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The sexual and reproductive health and rights movement in regard to international family planning funding during the Bush era

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Title:
The sexual and reproductive health and rights movement in regard to international family planning funding during the Bush era
Creator:
Millich, Krystie Rose
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English
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[vi], 73 leaves : ; 28 cm.

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Subjects / Keywords:
Reproductive health -- United States ( lcsh )
Sex and law -- United States ( lcsh )
Sexual health -- United States ( lcsh )
Social movements -- Political aspects -- United States ( lcsh )
Reproductive health ( fast )
Sex and law ( fast )
Sexual health ( fast )
Social movements -- Political aspects ( fast )
United States ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Thesis:
Thesis (M.A.)--University of Colorado Denver, 2007.
Bibliography:
Includes bibliographical references (leaves 63-73).
General Note:
Department of Political Science
Statement of Responsibility:
by Krystie Rose Millich.

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University of Colorado Denver
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Auraria Library
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227791966 ( OCLC )
ocn227791966

Full Text
THE SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS MOVEMENT IN
REGARD TO INTERNATIONAL FAMILY PLANNING FUNDING
DURING THE BUSH ERA
by
Krystie Rose Millich
B.A., Washington State University, 1995
A thesis submitted to the
University of Colorado at Denver and Health Sciences Center
in partial fulfillment
of the requirements for the degree of
Master of Arts
Political Science
2007


The thesis for the Master of Arts
degree by
Krystie Rose Millich
has been approved
by
Steve C. Thomas
V/2-4?/fl 7
'ate


Millich, Krystie Rose (M.A., Political Science)
The Sexual and Reproductive Health and Rights Movement In Regard to
International Family Planning Funding During the Bush Era
Thesis directed by Professor Jana Everett
ABSTRACT
Most social movement literature examines movements' abilities to enact social
change under favorable political opportunity structures. This paper instead analyzes
how a social movement, the Sexual and Reproductive Health and Rights (SRHR)
movement, has responded to the negative political opportunity structures of the
George W. Bush era. I utilize a political process/social movement framework to
examine the political opportunity structures and movement action strategies of this
enduring, dynamic movement. Phone interviews with spokespersons from central
actor NGOs are utilized to provide a firsthand account of the movement's work
during the Bush era. Despite, or even due to, the extremely negative macro-political
environment of neoliberalism, globalization, and religious fundamentalisms and the
combative Bush administration, the paper shows that the SRHR movement is still
able to achieve some success and, in some instances, even improve upon their
strategies to ensure the movement remains resilient.
This abstract accurately represents the content of the candidate's thesis. I recommend
its publication.
Signed
Jana M. Everett


DEDICATION
I dedicate this thesis to my Husband, who has always supported me in whatever I
have wanted to do with my life. I hate to think what this experience might have been
without his love, jokes, laughs, understanding, Mexico vacation companionship,
walking partnership, excitement at living a healthy lifestyle, shoulder to cry on,
wonderful family, parenting, housework, Broncos support, movie companionship,
smiley face, lightheartedness, and happy willingness to be woken up at all hours of
the night by whatever doubts or frustrations I might have been facing. I also dedicate
this thesis to my parents and my family, who, like my Husband, have always
supported me in whatever I have wanted to do with my life. They have been there for
me through thick and thin; at times when I didnt know how I was going to make it. I
am also extremely grateful that they have battled their health conditions and won, so
that they can be here to see me reach this goal and for many years to come. I am
indeed blessed to have grown up with two parents who told me I could do whatever I
wanted and not to grow up and marry a Doctor, but to grow up and BE a Doctor.
I would also like to thank my friends; old and new; those that have contributed to my
life in immeasurable ways that even they may never fully realize. My friends are like
a second family and I owe them for all their wonderful support, fun, insights,
camaraderie, and understanding. I also owe a deep debt of gratitude to all of the role
models I have had in my life who have inspired and encouraged me to strive for my
goals and to make my life the best that it can be. The female role models, especially,
showed me what I could do with my life and what it meant to be a strong woman in
this society. Grandma Rose is, of course, at the top of that list. My life would not be
what it is today had I not had these incredible angels fly into my world; sometimes I
am amazed when I think about the wonderful people that come into vour life at just
the right time. Lastly, I want to thank my babies, Buster and Nikki, for giving me
unconditional love (even if Nikki the cat sometimes attached conditions) and to
Buster for making me laugh every single day.


ACKNOWLEDGEMENT
I would like to give my thanks to my chair, advisor, and role model Jana Everett, for
her inspiration, experience, compassion, understanding, patience, insights, and overall
support throughout both my graduate program and my thesis work. Her calm tone,
understanding, and patience got me through the times when I wondered if I could
make it through this thesis process. I am also grateful for her experiences with and
commitment to social issues, especially in my interest area of gender issues, allowing
me to customize my work to the issues 1 felt most strongly about. I am also grateful
to Jana as well as Glenn Morris for providing me with excellent experiences as a
Teaching Assistant. 1 would also like to thank my committee members for their
participation and the faculty that made my graduate program a valuable, rewarding
learning experience: Wadi Muhaisen, Christoph Stefes, Andrea Haar. Tony Robinson,
Steve Thomas, and Lucy McGuffey. I would like to thank my fellow students and
Graduate Student Club members for their camaraderie, support, and insights in an
always rewarding, but sometimes trying, graduate school experience. Lastly, 1 would
like to extend my gratitude to Cory Gruebele for always being there with a smile, a
helpful manner, and a myriad of accurate, comprehensive information. He is a true
gem who goes above and beyond to ensure that the departments students and faculty
are the most successful that they can be.


TABLE OF CONTENTS
CHAPTER
1. INTRODUCTION.......................................................1
Theoretical Perspective.........................................5
Thesis Statement..........................................7
Literature Review...............................................7
Methodology....................................................12
Thesis Structure...............................................13
2. POLITICAL OPPORTUNITY STRUCTURES..................................15
Changes in Political Alignments................................16
Access to Institutions.........................................16
Religious Fundamentalists at the UN......................17
Bush, SRHR, the UN and International Policy..............19
UN changes in Population Assistance......................21
Influential Opponents and Allies...............................23
Opponents................................................23
Allies...................................................32
Conclusion.....................................................34
3. MOVEMENT ACTION STRATEGIES........................................35
Framing........................................................35
Safe Motherhood or Maternal Mortality...............36
SRHR Promoting Social and Economic Development...........36
A Prevention Challenge.................................37
Action Strategies..............................................37
Work at the UN...........................................38
New Funders..............................................39
Impact Reports...........................................41
Work of Central Actor NGOs...............................42
Conclusion.....................................................51
4. ACHIEVMENTS, CHALLENGES, AND THE FUTURE...........................52
Movement Achievements..........................................53
Ongoing Challenges.............................................55
Future Outlook.................................................56
2007 Congress............................................56


Pro-Choice President in 2009?.......................58
New Technologies....................................58
SRHR at Beijing+15 in 2010..........................59
Conclusion..............................................60
APPENDIX
A. LIST OF ACRONYMS...........................................62
REFERENCES..........................................................63


CHAPTER J
INTRODUCTION
In this thesis paper, I provide an analysis of how the Sexual and Reproductive
Health and Rights (SRHR) movement has responded to the Bush administration in
regard to international family planning funding and policy. I ground this analysis
within the context of neoliberalism, globalization, and religious fundamentalism,
utilizing political process theory (McAdam, 1982) and social movement theory
(Tarrow, 2001, 1998, Benford and Snow, 2000) in order to provide a systematic
examination of the broad range of factors impacting the movement's responses. I
utilize existing literature in my study as well as phone interviews with central actor
non-governmental organizations (NGOs) in the SRHR movement.
Globalization has dramatically altered the ways in which individuals,
corporations, and governments interact with one another in the new. free-trade-driven
global marketplace. Antrobus (2004) notes that trade liberalization requires the
adoption of a common policy framework by all countries and that the current macro-
economic policy frameworks under globalization are neoliberalism and structural
adjustment (p. 68). Neoliberalism can be defined as a new (neo) type of economic
liberalism which advocates the free market above all else, the reduced role of
governments, deregulation, and privatization.
Antrobus (2004) defines structural adjustment as a policy that persuades
...governments of less-developed countries to: cut allocations to key sectors such as
education, health, welfare and agriculture; cut subsidies to the poor; privatize public
services and public sector investments; and to devalue their currencies" (p. 68). She
goes on to explain that: ...these policies undermined the capacity of (nation-) states
to guarantee the well-being of the majority of their citizens. The retreat of the state
from the provision of social services and from policies to protect the most vulnerable
groups compromised the very legitimacy of many states" (p. 69). These changes in
the role of government coincided with a rise in private, voluntary organizations
formed to serve unmet needs, referred to as non-profit organizations in the U.S. and
non-governmental organizations (NGOs) outside the U.S. Instead of re-directing
government monies to private NGOs to provide services at the same funding level,
the world's governments have decreased their domestic social and health spending
and foreign aid, especially so on the part of the United States1.
1 Even though the U.S. is still the largest donor for foreign aid programs, it is only because
they are the richest country in the world. Measured as a percentage of GNP. the U.S. ranks last in
foreign aid spending among 21 industrialized member countries of the Development Assistance


One of the areas tremendously impacted by the effects of neoliberalism in the
past three decades has been reproductive health care services. When neoliberal
policies called for slashing government funding in the provision of reproductive
health services, NGOs became the primary providers for many women in developing
countries. Recent U.S. Republican Presidents have seized the opportunity to spread
the gospel of their anti-abortion and anti-reproductive rights agenda by slashing
family planning funding and establishing and maintaining such policies as the
'Mexico City Policy' (aka the Global Gag Rule) to further limit these women's
reproductive rights and health care options. Although neoliberalism calls for a
privatization approach involving reduced state funding for and provision of services,
the anti-abortion stances of American Presidents Ronald Reagan. George H.W. Bush,
and George W. Bush have actually called for an increase in state involvement
regarding reproductive health care policies in support of the Christian fundamentalist
agenda of limiting sexuality and prohibiting contraceptive choice and safe, legal
abortion.
This policy approach might be best explained by the rise in religious
fundamentalism in relation to the economic restructuring of global capitalism or
globalization'. Antrobus (2004) provides some reasons for this rise in religious
fundamentalism: ...economic decline and insecurity cause people to seek the solace
and certainty offered by religious fundamentalism (and) loss of access to jobs and
essential services can push marginalized people to seek the assistance offered by
religious groups" (p.71). She goes on to explain:
Fundamentalism exists in most religions, and the one thing they all
have in common is control of womenespecially women's
sexualityand the use of violence to impose this control. Violence is
not only physical, but also psychological and even spiritual. Political
power is reinforced when it can be linked to religious beliefs, and
religious groups use political connections to protect their interests, (pp.
71-2)
Shazia Rafia, a spokesperson for Parliamentarians for Global Action, a network of
over 1,300 legislators from 115 parliaments, explains, Where women have
opportunities, they tend to balance tradition with modernity, and form a bulwark
against fundamentalism. Thats why the first thing fundamentalists do is undermine
womens freedoms (Benen, 2004, p. 125).
Committee. Alter decades of being the world's biggest contributor of overseas development assistance
in the post-war era. U.S. spending on international programs (aid not including military security or
international affairs funding) has been cut almost in half when inflation is taken into account since the
height oflhe Cold War in the mid-1980's (Cooper, 1996).


