In the upcoming presidential
debate on foreign policy issues, will candidates be asked to address
sexual and reproductive health and human rights of women as a critical
component to our nation’s foreign policy? I submit that if we truly
want to regain international credibility and legitimacy, the U.S. must
become a collaborator with our global neighbors on a variety of issues.
Why not start with the global crises women face throughout the world
regarding fundamental sexual and reproductive health and rights? 

In this Friday’s debate,
the candidates should be pressured to talk about stands they would take
involving women and sexual and reproductive health. Let moderator Jim
Lehrer ask for responses to the facts:

• 80% of HIV infections
  are sexually transmitted and women account for more than half of those
  infected worldwide
• Women are 61% of
  those infected with HIV and AIDS in sub-Saharan Africa, the region most
  heavily hit by the HIV/AIDS pandemic
• 200 million women
  experience yearly an unmet need for contraceptive services
• 80 million unintended
  pregnancies occur each year, 60% of which end in abortion
• 500,000 women die
  each year from pregnancy-related complications
• 68,000 women die
  each year from unsafe abortions

The U.S. led the world for
decades in supporting voluntary family planning programs. Prior to 2000,
the U.S. joined other governments in signing international agreements
that recognized the rights of individuals–including adolescents–to
have access to accurate information and services to prevent unintended
pregnancies and HIV infections. Yet for the past eight years, a very
different U.S. government waged a narrow, moralistic crusade against
sex and reproduction–at times alone, and sometimes in the eclectic
company of the Vatican. 

Will the candidates continue
the U.S.’s so-called "balanced" approach to global HIV prevention
that promotes abstinence and fidelity within marriage as the best ways
to prevent HIV infection, even where marital sex represents the greatest
risk for women? Or would candidates commit to promoting HIV prevention
interventions that are based on evidence and are proven effective? Ask
whether as president they will ensure that U.S. foreign policy advances
the right to obtain information and to assure that individuals have
access to comprehensive information, tools and skills so that they can
decide freely what prevention method makes sense for their realities,
whether they are young, old, man, woman, married, single, gay, straight,
rich, poor.  

Will the candidates be asked
to commit to funding the United Nations Population Fund (UNFPA), the
UN agency effectively supporting a range of critical sexual and reproductive
health programs and services? Are they aware that the U.S. has withheld
funding from UNFPA based on a falsehood that UNFPA supports coercive
family planning in China? Do the candidates understand the facts, which
were delineated to the current Administration by assessment teams–including
delegations from the State Department and faith-based leaders–which found that UNFPA does not
support or participate in managing coercive family planning programs
in China, and in fact has been a catalyst for change in China? 

Will the candidates address
the crisis of maternal deaths due to unsafe abortions by supporting
public health best practices to ensuring that abortions are safe? I
would like to hear the candidates commit respect for all people to exercise
free speech and assembly and standard ethical practices. Where groups
are honest and open with patients about abortion or decide to legalize
abortion in their countries because women and girls are dying, they
should not be punished with denial of U.S. foreign assistance (read:
rescind the Global Gag Rule).  And I’d like to see candidates
decide that it is time that federal funds be used to provide safe, legal
and voluntary abortions to those who cannot afford the procedure-overseas
and at home (read: ask Congress to repeal the Helms and Hyde Amendments).   

And what about sex workers? 
Would the candidates declare that sex workers deserve dignity and respect
and have rights to U.S. assistance and HIV prevention? This question
should be posed because these Senators both supported legislation to
reauthorize PEPFAR with the condition that organizations have a policy explicitly opposing prostitution, and further requiring that funds
cannot be used to promote or advocate legalization of prostitution.
Such puritanical policies undermine public health and human rights,
while exacerbating stigma and isolation of marginalized persons, and
putting at risk the lives of sex workers, their clients and partners. 

There is much talk these days
about U.S. foreign assistance reform.  Much of this talk concerns
global humanitarian organizations–many who are recipients of U.S.
assistance.  But not much is being said about sexual and reproductive
health and rights. And I doubt the presidential candidates will volunteer
answers and therefore must be rigorously asked.

In a recent article for the ABA Human Rights
magazine, I make
recommendations for U.S. foreign assistance reforms that advance sexual
and reproductive health and rights, which is expanded here:

1. Institute greater
   transparency for foreign policy goals related to sexual and reproductive
   health and rights, delineating what the United States is trying to accomplish
   through its funding.
2. Align U.S. foreign
   assistance with the ICPD Programme of Action and the Millenium
   Development Goals.
   Build on the successes of European donor nations, and pool resources
   where creative partnerships are happening.
3. Create two new cabinet-level
   posts: one for global development and the other for women, making women’s
   equality and sexual and reproductive health and rights a priority of
   U.S. foreign policy.
4. Adopt modalities
   to ensure that U.S. funding goes directly to innovative, smaller grassroots
   organizations that promote sexual and reproductive health and rights
   and gender equality, and make sure U.S. money gets in the hands of women.
5. Eliminate restrictions
   and unnecessary reporting requirements, and fund comprehensive sexual
   and reproductive health programs that integrate HIV prevention based
   on public health best practices and human rights standards.

The U.S. must abandon its self-absorbed
role as Decider-in-Chief of morality and personal decisions on sex and
reproduction. The U.S. must become a collaborator in the global arena,
leading by example-leading by serving those who suffer most from ideological
restrictions on sexual and reproductive health assistance. 

I look forward to watching
the Friday debate to see if any candidate has chosen his path–Decider
or Collaborator for women and sexual and reproductive health and rights.