Restoring evidence-based approaches to US international reproductive health assistance

Throughout the last several Republican administrations, US foreign policies affecting the sexual and reproductive health and rights of the world's most vulnerable women were driven not by science but by ideology, with devastating impact. Three areas that will benefit enormously from a renewed emphasis on evidence are family planning, emergency contraception and abortion. The positive impact of family planning on women's health and lives is well documented. Although there is still tremendous unmet need, funding from the United States and other donors for international family planning assistance has waned significantly. Similarly, despite a strong record of safety and efficacy, emergency contraception remains inaccessible to most women. Reasons include lack of information–and, worse, deliberate misinformation—about the method, much of it rooted in opposition from anti-choice groups. The reproductive health imperative that has suffered most is the need to reduce the incidence and impact of unsafe abortion. A major contributor to global maternal mortality and morbidity, unsafe abortion is entirely preventable through known, feasible and affordable interventions. US foreign-assistance policies, including the Mexico City Policy (or Global Gag Rule) and the Helms Amendment, have not only ignored but have actively impeded public-health interventions to address unsafe abortion, including provision of safe, legal abortion. While President Obama has rescinded the Global Gag Rule, it is time to correct other failures in US foreign-assistance policies. Urgent needs include increased investment and renewed U.S.global leadership in family planning, evidence-based promotion of emergency contraception, and liberalization of policies governing US support for abortion.