This religious fundamenlalist-based political approach came boldly to the
forefront of U.S. foreign policy in 1984 in the form of the Mexico City Policy' or the
Global Gag Rule', as it is now termed by its opponents (and as I will refer to it in this
paper). The Reagan administration-initiated policy, presented at the United Nations
International Conference on Population in Mexico City, holds that foreign NGOs who
accept U.S. family planning funding or supplies must agree to the following
conditions: they cannot provide abortion services, even if they use their own, separate
money; they cannot provide any information on abortion as an option for an
unplanned pregnancy, including referrals for abortions; and they cannot advocate for
changing the abortion laws in their own country, even if it is with separate funds."
The policy only applies to foreign NGOs who receive US aid, not foreign
governments who receive the same aid. However, most of the recipients of US aid
today are NGOs: by 2002, 75% of all US population assistance was provided through
NGOs (Ethelston, et al, 2004, p. 133).
This is hardly a hands off', free market approach to delivery of services. The
Global Gag Rule has been in effect continuously since 1984, with the exception of the
terms of President Bill Clinton, 1993-2000. U.S. family planning funding has not
paid for abortions (domestically or internationally) in all but a few cases, since the
Hyde Amendment prohibited such in 19773. President Bill Clinton was able to
overturn most of the tenets of the Global Gag Rule by executive order, but was unable
to eliminate the Hyde Amendment, which is attached to Congressional appropriations
*>
' U.S. NGOs can continue to perform, counsel, refer or advocate on abortion with funds from non-U.S.
government sources without risking their eligibility to receive U.S. family planning assistance. The
only requirement imposed on U.S. NGOs by the Mexico City Policy restrictions is the responsibility to
enforce the policy on their foreign NGO partners (Population Action International. 2006).
The Hyde Amendment, passed by Congress in 1976, excludes federal funding of abortions for low-
income women receiving healthcare through the Medicaid program. The Amendment presently
includes an exception for cases of rape or incest, or when a woman's life is endangered. Individual
slates can fund abortions for low-income women for broader circumstances. Currently, only 17 stales
do so. while I state fails to comply with the Hyde Amendment by providing coverage only for
lifesaving abortions. The same restrictions as those in the Hyde Amendment also currently apply to
Native Americans, federal employees and their dependents. Peace Corps volunteers, low-income
Washington. DC residents, federal prisoners, military personnel and their dependents. Medicaid
recipients who are HMO members. Children's Health Insurance Program (CHIP) recipients, and
disabled women on Medicare. While Medicaid funding does not pay for most abortions, it does pay
for prenatal care, childbirth, neonatal care, and pediatric care if a woman chooses to carry her
pregnancy to term (ACLU. 2004).
3


bills, mainly because there was a Republican-controlled Congress throughout the
majority of his tenure.
In this paper, I provide an analysis of how the Sexual and Reproductive
Health and Rights (SRHR) movement has responded to the administration of George
W. Bush in regard to international family planning funding. I especially consider the
worlds geo-political climate during the time period of 2001 to the present, examining
the ways in which the movement has been affected by its forces during this era. I
argue that policies such as the Global Gag Rule have been especially effective for
U.S. conservatives promoting Christian religious fundamentalism because these
policies only affect foreign NGOs. which have now become the primary reproductive
health care providers in the Third World after nation states have abandoned
government health services4
After twelve years of conservative Republican administrations from 1980-
1992, the Sexual and Reproductive Health and Rights (SRHR) movement seemed to
make great strides by helping to elect Clinton (1993-2000), who nullified the Gag
Rule, increased international family planning funding, and agreed to landmark
international SRHR charters such as the Cairo Consensus' formed at the 1994 U.N.
International Conference on Population and Development. However, from the start
of the George W. Bush administration in 2001, many of these marks of progress were
erased by a new Republican President. I specifically examine the ways in which the
SRHR movement has tried to advance sexual and reproductive health and rights
during the time of an administration hostile to its goals.
4 When the Globa] Gag Rule was originally enacted in 1984. a larger proportion of services were
provided by government agencies which were nol subjected to the Gag Rule, thereby impacting a
smaller number of women. Now. a vast majority of women seek their reproductive health care through
an NGO; many of these women are subjected to the Global Gag Rule because USAID is still the
largest bilateral funding source for reproductive health services in low-income countries (Center for
Reproductive Rights. 2003). By 2002. 75% of all US population assistance was provided through
NGOs (Elhelston. cl al. 2004. p. 133).
The UN International Conference on Population and Development (1CPD) held in Cairo. Egypt in
1994. is viewed as a crucial turning point for those in the SRHR movement. The conference and its
programme, or agenda for future action, represented a monumental paradigm shift from old population
control programs to a righls-based framework. The Cairo programme, which was agreed to by a
record 179 countries, including the US. calls for universal access to reproductive health care by 2015.
Although the programme did nol demand universal legal abortion, it did make a ground-breaking call
for addressing the public health consequences of unsafe abortion and ensuring that where abortion is
legal it is safe.
4


Theoretical Perspective
Some scholars as well as activists see the neoliberal, free-market aspects of
globalization as opportunities for communities to govern themselves from the bottom
up (Grown, 2005, Hart-Landsberg, 2006, STWR. 2006, WGNRR. 2004). They argue
that a decline in state-run services will lead to less bureaucracy, less waste, and a
market where the best product or service wins out due to the "purchasing choices
made by individuals. However, many more view neoliberalism as a kind of free-
market fundamentalism connected to the rise in religious and other
fundamentalisms, one which has extreme effects on peoples lives, especially their
ability to make individual choices appropriate for them and their families (Antrobus,
2004, STWR, 2006, WGNRR, 2004). The International Women's Movement and the
SRHR movement have argued that the impacts are especially negative and severe for
women. The 2005-2006 Global Health Watch report notes, The fundamentalism of
the market joins the fundamentalisms of ethnic, religious, and moral right-wing
groups in dismantling women's livelihoods, economic security, and control over
womens bodiestp. 138).
The international womens movement has reacted to globalization and
neoliberalism in a predominantly negative way, feeling that their mandates,
structures, and impacts are counterproductive to womens well-being and
empowerment. I am defining the International Womens Movement here as a large
collection of individuals, groups, and local, regional, national, and international
women's organizations who work for an end to patriarchal privilege and control
through both inherently political activities and socially transformative organizations
that meet the needs of women and their families (Antrobus, 2004). The Sexual and
Reproductive Health and Rights (SRHR) Movement is a sub-set of the International
Women's Movement, consisting of the same types of individuals and groups, but
those who are focused specifically on advancing women's access to sexual and
reproductive health and rights. Many of these groups are NGOs and/or political
organizations that may provide direct health services, education, research, policy, or
lobbying activities, such as the Center for Reproductive Rights, Engender Health,
Ipas, the International Planned Parenthood Federation, Pathfinder International, and
Population Action International.
In this paper, I use both the political process (McAdam, 1982, McAdam, et al,
1996) and social movement literature (Benford and Snow, 2000, Rein and Schon,
1991, Tarrow, 2001, 1998) to develop an approach that examines how the SRHR
Movement has responded to the Bush administration's actions regarding international
family planning policies and funding. The macro-level political economy that the
SRHR movement has operated under during the Bush era has involved a world
5


deeply impacted bv globalization, neoliberalism, and religious fundamentalism.
Neoliberalist policies have called for privatization of health services coupled with
reduced public funding for such services (Antrobus, 2004, Crane, 2005. Grown. 2005,
WGNRR, 2004). Religious fundamentalism has grown and flourished both
domestically and internationally during the Bush era (Bass, 2001, Benen, 2004, Kort,
Kranish, 2006), impacting the SRHR movement in a variety of ways, from an
ideological shift against SRHR to funding being diverted to faith-based
organizations who promote abstinence only in lieu of family planning. Combine
these two phenomena with a globalizing world and the impact of their agendas affects
more women than ever (Buss and Herman, 2003, Chappell, 2006, Peoples Health
Movement, 2005).
Two components of political process theory (McAdam, 1982, McAdam. et al,
1996) that come into play after the broader, macro-level environment (of
globalization, neoliberalism, and religious fundamentalism in this case) is considered
are political opportunity structures and framing. Political opportunity structures
encompass the general context that a movement operates within. Tarrow (1998)
defines political opportunity structures as:
consistentbut not necessarily formal or permanentdimensions of
the political environment that provide incentives for collective action
by affecting peoples expectations for success or failure (pp. 76-77).
Political opportunity structures are divided into three sub-categories: 1) access to
institutions. 2) presence of influential allies, and 3) changes in political alignments
and conflicts (Joachim. 2003. p. 247), all of which are components that affect the
success and/or failure of the movements agenda. My analysis includes: an
examination of the access, or lack of access to institutions that the SRHR movement
has experienced; the presence of influential opponents and allies that the SRHR
movement has or has not had during the Bush era; and the various changes in political
alignments and conflicts that have improved or worsened the SRHR movements
cause. Several scholars (Chappell, 2006. Joachim, 2003) have utilized the concept of
political opportunity structure in their examination of the conditions favorable to the
emergence of a social movement. I will be looking at how unfavorable conditions, or
political opportunity strucutures, have impacted an existing social movement.
Secondly, I examined the tactics and strategies the SRHR movement has
utilized during the Bush era, employing interviews with key NGO actors to provide a
firsthand accounting. One component of the movement's tactics lie in the framing
of their issues. As defined by Snow (in McAdam, 1996) frames are (T)he conscious
strategic efforts by groups of people to fashion shared understandings of the world
and of themselves that legitimate and motivate collective action (p. 6). Framing
processes provide a perspective from which an amorphous, ill-defined and
6


problematic situation can be made sense of and acted upon" (Rein and Schon, p. 263).
Located within the political process framework, the concept of framing (Benford and
Snow. 2000) illustrates how the SRHR Movement has framed' their issues in
response to the limiting nature of the Bush administration. For example, in the case
of the SRHR movement, the central actors in the 1990's framed SRHR as a 'rights'
issue whereas in todays much more conservative, anti-abortion Bush era, they have
framed their issues in softer, healthcare-oriented terms such as promoting safe
motherhood or reducing maternal mortality". In my conclusion, I re-visit the
literature to provide an analysis of the movement in relation to these concepts from
political process and social movement theory.
Thesis Statement
The Sexual and Reproductive Health and Rights (SRHR) Movement has
existed in an ever-changing world of globalization, politics, needs, and resources,
exemplified by the great changes that have occurred during the George W. Bush era.
The movement responded to this administration in a variety of ways, some of which
have been successful and some of which have been defensive at best. In this paper, I
ask the questions: How has the SRHR movement responded to the Bush
administration in regard to international family planning funding and rights policies?
And, specifically, how has the worsening political environment of the Bush era and
its unfavorable political opportunity structures impacted the SRHR movement and in
what ways has the movement responded? A review of the literature finds that there
are no comprehensive studies analyzing the SRHR movement and its interactions
with the Bush administration regarding U.S. international family planning funding
and policies. Conducting such an analysis can help us to understand the grave effects
that the macro-level environment of neoliberalism, globalization, and religious
fundamentalism (as well as a particular U.S. President's influence) have had on a
movement struggling to protect and provide for the SRHR of women around the
world.
Literature Review
There is a great deal of literature concerning international Sexual and
Reproductive Health and Rights (SRHR) since the landmark UN population and
womens conferences of the 1990's (Crane, 2005, Crossette, 2005. Kort, 2004,
WGNRR, 2004). Literature concerning the specifics of political stances, policies, and
funding decisions of the Bush administrations exists, but as specific issue studies only
(Benen, 2004, Bishop, 2004, Crane and Dusenberry, 2004, Hwang. 2002). A large
7


