Message From the Chair
Dear PFPRH colleagues,
The past few years have been highly challenging for those of us working in the PFPRH field. At times, virtually all the areas that make up our diverse Section have been under attack. The Global Gag Rule continues to frustrate our efforts to expand integrated international family planning/reproductive health (FP/RH) services. Safe abortion in the United States is increasingly restricted, and Roe v. Wade’s days may be numbered. Comprehensive sex education is increasingly attacked and replaced by abstinence-only approaches. In international settings, the widely known ABC approach to HIV prevention (A for abstinence, B for being faithful, C for condoms) is more and more limited to A and B. International organizations are discouraged from undertaking programs with commercial sex workers, programs that could prevent thousands of new HIV cases every year. “Language police” attempt to restrict use of progressive terms that form the basis of our work. The list goes on and on.
As a result of these trends, we too often find ourselves on the defensive, wondering what restrictions will come next and how they will affect us, rather than focusing our full energies on
the vital and worthy goals of our work. Instead of increasing access to quality FP/RH services, and promoting favorable policies that expand sexual and reproductive rights, sometimes it seems we are struggling just to stay afloat. Then again, as an unknown philosopher once said, a smooth sea never made a skillful mariner.
What do these worrisome trends have in common? Most reflect increasing government intrusion into private sexual and reproductive health issues, and restrictions rather than expansions of individual rights. But it seems to me that an even more worrisome answer is that they all demonstrate, to greater or lesser degrees,
a trumping of ideology over science and evidence. Further, the ideology often comes backed by misinformation—-what I call anti-evidence—-that allows ideological decisions to masquerade as evidence-based.
For example, rather than expand the ABC approach in international programs to ABC+, based on evidence showing that more than A, B, and C is needed to prevent HIV in all common circumstances, ideology forces programs to restrict activities to large A, medium B, and small C. In the worst cases, anti-evidence of dangers associated with condom use are used to scare people from using that method, and the program becomes A-B-no-C. Meanwhile, in the United States, recent evidence from the National Longitudinal Survey of Adolescent Health showed that 88 percent of students who took “virginity pledges” had sex before marriage, and their rates of sexually transmitted infections (STIs) were almost identical to non-pledgers. But this is not likely to diminish proponents’ eagerness to enforce abstinence-only approaches.
Some political leaders may disagree with our causes based on deeply held and reasoned beliefs, but far too many have allowed short-term political interests to prevail over evidence that clearly points in other directions. As a result, worthy approaches and proven best practices are restricted or ended, leading to increased numbers of unintended pregnancies, unsafe abortions, HIV/AIDS cases, and other adverse sexual/ reproductive health outcomes for individuals, families, and the global community.
Given these recent trends and events, it seems to me that the theme for this year’s APHA Annual Meeting—-
Evidence-Based Policy and Practice—-couldn’t occur at a better time. Over the course of history, science and evidence-based practices periodically undergo challenges, but their base of logic generally prevails in the end. The ability to test and replicate findings, the resulting breakthroughs leading to irrefutable gains, and the logic of sound evidence, all should eventually lead to favorable policy decisions and effective programs. I genuinely believe that people throughout this country—-red state or blue—-would support all our FP/RH positions if they had even a fraction of the evidence that we have through our work. In many ways, it is our inability to make supportive evidence more widely known that allows political leaders to be swayed by opposition voices.
Yet even in this environment,
there are many things we can do as PFPRH Section members to counter these trends:
Go to APHA… and beyond. First and foremost, please bring the best of your ideas and research to the APHA Annual Meeting this year. This is a golden opportunity to challenge opposing ideologies and start shifting policies and decisions back toward best practices known to improve health outcomes. It’s also a golden opportunity to challenge our own mindsets, broaden our minds, and present new ideas for programs and approaches to improve sexual and reproductive health. So let’s make it a great turnout in New Orleans, and help give the conference high visibility. I know that Young Mi Kim is well on the way to producing an outstanding program!
