity and support-and prioritizes proven, lifesaving interventions such as family planning-will go a long way to reducing poverty and improving health. The incoming administration and the 111th Congress need to put politics aside and promote and support such efforts.