Population, Reproductive and Sexual Health
Section Newsletter
Spring 2004


Section Chair Dr. Claire Brindis, Institute for Health Policy Studies, 3333 California St., Suite 265, San Francisco, CA 94143 Phone: (415) 476-5255 E-mail: brindis@itsa.ucsf.edu

Dear Colleagues:

“It’s Your Choice, Not Theirs,” “My Body is Not Public Property” and “Vote as if Your Life Depends on it”. The sea of pink (representing Planned Parenthood, while others represented the American Civil Liberties Union), purple and yellow (National Abortion Rights League), and countless other handmade signs was an overwhelming sight. They came by plane, train, bus and car. Some brought their children; others came with their neighbors, college roommates from 20 years ago, and friends. Some families included three generations of women dedicated to keeping abortion safe and legal. For many participants, the recent March for Women’s Lives in Washington, D.C., was also an opportunity to protest this administration’s assaults on other aspects of women’s reproductive rights – oppositions to basic contraception, sex education, and international family planning and reproductive health services.

Will history judge April 25, 2004 as a turning point in America’s struggle with the increasingly political struggles for reproductive health rights and freedoms? As I marched with hundreds of thousands of concerned women and men from throughout the country, as well as from a number of countries across the world, I could feel the sense of urgency, energy, and passion. Whether the main take-home message was the necessity of assuring and maintaining access to legal abortions, the need to support international family planning efforts and the elimination of the global gag rule, access to emergency contraception, or eliminating inappropriate governmental interference in the lives of women did not seem to matter. What did appear to fire the passion of those who personally witnessed the March or participated in local efforts, as well as countless others who were in Washington that Sunday in spirit, was a profound realization that the March clearly could not be the end point. Rather, the March needs to be a spark for ongoing efforts to mobilize others throughout the country to save reproductive rights and assure the elimination of health disparities in this most basic of rights in both the national and international arena.

While the alliance of many well-established organizations in the reproductive health rights movement brought the event to life, the true successes were the thousands of other organizations from throughout the country that were mobilized to stand and be counted in support of these rights. While many were traditional organizations, what was particularly compelling was seeing groups of young people, some having been mobilized in their universities and high schools, or youth serving organizations, such as Advocates for Youth.

The question remains how this energy will continue to be mobilized and strengthened throughout the coming years. As someone devoted to reproductive health research and policy, I felt a clear sense of celebration and morale boost in recognizing that countless others care about these issues as passionately as I do. This Silent Majority was coming forth and advocating for reproductive rights, not only for this generation, but for generations of men and women to come. However, what was more concerning were the large numbers of others around the country who were not even aware that a March was occurring. For example, when I told other colleagues and friends that I was planning to go to Washington, D.C. for the March, few outside the field appeared to know about it. This brought home to me the importance of each of us continuously reaching out to others to expand the message of reproductive rights and choice. Clearly an important message that was reiterated over and over throughout the day was the need to assure that the 22 million women who had not voted in the last election cast their ballots in November.

I would welcome your thoughts and experiences of April 25, 2004 and request that you send your impressions to Susanna Binzen at SBinzen@cdc.gov to be included in the next Section Newsletter. Unlike other historical events -- most often horrific tragedies such as the assassination of President John F. Kennedy or the terrorist attacks of September 11th -- one hopes that the March for Women’s Lives will be seen as a positive and memorable event that contributed to maintaining one of our most important rights.

I also want to say a special thanks to Lois Uttley (Action Board Representative for our Section), to her colleague Jessica Fisher at the Education Fund of Family Planning Advocates of NYS, and to Cynthia Green (past Section Chair) for the development of a policy fact sheet that was distributed to our Section members (see a copy near the end of this newsletter) and to other APHA Section Members who participated in the Advocacy Training conducted by APHA on the Friday before and Monday following the March. Specifically, we want to thank Lakitia Mayo, APHA’s Director of Grassroots Advocacy & Affiliate Affairs and Don Hoppert, Director of Federal and Congressional Affairs, for their training, along with Lois who provided training on Monday (I was there on Friday). Lakitia and Don not only helped to provide APHA members with an orientation, but also assisted in coordinating Congressional visits. They provided important tips on Capitol Hill visits and information to give to members of Congress pertaining to APHA’s priority areas of access to health care, elimination of health disparities, and public health infrastructure so attendees could address those issues along with the issues surrounding the March. Unfortunately, only a few members were able to participate, as many came to Washington just for Saturday and Sunday. Thus, we are planning to work with Section members over the next few months to consider a Capitol Hill visit while you are attending APHA in the Fall (more information will be forthcoming in the next few months). Please do let me <brindis@itsa.ucsf.edu>, or Lakitia, <lakitia.mayo@apha.org>, know if you are interested.
As APHA's goal this year is to get at least 200 APHA members to visit Capitol Hill to advocate on public health issues, this provides an important opportunity to consider how our own Section members can play a more visible role both within APHA and on Capitol Hill. Please consider that the next time you come to Washington(or if you are based in D.C.), to participate in a Hill visit, even when not associated with our Annual Meeting. If you are interested, please contact Lakitia Mayo by e-mail at <lakitia.mayo@apha.org> or by telephone at (202) 777-2515. As Lois can attest to, APHA was much more successful in setting up an appointment with her representative than had been her own reproductive health-related organization.

Lois Uttley, who serves on the Access to Care Subcommittee of the Action Board, is planning to produce a series of fact sheets on topics related to our Section that could be added to those presently posted on the APHA Web site. Her goal is to develop a fact sheet on emergency contraception (EC) that can be posted and distributed with the APHA name, to assist in the efforts to bring mainstream public health and medical voices to bear on the issue of making EC available over the counter. If you are interested in helping Lois, please contact her at <Lois@mergerwatch.org>.

* * * * *
A number of Section members have approached me about reconsidering the name of our Section and whether the word Population in our Section name continues to reflect the efforts, interests, and activities of our members. Some of you will remember the efforts to expand our name to include reproductive health several years ago. That effort was ably chaired by Roger Rochat. At this time, I will be inviting our key elected Section leaders and Task Force Chairs to participate in a short series of phone calls to discuss this topic further. I would also like to invite any other members who are interested in this topic to write to me at <brindis@itsa.ucsf.edu> to become part of the Ad Hoc Committee.