amount of this literature can be found in scholarly journals; however, there is also a
great deal to be found in publications by the UN and NGOs as well as in books (Feldt,
2004, Michelman, 2005, Page, 2006), popular media, and Congressional reports.
There is a sizeable amount of literature linking the politics of neoliberalism and the
process of globalization to women's and health issues (Barton, 2005, Grown, 2005,
Peoples Health Movement/Global Health Watch, 2005, WGNRR, 2004). A final
category under this umbrella involves the literature on the impact of religious
fundamentalism on SRHR (Benen, 2004, Buss and Herman, 2003, Chappell, 2006,
Hinrichsen, 2004) However, there does not seem to be any comprehensive analyses
of the Bush administration in regard to international SRHR funding and policies that
both consider the broader geo-political elements of his time and the political
opportunity structures in place in regard to the SRHR movement. My review of the
literature starts with analyses of how the macro-level elements of globalization,
neoliberalism, and religious fundamentalism have impacted SRHR and goes on to
identify critiques of the SRHR movement since Cairo, research on Bush
administration SRHR policies, and ideas on how the SRHR movement might proceed
into the future.
Several scholars are now analyzing and critiquing the SRHR movement in
light of the broader macro-level environment of globalization, neoliberalism, and
religious fundamentalism. In 2004 and 2005 reports respectively, the Women's
Global Network on Reproductive Rights (WGNRR) and the Global Health Watch
assessed women's health in a free market economy since the instrumental Cairo U.N.
Population Conference in 1994, identifying several key processes that affect women's
SRHR, including; The negative impacts of neoliberal economic policies on women's
health generally" and the restriction of women's rights due to such policies in
combination with religious fundamentalisms (WGNRR, 2004, p. 2). Both the
WGNRR and the Global Health Watch contend that a problem of the SRHR
movement since Cairo has been that many womens rights activists lobbying a
decade ago (in 1994) for reproductive and sexual rights did not, in short, pay
sufficient attention to the structural and macroeconomic conditions for those rights"
(WGNRR, 2004, p. 18). The authors of the Global Health Watch (2005) maintain
that the Cairo conference attendees and the final document did not lake into account
the enormous power imbalances in economic and social structures among and
between countries and between men and women (p. 138). Crane (2005) contends
that the endeavors of the SRHR movement are particularly handicapped by the
compromise language' of the Cairo Programme which states. In circumstances
where abortion is not against the law, such abortion should be safe (p. 86). Crane
explains that adherence to the ICPD compromise language by international actors
8


effectively leaves many women without care in countries where restrictive laws
remain in place (2005, p. 87).
Both the WGNRR (2004) briefing and the Global Health Watch report (2005)
point to a backlash to Cairos Programme of Action and a rise in religious and ethnic
fundamentalisms as a result of the extreme economic fundamentalism of
neoliberalism. At ground level, says Brazilian reproductive rights researcher and
activist Sonia Correa, the growth and violence of traditional fundamentalisms are
directly related to the outcomes of market-oriented globalization" (WGNRR, 2004,
p. 18). The literature also significantly points to other ways in which fundamentalist
forces have been able to join with the US government to restrict not only abortion, but
many other SRHR. George W. Bush joined with religious fundamentalists when he
was inaugurated in 2001 to re-impose the GGR and stop payment of the US's S34
million annual contribution to the United Nations Population Fund (UNFPA) in 2002.
The Bush administration went on to call for all language referring to reproductive
health services, reproductive rights, and sexual health in the Cairo Programme to be
removed (WGNRR, p. 19).
The Global Health Watch (2005) and the WGNRR (2004) explore the
connections between the latter-century movement from government provision of
health care services to private and World Bank-led funding and provision of services
that saw health care not as a right or a need, but as a consumer demand or want.
Crane (2005) specifically examined the omission of sexual and reproductive health
rights in the Millennium Development Goals (MDGs) and calls for a strategic
response by the SRHR movement to focus on issues of global economic justice.
Crane (2005) reports that Some critics have argued that the MDGs are so much a
product of the neoliberal agenda that there is little to be gained by working within that
framework; others argue for greater efforts to bring in feminist and human rights
perspectives (p. 85). in regard to safe abortion. Crane (2005) maintains, Even the
SRHR movement's willingness to advocate for safe abortion care is influenced by the
overall dependency of key actors on U.S. resources, whose decisions in turn are often
governed by conservative forces that include entrenched corporate interests and
religious ideologies (p.86).
Several authors locate the problems with lack of international family planning
funding and restrictive policies squarely within the realm of the Bush administration.
Most of the focus on Bush is due to his reinstatement of the Global Gag Rule and its
damaging consequences to women. Hwang (2002) maintains that the U.S.
government is actively discouraging international and national-level efforts to realize
womens rights to safe abortion care by such measures as restricting family planning
and development funding (because they are the single largest development and
humanitarian aid donor government and often the single largest funder of
9


international organizations) and by attaching explicit or implicit conditions (including
the GGR) to their funding and endorsement of executive appointments to
international agencies.
Most of the scholars researching and reporting on the GGR are incredulous
that a policy that would be a first amendment violation in the US would be initiated
and enforced by our government elsewhere. Crane and Dusenberry (2004) maintain
that the Global Gag Rule violates the norms that the great majority of the
international community have come to believe should govern donor-recipient
relationships as well as the US governments own stated commitments to promoting
civil society and women's human rights in overseas development assistance (p. 129).
Crane and Dusenberry also argue that the GGR sets a dangerous policy precedent by
interfering with the autonomy and private decision-making of NGOs and violating
medical ethics and the human rights of pregnant women and health professionals
(2004, p. 129). The United States had long been a leader in development assistance
and family planning, helping to create the UNFPA in the 1960s and acting as major
proponents of the Cairo programme agreed to by 179 countries in 1994. Hwang
(2002) argues that (the reinstatement of the GGR by Bush) put the United States in a
peculiar diplomatic position: while formally committed to the Cairo programme of
action, the US is in effect using its economic power to undermine the human rights
principle upon which the programme is built (p. 2). Others wonder about the effect
of US policy on the international donor community. Crane (2005) notes, ...the
contrast is striking between directions the international community was taking on
SRHR issues in the 1990s, when U.S. policy was more liberal, and the current
situation (p. 87).
Many SRHR researchers are being more pro-active in researching and
documenting the effects of the Global Gag Rule than they were during its first phase
of 1984-1992. Crane and Dusenberry (2004) argue that policies such as the GGR are
more damaging now than when they were first introduced two decades ago. They
note that the Gag Rule appears to be the cause of more internal contradictions within
the reproductive health community and a cause of conflict involving NGOs,
governments, donor agencies, and others (p. 131) Crane and Dusenberry maintain
that this damage is due to: both more NGOs rejecting US funding because of the
GGR as well as more NGOs agreeing to adhere to the GGR to receive US funding;
more countries permitting abortions, laws that basically conflict with the GGR and
unduly restrict NGOs operating in that country; more focus since Cairo on provision
of safe abortion services, another measure that is prohibited by the GGR; the
integration of reproductive health services with other service provision, such as for
HIV/AIDS, that would severely impact an NGO who refused US funding because of
the GGR; and the limits applied to USAID programs to promote an active post-
10


abortion care program while working with both non-GGR NGOs and those that
adhere to the GGR.
Crane and Dusenberry (2004) insist that the harmful effects of the Global Gag
Rule must be determined in a country-by-country analysis:
In each country, the effects are determined by the political economy of
reproductive health in that countryincluding how large a role is played
by NGOs in both services and advocacy, the presence of other
reproductive health donors, the salience of abortion as a privacy issue, and
the commitment of the national government to reproductive health (p.
131).
Hwang (2002) notes that, In developing countries that permit abortion, the rule has
the bizarre effect of preventing counselors from discussing a procedure allowed by
law... (p.4).
Crane (2005), Crane and Dusenberry (2004), and the Global Health Watch
(2005). among others, argue for a linkage between related arenas and the fight against
the GGR and for broader SRHR for better outcomes. These authors argue that the
SRHR movement can benefit by linking with related movements (such as HIV/AIDS,
maternal and child health, humanitarian response, anti-poverty, development, and
human rights) to devise holistic approaches to the issues that will better reflect and
meet the needs of all those involved. Crane (2005) contends that fundamentalist
forces are at work dismantling SRHR in these other arenas and that the SRHR
movement needs to pay attention and get involved. The Global Health Watch (2005)
authors offer seven specific recommendations for future action for the SRHR
movement: strengthen the human rights framework; work in alliances for economic
and social justice; fight against fundamentalisms; support policies for greater bodily
integrity; hold donors, governments, and institutions to account; measure progress;
and produce better research (pp. 144-5). Although successes have been few and far
between during the Bush era, according to these scholars, there are some gains to be
had. Crane and Dusenberry (2004) point to the example of the Bush administration
deciding in 2003 to not extend the GGR to HIV/AIDS funding, which, according to
the authors, ...underscore(d) the lack of strong support for the Gag Rule when other
values (were) seen to be at stake (p. 130). Crane (2005) sees hope for combating the
GGR in actions such as the advancement of medical/pharmaceutical abortion,
especially after the World Health Organization recently resisted U.S. government
pressure to ban (pharmaceutical abortion) medications from their Essential Medicines
list after SRHR leaders had worked hard to advance the issue.
There is a significant amount of literature regarding SRHR since the UN Cairo
Conference, US spending on international family planning, and SRHR in relation to
the broader macroeconomic world of the new millennium. There is also a fair


amount of information detailing the Bush administration's stances, policies, and
funding decisions regarding SRHR internationally, but it is almost always set in a
discussion of one specific SRHR issue or another. There does not seem to be any
comprehensive analyses of the funding and policy decisions of the Bush
administration in regard to international family planning funding and policies and
how the SRHR movement has responded to the administration's actions. This case
study enables me to focus on how the unfavorable political opportunity structures of
the Bush era have impacted the SRHR movement's tactics and strategies. This study
is helpful because so few studies have examined the effect of unfavorable political
opportunity structures on an existing movement.
Methodology
I have conducted a case study analysis of how the SRHR movement has
responded to the Bush Adminstrations opposition to the movement's agenda.
Gerring (2004) defines a case study as an intensive study of a single unit for the
purpose of understanding a larger class of units" (p. 341-2). Gerring (2004) goes on
to say that a unit connotes a spatially bound phenomenon...observed at a single
point in time or over some delimited period of time" (p. 342). In this instance, the
SRHR movement is the unit I am studying, during the time of the Bush
administration. The variables, or dimensions, 1 will examine within this study are: the
Bush administration; the United Nations; the Right-to-Life Movement; private
foundations; other donor governments; pro-choice congresspersons; and central
SRHR movement actor NGOs. The larger class of units I am seeking to understand
are existing social movements within a world of negative or mainly closed political
opportunity structures. Case studies are helpful because they focus on an extensive
amount of information (the variables or dimensions noted above) in regard to very'
few units or cases, in this instance, the SRHR movement during the Bush era. A case
study allows me to provide an in-depth analysis of my topic area. Case studies
(H)elp researchers connect the micro level, or the actions of individual people (in
this instance the SRHR movement), to the macro level, or large-scale social structures
and processes (in this instance the political opportunity structures of the Bush era and
the macroeconomic global environment) (Vaughan, 1992 in Neuman. 2006, p. 41).
In this analysis, I utilized information from scholarly journals, studies by and
reports from the UN and international NGOs, Congressional reports, U.S. funding
reports, popular media, books, and websites to support my thesis. I supplement this
information with firsthand accounts of the movement's tactics and strategies utilized
during the Bush era. These accounts were gathered from phone interviews I
conducted with three NGOs who are key actors in the SRHR movement. The phone
12


