My concern really would be with how deeply will the cultural, regional sub-context be taken in to account while implementing the PEPFAR Bill. The way it looks to me with so many clauses and sub-clauses it appears already to have a target group in mind at the cost of keeping certain groups beyond its reach as a form of 'disciplining' for not adhering in the first place (in the last five years!). And what worries me is that such a huge amount of money will go in to sticking to the "dos and don'ts" of the Bill rather than reaching substantially larger groups of people. Haven't we already seen this before? In conflict zones like Afghanistan ... in Iraq ... where so much money has gone yet women live lives not very different from the previous decade; and of course much too often also reflected in policies taken up by each of our own governments?

Countries in Asia and Africa already suffer from the burden of too many cultural practices and unfair, gender imbalanced value systems (the experience of development workers will show) which cannot be challenged but have to be worked around slowly and deliberately. When one invokes the prostitution pledge I wonder what happens to girls who have been unwittingly lured in to the sex trade in the first place and are unable to return back to their own communities (even when rescued) out of fear of ostracism or the 'shame' that they bring to the family. Thus, they are often compelled to return to the very life they fight to leave. <!--break-->These are common narratives for almost every girl in the business and it is these narratives that make up the bulk of the sex workers in these countries. So are these young lives to be deprived of medical care and attention and continue to face persistent stigma and discrimination, (apart from the violence they endure) simply because they reconciled to sex work being the only economically viable means of survival. Even as local groups and communities fight social values to allow some sense of respect to these women in introducing this clause what in effect is being communicated is that they women do not deserve care and support because of the work they do. If that is not discriminatory behaviour then what is? What about men who might contract the virus from the sex worker? Are they also to be denied the aid? And finally down the same chain what about the spouse who contracts it from the husband? In countries like India and patriarchal set-ups such blanket bans only help to perpetuate the practices (which groups have spent years fighting) that while a woman (in this case a sex worker) can be punished for her trade (by limiting her accessibility to medical relief) men correspondingly do not have to bear that burden. So in condemning it for women it carries legitimacy for men -- an extremely disastrous situation in societies where women are socially and politically disenfranchised.

Married women form a very large component of the HIV infected population mainly because of the fact that girls are married very early to men much older to them (and often already sexually active). In the absence of information on the subject -- since sex itself is a taboo subject as is the use of contraceptives in such traditional, patriarchal set-ups where the value of women is judged by the number of male children they bear -- they very rarely are equipped to protect themselves from infections.

More often than not since women in such set ups have very little access to information, groups working on contraception are also the information providers on HIV/AIDS especially since these are subjects that women themselves are hesitant to talk about. Pre- and post-natal care become the entry points to discuss other issues like reproductive and sexual health, HIV/AIDS within these communities and even abortion as an Family Planning tool is commonly used especially in countries like India where it has been legalized for long.

What would be the implications of the Global Gag Rule here? For many women in the lack of any other access to information on family planning (since many traditional families even condemn the idea) it is very often midwives who also act as the carriers of information on various issues like HIV. Again with women contracting the virus so often from their spouses and coming to know of it during a pregnancy the GGR in effect is snatching from them their only access to information and help on the subject, especially since they are often better positioned to prevent new infections among women and youth - the two most vulnerable groups currently.

Besides, to me the hypocrisy of it all lies in the fact that how can something that can not be implemented in the host country (as the GGR can not be applied to US organizations as it raises the issue of unconstitutionality) be force-fed to other nations and yet be used as a position to prevent funding abroad? Is there really no underlying conscientious compulsion to link domestic policies and their enforcement with the moral position beyond the national borders -- particularly since morality has such an important role to play by way of 'abstinence' earlier and the continuing 'anti-prostitution pledge.'

My concern is that clauses and sub-clauses in programmes that fail to take in to account the specifics of the cultural and social milieu where they need to be implemented is a way of ensuring their failure. Flexibility needs to be at the core of these programmes. But then whom are we attempting to impact ultimately? All those who require this care or simply those (women specifically) who have made morally correct choices. And where are the definitions of these morally correct choices emanating from?