If there is consensus that a potential name change be instituted, we would work with our Section members first and conduct an e-mail survey of the entire PFPRH membership, requesting that they vote on changing the name (of course, including alternatives as well). I have checked in with APHA regarding the process. If we decide to proceed, we would need to notify the Executive Board of our efforts to change our name. Once these steps have been accomplished, it would need to be voted on by the Governing Council. As this is an important activity, I want to be sure that members have an opportunity to reflect their views. The first conference phone call on this subject will occur in June. Please do let me know if you are interested.


Lois Uttley and Fran Atkinson carry APHA banner 
Fran Atkinson and Lois Uttley carry APHA banner
Washington, D.C., Sunday, April 25, 2004

Several Section members who participated in the March sent in their impressions of the day:

From Lois Uttley: I was proud to raise the APHA banner and help carry it along the streets of Washington, D.C., in the March for Women’s Lives. A small but mighty band of APHA staff and members marched behind the APHA banner as part of the Health Care Contingency, which also included such groups as Medical Students for Choice, the American Medical Women’s Association and Physicians for Reproductive Choice and Health. Other APHA members marched in the delegations of their home states. Having APHA represented in the march was fitting, because we as an organization stand for the rights of women and our families to have affordable access to comprehensive, culturally-appropriate health services, including but not limited to reproductive health. Reproductive health IS public health!

On Monday, we had two of us at the briefing, and three others who went out later. I had three excellent sessions [on Capitol Hill], including one with my own mixed choice GOP Congressman's legislative director, who actually expressed some interest in pressuring the Bush administration to let EC go OTC!

From Cynthia Green: For me, a desk-bound activist, the April 25 March for Women’s Lives was inspiring and encouraging. Hundreds of thousands of people felt strongly enough about this issue to come to Washington, D.C., to be counted. The mile-long Mall stretching from the Capitol to the Washington Monument was crammed with people, and yet the crowds did not seem threatening because they were just regular folks.

Press reports did not do the March justice because they focused on unusual aspects such as a comedian spewing profanities and the few right-to-life demonstrators on the sidelines. They did not remark on the sheer ordinariness of the crowd – young, old and in-between, striding energetically, hobbling on a cane, clutching children, pushing baby carriages, carrying banners, and wearing colorful T-shirts and buttons. Waving placards and chanting, they marched in endless streams. It was good to feel their strength, energy and determination.

It was so crowded I never did find my CEDPA group, so I linked up with my various affiliations—home state, alma mater, church, and various nonprofit groups. I spoke with a young woman from Kansas who had ridden on the bus for 30 hours and was determined to march the entire route before getting back on the bus. A nurse from Delaware said that she had cared for abortion patients and strongly believed that individuals needed to make their own decisions regarding reproduction. College students from Massachusetts expressed their concern for protecting women’s choices. Medical students from George Washington University stressed their responsibilities as future physicians. Men and women were wearing T-shirts proclaiming “This is what a feminist looks like.” The number of young people was impressive.

Let’s hope that this March galvanizes a new generation of activists.

If you also attended the march, please send your impressions and experiences to SBinzen@cdc.gov, to be included in the Fall newsletter.


Cynthia Green, Director of Monitoring and Evaluation, Centre for Development and Population Activities, 1400 16th St. N.W., Suite 100, Washington, DC 20036 Phone: (202) 939-2690 Fax: (202) 332-4496 E-mail: cgreen@cedpa.org

Dear Colleagues,

Once again we have a slate of distinguished and energetic colleagues running for PFPRH Section Council offices. Thanks so much to all you who agreed to run and to those who have an interest in running in future years.

Here’s the slate:

(vote for one)
Young-Mi Kim, EdD, MS

(vote for one)
Erica Fishman, MSW, MPH
Michael Klitsch, BA, BS

Section Council
(vote for three)
Joseph A. (Tony) Ogburn, MD
Linda Prine, MD
Lourdes A. Rivera, JD
Diana Romero, PhD, MA
Cate Teuten-Bohn, MPH
Sheryl Thorburn Bird, PhD, MPH

Governing Council
(vote for three)
Kay A. Armstrong, MS, BA
Toni L. Felice, PhD, MA, BS
Henry L. Gabelnick, PhD
Walter W. Klausmeier, Jr
Lisa Maldonado, MA, MPH
Sharon Rudy, PhD, EdS, MEd, BA, AA

APHA will notify you by e-mail with instructions on casting your ballot. Elections will be open from May 14 through June 15, 2004. If you do not receive your electronic ballot, please contact Fran Atkinson, Manager of Section Affairs at frances.atkinson@apha.org


Thanks to the hard work of Section Council member Larry Finer, the PFPRH Section now has a Web site -- <www.pfprh.org>! It can also be reached through the APHA Web site at: <http://www.apha.org/sections/sectwww.htm>.

You can find general information about the Section and its leadership; information on our standing committees, Task Forces, Section awards, and listserve; current and past newsletters; links to other sites of interest; Section contact information; and more. Visit <www.pfprh.org> today.

Please thank Larry at <lfiner@guttmacher.org> for a truly outstanding job!

If you have suggestions for further improvements or can help to maintain the website, please contact Cynthia Green at <cgreen@cedpa.org>


Board Representative Lois Uttley, Education Fund of Family Planning Advocates of NYS, 17 Elk Street, Albany, NY 12207 Phone: (518) 436-8408 Fax: (518) 436-1048 E-mail: <lois@mergerwatch.org>

I would like to request suggestions and help from Section members in developing new fact sheets on reproductive health issues that can be posted on the APHA Web site. The first fact sheet being developed is one on emergency contraception, with the purpose of better informing members from other Sections (as well as the general public) about how emergency contraception works and how improved consumer access to the medication could prevent unintended pregnancies.

You can view the existing APHA fact sheets at <http://www.apha.org/legislative/factsheets>

To offer suggestions or help in writing a fact sheet, contact me at <lois@mergerwatch.org> or (518) 436-8408, ext. 211.


Cynthia Green, past Section Chair and now Chair of the Nominations Committee, has issued a call for nominations for two awards, to be given out at APHA's Annual Meeting in Washington, D.C., in November 2004.

