Analysis Contraception

On World AIDS Day, A Health Hut In Senegal Reveals What’s Possible

Maureen Greenwood-Basken

Senegal provides a fascinating case study in how to work simultaneously to prevent the spread of HIV and meet the family planning needs of women and families. The country's successes also reveal why now, more than ever, U.S. investments in family planning are critical to empowering women, reducing poverty, reducing transmission of HIV and deaths from AIDS, and saving lives.

I’m marking World AIDS Day from an interesting vantage point. This week, I am in Dakar, Senegal, attending the 2011 International Conference on Family Planning, hosted by the Gates Institute. The conference brings together world leaders to discuss best practices, share research, and find a way forward to achieving universal access to reproductive health care. I am inspired by the great leadership from traditional donors, emerging economies, and developing countries, including a statement from our own Secretary of State Hillary Clinton who said that we must accelerate our efforts to ensure that all women have access to family planning and reproductive health care and services.

As we commemorate World AIDS Day on December 1, it is a particularly fitting time to think about how we can better integrate family planning and reproductive health into HIV and AIDS services. We know that HIV and AIDS, reproductive health, and child survival are interconnected, are matters of human dignity and of life and death. A consistent, integrated approach to these challenges has been an elusive goal that the international community knows it must realize. As UNFPA’s Dr. Babatunde Osotimehin recently stated, these issues must be addressed simultaneously in global development efforts.

Senegal provides a fascinating case study. Senegal is considered a success story – it has maintained one of the lowest HIV-prevalence levels in Africa, with HIV rates holding stable at under 1 percent of the adult population since 1997.

On Tuesday, I had the opportunity to visit a USAID-funded health hut that takes a comprehensive approach to preventing the spread of HIV. The health hut is located in the village of Kignabour, about 70 km outside of Dakar, and provides services to the rural, Muslim population. The community is faced with many challenges: The literacy rate in the village is approximately 20 percent, for example, and girls are typically married by age 16.

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I met Astou Ndour, a community health worker and traditional birth attendant, who gave us a tour. In her health hut, they educate community members about HIV and AIDS. Additionally, the health hut provides other health services related to issues such as malaria and neo-natal care. They educate individuals on ways to prevent the transmission of HIV by promoting the use of condoms. On a community level, they do outreach and education and conduct screening to prevent mother-to-child transmission of HIV. A study estimated that adding family planning to services for preventing mother-to-child transmission (PMTCT) of HIV in 14 high HIV-prevalence countries would double the impact of providing PMTCT services alone.

There is a separate room in the hut that is used for family planning counseling. The process includes a welcome, a list of products available, a discussion of side effects and benefits, and choices of methods appropriate for the client. The contraceptive methods include cycle beads, condoms, female condoms, and birth control pills.

The health hut staff arranged a fascinating community dialogue to identify the biggest challenges related to voluntary family planning, forming two separate discussion groups, one for young mothers and one for grandmothers. In the course of the afternoon, it became clear that while the husband is “chief” of the family, often in this community, the grandmothers make the decisions regarding contraception use. In this group, they try to encourage conversations about family planning, often through singing, storytelling and dialogue. The grandmothers are viewed as integral partners in creating a space for dialogue around voluntary family planning.

In the young mothers group, Mariana tells us that women are not aware that they have the right to make their own decisions about family planning. Conversations like these are critical to empower young women with the knowledge that they can make decisions about the number, timing and spacing of their pregnancies.

Staff of the health hut notably address not only health care services but also the social customs that allow for discussion of health issues and lead to behavior change.  USAID currently supports 1663 health huts in Senegal. These USAID-funded health huts are providing valuable front-line education and health services to address HIV and AIDS and provide reproductive health care for low-resource, rural populations. Integrating family planning with other services can enhance the path to economic growth and development. Offering these services together is also cost effective – the net savings and benefits realized by health systems outweigh the initial costs of integrating family planning. Additionally, integrated services save women time, enabling them to be more active in income producing activities, and invest more in their own – as well as their children’s – health, education, and well-being. Clearly, these health huts are a sound investment.

At the United Nations Foundation, I lead an initiative to strengthen U.S. leadership on international reproductive health and family planning.  Currently there are 215 million women who lack access to quality reproductive health and family planning services. By investing in community health clinics like the one I visited, we can get closer to our goal of universal access to voluntary family planning. After seeing the impact that family planning can have on the lives of women, their families, and communities, I know now more than ever that investments by the U.S. in family planning are critical to empowering women, reducing poverty, reducing transmission of HIV/AIDS, and saving the lives of women and children.

News Family Planning

Judge Thwarts Ohio GOP’s Attack on Planned Parenthood Funding

Michelle D. Anderson

“This law would have been especially burdensome to communities of color and people with low income who already often have the least access to care—this law would have made a bad situation worse,” said Iris E. Harvey, president and CEO of Planned Parenthood of Greater Ohio.

An effort to defund Ohio Planned Parenthood affiliates by Gov. John Kasich (R) and the Republican-held legislature has come to an end.

Judge Michael R. Barrett of the U.S. District Court of the Southern District of Ohio on Friday ruled in Planned Parenthood’s favor, granting a permanent injunction on an anti-choice state law.

The court ruling will keep Richard Hodges, the Ohio Department of Health director, from enforcing HB 294.

The 2015 law, sponsored by Rep. Bill Patmon (D-Cleveland) and Rep. Margaret Conditt (R-Butler County), would have redirected $1.3 million in state and federal taxpayer funds from Planned Parenthood’s 28 clinics in Ohio.

