Naina Dhingra is the Director of International Policy at Advocates for Youth and serves on the Developed Country NGO Board Delegation of the Global Fund.

There is no doubt that the outcome of the upcoming U.S. Congressional elections will have a major impact on the sexual and reproductive health of women and youth worldwide. Consequently, policy advocates are closely watching each race.

But these are not the only elections that will determine the future of sexual and reproductive health. Two of the most important international public health jobs are currently in the midst of highly-political selection processes: the Director-General (DG) of the World Health Organization (WHO) and the Executive Director of the Global Fund to Fight AIDS, TB, and malaria.

Because of the United States' anti-family planning and condom positions, the WHO DG position is particularly important for sexual and reproductive health. The unexpected death of Dr. J.W. Lee requires the election of a new DG and the last few years have shown how critical it is to have a high level of support for sexual and reproductive health issues from the DG who will stand up to ideological pressure from the U.S. While it’s not a secret that the U.S. promotes an anti-ICPD agenda at international conferences, what is less apparent is their work in the shadows to promote an anti-reproductive health agenda within United Nations agencies. This anti-ICPD agenda has been most apparent at the WHO. Dr. Lee was elected into his position primarily with the support of the U.S. leading them to have an unprecedented level of influence. In 2005, it was heavily rumored that the DG made a deal with the U.S. to cut the budget of the Department of Reproductive Health and Research in order to receive approval of an overall budget increase. On the whole, there has been a chilling effect among reproductive health staff due to the lack of support from the former DG.

So how does it all work? WHO member states nominate potential candidates and the thirty-four member Executive Board will make the selection. Thirteen candidates have been nominated, and the Board will hold a special meeting in early November to make the selection. The rumored frontrunners are:

Dr. Julio Frenk: Nominated by Mexico and currently serving as the Minister of Health. Frenk was also a DG candidate in the 2002/03 election and has WHO experience having served as the WHO Executive Director for Evidence, Information, and Policy.

Dr. Margaret Chan: Nominated by China and currently serving as WHO Assistant Director-General for Communicable Diseases. Chan previously served as the Director of Hong Kong’s Health Department.

Dr. Pascal Mocumbi: Nominated by Mozambique and Africa’s only candidate for the post. Mocumbi was also a frontrunner in the 2002/03 election and is the former Prime Minister along with having a medical training background.

Norway, a staunch supporter of sexual and reproductive rights has put their full support and weight behind Dr. Julio Frenk. The U.S. has not indicated which candidate it will support. November could bring about big changes for the sexual and reproductive health of women and youth worldwide. Civil society must monitor and influence the WHO DG election to ensure that the new DG is supportive of sexual and reproductive health and can stand up to U.S. pressure.