The two awards are:

* The Carl S. Shultz Award, which is for individuals with a distinguished career in reproductive health in the United States and around the world.
* The Outstanding Young Professional Award, which recognizes individuals whose professional accomplishments, initiative, and dedication to the field, especially the work of the Section, deserve recognition early in their careers.

In your nomination letter/e-mail/fax, please provide a paragraph or two on the nominee's background as well as a resume or other brief summary of his/her accomplishments.

The deadline for nominations is: June 1. Please send your nominations (or any questions on the nominations process) to Cynthia Green, Centre for Development and Population Activities, 1400 16th St. N.W. Suite 100, Washington, DC 20036 Phone: (202-939-2690) E-mail: <cgreen@cedpa.org>.


Terri Bartlett, Vice President, Public Policy and Craig Lasher, Senior Policy Analyst, Population Action International, 1120 19th Street, NW, Suite 550, Washington, DC 20036 Phone: (202) 659-1833 E-mail: <tlb@popact.org> (Terri) and <clasher@popact.org> (Craig)

Electoral politics will play a dominant role in debates over foreign assistance as it relates to family planning and reproductive health during 2004. And without exaggeration it can be stated that the outcome of this year’s presidential race will have profound implications for the future of U.S. foreign assistance programs in general and U.S. involvement in international family planning and reproductive health in particular.

Since the last Section newsletter, a number of important legislative and policy developments have occurred in Washington—most notably belated approval of fiscal year (FY) 2004 appropriations and FY 2005 budget deliberations.

Currently, however, Washington remains paralyzed by the inability of House and Senate Republicans to agree on a federal budget in the face of mounting deficit projections. The process of appropriating funds for government programs—one of the few tasks that Congress must do each year—has recently been thrown into disarray by the Administration’s unexpected decision to seek $25 billion in supplemental funds for the Iraq war before the election.

Current Year Appropriations

On Jan. 23, 2004—one day after touting his efforts to anti-choice marchers protesting the 1973 Roe v. Wade decision by stating that “working with the Congress, we have refused to spend taxpayers’ money on international programs that promote abortion overseas”—President Bush signed a massive FY 2004 omnibus appropriations act (Public Law 108-199) containing a multitude of provisions of interest to supporters of international family planning and reproductive health (FP/RH) programs.

For the full text of the bill, go to: <http://frwebgate.access.gpo.gov/cgiin/getdoc.cgi?dbname=108_cong_reports&docid=f:hr401.108.pdf>.


The bill contains an earmark of "not less than" $432 million for FP/RH from all bilateral foreign aid accounts, of which $375.5 million is to be allocated from the Child Survival and Health Programs Fund (CSH) managed by the Bureau for Global Health at the U.S. Agency for International Development (USAID). The $56.5 million difference between the two figures is to be made up by funds drawn from other accounts, such as Economic Support Funds and assistance to Eastern Europe, and includes $15 million specified in report language from health funds provided to the independent states of the former Soviet Union.

The overall earmark is slightly less than last year's level of $446.5 million, but the more programmatically significant CSH number is an increase above the $368.5 million allocated in FY 2003. Actual FY 2004 funds available will be reduced to $429.5 million and $373.3 million, respectively, as a result of a 0.59 percent across-the-board cut enacted by Congress as part of the omnibus bill.


Resolving the question of how UNFPA would be treated in the bill proved to be one of the most difficult issues the House and Senate negotiators faced. The omnibus appropriates a contribution of "not more than" $34 million for UNFPA.

In an important policy change from the prior year, the President is required to determine that UNFPA is in violation of the Kemp-Kasten amendment prior to withholding a U.S. contribution to the Fund. [The Kemp-Kasten restriction prohibits funding to an organization that "supports or participates in a program of coercive abortion or involuntary sterilization" and was broadly interpreted by the Bush Administration to render UNFPA ineligible beginning in July 2002.] Under the FY 2003 bill, no such determination was required allowing the President to quietly, without fanfare or reassessment, transfer UNFPA funds to USAID.

Due to the inability of UNFPA supporters to change the language of Kemp-Kasten amendment, however, UNFPA will not receive a contribution in FY 2004. You will recall that a House amendment to the State Department authorization bill authored by Rep. Joe Crowley, D-N.Y., to prohibit funding to an organization only if it "directly supports" coercive practices was narrowly defeated in July 2003.

Reprogramming of Blocked UNFPA Funds

Part of the deal on UNFPA related to the disposition of the withheld FY 2002 and FY 2003 contributions that congressional supporters of UNFPA had blocked the Administration from spending by placing "holds" on the release of the money. The $34 million FY 2002 UNFPA contribution was reprogrammed to USAID for "family planning, maternal and reproductive health" activities in the Congo, Ethiopia, Nigeria, Tanzania, Uganda, Haiti, Georgia, Azerbaijan, Russia, Albania, Romania, and Kazakhstan.

The FY 2003 UNFPA contribution—or at least $25 million of it—is being diverted to "assistance for ‘vulnerable children’ and made available for a new initiative for assistance for young women, mothers and children who are victims of trafficking in persons." As a result of this diversion, not only is a contribution not going to UNFPA as Congress intended, but the funds are not being used for FP/RH activities as the President implied that they would be when he transferred them to USAID on Sept. 30, the last day of the fiscal year. While reducing sex trafficking is a laudable activity, such programs will benefit a relatively small subset of women compared to the many more that would have been assisted by UNFPA.

Global Gag Rule Restrictions

Language in the Senate version of the bill repealing the Mexico City Policy/Global Gag Rule restrictions was dropped in conference. Family planning supporters sought to overturn the executive branch policy by prohibiting the President from refusing to fund foreign NGOs solely because they provide medical services, including counseling and referral, that are legal in their countries and are legal in the United States and from imposing free speech restrictions on foreign NGOs that are not imposed on U.S. organizations receiving assistance under the foreign aid program.


The omnibus conference report includes an important statutory requirement that "information provided about the use of condoms . . . shall be medically accurate and shall include the public health benefits and failure rates of such use." The provision does not require organizations that may have a moral objection to the promotion of condoms as part of a comprehensive HIV/AIDS prevention strategy to provide information on condoms, but it is intended to prevent those same organizations from disparaging condoms as a means of promoting an abstinence-only approach.