interviews lasted one half to one and one half hours and were conducted in August of
2007. The three NGOs interviewed were: lpas; Pathfinder International; and
Population Action International. I have also provided an integrated analysis of the
effects of neoliberalism and globalization during the Bush era, the subsequent rise in
religious fundamentalisms, and their effects on the international SRHR movement.
Thesis Structure
My thesis begins with this introductory chapter detailing the central issues of
the Sexual and Reproductive Health and Rights (SRHR) movement in regard to
international family planning funding during the administration of President George
W. Bush. I discuss the theoretical framework I used to analyze the issue and provide
an analysis of the current scholarly literature in relation to my topic area. 1 also
describe the methodology I used during my study and identify the central actors
examined from the SRHR movement.
Chapter two provides an in-depth analysis of the political opportunity
structures in place during the Bush era, relating them to the SRHR movement and
specifically US international family planning funding and policies during that time
period. This includes a detailed analysis of the changes in political alignments and
conflicts that came to be during the administration, such as the induction of a new,
anti-choice religious fundamentalist administration under the direction of George W.
Bush. I describe the movement's (lack of) access to institutions during the Bush
administration, intertwining the impacts of religious fundamentalisms, neoliberalism,
and globalization on the UN, the Bush administration, and SRHR donors. I go on to
provide an in-depth analysis of all of the movement's influential opponents (ie; the
Bush administration and the Right to Life movement) and allies (ie; private
foundations, other donor countries, and pro-choice congresspersons) in place during
this time period.
In the third chapter, I examine the movement's action strategies and tactics.
Framing processes are identified and related to the larger political economy of the era,
including the increasing focus on globalization, neoliberalism, and religious
fundamentalisms. I identify the tactics the movement utilized during this era,
including those employed in the international arena (such as at UN meetings and
conferences and in the field) and those utilized within the US (such as at
Congressional hearings or appropriations bills challenges). I also provide a firsthand
account of the activities of key actors within the SRHR movement during the time as
well as the movements interactions with funders, policy makers, and researchers.
In chapter four, I examine the movement's achievements, ongoing challenges,
and outlook for the future. For example, what tactics and strategies has the
13


movement utilized even in a time of extremely negative political opportunity
structures, and how effective were they? How has the change in the US Congress to
pro-choice, Democratic control in 2007 impacted the movement's goals and
objectives? Finally, I examine issues that may have significant impacts on the future
of the SRHR movement in regard to international family planning funding (new'
administrations, new technologies, and work at the UN).
14


CHAPTER 2
POLITICAL OPPORTUNITY STRUCTURES
This chapter explores the setting in which the Sexual and Reproductive Health
and Rights (SRHR) movement has operated within during the George W. Bush era.
In the social movement literature, the political context in which a movement operates
within is referred to as the political opportunity structure, a concept that emphasizes
the opening up and closing down of a social movements opportunities for action
within a particular political context (Tarrow, 1998, McAdam, et al, 1996). The
political opportunity structures that have existed during the Bush era, that I will
define and describe in this chapter, have very strongly shaped the tactics, strategies,
and responses that the SRHR movement has utilized, which I will explore in the next
chapter. In regard to political opportunity structures, I will be following the political
process framework (Tarrow. 2001, 1998, McAdam, et al, 1996, Davis, et al, 2005) by
defining and describing three key components for this study: changes in political
alignments and conflicts; access to institutions; and influential allies and opponents.
A strongly conservative, patriarchal, religious fundamentalist worldview' from
both the administration itself and on the international stage has forced the SRHR
movement to operate in a predominantly reactive nature. Changes in political
alignments and conflicts have had a significant impact on the movement's goals, from
George W. Bushs election and the Iraq war, to the continuing effects of neo-
liberalism and globalization. In the Bush era, as opposed to the SRHR-friendly
Clinton era, the movement has had a massively decreased amount of access to
institutions, from significant negative changes at the UN to Bush's disdain for the
UN, its politics, and its agreements. During this era, those in the SRHR movement
have encountered more influential opponents than they have allies, with the
traditional Right to Life' movement joining forces with the SRHR movement's most
influential opponent, the Bush administration. Allies have remained, and even
expanded in some cases, in spite of national and international changes and include
pro-choice congresspersons. private donor foundations, and other donor countries.
This chapter will explore these elements of political opportunity structures at length
in order to describe and illuminate the setting the SRHR movement has operated
within during the Bush era.
15


Changes in Political Alignments
The first political opportunity structure component I have examined in regard
to the SRHR movement during the Bush era revolves around changes in political
alignments or conflicts. The end of the Clinton era brought the new anti-choice, anti-
family planning administration of George W. Bush into the White House, and with it
renewed challenges to the SRHR movement. Each January of his presidency, on the
anniversary of the Roe v. Wade decision legalizing abortion, George W. Bush has
spoken to the anti-choice protestors gathered in Washington to commemorate the date
and lend his support. He has said that he shares their commitment to "protect the
lives of innocent children waiting to be born" (Toner, 2003) and has pushed for
domestic and international policies that support that agenda. NARAL Pro-Choice
America reports, On his first working day in office in January, 2001, President
George W. Bush ordered the reinstatement of the Global Gag Rule on international
family planning programs: programs that strive to prevent unintended pregnancy,
reduce abortion, and avert hundreds of thousands of infant and maternal deaths
worldwide each year (NARAL. 2007a, p. 13). The US, as well as the U.N., does not
provide funding for abortions anywhere in the world. The political conflicts arising
from an administration like that of George W. Bush have to do with access to
abortion services and funding of and access to family planning (contraceptive)
services. Because the administration is not able to stop abortions altogether by not
funding them, it tries to do so by limiting women's access to abortion services by
attaching conditions to their family planning funding so that reproductive health care
providers cannot also perform abortions (with other monies). Ironically, the
administration has at the same time limited the reach of the Global Gag Rule by
significantly reducing its international family planning funding, services which
would, in fact, reduce the number of abortions. These policies have created a
firestorm in the international community and at the UN and have alienated the US
from its traditional allies and partners in family planning assistance, with whom the
US had enjoyed good relations dating back to the 1960's.
Access to Institutions
The second component of the political opportunity structure that the SRHR
movement operated within during the Bush era is in regard to their access to
institutions. After enjoying eight years of relatively open access to a pro-choice
President, State Department, and USAID during the Clinton era, the SRHR
movement has had to deal with a closed door scenario with the Bush
administration. Even the UN, the setting that the movement worked so hard to secure
16


access to throughout the Clinton era, especially in regard to SRHR, has become a
hostile environment to both women's and Sexual and Reproductive Health and
Rights. The landmark Cairo programme adopted in 1994 has been repeatedly
attacked, especially by religious fundamentalists at the UN, which have included
Bush administration officials. George W. Bush has distanced himself from prior US
(and SRHR movement) allies with his agenda of religious fundamentalism mixed
with neo-liberalism and globalization. Where actors in the SRHR movement had
enjoyed a large amount of success at and access to the UN during the Clinton era,
they now had to fight for every bit of access and encountered a backlash to their
earlier gains. This all occurred in a time of increased globalization, privatization, and
spreading neo-liberalism that took the focus away from human rights and moved it to
a market-based system of service delivery, often neglecting the poor women and
children in developing countries who need services such as health care the most. In
addition to these forces, the terrorist attacks of September 11, 2001 led to an
increased focus and spending on terrorism and security, which also diverted attention
aw'ay from womens rights.
Religious Fundamentalists at the UN
After the United Nations-friendly Clinton administration came to a close,
conservative forces at the UN, including certain UN member countries, were gearing
up to turn back the clock on SRHR that the liberal US administration had advanced in
the 1990s in partnership with the international SRHR movement. The ideology that
these conservative countries all have in common is one of religious fundamentalism
that limits women's rights, whether it comes from a Protestant evangelical Christian
(US), Catholic (the Vatican, Ecuador, Nicaragua, etc.), or Islamic (Iran, Syria, Libya,
and Pakistan, among others) background. This partnership has been referred to by the
international womens movement and scholars as an unholy alliance because of its
various dichotomies of partnering of West with East and military enemies with
religious fundamentalist allies (Chappell, 2006).
At UN conferences and agency and General Assembly meetings, the formerly
domestically-focused (US) Religious Right" has been able to export their Protestant
evangelical Christian fundamentalist agenda by partnering with the Bush
administration and fundamentalist Islamic and Catholic organizations and countries to
limit or eliminate international SRHR under this so-called unholy alliance. Benen
(2004) reports, By collaborating with the Bush administration and Islamic and
Catholic allies, the Religious Right has turned its US culture war into an
international battle that impacts families around the world (p. 122). These impacts
have come at UN meetings and conferences in the form of actions such as stalling
17


tactics, opposition to previously-agreed upon commitments, and limiting language
and actions in new documents (Chappell, 2006). The partnerships between religious
fundamentalists and military opponents seem particularly ironic during a Global War
on Terrorism'. Adrienne Germaine, President of the International Womens Health
Coalition, told the Washington Post, This alliance shows the depths of perversity of
the (US) position. On the one hand were presumably blaming these countries for
unspeakable acts of terrorism, and at the same lime we are allying ourselves with
them in the oppression of women" (Benen, 2004, p. 125-6).
Those within the SRHR movement are concerned about the Bush
administration's alliance with the Religious Right and fundamentalist countries
because the US, as the foremost superpower in the world, has a tremendous
influence at the UN, and on international policy and funding in particular. When
even a small, fanatical religious alliance has the support of one of the most powerful
countries in the world, the outcome can be dangerous. Benen (2004) reports that this
alliance can ...dictate the outcome of several policy debates... in regard to SRHR
and women's rights, as is reported at length in the following sections on Bush's
influence at the UN and UN changes in population assistance. Perhaps one of the
most damaging effects this unholy alliance' has had on the SRHR movement at the
UN is the defensive position Chappell (2006) reports that the movement has been
kept in, making it difficult to both maintain current rights agreements and expand on
their agenda.
The SRHR movement became so wary of the hostile environment at the UN
that key actors elected to downplay the 10lh anniversary conference of the Beijing
International Womens Conference in 2005 due to "the rise of religious
fundamentalism...and the internationalization of political conservatism, which they
felt might allow governments to back out of previous commitments and ultimately
wind back women's rights (Chappell, 2006, p. 518). Indeed, the US played the
leading role in trying to turn back the clock on the agreements made at the original
Beijing conference by trying to reopen and amend the programme to include the
statement that the document does not confer any international legal rights or legally
binding obligations on states under international law (Chappell, 2006, p. 503).
However, the US delegation was ultimately unsuccessful and unpopular amongst the
majority of the delegations, who are not part of the unholy alliance. Most of the
American public is unaware of the changes that happen on the UN stage in relation to
SRHR. As Kort (2004) reports, The decisions the US government makes (in regard
to international SRHR) are not widely reported, and they're in areas that are very
technical and complicated, so programs are being eliminated and no one knows about
this (p. 119).
18