And this is what makes it imperative that the language of aid does not enjoy such ambiguity that it becomes more a tool to deny groups rather than be more inclusive.

I am interested in hearing from those of you who work primarily on women's reproductive health and rights globally whether you think the "walk the talk" at home argument holds water?

Would the United States be able to be a better defender of women's rights abroad if it set high standards for the same at home? How do do those realities affect this country's actions overseas or the ability of women's rights organizations that are US based to be successful in their work with partners in the rest of the world?<!--break-->

I think it is terribly important for the new U.S. administration to advance gender equality as part of a more comprehensive strategy for peace and social justice both at home and in the rest of the world. It is also vital to show by deed as well as by word that the United States means to walk its talk on gender justice. This would go a long way in rebuilding the trust and goodwill that the past administration has squandered in the rest of the world.

AT HOME
The new administration needs to be willing to stand up and publicly recognize that the United States, despite being among the wealthiest nations, has a long way to go before it is close to meeting some of the most basic gender equality standards in terms of women's representation in the political process and in terms of economic justice. Women represent over 51 percent of the US population, but only 14 percent of representatives in both the US House and Senate are women. There is enough research to show that increased representation by women in legislative bodies results in policies that invest in the long term human security of their citizens. Repeated studies by the AFLCIO, have shown that you can cut poverty rates in the United States (close to 70 percent of those who are poor in this country are women and their dependent children) simply by paying women equal pay for equal work. Not a single new Congressional appropriation would be needed for such a war on poverty. Yet, the fight for the ERA -- or Equal Rights Amendment, which would be the most effective strategy to achieve "equal pay for equal work" has long since ceased to be a mobilizing banner for the US women's movement. It is also arguably the most likely reason that the United States has simply failed to ratify the most universally recognized women's human rights treaty worldwide, the Convention for Elimination of all Forms of Discrimination against Women or CEDAW.<!--break-->Violence against women in the United States continues to claim unacceptably high numbers of victims and basic pre-natal care for pregnant women is almost non-existent for poor women without health insurance. 15 years ago when I worked in Chicago, Black women suffered from maternal mortality rates that were worse than Bangladesh. Poor children continue to die across the US because they lack basic preventive health care, including vaccinations against common diseases like measles. Despite the horrors inflicted on poor residents of the Gulf coast, it seems that Katrina barely ruffled a political feather -- it hasn't shown up as a major policy agenda on a single candidate's stump speech. The new administration must demonstrate that it is willing to take action on such blatant violations of basic human rights -- right here at home.

Finally, an effective US administration will need the active and tactical support of the women's movement in the US. To provide sufficient ballast, the movement in the US needs to deepen and broaden its message beyond the rather narrow confines of fighting to preserve Roe v. Wade. On reproductive rights and health, it must be willing to stand up for the right of all women (immigrants, the poor, rural, sexual minorities, etc) to be able to plan their families, have access to contraception, and to bear and raise healthy children. Finally, the women's movement needs to show the political will and courage to refuse to cede the moral high ground by showing itself able and willing to speak to the moral ambiguities around the issue of abortion.

INTERNATIONALLY
At the most base level, a U.S. administration's commitment to advancing women's rights would serve to reinforce our country’s commitment to social justice and international law. Neither our government -- nor any -- can invade nations or bomb them into submission -- even under the guise of "fighting terror" -- with a carrot in the other hand touting “human rights.”. Such practice looks too much like the hypocrisy the developing world has come to expect from its former colonial powers.

The same holds for economic coercion or what I like to call "market fundamentalism." The free markets the West and the US are so keen to export and impose on the rest of the world are remarkably well regulated here in the US to serve the "national" interest. Look at how farm subsidies to the tune of $20 billion per year continue to underwrite US agriculture, even as the World Trade Organization and the World Bank are busy demanding that the rest of the world (Brazil, India, Egypt, and most sub-Saharan African nations) tear down their subsidies on agriculture and food. A recent article in The New York Times quoted the President of Malawi saying, "we decided to follow what the West did, not what they preached, and expanded subsidies to our farmers." Malawi has made remarkable progress in the past few years on food production as a result.