The omnibus bill appropriates a total of $2.4 billion for global HIV/AIDS activities—$1.65 billion in the foreign operations bill and $754 million in the Labor-HHS-Education portion of the omnibus. This figure is less than the $3 billion amount in the HIV/AIDS authorization bill (H.R. 1298) enacted in May 2003, but considerably more than the $2 billion that the President requested.

Because the omnibus bill did not include longstanding waiver authority or specific legislative changes, HIV/AIDS and other CSH programs are not exempted from ideologically driven provisions in H.R. 1298, such as the "abstinence-until-marriage" earmark (one-third of bilateral prevention funds), the "conscience clause" for faith-based groups, and the anti-prostitution policy requirement.

The authorizing bill requirement that recipients of HIV/AIDS funds have an official policy explicitly opposing prostitution and sex trafficking remains in force but a specific waiver for the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, WHO, the International AIDS Vaccine Initiative or "any United Nations agency" was included.

Potentially important programmatically and politically, Congress requests that the new Global AIDS Coordinator based at the State Department submit a report within 60 days of enactment of the bill describing the estimated proportion of all global HIV/AIDS funding that will be spent on prevention and the amount estimated to be spent on "abstinence until marriage" programs in FY 2004 and a description of the "criteria for determining which programs are included under treatment; prevention, with the criteria for ‘abstinence until marriage’ programs specifically outlined; palliative care; and orphans and vulnerable children." [emphasis added]

Millennium Challenge Account

The omnibus includes a total of $1 billion for a new presidential initiative called the Millennium Challenge Account targeted only to relatively well performing countries committed to democracy, free markets, and human rights. The implications of the MCA for funding to USAID's traditional development assistance programs—including FP/RH activities—and for the poor countries it attempts to assist remains to be seen.

In early May, the Millennium Challenge Corporation selected 16 countries to be eligible for MCA funds in FY 2004 -- half from Africa. The nations selected are: Armenia, Benin, Bolivia, Cape Verde, Georgia, Ghana, Honduras, Lesotho, Madagascar, Mali, Mongolia, Mozambique, Nicaragua, Senegal, Sri Lanka, and Vanuatu. For additional information, please go to the official MCC Web site at <http://www.mcc.gov/>.

FY 2005 Budget

Under the President’s FY 2005 budget request released in early February, bilateral international family planning and reproductive health programs are slated to receive $425 million from all funding sources, of which $346 million is from the Child Survival and Health Programs Fund. Global HIV/AIDS programs would increase to $2.8 billion.

On the question of UNFPA funding, in the international organizations and programs section of a State Department budget document, a chart lists all of the voluntary contributions to UN agencies. There is no line-item for the UN Population Fund. In a category labeled "Reserve to be Allocated", the amount of $25 million is listed. This is likely to be the amount set-aside for a UNFPA contribution, in case of the unlikely event that UNFPA is deemed eligible for U.S. funding later in 2004.

According to InterAction, the proposed FY 2005 budget request cuts or level funds many of the core development and humanitarian assistance accounts even though the $31.5 billion request for international affairs programs represents a $2.1 billion increase over current levels. However, most of the proposed increase is consumed by two new presidential initiatives—the Millennium Challenge Account ($1.5 billion increase) and global HIV/AIDS ($400 million increase). As one of the only non-defense, non-homeland security budget functions to have been selected to get more funding, increases for international affairs programs have already proved to be a tempting target for those in Congress seeking to fund domestic priorities.

Outlook for 2004

During this election season with partisanship at an all-time high—or a new low—Congress is expected to struggle even with those tasks that must get done like appropriating funds to run the federal government. The likelihood of passage of a free-standing foreign operations bill containing FP/RH funds is slim, limiting opportunities for family planning champions to challenge harmful Bush Administration policies such as the Global Gag Rule, UNFPA contribution cut-off, and a skewed HIV/AIDS prevention strategy focused largely on the promotion of abstinence and monogamy.

How debates over international family planning and reproductive health programs will be resolved remains to be seen. As a constituent, voter, and public health professional, your well-informed opinion on these vital programs has tremendous credibility and carries great weight with your Senators and Representative. Please let them know what you think.


Co-Chairs Jennifer Hirsch, Assistant Professor, Department of International Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322 Phone: (404) 727-9976 Fax: (404) 727-4590 E-mail: <jshirsc@sph.emory.edu> and Dina J. Feivelson, 141 E. 33rd St., #9J, New York, NY 10016 Phone: (212) 532-4724 Fax: (212) 305-3702 E-mail: <djf64@columbia.edu>

After two years in a row of almost entirely unattended 6 a.m. meetings, the Sexuality Task Force desperately needs some new blood (or maybe we just need more coffee???). Anyway, we were delighted to hear rumors from our Section Chair of some new meeting times, and we have our fingers crossed that this fall in Washington, D.C., we will be meeting at a more civilized time.

Almost all of the issues we deal with in our Section have some sort of sexuality element, and so many of you are, presumably, interested in public health aspects of sexuality. And of course, whichever way the November election goes, there will be important implications for health and legislative issues related to sexuality. Session proposals... policy work... reviving the "pink sheet"... various forms of rabble rousing... Who knows where we might go? Come join us this year at the Task Force meeting and let's talk about what we can do!


Co-Chairs Geri Lynn Peak, Two Gems Consulting Services, Baltimore, MD Phone: (410) 323-7212 Fax: E-mail: <gpeak@charm.net> and Lindsay Stewart, Senior Advisor on HIV/AIDS and Family Planning, Latin America and Caribbean Bureau, # 5.9-101 RRB, USAID Phone: (202) 712-4964 Fax: (202) 216-3262 E-mail: <lstewart@usaid.gov>, and John Santelli, Division of Reproductive Health, Mail Stop K-22, Centers for Disease Control and Prevention, Atlanta, GA 30333 Phone: (770) 488-5611 Fax: (770) 488-6291 E-mail: <JSantelli@cdc.gov>

The Adolescent Task Force met on Nov. 16, 2003. Approximately 20 people were in attendance.

Information Exchange. The Task Force discussed two topics: Abstinence and Statutory Rape.

Abstinence. John Santelli, one of the three Task Force co-chairs, led an open discussion of the Title V Section 510 Abstinence Education program (known as the A-H abstinence education guidance, see <http://aspe.hhs.gov/hsp/abstinence02/ch1.htm#What> for a clear statement of the program).