Amy Coen, of the NGO Population Action International (PAD, is one of those
in the movement that are extremely concerned about the unholy alliance* between
conservative, fundamentalist and/or anti-choice groups and religious groups with like-
minded governments. PAI's concerns lie in the impacts on both women
internationally and in the US from this type of a coalition. She says, It appears that
this (Bush) administration tests things abroad first, and thats what were worried
about (in Kort, 2004, p. 119). The unholy alliance and Christian Right UN
activists have even been able to find friends in the once off-limits liberal European
landscape. Opposition to SRHR in Europe has intensified and has even shown up in
complaints to the European Commission, whom anti-choice activists have now
branded as promoting abortion for their support of SRHR (Ethelston, et al, 2004, p.
12). Wanda Nowicka of the Federation for Women and Family Planning in Warsaw
told the Village Voice, We used to be able to say, Look at those progressive
countries like the US.' But now Im afraid...progress is headed in a different
direction (in Benen, 2004, p. 128).
Bush, SRHR, the UN and International Policy
While working to oppose women's and SRHR at the UN in support of a
conservative social agenda, the administration of George W. Bush became
increasingly antagonistic toward the UN in regard to military and security issues after
the UN rejected Bushs unilateral military response to the September 11, 2001
terrorist attacks by invading Iraq. The Bush administration has found its few military
and diplomatic allies in countries like England and Canada and identified enemies in
Iraq, Iran, Syria. Libya, and the Sudan, some of whom Bush identified as the axis of
evil'. Paradoxically, even after September 11. the Bush administration has partnered
with these so-called enemies' in its opposition to SRHR, part of the fundamentalist
alliance's larger campaign against womens rights (Benen. 2004, p. 122).
Since the beginning of George W. Bush's terms in 2001, his administration
has repeatedly tried to turn back the clock on SRHR in the international community
by sending conservative, anti-choice and/or fundamentalist representatives to
international meetings and conferences and empowering them to object to SRHR,
block their inclusion in agreements, and/or back out of previously agreed upon
commitments (Eth, >ton, et al, 2004). One international agreement that the Bush
administration has been particularly active in trying to destabilize is the Cairo
Programme of Action. The UNFPA notes, Currently, the most significant U.N.
document (on reproductive health and rights and population) is the Programme of
Action resulting from the International Conference on Population and Development,
held in Cairo in 1994, which forms the blueprint for reproductive health policy
19


around the world. One hundred and seventy-nine governments (including the US)
adopted the Cairo Programme of Action by consensus. All but a handful are fully
committed to its principles and recommendations" (UNFPA, 2007). The US, under
George W. Bush, is one of those handfuls of countries that are not committed to the
Cairo Programme, going against the agreement made by our government in 1994,
while Clinton was in office. The Cairo programme was an agreed-upon plan for
achieving universal access to basic reproductive health care by 2015, with a budget
laid out for both donors and developing nations. The U.S.. from the introduction of
the Republican-controlled Congress in 1994 to the current Bush administration now
in 2007, has not met its financial obligations agreed to in the Cairo programme.
Although the U.S. is the largest donor in dollar terms, they contributed just one-third
of their fair share of the 2005 spending goal agreed to in the Cairo programme
(Ethelston, et al, 2004).
In 2002, the Bush administration sent an anti-abortion and anti-family
planning delegation to the Asian and Pacific Population Conference in Bangkok
where they insisted that the Cairo language of reproductive health and rights were
code words for abortion. The US contingent forced a vote on its objections and was
the only country to vote for a change in the language (Bishop, 2004, Kort, 2004). At
a 2002 UN meeting on the rights of children, intended to create a new document
entitled, A World Fit for Children, the Bush administration delegation included
representatives from anti-choice, anti-family planning groups such as the Family
Research Council, Concerned Women for America, a Virginia private Christian
school, along with the Vatican. The American delegation teamed with fundamentalist
Islamic countries including Syria, Libya, and Pakistan to make sure that the word
services was not included in the document. The document endorsed young
peoples access to reproductive health, but no services to ensure they have it (Benen.
2004).
A similar approach to international SRHR by the Bush administration
occurred in April 2004 when, NARAL Pro-Choice America reports,
Succumbing to political pressure from anti-choice activists...
the Bush administration abruptly ended a 30-year tradition of federal
funding for a prominent Public health conference hosted by the
nonpartisan Global Health Council. Federal support was rescinded
because organizations with pro-choice positions were among the
conference's diverse participants. The conference included
perspectives on youth health issues from a range of groups, and (as is
often the case) some speakers had positions that differ from President
Bush's in the area of reproductive health. Now, however, the
president appears to be subjecting an event's speakers to an ideological
20


litmus test, and hy doing so, is crippling efforts to disseminate
information on important public health issues.
One of the most worrisome aspects of the Bush administration's reversals of
US support for international family planning comes in the effect it has on our former
allies on SRHR. A former US official, speaking anonymously to the Los Angeles
Times, said in 2002, The US position on health issues and international instruments
has been so combative and isolationist weve ended up alienating traditional friends,
especially Europeans (in Benen. 2004, p. 124). At a UNFPA Board Meeting in June
2004, European Commissioner of Development and Humanitarian Aid Poul Nielson
stated, 1 must say here that 1 have been extremely dismayed by the actions of the
United States in refusing to fund UNFPA and in attempting to undermine the Cairo
consensus. Here we had the country that championed the founding of UNFPA now
spurning it. Added to this, we have official support for so-called abstinence
programmes and negative and factually wrong messages about condoms, which will
only serve to worsen reproductive health in developing countries through increasing
unwanted pregnancies and sexually transmitted infections (Nielson, 2004, p. 2).
UN Changes in Population Assistance
The UN has become increasingly conservative in response to globalization
and neo-liberalisms effects on development and population assistance in general
since the landmark 1994 Cairo SRHR agreement. Since Cairo, the new buzzwords at
the UN have been heavily influenced by the spread of neo-liberalism, exemplified in
terminology such as poverty reduction" and health sector reform, rather than
sexual and reproductive health care or womens rights or even human rights".
At the turn of the millennium, the UN Millennium Development Goals (MDGs) were
drafted as a new blueprint for development assistance to offer precise targets for
reducing poverty and promoting global development (PA1, 2005). Giffard and Van
Leuven (2005) report,
For the first time, international leaders had committed themselves to a
worldwide campaign encompassing eight specific goals and with an
absolute deadline. The MDGs are the first truly global effort to
eradicate poverty. If the MDGs are successfully implemented by the
year 2015, the projected benefits are staggering: 30 million children
will not die before the age of five; more than 300 million will not
suffer from hunger; more than 500 million people will not live in
extreme poverty; 350 million fewer people will be without safe
drinking water; and 650 million fewer people will live without basic
sanitation measures. Each goal has its own set of targets and
21


benchmarks that offer a measurable way to track its implementation.
The MDGs are a mandate for developing countries to shape policies
and strengthen their own governance. More wealthy countries are
asked to increase aid, relieve debt, and give poor countries fair access
to their markets and technology (p. 2).
By 2001, when the MDGs were adopted and presented, many women's groups were
dismayed that only one goal had limited specificity to gender equality (goal 3, in
regard to education only) and none explicitly addressed reproductive rights (Barton,
2005, Peoples Health Movement, 2005). The Global Health Watch reports,
The goals exclude sexuality, reproductive rights, and health as
determinants of gender equality, and focus on education for girls and
maternal health and morbidity. This places women and childrens
right to health within a purely biological framework (Peoples Health
Movement, 2005, pp. 136-137).
DAWN, or Development Alternatives with Women for a New Era, a Southern-
hemisphere-based NGO that has been a central actor in the SRHR movement before
and since Cairo, goes on to explain,
(T)he absence of other reproductive health and rights concerns (in the
MDGs) reflects the UN's reluctance to recognize or take a strong stand
on other (SRHR) issues in many arenas, particularly women's
autonomy to choose, abortion, and sexuality (in Peoples Health
Movement, 2005, p. 137).
Many in the SRHR movement were caught off guard by this crucial omission and
were forced to look inward for reasons why they had dropped the ball' on both the
MDGs and family planning assistance in general. Steven Sinding, Director General
of the International Planned Parenthood Federation, said at a 2003 international
conference on how reproductive health is being dealt with in the agendas of donor
nations; Sexual and reproductive health and rights as a development theme have
fallen away from the center of the international development agenda. (Crossette,
2005. p. 77)
Changes at UNFPA during the new millennium would also spell doom for
many of the SRHR movement's efforts, especially in regard to the MDGs and the
Cairo programme. Several of those in the movement have argued that UNFPA was
not in a strong lobbying position at the time and "dropped the ball' on the MDGs
(Crossette, 2005). UNFPA's Executive Director, Nafis Sadik. had resigned in 2000, a
crucial time for the Beijing+5 conference and the MDGs. UNFPA had met such
major resistance from religious fundamentalists at the Cairo+5 conference in 1999
that the General Assembly did not support a Cairo+10 meeting in 2004 (Crossette,
2005). The new UNFPA Director did not seem entirely prepared to handle the
n


onslaught of resistance to SRHR at the turn of the millennium (Crossette, 2005).
Others, like Sadik, had come to feel that the UN was backpedaling fast from its prior
support of SRHR, in historic documents like the Cairo Programme. Sadik explained
to Crossette (2005),Gender is supposed to be mainstreamed in everything at the UN,
but when it comes to actually designing how to treat the main issues of women's
empowerment and control, their reproductive decisions are totally ignored. Some of
this is the fault of governments, but some is also the reluctance of some of the
Secretariat, she said. Many men, deep down, don't really want women to have
control. I really start to believe that, because it's really quite strange the way people
who you think have supported the idea of reproductive rights for women find
justification and excuses for not doing so. (p. 76)
Influential Opponents and Allies
The third, and most comprehensive component I have examined in regard to
the SRHR movements political opportunity structures during the Bush era is in
regard to influential opponents and allies. Who were the main opponents that the
movement has had to deal with during the Bush era? Which allies could the
movement still rely on from years past, when they had greater access to institutions?
In the following section, I identify and describe the prominent opponents and allies at
length and then go on to explore the frames and strategies the movement utilized in
response to these actors in Chapter three.
Opponents
The SRHR movement has had to navigate amongst many opponents during
the Bush era, the main one being the administration itself. It is an administration
heavily influenced by conservative, Christian religious fundamentalists who
adamantly oppose womens sexual and reproductive rights and seek to impose that
opposition on as many women as possible. The administration has been very
successful in limiting SRHR both in the US and abroad through a variety of
measures. Very closely aligned with the Bush administration is the Right to Life or
pro-life movement, re-energized after electing another pro-life politician to the
White House in 2000. The SRHR movement has had to fight the Right to Life
movement (RLM) not just on the domestic level, but also on the international level,
after the RLM has become more savvy about advancing their objectives and activities
on the international stage and in developing countries. The administration, of course,
has fully supported the RLMs expansion to international politics both ideologically
and financially through their faith-based initiatives.
23


Bush administration
The George W. Bush administration has been the single largest opponent to
the SRHR movement in regard to international family planning from 2001 to present.
Although Bush has spoken in terms of finding common ground for agreement with
others' in regard to SRHR since his first presidential campaign speeches through
present times (On the Issues. 2007). the movement has not seen any room for
common ground or agreement based upon the many actions he has taken in direct
opposition to their support for international family planning funding. I describe the
following main actions Bush has taken in opposition to international family planning
funding here: USAID funding cuts; the Global Gag Rule; UNFPA funding cuts; and
contraceptive supply cuts.
USAID Funding Cuts
The main US agency for international family planning funding is the US
Agency for International Development, or USAID. USAIDs international family
planning assistance program will spend $432 million in 2007, which represents about
5% of USAIDs foreign assistance budget and 0.02% of the USs total development
assistance budget (USAID, 2007). NGO Population Action International reports,
When adjusted for inflation, current (FY 2007) US funding for family
planning/reproduclive health programs is 41 % less than the FY 1995 level. At the
same time these steep funding reductions have taken place, the number of women of
reproductive age (15-49) in the developing world alone has increased by
approximately 275 million women. The US is still the largest international
development donor in terms of actual dollars, but it is the least generous among donor
governments relative to gross national income (PAI, 2007c).
Since the 2001 terrorist attacks in New York, the Bush administration has
increasingly tied development assistance to its National Security Strategy for
combating global terrorism and has involved previously domestic-level, more
political, departments in international matters. These changes have allowed the
administration to utilize neo-liberal approaches to development and international
affairs by sidestepping the traditionally less political agency of USAID, emphasizing
free markets, and rewarding countries committed to democracy (Ethelston, et al,
2004. p. 130). After decades of the US being an international leader in population
assistance and believing that it was a crucial factor in promoting economic and social
progress in developing countries, USAID is now forced to justify its SRHR funding
in narrow, market-based terms of improving health (Ethelston, et al, 2004, p. 131).
24


