On April 18, the Senate Appropriations Subcommittee on State, Foreign Operations, and Related Programs held a hearing examining funding for international maternal and child health and family planning and reproductive heath programs.
In his opening statement, Chair Patrick Leahy (D-VT) applauded the recent increases for international HIV/AIDS programs, but said that “funding for maternal and child health, and family planning/reproductive health, has languished. This should concern all of us, when you consider what a difference those programs make, and when you consider what we take for granted in our own country.” Sen. Leahy said that “11 million children under age five die each year, mostly from easily preventable and treatable causes like diarrhea, pneumonia, or measles…An estimated 200 million women still lack access to family planning, and up to one-third of the half a million yearly maternal deaths could be prevented with basic reproductive health care services.” He concluded, “It is simply unacceptable to me that a country of our economic means would spend far less on maternal and child health, and family planning/reproductive health, for the world’s two billion poorest people, than we spend for the same purposes in a tiny state like Vermont with a population of 625,00 people.”
Kent Hill, assistant administrator for global health at the United State Agency for International Development (USAID), discussed his agency’s progress in increasing life expectancy and reducing maternal and early childhood mortality in the developing world: “Across all USAID-assisted countries, skilled attendance [at childbirth] has increased from an average of 37 percent in 1990 to 50 percent in 2005; the greatest progress has been in the Asia and Near East region, where coverage has more than doubled, increasing from 21 to 47 percent.” Dr. Hill discussed USAID’s targeting of the five conditions responsible for two-thirds of maternal mortality hemorrhage, hypertension, infections, anemia, and prolonged labor by “promoting active management of the third stage of labor.” He said that despite USAID’s progress, “more than 500,000 women die annually from maternal causes, almost all of them in the developing world.” Dr. Hill said that there is “great need” for family planning services that is unmet. He stated that increasing the availability of family planning services will increase child survival (due to child spacing) and women’s education and employment, a factor he called “critical” as “research has shown a strong link between girls’ literacy and many other development objectives.”
“Over the past 20 years, the United States has committed more than $6 billion in support of USAID’s global child survival efforts,” Dr. Hill said. The funds have allowed USAID to treat almost a billion children with oral re-hydration therapy to prevent death from diarrhea, immunize more than 100 million children against polio, measles and other diseases, and reduce malnutrition. Despite these efforts, “a greater challenge is saving the lives of the 10.5 million children who still die each year,” he stated. “During the past few years, we have seen new commitments that we believe can lead to a ‘second wave’ of global effort to improve maternal and child survival,” he said, referencing the work of private sector organizations, such as the Bill and Melinda Gates Foundation, and partners, such as Norway and the United Kingdom. Dr. Hill said that health systems also need to be strengthened to maximize access, cost-effectiveness, and long-term sustainability.
Helene Gayle, president and CEO of CARE USA, testified about her organization’s experience combating poverty-related health conditions. Dr. Gayle detailed a selection of CARE’s programs, including a culturally and linguistically competent obstetrical care program in Peru, a public awareness campaign in Egypt aimed at reducing childhood diarrhea, and a family planning program in the Democratic Republic of Congo designed to meet the needs of a post-conflict population. She focused her remarks on four major points: technical solutions must be sustainable and fitted to social and cultural needs of recipients; “empowerment has much to do with access to health care services, accountability of health systems, and the ultimate health status of the most vulnerable”; dividing global health programs into distinct categories does not account for the inseparable nature of some health areas, notably maternal health and child survival; and “reproductive health programs targeting youth are increasingly constrained in terms of the information and services they can provide as a result, U.S. funded programs are less effective at protecting young people from pregnancy, or HIV and other STDs [sexually transmitted diseases].” Dr. Gayle recommended the subcommittee focus on reducing maternal mortality and increasing child survival by investing resources for maximum effect: “Simple interventions like promoting breastfeeding, oral re-hydration therapy, vaccinations, clean water, and insecticide-treated bed nets could make a huge impact on child survival, even where health systems are weak.” She also urged the subcommittee to “recommit to the importance of family planning… [and to] commit to evidence-based reproductive health programming for youth that is grounded in sound public health practice.”
Dr. Nils Daulaire, president and CEO of the Global Health Council, and Ms. Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, also testified.