We began by reviewing the guidance. Long-time Task Force supporter Patrick Sheeran (Director of the Office of Adolescent Pregnancy Programs) was invited to add any comments. Patrick noted that OPA has their own guidance from 1987 for adolescent family life programs and they advocate for programs to select among the A-H guidance. He also noted that the administration of SPRANS (Special Projects of Regional and National Significance) programs has shifted from MCHB (Maternal and Child Health Bureau) to CYF (Children, Youth and Families). Clarification was made that SPRANS grantees must adhere strictly to the A-H guidance.

During the discussion, we touched on abstinence research and program work, with Susan Newcomer and John citing some of the current work studying the impact of A-H. Also noted was that the Emerging Answers report is a great resource for programs and that Doug Kirby will be reviewing programs for YouthNet, similar to his domestic U.S. assessments.

The discussion moved on to a discussion of where abstinence fits in the spectrum of information and choices that young people have. Youth development became the watchword, as people discussed the importance of giving young people the tools they need within ARSH programs to address the issues facing their lives. And we asked where were the youth voices in these policies.

The debate over media influence on behavior was also raised, with differing opinions being stated as to the scientific evidence for that influence, or lack thereof. It was noted that the Emerging Answers documents lists 43 risks and behaviors – determinants of which 20 really have the potential to change adolescent risk behaviors.

Statutory Rape. There are statutory rape (SR) laws in every state, and they vary enormously. These are defined as sex below a certain age -- there may be gender-specific age limits or thresholds like greater than a five year age difference.

ABA had a listing of statutory rape research. Patrick S. chaired a panel on SR, and there is definitely the legal side and the social behavior side. There are a lot of hazards involved with SR laws. Title X is required to abide by SR laws, so you can't ignore this in if it comes up in your practice. The implications are staggering.

California was the first to put legal language in place – the state has funded the District Attorney to go after sexual predators, although there was no funding to act with. Someone noted that there is a difference between SR and child sexual abuse.

We also discussed cultural and regional differences – for example, imagine a scenario where a 14-year-old is pregnant by her 22-year-old boyfriend, and everyone in the family is thrilled. Another example raised compared a young Mexican couple living together as married in contrast with a white or black teen who became pregnant after a one-night stand with an older male who is no longer in the picture. There is concern that practitioners are put on the front line to act like legal officials. There are examples of joint training -- San Mateo, Calif., and another example in Oregon where all the agencies are trained together.

It's not entirely clear what the objective is and if it were clear, if you could write a law that would meet that objective. Someone noted that criminal statutes don't necessarily match mandatory reporting laws. In a training program, very few clinicians even knew about the law and had no idea what to do or what is required. OPA new guidance suggests that training and information for clinicians needs to be a priority.

Agencies are not accountable between providers and police and CPS agencies.

We don't have any unanimity about this either, but it goes back to that healthy sexuality piece. Iris Meltzer raised the issue of how SR denigrates women’s sexual decisions, reducing them to good girl/bad girl stereotypes. Someone suggests that it wasn't good/bad, but about power and ability to decide between right and wrong. So it is in loco parentis action on the state's part. Is a 14-year-old able to make a good decision about sexual behavior? What about 16 or 12? And where are youth voices in this debate?

Issues for the APHA Agenda
The meeting discussion suggests considerable support for abstinence as an important option for teens, particularly younger teens, but considerable concern about programs where financing is limited to abstinence-only. The Adolescent Task Force is exploring interest in creating an APHA position paper on the scientific and ethical issues with abstinence promotion and abstinence-only financing for public health programs. We are interested in including information from both U.S. and international programs. If interested please contact Geri Peak.

Topics for Future Task Force Discussion
At the meeting, we brought up the issue of minor's consent and any implications of it, since it is already a requirement of federal funding. If there is a policy on this in APHA, we should bring this up. John said he would attempt to gather information on this.

Annual Dinner
A small but lively group went to dinner – our annual “Journal of Negative Results” -- later on Sunday evening. We will be looking for locations for this year’s meeting. Let John Santelli know if you have ideas.


Co-Chairs Erica Fishman, Director of Community Outreach, MCH Training Program, School of Public Health, University of Minnesota, 1300 So. 2nd St., Suite 300, Minneapolis, MN. 55454 Phone: (612) 625-4891 E-mail: <erica.fishman@epi.umn.edu> and Lisa A. Hare, Senior Policy Advisor, DELIVER - JSI, 1616 North Fort Myer Dr., 11th Floor, Arlington, VA 22209 Phone: (703) 528-7474 E-mail: <lhare@jsi.com>

The Task Force serves as a means to increase communication on management and sustainability issues, with a particular focus on sharing experiences between those members working internationally and those working domestically. During these times of programmatic changes due to shifting financial and political support, it is important to share lessons so that we are able to continue to meet the public health goals in this area.

Lisa Hare, the new co-chair of the Task Force, and Erica Fishman have been busy making plans for sessions at APHA that represent current issues in Management and Sustainability. These include:
  • sustaining family planning/reproductive health in the face of changing environments;
  • maintaining systems for access to a comprehensive method services;
  • sustaining adolescent reproductive health services; and
  • the impact of the private sector in the delivery of services.

We are also looking forward to having a Task Force meeting at a time that is more inviting! You are invited to submit any suggestions for the Task Force to Erica, and we hope that you will join our meeting in Washington, D.C.


The following did not have reports for this issue of the newsletter, but contact information is listed below.