The US has donated a sizeable amount of family planning money in the past to the
UNFPA, the UN Fund for Population Assistance. However, those funds have been
eliminated under the Bush administration. (See upcoming section on UNFPA
funding cuts).
The SRHR movement has been justifiably dismayed over Bush's cuts to the
USAID population assistance (PA) budget. USAID PA funds hit an all-time high
under the Clinton administration in FY95 at $541.6 million (PAI, 2007c). The
seating of a Republican-controlled Congress in 1995 changed the budget dramatically
so that it dropped during Clinton's tenure to a low of $372.5 million (PAI, 2007c).
The Bush administrations funding of USAID PA programs has ranged from a low of
$429.5 million to a high of $446.5 million (PAI, 2007c). Opponents to international
family planning assistance point to the fact that the Bush administration has kept PA
funding levels at about three-quarters of the record high set by the Clinton
administration. However, family planning proponents counter that much of the
funding is committed to supporting abstinence-only and faith-based programs that
discourage contraception. Ed Szymkowiak of the American Life League, an anti-
choice political group, says, I would say we've got to cut that USAID (referring to
the agencys population funds). I mean, wed like to eliminate it totally (Mercier,
2003, March 9). According to USAID, studies in several countries have shown that
for every $1 invested in family planning programs, governments save as much as $16
in reduced expenditures in health, education, and social services (US Senate, 2001).
Since taking office in 2001, George W. Bush has applied the Global Gag Rule (GGR)
restrictions to not only USAID funding, but also to PA funds distributed through the
State Department, and, to some extent, the UN Fund for Population Assistance
(UNFPA) because he has eliminated the US contribution completely (see following
sections).
Global Gag Rule
The Global Gag Rule (GGR) does not seem to have had a consistently
negative effect on abortion legalization internationally, either in its first term of 1984-
1992 or in its current term of 2000 to present. Despite the Global Gag Rule, twenty-
nine countries have liberalized their abortion laws since it was first enacted in 1984.
Although international family planning opponents may try to argue that the Gag Rule
is consistent with the laws and values of the countries where USAID operates, in
reality more than two-thirds of those countries permit legal abortion for reasons other
than to save the life of the woman, rape, or incest (PAI. 2004, p. 2). Since the GGR's
first enactment in 1984, five countries have tightened their laws against abortion and
only 25% of the worlds population live in countries where abortion is illegal (IPPF,
25


n.d.). However, because of the Gag Rule, NGOs in countries where abortion is illegal
who receive any US funding are strictly prohibited from lobbying to liberalize
abortion laws, even if it is not with US funds. On the other hand, anti-choice NGOs
who receive US funds and operate within countries w'here abortion is legal are
perfectly entitled to lobby to limit or criminalize abortion (IPPF, n.d.).
The Global Gag Rule and laws making abortion illegal do not stop women
from having abortions. It is estimated that in 2006, 19 million w'omen had unsafe
abortions (defined as an induced abortion conducted either by persons lacking the
necessary skills or in an environment lacking the minimal medical and hygienic
standards, or both), with approximately 70,000 of those women dying from their
unsafe abortion (IPPF, n.d.). The International Planned Parenthood Federation notes,
In Latin America abortion is illegal or severely restricted in virtually every country,
yet the abortion rate is one of the highest in the world, far exceeding that of Western
Europe or North America. Senator Barbara Boxer, (D-CA). noted in a 2001 Senate
hearing on the Global Gag Rule, The recent increased availability of modern family
planning methods has already resulted in a 33% drop in the abortion rate in Russia
and a 60% reduction in Hungary (US Senate, 2001)." The Bush administration seems
to ignore the fact that in developing nations, family planning services, which decrease
the abortion rate, are usually co-located with other health services, including abortion
where it is legal. Therefore, if a clinic that refers for, provides, or lobbies for safe,
legal abortion also provides other health services, they will have to refuse all US
funding.
Both American and international observers point to the hypocrisy of the US
imposing a policy like the GGR. Bishop (2004) notes, The policy restricts the
freedom of speech in other countriesan action that would be unconstitutional if
implemented in this country (p. 5). Cyprian Awiti, a Kenyan program director for
the reproductive health organization Marie Stopes International says, I think the
Americans are running away from their responsibility. I mean, how do Americans
talk about equality of women, and run away from reproductive health? (Mercier,
2003, March 9). US Senator Harry Reid, D-NV. said at a 2001 Senate hearing, (the
GGR) restricts foreign organizations in a way that would be unconstitutional in our
own country. Exporting a policy that's unconstitutional at home is. iii my opinion,
the ultimate act of hypocrisy (US Senate, 2001). Many non-profits and NGOs have
sued various agencies of the US Government for the constitutional free speech
violations of the Global Gag Rule, but each time the US courts have not found in their
favor6 (Page, 2006, PAI, 2004, 2006, n.d.).
6 When NGOs including Planned Parenthood Federation of America. Population Action International,
the Pathfinder Fund. Population Council, the Association lor Voluntary Surgical Contraception, and
26


The Bush administration and its allies, while adamantly defending the
limitations of the Global Gag Rule, downplay its effects on family planning providers
in developing nations. Former senator Tim Hutchinson (R-AR). maintained in a 2001
Senate hearing that only nine NGOs out of 547 refused US funding for FY2000 due
to the Global Gag Rule's restrictions. At the same hearing. Senator Olympia Snowe
(R-ME). testified that, According to the Center for Reproductive Law and Policy,
the (Global Gag Rule) will penalize 59 countries whose (NGOs) receive family
planning assistance funds from the US (US Senate, 2001). Even if only a few'
NGOs refuse funding, some of the NGOs provide the great majority of all services.
The largest international provider of family planning services, the International
Planned Parenthood Federation (1PPF), could not abide by the GGR's restrictions and
had to forgo all $17 million of US funding in 2001. IPPF has 149 member
associations in 182 countries, so the impacts were indeed major for women (IPPF,
n.d.). Due to this disparity in reporting on the effects of the GGR, NGOs within the
SRHR movement are now conducting their own impact studies to document the
consequences of the debilitating policy. These studies will be discussed in an
upcoming chapter on the movements activities in response to the Bush
administrations policies.
The effect in the field of the Global Gag Rule on H1V/AIDS programs has
been tremendous, considering that most HIV/AIDS service are hosted jointly with
family planning programs, many of whom have had to refuse US funds because of the
Gag Rule. Reproductive health proponents say that in most parts of the world,
family planning services and HIV/AIDS programs are integrated, (so) separating
them would be extremely difficult for both logistical and financial reasons (Mercier,
2003, March 10). If the one clinic in the area that provides family planning services
as well as HIV/AIDS services closes down or significantly reduces their services
because of reduced funding, there may be no other clinic to take their place. Valerie
DeFillipo, services director for Planned Parenthoods Global Partners Program, asks,
If (U.N. Secretary General) Kofi Annan says the face of AIDS in Africa is a woman,
why have family planning in one place and another for AIDS treatment? (Mercier.
2003, March 10).
Yet another issue that NGO workers and SRHR advocates consistently bring
up in relation to the Global Gag Rule is the (perceived) concept of fungibility. The
Bush administration maintains that the need for the GGR lies in the idea that aid
the Center for Reproductive Law and Policy sued the U.S. government regarding the GGR, US courts
maintained that the policy did not violate the constitutional first amendment rights to free speech, or
NGOs" ability to support abortion services because the decision to accept US funding is based on
"independent choice" (PAL n.d.)
27


money is fungible so that if the US gives funding to NGOs who provided abortions,
even if it was not to go toward funding abortions, the NGO would then just use other
money to provide abortion services, and the US would actually be funding'
abortions. However, those in the SRHR movement argue that if there is to be a
matter of fungibility' applied to these funding matters, then faith-based
organizations that are being supported by the administration, with no concerns of
conflict of interest or tax violations, should be restricted. The administration has
maintained, when questioned about the co-mingling of taxpayer funds with funds
from churches for faith-based organizations, that the faith-based organizations
are somehow able to keep the funds separate in a way that abortion providers would
not. Faith-based organizations have become increasingly active in the international
SRHR arena during the Bush era. most often promoting Bush's abstinence-only
agenda with a no-condoms approach, even in areas the most devastated by
HrV/AIDS. Population Action International (2004) reports, Indeed, it is important
to note that current law does not require groups receiving HIV/AIDS funds to
endorse, utilize, or participate in a prevention method or treatment program to which
the organization has a religious or moral objection (p. 132). Meanwhile, SRHR
advocates are not entitled to raise religious or moral objections to the Global Gag
Rule and its restrictions.
Although the Global Gag Rule may not get much attention from the American
public, the international community is very vocal in its opposition. The policy is
regularly addressed at international meetings and when discussing international
family planning assistance in the international press. In July 2003, The Reproductive
Rights Alliance (RRA), a South African abortion-rights NGO. held a demonstration
protesting Bush's trip to South Africa. The group said that Bush's support of the
Global Gag Rule amounted to "genocide" and a "war on women's bodies" in Africa.
RRA also claimed that the Policy is responsible for 1.5 million unwanted births,
15,000 maternal deaths, 92,000 infant deaths and 2.2 million unsafe abortions (Kaiser
Family Foundation, 2003). The Global Gag Rule restrictions were put into effect for
another source of US international aid in August, 2003, when President Bush applied
the restriction to all Stale Department funds. The State Department budget, which
was over $8 billion at the time, is now subject to the policy that before had only
applied to grant monies from the USAID family planning program (NARAL, 2007a).
UNFPA Funding Cuts
In July 2002, George W. Bush launched another assault on funding for
international family planning services when he zeroed out the US's entire $34 million
budget for the U.N. Fund for Population Assistance (UNFPA) by executive action.
28