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The law would have required the state department to keep federal funds and materials that the health department receives from being distributed to entities that perform or promote non-therapeutic abortions, or maintain affiliation with any entity that does.

Funding that would’ve been cut off from the state health department went to the Violence Against Women and Breast and Cervical Cancer Mortality Prevention acts, the Infertility Prevention Project, Minority HIV/AIDS and Infant Mortality Reduction initiatives, and the Personal Responsibility Education Program.

Planned Parenthood in a lawsuit argued that the Republican legislation violated the First Amendment and the Due Process Clause and Equal Protection Clause of the 14th Amendment.

Barrett had temporarily blocked the law after Planned Parenthood affiliates filed the lawsuit and requested a preliminary injunction. The judge had issued an opinion contending that some legislators passed the law to make it difficult for people to access abortion care, as Rewire reported.

Iris E. Harvey, president and CEO of Planned Parenthood of Greater Ohio, praised the judge’s temporary order.

“This law would have been especially burdensome to communities of color and people with low income who already often have the least access to care—this law would have made a bad situation worse,” Harvey said in a statement.

Kellie Copeland, NARAL Pro Choice Ohio’s executive director, said in a statement that the Ohio legislature passed the anti-choice measure in an effort to appeal to conservative voters in early primary states during Kasich’s presidential campaign.

Copeland said that while the legislation made no effort to reduce the number of abortions performed, “it actively blocked critical health care for low-income women and families.”

Planned Parenthood said those services included 70,000 free STD screenings, thousands of HIV tests for at-risk community residents, and the largest infant mortality prevention program in the state.

In the 23-page court order and opinion, Barrett, an appointee of President George W. Bush, acknowledged that the law would have deterred “patients from seeking these potentially life-saving services.”

Planned Parenthood noted that the recent ruling in Ohio makes it among the ten states where courts have blocked anti-choice laws following June’s landmark Whole Woman’s Health v. Hellerstedt U.S. Supreme Court ruling.

News Health Systems

Texas Anti-Choice Group Gets $1.6 Million Windfall From State

Teddy Wilson

“Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services," Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement.

A Texas anti-choice organization will receive more than $1.6 million in state funds from a reproductive health-care program designed by legislators to exclude Planned Parenthood

The Heidi Group was awarded the second largest grant ever provided for services through the Healthy Texas Women program, according to the Associated Press.

Carol Everett, the founder and CEO of the group and a prominent anti-choice activist and speaker, told the AP her organization’s contract with the state “is about filling gaps, not about ideology.”

“I did not see quality health care offered to women in rural areas,” Everett said.

Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement that it was “inappropriate” for the state to award a contract to an organization for services that it has never performed.

“The Heidi Group is an anti-abortion organization, it is not a healthcare provider,” Busby said.

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State lawmakers in 2011 sought to exclude Planned Parenthood from the Texas Women’s Health Program, which was jointly funded through federal and state dollars. Texas launched a state-funded version in 2013, and this year lawmakers announced the Healthy Texas Women program.

Healthy Texas Women is designed help women between the ages of 18 and 44 with a household income at or below 200 percent of the federal poverty level, and includes $285 million in funding and 5,000 providers across the state.

Bubsy said the contract to the Heidi Group was “especially troubling” in light of claims made by Everett in response to a recent policy requiring abortion providers to cremate or bury fetal remains. Everett has argued that methods of disposal of fetal remains could contaminate the water supply.

“There’s several health concerns. What if the woman had HIV? What if she had a sexually transmitted disease? What if those germs went through and got into our water supply,” Everett told an Austin Fox News affiliate.

The transmission of HIV or other sexually transmitted infections through water systems or similar means is not supported by scientific evidence.

“The state has no business contracting with an entity, or an individual, that perpetuates such absurd, inaccurate claims,” Busby said. “Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services.”

According to a previous iteration of the Heidi Group’s website, the organization worked to help “girls and women in unplanned pregnancies make positive, life-affirming choices.”

Texas Health and Human Services Commission spokesperson Bryan Black told the Texas Tribune that the Heidi Group had “changed its focus.”

The Heidi Group “will now be providing women’s health and family planning services required by Healthy Texas Women, including birth control, STI screening and treatment, plus cancer screenings to women across Texas,” Black said in an email to the Tribune.

Its current site reads: “The Heidi Group exists to ensure that all Texas women have access to quality health care by coordinating services in a statewide network of full-service medical providers.”

Everett told the American-Statesman the organization will distribute the state funds to 25 clinics and physicians across the state, but she has yet to disclose which clinics or physicians will receive the funds or what its selection process will entail.

She also disputed the criticism that her opposition to abortion would affect how her organization would distribute the state funds.

“As a woman, I am never going to tell another woman what to tell to do,” Everett said. “Our goal is to find out what she wants to do. We want her to have fully informed decision on what she wants to do.”

“I want to find health care for that woman who can’t afford it. She is the one in my thoughts,” she continued.

The address listed on the Heidi Group’s award is the same as an anti-choice clinic, commonly referred to as a crisis pregnancy center, in San Antonio, the Texas Observer reported.

Life Choices Medical Clinic offers services including pregnancy testing, ultrasounds, and well-woman exams. However, the clinic does not provide abortion referrals or any contraception, birth control, or family planning services.

The organization’s mission is to “save the lives of unborn children, minister to women and men facing decisions involving pregnancy and sexual health, and touch each life with the love of Christ.”

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