Resolutions Committee

Co-Chairs S. Marie Harvey, Associate Professor of Public Health & Director of the Research Program on Women's Health, Cneter for the Study of Women in Society, University of Oregon, Eugene, OR 97403, Phone: (541) 346-4120, Fax: (541) 346-5096, E-mail: <mharvey@oregon.uoregon.edu> and Paula Tavrow, Deputy Research Director, Quality Assurance Project, University Research Company, LCC, 7200 Wisconsin Ave., Suite 600, Bethesda, MD 20814, Phone: (626) 796-1890, Fax: (301) 941-8427, E-mail: <ptavrow@urc-chs.com>

Men and Reprobductive Health Task Force

Co-Chairs Robert Becker, Associate Vice President of Education and Training, Planned Parenthood of New York City, 26 Bleecker Street, New York, NY 10033 Phone: (212) 274-7336 Fax: (212) 274-7300 E-mail: Robert.becker@pphyc.org, and Héctor Sánchez-Flores, Center for Reproductive Health Research and Policy, University of California, San Francisco, Box 0936, San Francisco CA 941143-0936 Phone: (415) 476- 3375 Fax: (415) 476-0705 E-mail: hectors@itsa.ucsf.edu

Abortion Task Force

Chair Joan Healy, Director, International Programs, Ipas, 300 Market Street, Suite 200, Chapel Hill, NC 27526, Phone: (919) 967-7052, E-mail: <jhealy@ipas.org>, and Sally Girvin, Institute for Reproductive Health Access, NARAL/New York, 462 Boradway, Suite 540, New York, NY 10013, Phone: (212) 343-0114, Fax: (212) 343-0119, E-mail: <sgirvin@naralny.org>


Washington, D.C., Nov. 6-10, 2004

Chair-Elect Tim Williams, John Snow Inc., 1616 N. Fort Myer Drive, 11th Floor, Arlington, VA 22209 Phone: (703) 528-7480 Fax: (703) 528-7480 E-mail: <tim_williams@jsi.com>

First of all, many thanks to the 330+ Section members and others who submitted high quality abstracts for this year’s APHA Annual Meeting, and to the many others who reviewed abstracts or provided invaluable insights. Because of your inputs, our program this year promises to be highly informative, with something of interest for everyone. Add the energized climate of Washington immediately following national elections, and we can expect a most exciting and memorable event!

The preliminary PFPRH program shown below highlights the breadth of interests and expertise that reside in our Section. In addition to the standard multiple sessions on youth, abortion, HIV/AIDS prevention, men, gender, policy, etc., this year’s program will also showcase some timely topics that haven’t always received much coverage in our Section, such as reproductive health in emergency/conflict settings, contraceptive advances, partnerships, cloning, and many others. And in keeping with this year’s theme of public health and the environment, we will sponsor two panels on population, reproductive health, and the environment.

We are able to offer these additional topics because we were awarded some extra panel sessions and roundtables this year. The roundtables offer a potentially exciting opportunity to present and receive information on cutting edge issues in an interactive way. Because of the added sessions, there will be plenty of learning opportunities to choose from every day, from start to finish.

Have a safe and productive year between now and the Annual Meeting, stand up for what you believe in, and see you in Washington in November!

Preliminary PFPRH Program

Sunday, Nov. 7, 2004
2:00 – 3:30
Sexuality Task Force Meeting
Men and Reproductive Health Task Force Meeting
4:00 – 5:30
Adolescents Task Force Meeting
Abortion Task Force Meeting
6:00 – 7:30
PFPRH Section Council Business Meeting

Monday, Nov. 8, 2004
8:30 – 10:00

Reproductive Health of Youth
Men, Couples, and Gender Issues in Reproductive Health
HIV/AIDS/STI Prevention in RH Programs
U.S. and International Perspectives on Abortion
Factors Related to Use of FP/RH Services
PFPRH Roundtables

10:30 – 12:00
Integrating Family Planning and HIV/STI Prevention: U.S. and International Perspectives
Population, RH, and the Environment: Implementing and Evaluating Effective Integrated Programs
Improving FP/RH Program Performance and Outcomes

12:30 – 2:00
Addressing Unsafe Abortion in International Settings
Role of Relationships, Gender and Men in RH
Improving RH Program Quality and Outcomes
Improving RH Access to Underserved Populations
PFPRH Poster Session

2:30 – 4:00
Defining “Personhood:” Ethical and Public Policy Implications for RH Services and Biogenetic Research
Where Do Youth Get RH Information? Communication to Improve Behavior
Advances in Contraceptive Method Choice and Programmatic Guidelines for Effective Use

4:30 – 6:00
PFPRH Business Meeting and Awards Ceremony

6:30 – 8:00
PFPRH Social Hour

Tuesday, Nov. 9, 2004
7:00 – 8:00

HIV/STDs/ Teen Pregnancy Prevention Task Force

8:30 – 10:00
Gender-Based Violence: Context, Consequences, and Program Responses
The Struggle to Maintain or Expand Access to Safe Abortion Services in the U.S.
Factors that Affect Sexual and Reproductive Health of Young People, and How to Address Them

12:30 – 2:00
Improving and Monitoring Reproductive Health Commodity Security from the Global to Country Level
Making Gender Equity an Integral Part of Reproductive Health: Progress and Challenges
Preventing “Other” STIs in RH Programs: U.S. and International Perspectives
Improving Maternal and Perinatal Health in the Context of RH

2:30 – 4:00
From Prevention to Care: HIV/AIDS Issues in High Prevalence Countries
Factors Affecting Sexual Behavior and Contraceptive Use
Introduction and Provision of Medical Abortion: Perspectives from Five Countries
PFPRH Roundtables

4:30 – 6:00
Post-Abortion Care: Programming for Success
Managing and Sustaining FP/RH Programs in the Face of Change: Funding Shifts, Health Reform, and Political Swings
PFPRH Poster Session

6:00 – 7:30
Management & Sustainability Task Force Meeting

Wednesday, Nov. 10, 2004
7:00 – 8:00

PFPRH Section Council Business Meeting

8:30 – 10:00
Improving and Sustaining RH Programs for Youth in Developing Countries
Men and RH: Global Experience and Lessons
Reproductive Health in Emergency and Conflict Settings
Reproductive Health and the Environment: Reaching Underserved Populations through Intersectoral Programming

12:30 – 2:00
The Unfinished Agenda for Family Planning and Reproductive Health
Teen Pregnancy Prevention in the U.S.: Current Challenges and Promising Approaches

2:30 – 4:00
Emerging Issues in Reproductive Health Programming
Emergency Contraception: Challenges and Opportunities as Availability Increases
Developing New Partnerships to Address RH Care


I asked Section members to please send in a note about the presentations that you found the most interesting at the Annual Meeting in San Francisco. Here are some sessions that your fellow Section members found most noteworthy:

Susan Newcomer: Parents’ beliefs about condoms and oral contraceptives: Are they medically accurate? by Marla Eisenberg, Linda Bearinger, Renee Sieving, Carolyne Swain, Michael Resnick: Most interesting was the finding that the more conservative the parent, the less likely s/he was to hold accurate beliefs about the efficacy of condoms in disease prevention and the efficacy of oral contraceptives for pregnancy prevention.