NARAL notes, He subsequently canceled funding for the FY04, FY05, and FY'06
cycles as well. UNFPA provides reproductive health care, including family planning
services, but not abortion, to the worlds poorest women, and specializes in caring for
refugees and addressing other crises" (NARAL,UNFPA). Bush's cancellation of the
UNFPA funds came after an extreme anti-choice organization, the Population
Research Institute (PR1), made unsubstantiated claims that UNFPA funding was
linked to forced abortions in China.
Bush has justified the UNFPA cuts by saying that the UNFPA was violating
the 1985 Kemp-Kasten Amendment, which stipulates that no funds can be allocated
to any organization or program which supports or participates in the management of
a program of coercive abortion or sterilization" (Benen, 2004, Hinrichsen, 2004, &
Kort, 2003). Anti-choice lawmakers and organizations were instrumental in
convincing the administration that UNFPA funds were being used in this manner,
even when there wasnt sufficient evidence to support their claims. A fact-finding
team from the administrations own State Department found on their mission to China
in May 2003 that there was no evidence linking UNFPA to coercive practices in
China. News agency Knight Ridder and The Washington Post obtained the
unpublished State Department report that found that the UNFPA program in China
actually improved womens lives by helping them prevent unwanted pregnancies
through education and family planning services, thus reducing the number of
abortions under Chinas repressive population policy (Benen, 2004 & Mercier, 2003,
March 10). Even though the Bush administration has strong ties with the Chinese
government in a myriad of business endeavors and provides funding for such health
issues as HIV and SARS, their religious fundamentalist aims in regard to
international family planning funding came into play again when the administration
decided to cut all UNFPA funding (NARAL. 2007).
A UN delegation to China found that the UNFPA programming in China was
...entirely based on a voluntary approach to family planning. A British inquiry also
found no link between the UNFPA and abuses in China (Benen, 2004, Hinrichsen.
2004, & Mercier, 2003, March 10). Those in the SRHR movement point once again
to the Religious Right and its strong relationship with Bush in the UNFPA funding
battle. Representative Carol Maloney (D-NY) notes, PRI is the only organization
that has ever made these allegations. The administration is going against the will of
Congress and the international community by allowing a small band of extremists to
hamstring its foreign policy (Hinrichsen, 2004). Ronald Green, Chairman of the
Department of Religion at Dartmouth and a member of the 2003 fact-finding trip to
China, says, The Bush Administration has made UNFPA a sacrificial lamb for the
Religious Right in America. Its crass election politics. These groups not only
29


oppose abortion, they are against family planning and reproductive health in general.
Their positions...have no basis in reality" (Hinrichsen, 2004).
Benen (2004) notes that when Bush initially cut the funding in 2002, Over
120 members of Congress cosigned a letter... arguing that they considered the
(Congressional funding allocation for) UNFPA to be binding." But, Bush said he
disagreed and refused to release the funds while also declaring that he would veto any
bill that Congress passed to restore the funding (Benen, p. 126). Additionally, Bush
went against this Congressional intent for funding international family planning when
he diverted $25 million of the FY03 and $12.5 million of the FY04 funds that
Congress had appropriated for UNFPA to programs to combat sex trafficking (PAI,
2007c). The funding for UNFPA, traditionally provided through the Foreign
Operations spending bill, is moot until Congress lifts the administration's funding
restriction. Pro-choice lawmakers, including Democrats and Republicans, attempted
to lift the restriction during debate of the FY03, FY04, and FY'05, and FY'06
spending bills, but were ultimately unsuccessful (Kort, 2004 and NARAU).
Congress has even tried to float bills for UNFPA funding that would withhold
country-specific" funds if China failed to certify that it met the conditions set in the
Kemp-Kasten amendment. However, the administration has failed to agree to even
that pragmatic of an agreement (Kort, p. 120).
Total UNFPA funding withheld to date by Bush is $127 million (UNFPA).
NARAL and the UNFPA report that each year, the cancelled funds could prevent: 2
million unintended pregnancies; nearly 800,000 abortions; and more than 81,000
deaths (Benen, 2004, Hinrichsen, 2004, Kort. 2004, and NARAL). The elimination
of UNFPA funding is especially debilitating because of the fact that the UNFPA has
a presence in dozens of countries where USAID population funds are unavailable.
UNFPA notes, With 171 donor countries, UNFPA enjoys the broadest base of
support of any UN agency. This includes commitments from every country in sub-
Saharan Africa and each region of the world (UNFPA).
Contraceptive Supply Cuts
Under the Clinton administration, the USAID, along with the UNFPA, was
one of the two largest donors in the world of condoms to poor, developing countries
to aid in the prevention of HIV/AIDS, as well as to provide protection against STDs
and unwanted pregnancies. USAID was responsible at the time for procuring and
delivering more than one-third of all contraceptive supplies to developing nations
(GGR.org). After seven years of a Republican-dominated Congress, a shift toward
Christian religious fundamentalism, and the introduction of the Bush era, in 2002
USAID provided less contraceptive supplies than they had in 1990, even before
30


inflation is taken into account (Ethelston, et al, 2004, P. 134). Bush ended shipments
of condoms and other contraceptive supplies to 16 of the poorest developing nations
in Africa, Asia, and the Pacific. These recipients were the only NGOs receiving
USAID-donated contraceptives in their respective countries (GGR.org). Total
donation of supplies has remained about the same since 2001, even though their costs
have risen dramatically and the demand has risen even faster (Cohen, 2006). Because
of the Global Gag Rule and their refusal to abide by its conditions, family planning
agencies in another 13 countries, nearly all in sub-Saharan Africa, no longer get
condoms and contraceptives from USAID (Hinrichsen, 2004). If a foreign family
planning NGO refuses to comply with the GGR, in addition to losing funding dollars,
they also lose all US-donated contraceptives, including condoms for HIV/AIDS (PAI,
2004. p. 1).
The Right to Life Movement
In addition to the administration itself, another powerful opponent during the
Bush era has been the Right to Life movement. The Right to Life or Pro-Life"
movement is a highly organized coalition of individuals, churches, and organizations
that work together to limit and/or eliminate women's SRHR, especially abortion. The
movement enjoyed a peak in activity in the 1980s and early 1990's, when they were
able to push the boundaries of US laws to limit healthcare access, threaten patients
and doctors, and even bomb and kill at abortion clinics. In the 1990s, the Right to
Life movement was especially aroused when the SRHR movement was able to elect
a pro-choice President for the first time in 12 years. A US-based conservative,
Christian organization called Human Life International founded and financed the
influential Catholic Family and Human Rights Institute (C-FAM) and the Population
Research Institute (PRI) in the 1990s while Clinton was in office.
Now, in the Bush era. these groups have become Washington insiders and
regulars at the UN. Richard Snyder of UNFPA pointed out in 2004 that, These
groups have been around for the past decade. The difference is that now they have an
ear in the White House (Hinrichsen, 2004). The PRI had such a ready and waiting
ear in George W. Bush that they w;ere the ones to take their unsubstantiated claims of
UNFPA funding going toward forced abortions in China all the way to the point of
the President cancelling all UNFPA funding, despite the repeated field reports that
PRIs information was unequivocally false. Other groups that are part of a coalition
with C-FAM and the PRI include the Pro-Life Action League, the American Life
League, Campaign Life Coalition, Concerned Women for America, and National
Right to Life Committee. Several researchers are now reporting on a conservative
counter-network at the UN, with Buss and Herman (2003) dubbing this coalition the
31


Christian Right United Nations (CR UN). In addition to those mentioned above as
partnering with C-FAM, the CR UN is said to include such organizations as Focus on
the Family, the Family Research Council, REAL Women, and the World Movement
of Mothers (Chappell, p. 494).
C-FAM is reported to disrupt UN meetings and actively orchestrate
misinformation campaigns against the UN from their offices nearby in New York
City. This includes characterizing UNFPA and NGOs engaged in reproductive
health and family planning initiatives in developing countries as anti-family".
Stirling Scruggs of UNFPA says that these groups "...(are) not just anti-abortion,
they are anti-women, and oppose population policies and programs in general. They
hate us because we have been very effective in promoting women's rights and
providing poor communities with the information and means to voluntarily plan their
families (Hinrichsen, 2004, pp. 1-2). Although groups like C-FAM and the CR UN
are not official governmental delegates to the UN. they are almost always able to
enlist the support and leadership they need from Bush administration officials and
other governments that join in on their unholy alliance (Chappell, p. 503).
Allies
Allies to the SRHR movement during the Bush era have been few and far
between. The UN and UNFPA have not been, or have not been able to be, as
powerful a resource to the movement as they had been in the past. The ongoing work
of the key NGOs in the movement has had the greatest impact on SRHR (see next
chapter). Private foundations have continued to support international family planning
funding, although they are doing so at lower levels, partly due to the demands of the
HIV/AIDS crisis, partly due to donor fatigue around the issue, and partly due to
pressures from the neo-liberal, religious fundamentalist environments the US and
other major donor countries are perpetuating. However, several other donor countries
have stepped up to meet the challenge of the loss of funding from the US and private
foundations. The US has seen continued efforts by the Congress to support the
SRHR movement, but a Republican party majority (until 2007) with a pro-life"
platform has overshadowed most efforts.
Private Foundations
Although it can be said that total funding for family planning from private
foundations has been negatively impacted during the Bush administration, private
foundations have done a great deal to increase their support for SRHR in the
developing world over the past two decades. Major private foundations that currently
32


support international SRHR include: The Bill and Melinda Gates Foundation; The
Ford Foundation; The William and Flora Hewlett Foundation; The John D. and
Catherine T. MacArthur Foundation; The David and Lucille Packard Foundation; the
Rockefeller Foundation; the United Nations Foundation; and the Wellcome Trust.
UNFPA actually saw a five-fold increase in their contributions from private
foundations from 1996 to 2002 (Ethelston, et al, 2004. P. 143).
Funding trends for private foundations for SRHR, especially family planning,
have not progressed in an entirely positive upward trend. As of 2002, as much as
one-half of all population assistance funds from private foundations were earmarked
for HIV/AIDS activities. Formerly one of the largest donors for family planning, the
Mellon Foundation discontinued their funding in 2005. In the past, they had funded
universities and NGOs including the Alan Guttmacher Institute and the Population
Council for research, policy analysis, and training activities (Ethelston, et al, 2004, P.
145).
Other Donor Countries
Many donor countries have stepped up to the challenge to increase their
family planning funding after the reductions made by the Bush administration.
Belgium, Canada, France, Germany, Ireland, Italy, Spain, and the United Kingdom
had committed by 2004 to increase their assistance relative to their gross national
income by 2015. Some nations, including Canada, Germany, the Netherlands,
Sweden, and the UK, as well as the European Commission, have been especially
critical of the increasingly conservative stance of the Bush administration in regard to
family planning funding and have increased their SRHR policy and funding
commitments. Several of these donor countries have characterized the loss of
funding to NGOs from the US due to the and for UNFPA as a decency gap
(Ethelston, et al, 2004, p. 11). The European Commission specifically increased its
grants for International Planned Parenthood Federation projects in Rwanda and the
Dominican Republic to address this funding gap (EC, 2004).
Pro-Choice Congresspersons
Although the US Congress had been dominated by the Republican party from
1994-2004, the Senate has actually held a pro-choice majority, with both Democratic
and Republican Senators supporting SRHR (NARAL). The largest amount of
Congressional support to the SRHR movement in relation to international family
planning funding has been around the issues of the Global Gag Rule and the
elimination of UNFPA funding by the US (as discussed previously). Since Bush re-
33


enacted the GGR on his first day in office, pro-choice congresspersons have tried
every year to pass legislation that would nullify his Executive Order. They have most
often attached their efforts to foreign policy funding bills, but have always come up
short for the number of votes needed to override a presidential veto. Republican
representative James Greenwood (PA) has strongly criticized the GGR and even went
to Kenya in 2002 to see its effects in person. Greenwood told a reporter at the time,
Unfortunately, our party has been co-opted by so-called religious or neo-
conservatives. They have persuaded themselves that if they cut funding to agencies
that provide or counsel on abortions, somehow that will actually reduce abortions"
(Kort. 2004).
In the 2006 Congress, a bi-partisan group consisting of both pro-choice and
anti-choice Congresspersons proposed legislation that would free up much-needed
contraceptive supplies to developing nations. The Ensuring Access to
Contraceptives Act of 2006" would have doubled the amount that USAID spent on
contraceptives to SI50 million each year in FY 2007 and FY 2008. The legislation
would also have enabled NGOs restricted by the Global Gag Rule to again receive
US-donated contraceptive supplies (Cohen, 2006). However, under threat of
presidential veto and a still Republican-dominated Congress, the measure failed to
gain passage.
Conclusion
This chapter explored at length the Political Opportunity Structures in place
during the Bush era. The election of a religious fundamentalist, neo-liberal
conservative in George W. Bush and the concurrent international trends toward an era
of increased globalization and growing neo-liberalism were significant factors in the
era's political alignments and conflicts. Access to institutions for the SRHR
movement greatly diminished during this time, both in Washington and at the UN.
influential opponents far outnumbered allies, with the Right to Life" movement
being greatly enabled by the Bush administration, the largest opponent to SRHR. The
SRHR movement was able to keep and even expand many of its Allies, namely
domestic pro-choice congresspersons, private donor foundations, and other donor
countries. The following chapter will explore the mobilizing, or movement action
structures, the SRHR movement utilized to frame their issues and advance their cause
during the Bush era. This will include an in-depth description of the key actors in the
SRHR movement during this time, as well as the strategies and actions they have
employed to strive for their goals.
34