Share your important findings beyond APHA as well, through journal articles, presentations, interviews, letters to newspapers, etc. The wider our Section’s research is known, the harder it will be for anti-evidence to refute.
Stay informed and become active. Read APHA newsletters and act on their alerts. APHA advises periodically about specific PFPRH issues, but all APHA positions deserve our support. Many are related to FP/RH, and supporting them can strengthen APHA as a body, increasing its effectiveness when PFPRH issues arise.
Please see Lois Uttley’s report below on her experience as Section representative to the
APHA Action Board. She would love more Section members to become involved with policy and advocacy issues that will further our goals. Become active—-our opponents are, and so should we!
Help build our Section leadership. We will elect new leaders through web-based elections May 13-June 17. Please watch for an announcement from APHA telling you how to vote, and most important, please vote! We have a great slate of candidates. See the complete list of those running in the report of the Nominating Committee below as well as in the most recent edition of
The Nation’s Health.
Please also take advantage of the Annual Meeting each year to
become more active in our Section yourself. Join a Task Force as a way to stay informed and influence the APHA annual program and policies. Task force leaders always welcome new members at business meetings, usually held on Sunday at the beginning of the week of the conference. See the reports of Task Force Chairs in this newsletter for more information. Task Force Chairs and other current officers are also listed on our Section Web site, <
http://pfprh.org/>, which also has useful information on policies, fact sheets, standing committees, awards, etc.
Let us know your ideas. Please e-mail me <
tim_williams@jsi.com> or other Section leaders with any ideas you have for improved leadership and effectiveness. This can include anything from information requests, information you’d like to share with the Section, and ideas for improved Section visibility or action. There is a tremendous amount of expertise and energy in our Section membership and leaders. I am eager to explore ways to utilize it creatively for the benefit of improved FP/RH.
Keep doing good work based on good evidence. No matter the political climate, we must keep striving for good programs that advance FP/RH, meet people’s needs, and that reflect the best available evidence. We are energized by our own ideology as well, so as good social scientists, we must always listen to our own evidence and be willing to challenge our own ideas. This is how we have continually improved programs through the years, and will continue to do so in the years ahead, and how we will once again eventually shift to a more supportive PFPRH policy environment.
May we find calmer seas ahead someday, and become “skillful mariners” in the meantime! I look forward to seeing you in New Orleans!
Section Chair 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>
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Capitol Hill Rally
On Nov. 9, 2004, during APHA’s 132nd Annual Meeting & Exposition, hundreds of APHA members joined forces to walk Capitol Hill for public health, including a number from our Section. The solidarity and genuine interest expressed by hundreds of members during the rally to walk the Hill for public health was made evident by the fact that together APHA members visited more than 495 congressional offices.
Among those participating from our section were Section Chair Claire Brindis of California and Action Board representative Lois Uttley of New York. They and other Section members were able to express special concern to members of Congress about reproductive health issues, including the failure of the Food and Drug Administration to approve over-the-counter status for Plan B emergency contraception.
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Action Board
Increasing APHA’s Advocacy Power on Reproductive Health IssuesHow can APHA increase its advocacy power in Washington at such a critical time for public health, including reproductive health? The Association’s national Action Board explored this question during a two-day retreat held at APHA headquarters in Washington, D.C., in February 2005. I attended, representing the Population, Family Planning, and Reproductive Health Section.
APHA Executive Director Georges Benjamin, MD, MPH, addressed the Action Board, giving an inspiring talk about how
he views APHA as a “sleeping giant” when it comes to our collective potential to influence national public health policy. He urged the Action Board and APHA staff who were present to work together to make our organization’s voice more powerful in Washington. Key issues for APHA action this year include
saving Medicaid (which is an extremely important source of health insurance coverage for low-income women of reproductive health age) and
addressing health disparities .
Among the steps that I and other members of the Action Board will be taking to meet Dr. Benjamin’s challenge are these:
1.
Reviewing the base of existing APHA policy to identify any gaps in policy or out-of-date policies that need to be updated. Of special interest to our Section are three policy areas that have been identified in which new policies are being developed or need to be developed:
a.