Lori Rolleri: Realistically how rare can abortion be? Learning to accept abortion as a component of reproductive health, by Tracy Weitz, MPA. This was a great presentation - content and delivery!

And here are your editor’s picks:

Managing Contraceptive Controversies by Sujata Bose, Abt Associates. The speaker defined contraceptive controversy as when opposition to family planning enters the public domain. There are two main sources of opposition: from religious/political groups, and from consumer/women’s groups. The reasons for the objections generally fall into the following categories: ethical objections; objections due to marketing to specific audiences (sex workers, adolescents, etc.); health concerns; and fear of coercion or hidden political agendas. Religious groups’ objections are usually on ethical or marketing grounds; consumers’ objections usually due to health or coercion issues. A controversy can have one of several different impacts: it can cause product withdrawal (such as the removal of IUDs from the U.S. market after the Dalkon Shield), have a negative impact on sales or use, have a negligible impact, or sometimes provide additional (helpful) publicity. To reduce the consequences of a crisis: keep a low profile; develop a one-product company (e.g., a company that sells only that product, such as emergency contraception). How to counter controversy with consumers’ groups: listen to them and gain their trust, educate them, involve them in dialogue, be honest about your product (claiming the Dalkon Shield was safe when it wasn’t did no good in the long run), improve your product if possible (as with oral contraceptives), assess consumer concerns and modify where possible, and put up ethical safeguards (especially with long-term or permanent methods).

Reducing Maternal Mortality: the Role of Social and Behavioral Factors, Honduras 1990-97 by Shana Yansen, Johns Hopkins School of Public Health. Honduras successfully reduced maternal mortality by 40 percent over the past 20 years. They conducted a study and learned that their rate was 182 maternal deaths per 100,000 live births and that the leading cause of death was hemorrhage. The results of this study were widely disseminated in order to galvanize financial and technical support, and they took a multi-pronged approach to reducing the maternal mortality rate. The approaches included: intensive training of traditional birth attendants, including identification of complications; development of new clinical norms; strengthening of the referral system; adding shelters to hospitals where high-risk women could stay while awaiting birth; development of a Ministry of Health community-based tracking system of every pregnant woman to see if she was at risk, and if so to encourage her to go to hospital; and meetings of Traditional Birth Attendants to reinforce the messages and have updates on the pregnant women. Communities were involved in constructing the shelters; this community participation was crucial to behavior change.

The next Annual Meeting promises to have many excellent presentations on topics of great interest. Please send in notes on your favorites to <SBinzen@cdc.gov> for inclusion in next Spring’s newsletter.


Please review attached APHA Reproductive Talking Points

Related Files:


The Population, Family Planning, and Reproductive Health Section has a listserv for its Section members. Join the listserv – and use it! Let other Section members know about:
  • the latest developments in our field,

  • job postings;

  • grants that are available;

  • action alerts;

  • new projects,

  • upcoming conferences;

  • releases of new publications; and

  • and any other information you think might be of interest to the Section memberhship.

  • Here's how to subscribe:

    * In the "To" line of the e-mail, type: pop-hlth-l@liststar.apha.org. Note: use lower-case letter "L" and not the number one.
    * In the "Subject" line of the e-mail, type . Note: use lower-case letter "L" and not the number one.
    * Leave the body of the message blank and send.

    Please note that if you signed up for the listserv before it was established at APHA about two years ago, you need to sign up again. If you haven't received any notices from the listserv in recent months, please sign up again. Note that one does not need to be a PFPRH Section member to receive the listserv; it is open to everyone.

    To post a message to the listserv, send an e-mail addressed to <pop-hlth-l@liststar.apha.org>.


The Population Council's Frontiers in Reproductive Health Program (FRONTIERS) released five new Operations Research Summaries at a September 2003 conference, New Findings from Intervention Research: Youth Reproductive Health and HIV Prevention, co-sponsored by FRONTIERS, Horizons, and YouthNet. The purpose of the conference was to disseminate newly available research findings on how to change youth reproductive health/HIV knowledge, attitudes and behaviors in developing countries. The two-page summaries of recent research results on adolescent reproductive health in Bangladesh, Cameroon, Kenya, Mexico and Senegal are available on the FRONTIERS Web site at <www.popcouncil.org/frontiers>. Paper copies are available free of charge upon request from <frontiers@pcdc.org>. Information about the conference, including the agenda and presentations, is available on the Family Health International Web site at <www.fhi.org/en/Youth/YouthNet/NewsEvents/researchmtg.htm>.

The Centre for Development and Population Activities (CEDPA) is pleased to introduce a new set of training manuals for program managers and trainers working on HIV/AIDS. The new four-part series: Integrating Reproductive Health and HIV/AIDS for Non-Governmental Organizations, Faith-Based Organizations & Community-Based Organizations, was produced under the Enabling Change for Women's Reproductive Health (ENABLE) project, funded by USAID. In addition to this series, CEDPA also now offers a training manual on dual protection against STI/HIV/AIDS and unwanted pregnancy. For copies of these training manuals and other related reports, visit <http://www.cedpa.org/publications/enable/>. All ENABLE publications are available in print, PDF or CD-ROM.

Ipas announces two new publications. 5 portraits, many lives: How unsafe abortion affects women everywhere puts a human face on the issue to which Ipas has dedicated 30 years: the need to ensure access to safe abortion services for all women, no matter how rich or poor, no matter where they live. Through fictionalized stories- several based on real life - set in India, Kenya, Nicaragua, Russia and the United States, it illuminates the personal contexts that lead women to seek abortions and the obstacles they too often encounter in exercising their sexual and reproductive rights. Hard copies are available free of charge, or the PDF may be downloaded from <www.ipas.org>. A mandate to reduce maternal mortality from unsafe abortion is an update of Preventing unsafe abortion: A call to action for health professionals highlighting new guidance from the World Health Organization. This eight-page factsheet provides advocates in the health-care field with the necessary background to speak about the issue and advocate for change in restrictive abortion laws and policies. Available free of charge or at Ipas's Web site, <www.ipas.org>.