This speaks particularly to Michelle's point making the links between women's fertility, population growth and the rising cost of food. I submit that the cost of food prices has far more to do with oil prices, uneven and unfair trade practices than with how many poor mothers are having babies. This is not to undermine the critical need for inexpensive and reliable means of family planning. They should be made as widely available as possible. In fact, women's rights is as appropriate a lens by which to understand the challenges around population as any. What women's rights activists in the West need to be more outspoken about is the model of growth that is based entirely on consumerism. A few statistics will make my point clear as day:
Americans eat 815 billion calories of food daily, that is about 200 billion more than needed, more than enough to feed 80 million hungry people. 200,000 tons of edible food are thrown out daily in the US. 80 percent of corn grown and 95 percent of oats are fed to livestock in the US. 56percent of all available farmland in the US is used for beef production. In turn, when the US exports our model of high economic growth to the rest of the world consumption of meat rises in countries like China and India.

With all due respect, I would argue that those are the key factors contributing to rising food prices, not women in poor countries having babies.

I suspect many of us will agree that Adrienne's solid, common-sense paper (pdf) articulates pretty much exactly what we'd like to see the next president do. I'm curious, though, what others think about the political tactics he or she should employ (assuming, that is, that he or she is a Democrat, and thus not actively hostile to everything we're talking about).

There are two particular questions I've been mulling over quite a bit lately. First, how much should the administration pressure foreign governments to reform anti-woman laws? Here's an example: I spent quite a bit of time in Uganda last year, where feminists were quite devastated over the failure of the Domestic Relations Bill, which would have, among other radical provisions, criminalized spousal rape. Many men considered this an outrageous curtailment of their freedom. The Monitor, a Ugandan newspaper, reported that "[l]aw enforcers, legal and health experts, however ... think the law prescribing the offence of marital rape is discriminatory as it seems to target men alone." A member of the Parliament's legal affairs committee said the bill should address women's denial of sex, arguing, "Refusing to have sex is the most violent thing a spouse can do."

Uganda gets a lot of aid from the US, and has shown itself willing to change its policies to make the US government happy (witness abstinence-only, for example). Should the US government be pressuring other countries to pass domestic laws protecting women, even if those laws don't have a popular base of support? I tend to think yes, even though it inevitably leads to howls about cultural imperialism. A similar questions come up with FGM, where in the past US pressure seems to have played quite an important role in getting bans passed, even in the face of cultural nationalist sentiment to the contrary.

Here's the second question. We all know that the original, crudely Malthusian justification for global family planning programs has been disgraced and discredited, in no small part through Adrienne's own pioneering work. The whole population explosion thesis came to see risible as the predicted food shortages and resource wars never manifested, at least on the scale that people like Paul Erlich predicted. Now, though, decades after the doomsayers envisioned, we are starting to see really serious effects of a rapidly growing (and developing) population -- huge spikes in food prices, mushrooming megacities, disputes over diminishing agricultural land, etc. There is enormous international concern over the state of the environment. My question is this: should US policymakers, and the women's movement, try and leverage that to garner more support for reproductive health and women's empowerment programs? Is it time to break the taboo against making demographic arguments? I don't mean this as a rhetorical question -- I'm asking because I really don't know and am curious to hear what others think.

Steve Sinding, former head of IPPF (among lots of other things), has argued that when the dominant paradigm of population control, with its environmental and national security rationale, gave way to women's rights, donors and the public lost interest. I've heard arguments for and against this position and am not sure who is right. I do wonder, though, whether a new administration might be better able to effect a massive increase in aid for reproductive health as part of a wide-ranging environmental initiative, because elite opinion evinces an urgency about the environment that's unfortunately unmatched by its concern over women's rights.<!--break-->