Comprehensive sexuality education in grades K-12. A proposed policy has been drafted by the HIV/AIDS Section and is moving forward through the APHA policy review process. I contributed suggestions for improvement of the draft policy, acting on behalf of our Section.
b.
Policy on mid-to-late-term abortion. APHA staff have identified this as an area in which little or no policy exists and is asking for development of proposed policy. Anyone interested in working on this can contact me at
ljuttley@earthlink.netc.
Pharmacist refusals to dispense birth control or emergency contraception, based on religious or moral beliefs. APHA staff have asked our Section to draft such policy so that the staff will have a clearer policy base from which to take action. I am gathering a working group to begin drafting a proposed policy and will welcome participation by interested Section members. Our goal will be to prepare what is known as a “late-breaker” resolution that could be submitted close to the time of the November APHA Annual Meeting and considered for adoption by the Governing Council during that meeting. Contact me at <
ljuttley@earthlink.net> if you would like to work on this.
2.
Identifying ways in which new and existing APHA policy can be implemented, both at the national and state level. APHA has a strong and extensive base of existing policy, and new policies are adopted each year. If you are unfamiliar with our policies, visit the Legislative, Advocacy and Policy section of the APHA Web site at <
www.apha.org>. When issues arise in Congress, APHA staff consult the base of existing policy in determining what position to take. So, getting a policy adopted does matter, and has long-term potential to improve APHA’s ability to take action, even years after the policy is approved. APHA staff are very responsive to suggestions from members, especially those of us on the Action Board. So, if a reproductive health issue has arisen on the national level, and you believe existing APHA policy would allow us to take action, let the APHA staff or me know immediately.
3.
Seeking advocacy action by APHA members to help staff in communicating public health concerns to Congress and federal officials. The APHA advocacy staff is small and can only do so much. They need the help of our members in communicating with federal officials. You can help in the following ways:
a.
Join the APHA’s Legislative Advocacy Network. It’s easy to do. Just go to <
www.apha.org/legislative/> and click on “Join APHA’s Legislative Advocacy Network.” You will begin to receive e-mail alerts from APHA staff on current issues that need our advocacy attention. Please respond to these alerts as quickly and diligently as possible.
b.
Keep informed about top health issues before Congress. For example, you can find out about Medicaid and its importance for reproductive health by visiting APHA’s Medicaid Advocacy Center on the APHA Web site at <
www.apha.org/legislative/legislative/medicaid.htm>. The Medicaid Advocacy Center has a Medicaid Backgrounder for APHA members that includes specific discussion of reproductive health issues. I contributed this information on behalf of our Section.
c.
Find out who your Congressional representatives are and contact them on key reproductive health issues. APHA staff have repeatedly stressed how important it is for APHA members to develop working relationships with their own Congressional representatives. A visit to your Congressperson in his/her district office during Congressional recesses can be a great idea. Let your Congressional representative know you care about reproductive health issues and will be watching his or her votes. Offer to provide background or educational information for your representative on key issues.
d.
Participate in APHA rallies and advocacy days in Washington. A number of PRHFP Section members participated in the rally and advocacy day held in conjunction with last November’s Annual Meeting in Washington.
PFPRH Section Gets Representation on Joint Policy CommitteeAPHA’s Joint Policy Committee is the entity that reviews proposed APHA policy statements and resolutions and works with authors of these statements to ensure that all policy and scientific/medical concerns are properly addressed. The JPC includes representatives from the APHA Action Board, Science Board, and Education Board. This year, Lois Uttley (the Section’s representative to the Action Board) was appointed to the JPC to represent the Action Board. She participated in the JPC’s annual spring policy review session at APHA headquarters in Washington April 19 and 20, 2005. She was further appointed by the JPC to chair one of the public hearings that will be held at this fall’s APHA meeting in New Orleans. She will preside over the public hearing on all proposed policy statements pertaining to “access to care” issues.
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