JHPIEGO's Maternal and Neonatal Health (MNH) Program, in collaboration with Save the Children/Saving Newborn Lives and Family Care International, has compiled and published a collection of case studies demonstrating different approaches to influencing national policies on maternal and newborn health. Each case study presents a strategy that has been used to achieve or influence policy change in a country or region, details of the implementation process, and the changes that have been made in maternal and newborn health and healthcare as a result. Specific policies in Bangladesh, Burkina Faso, Guatemala, India, Indonesia, Kenya, Mexico, Nepal, and Pakistan are addressed. Together the case studies show how civil society and nongovernmental organizations can contribute to positive change for safe motherhood and newborn health. View the publication online at: <http://www.mnh.jhpiego.org/resources/shapepolicy.asp>. To order, please contact <orders@jhpiego.net>.

YouthNet, a program of Family Health International, is pleased to announce the launch of Youth InfoNet, a one-stop monthly source for new publications and information on youth reproductive health and HIV prevention. This newsletter is divided into two sections: (I.) summaries of innovative program resources and (II.) summaries of recent research articles. We hope this information enhances your work with youth, and we invite submissions and ideas for the newsletter. For more information on subscriptions to Youth InfoNet (and other electronic notices of YouthNet publications and nformation), or to propose submissions to this newsletter, please send an e-mail to <youthnetpubs@fhi.org>.

Pathfinder International is proud to announce the launch of its new publication, Pathfindings, which is dedicated to highlighting research, evaluation and program activities in the field. The debut issue features an analysis of Pathfinder/Kenya's integrated reproductive health and peer counseling program at Kenyatta University in Nairobi and Egerton University in Njoro. Over the past 15 years, Pathfinder's university-based program has improved access to and quality of reproductive health education and services, which has in turn contributed to a remarkable decline in unplanned pregnancies and HIV/STI transmission among in and out of school youth. To download a copy of Pathfindings, please visit
<http://www.pathfind.org/site/DocServer/2003-12-03-merged_final_lowres.pdf?docID=1401>. For more information about this and other Pathfinder programs, please contact Jinna Halperin at <jhalperin@pathfind.org>.

The Frontiers in Reproductive Health Program (FRONTIERS) announces the publication of The Contribution of Sexual and Reproductive Health Services to the Fight against HIV/AIDS: A Review, by Ian Askew, Senior Associate, Population Council, Nairobi, Kenya and Marge Berer, Editor, Reproductive Health Matters, London, UK. Approximately 90 percent of HIV transmission occurs sexually, perinatally, or during breastfeeding. Thus reproductive health programs--traditionally offered separately from HIV services--can provide vital information and counseling to prevent these forms of transmission. This paper reviews the contributions of sexual and reproductive health programs to HIV/AIDS prevention and treatment programs. Though the paper focuses on benefits from services to provide family planning, prevent sexually transmitted infections (STIs), and improve maternal care, it also describes other services that can benefit HIV-positive women, such as infertility services and screening and treatment for cervical cancer. The authors demonstrate the contribution of reproductive health services to HIV prevention and treatment, and that STI control is important for both reproductive health and the prevention of HIV transmission. Please see the full text at: <http://www.popcouncil.org/pdfs/frontiers/journals/AskewBerer.pdf>.

CARE is pleased to share with you Individuals, Communities & Institutions Managing Risks to Reproductive Health: Final Report of the CARE-MoRR Project. This is the final report for CARE's five-year Management of Reproductive Risk (CARE-MoRR) project, implemented by CARE in partnership with other international and local organizations, and funded by the Office of Population of the United States Agency for International Development (USAID). CARE-MoRR provided technical guidance in the key intervention areas of family planning, maternal health, newborn care and STI prevention and treatment, including HIV/AIDS and worked to assist individuals, communities and institutions in developing the ability to help themselves and their clients better manage reproductive health in order to minimize risks and optimize healthy behaviors. One of the key lessons to emerge from the CARE-MoRR experience was the critical role that PVOs and NGOs can play when they work in partnership with other agencies to reach underserved, isolated populations. The report provides a convenient summary of CARE-MoRR, and details its program approaches, achievements, experiences, and lessons learned, and key strengths and challenges of the project. An electronic copy of this publication can be accessed on the CARE Web site at: <http://www.careusa.org/careswork/whatwedo/health/hpub.asp>.

The Population Reference Bureau has recently produced a new report, Improving the Health of the World's Poorest People. Despite the dramatic improvements in public health achieved in the 20th century, large disparities in health persist both within and between countries. This Bulletin examines facets of the poor-rich health divide, factors that play a role in health disparities, and approaches for improving the health of people living in extreme poverty. In recent years, a great deal of new research has become available on health inequalities within less developed countries. This report provides the latest data on how the world's poorest people are faring. PRB developed this report through a grant from the Bill & Melinda Gates Foundation. It is available for $7 per copy from the Population Reference Bureau,1875 Connecticut Ave., NW, Suite 520, Washington, DC 20009-5728, phone: (202) 939-5408; Fax: (202) 328-3937. Copies are free to writers and members of the press and to people from less developed countries. The full text of this report is available at <www.prb.org>.

Journeyworks Publishing announces the publication of two new pamphlets: Abstinence and Oral Sex, and HIV, STDs and Oral Sex which discuss the health risks of oral sex and ways to reduce those risks. There are also two new posters promoting the choice to be abstinent: I’m Choosing Abstinence Because… and How to Say No to Sex and Keep Your Boyfriend or Girlfriend. Journeyworks has also translated their popular pamphlet on Dating and Violence: How to Tell if a Relationship is Abusive into Spanish. Free review copies are available to health professionals and educators by calling (800) 775-1998, sending a fax to (800) 775-5853, visiting the Web site at <www.journeyworks.com>, or writing to Journeyworks Publishing, P.O. Box 8466, Santa Cruz, CA 95061-8466. For information on bulk pricing, call (800) 775-1998; prices start at $16 for 50 pamphlets and $1.95 per poster.


Share your news! Let us know about books or papers you have recently published, upcoming conferences you are involved in, or policy or program news that might be of interest to fellow Section members. Perhaps we can abstract an article or include a description of an innovative program. Please send all submissions by Friday, Aug. 6, 2004 to:

Susanna Binzen
Division of Reproductive Health, MS K-35
Centers for Disease Control and Prevention
4770 Buford Highway, NE
Atlanta, GA 30341
Phone: (860) 232-3262
Fax: (860) 232-6648
E-mail: SBinzen@cdc.gov