CHAPTER 3
MOVEMENT ACTION STRATEGIES
In this chapter, I examine the mobilizing, or Movement Action Strategies, that
the SRHR movement has utilized in response to the predominantly negative Political
Opportunity Structures of the Bush era. The strategies the movement has utilized to
present, 'sell', or spin their issues are called frames" and, in this case, consist of
three main categories that I will identify and describe. I will go on to an analysis of
the different action strategies the movement utilized beyond their framing of the
issues. This includes an in-depth description of the work of key NGOs in the SRHR
movement during this time, with phone interview data from organizational
spokespersons. The main action strategies the movement utilized fall into four main
categories: fighting for their cause in the US Courts and Congress; working within the
UN system; obtaining new funders; and producing research impact reports.
Framing
Another major theoretical component of social movement or political process
theory lies in the framing" of a movements issues. Benford and Snow (2000)
define frames as action-oriented sets of beliefs and meanings that inspire and
legitimate the activities and campaigns of a social movement organization" (p. 614).
In the case of this study, I am examining a social movement and the organizations
within that movement. The Sexual and Reproductive Health and Rights movement
has sought to frame its issues in a number of ways over time, in an ever-evolving
response to the domestic and international political climate. While the more SRHR-
friendly Clinton administration of the 1990s allowed for framing the movements
issues under the terminology of womens rights" or reproductive rights, the
negative political opportunity structures of the Bush era have necessitated more
conservatively-minded approaches to framing SRHR. In order to try to make any
headway in the hostile environment of the new millennium, the movement has had to
carefully craft frames that will speak to a broader audience and connect the issues of
SRHR with womens health, social and economic development, and prevention of
unintended pregnancy and abortion.
35


Safe Motherhood or Maternal Mortality
One of the most oft-used frames by the SRHR movement during the Bush era
has involved the prevention of womens deaths front unsafe abortions, lack of
prenatal care, and unsafe deliveries. Safe Motherhood or Maternal Mortality are
the terms used for these frames that are most frequently presented by the SRHR
movement today. The UNFPA (2007) states that 251,340 women have died as of
June 2007 from a lack of family planning, skilled birth attendance, or emergency
obstetric care. UNFPA (2007) calls attention to the fact that an estimated 74,000
women die from unsafe abortions every year and that every minute one woman dies
in childbirth. Due to the fact that almost no one, public or private citizen, can argue
against the need for reducing maternal mortality or ensuring safe motherhood, this
frame has been the most widely accepted during the Bush era and the most easily
incorporated into funding, programming, and policy making. Even with the high
level of disappointment by those in the SRHR community around the lack of SRHR
in the Millennium Development Goals (MDGs), one entire goal out of eight is
focused solely on the issue of reducing maternal mortality (World Bank, 2004).
SRHR promoting Social and Economic Development
Several actors in the SRHR movement currently frame SRHR in terms of
advancing social and economic development. This has been a frame used by the
movement in some form or another since the beginning of UNFPA and population
assistance programs in the 1960's. In its current form, this frame emphasizes human
rights (implicitly including women's rights) and individual autonomy in controlling
ones reproduction as being paramount to the advancement of social and economic
development. Population Action International is one of the NGOs that situates SRHR
in the broader frame of social and economic development. They believe that, the
single biggest factor affecting the world's natural resources is human population
growth (PAI. 2007). A sub-frame of economic development includes the
environmental movement and its aims to curb population growth and the subsequent
depletion of natural resources. However, feminist actors in the SRHR movement are
careful to assert that it is an individual's right of reproductive choice that should be
the deciding factor in the control of population growth, rather than targets or
governmental incentives or mandates. This frame can be more contentious than the
safe motherhood frame to those in the Right to Uife movement because they
disagree with the right of women to control their reproduction, especially through
contraception and/or abortion.
36


A Prevention Challenge
The most current, and perhaps most controversial frame advanced by the
SRHR movement has been in the terms of a prevention challenge". Several NGOs
have worked to focus the Bush administration and the donor community on the
prevention end of international family planning issues, both as a way to tone down'
their volatility and to try to reduce the negative effects brought on by a lack of
prevention efforts. Population Action International is one of the NGOs, along with
NARAL Pro-Choice America, that have sought to consistently frame the issues
around international family planning funding in terms of prevention. Both
organizations have worked alongside other SRHR NGOs on the domestic level to
pursue a Prevention First initiative in Congress which emphasizes prevention
education, information, and supplies to combat the issues of unplanned pregnancies,
teenage pregnancies, and abortion. On the international level, they hope that
prevention first can lead to increased donations of contraceptive supplies and an end
to abstinence-only sexuality/HIV/AIDS education (Lasher, 2007). A sub-frame of the
prevention frame is found in the terms evidence-based" or medically accurate".
This frame is being advanced in response to the abstinence-only funding and
programming promoted by the Bush administration. SRHR researchers, including
those from the executive branch, have had six years to study the results of
international (and domestic) abstinence-only education and have found that it is not
effective in preventing pregnancies. STDs/HIV/AIDS, or abortions and may even
lead to an increase in these outcomes because of its lack of information for sexually
active individuals (Pathfinder, 2007).
Action Strategies
The SRHR movement has utilized a number of tactics and strategies to
advance international family planning funding issues during the Bush administration.
I start this section talking about UN documents and conferences in general that the
movement has worked on during this era. I then go on to examine new funders the
movement has turned to in response to the lack of funding from the US as well as
impact reports the movement has generated to demonstrate the effects of a lack of
international family planning funding. Lastly, I profile the work of three different
central actor NGOs during this time; Ipas; Pathfinder International: and Population
Action International. I conducted phone interviews in August 2007 with
spokespeople from these organizations, focusing on their response to the negative
opportunity structures presented by the Bush administration and the international
community during the Bush era.
37


Work at the UN
After the successes of NGOs at the UN population and women's conferences
of the 1990's, SRHR NGOs were caught off guard by their exclusion in the MDG
drafting process. Crossette (2005) reports the following: (The UN General Assembly
President and Secretariat)...
...did not want to deal with the controversies of and backlash to the
Cairo programme. They wanted a streamlined report-writing process
with little controversy or stalling. Most governmental delegates were
not included in the drafting, and there was no preparatory committee,
as there often is when drafting UN documents. NGOs and even
government experts were barred entirely from the process of drafting
the declaration. (Many nations at the UN) had become alarmed at the
exponential growth and influence of civil society organizations
(NGOs) and were trying to limit their participation and action.
Crossette (2005) notes that the SRHR movement had a significant friend in the World
Bank at the time of the MDG drafting, because the Bank argued vigorously for an
unambiguous and explicit statementindeed a separate goalon sexual and
reproductive rights, but it was unable to budge the UN (p. 72).
Jacqueline Sharpe, president of the Family Planning Association of
Trinidad, says that important lessons were learned about why the MDGs emerged as
they did, shorn of reproductive rights. We did not really pay the kind of attention we
should have," she said of NGOs that were excluded from the discussion (Crossette,
2005, p.74). After the tough lessons learned from the MDG process, several NGO
leaders have increased their push for more official standing of NGOs by the UN so
that they have a seat at the table. Sharpe (Crossette, 2005) contends, We need to get
on official delegations given that the exclusion of NGOs from the discussion is likely
to continue" (p. 74).
The SRHR movement has worked hard to see that SRHR were more
thoroughly covered in the MDGs by pushing for their revision since their
implementation in 2001. The movement was successful in its efforts when at the
2005 UN World Summit they were able to gain an agreement to revise the MDGs to
include universal access to reproductive health care, a measure in line with the Cairo
programme adopted 11 years earlier (PlanetWire, 2005). This was indeed a huge
victory for the SRHR movement, as UNFPA Director Thoraya Ahmed Obaid stated
after the conference, This outcome is a success for millions of women, men and
young people all over the world whose appeals have been heard. We must now focus
our energy on fulfilling the commitments made by world leaders (PlanetWire, 2005).
The draft measure from the September, 2005 World Summit was finally solidified in
38


October, 2006 when the UN General Assembly agreed to adopt the new target (UN-
INSTRAW, 2006). Dr. Gill Greer, Director General of IPPF said at the time,
Despite continued opposition from some governments, including the United States,
the UN General Assembly has made a decision that will save the lives and reduce the
suffering of millions of women worldwide... (UN-INSTRAW, 2006).
New Funders
During the Bush era, the SRHR movement has had to work with increasingly
diminished funding from the US government for international family planning. US
funding for family planning/reproductive health programs is 41% less than the FY
1995 level when adjusted for inflation. The US is still the largest international
development donor in terms of actual dollars, but it is the least generous among donor
governments relative to gross national income (PAI, 2007c). The SRHR movement
has worked hard to solicit new donors and funding streams since they can no longer
count on US funding to provide the largest segment of international family planning
funding as they had from the 1960s to mid-1990s. The movement has found these
new funding allies in foreign donor governments, private donors, and private
foundations.
34 Million Friends of UNFPA
In response to George W. Bush's elimination of all of the ($34 million)
UNFPA funding contribution, two American women began a grass-roots campaign in
2002 to mobilize the public to give $1 or more each to make up for the funding loss.
They call their initiative the 34 Million Friends of UNFPA campaign and conduct it
via email, a link through the UNFPA website, speaking engagements, and rallies.
They have raised over $3.5 million so far from over 100,000 individuals and donors
(UNFPA, n.d.). Funds are applied to UNFPAs main priority area, which is to help
ensure universal access to quality reproductive health information and care to all
couples and individuals by the year 2015. UNFPA does not provide funding for
abortions, but rather other reproductive health care services which may include post-
abortion care.
Safe Abortion Action Fund/UK government
After asking the IPPF to provide a study of the effects of unsafe abortion
worldwide (see upcoming section on Impact Reports), the UK government decided to
create a fund to address the funding gap created by policies such as the Global Gag
39


Rule and diminished international support for family planning (Boseley, 2006,
February 6). In early 2006, the (JK government initiated the $5.6 million Safe
Abortion Action Fund (SAAF). The governments of Denmark, Norway. Sweden,
and Switzerland subsequently agreed to add to the fund, bringing the total to $14.87
million. The SAAF is intended to offset the reduction in reproductive health care
funding by the US, especially due to the limits of the GGR. There is no official sum
for the amount of funding lost due to the GGR, but some of the figure can be
illustrated by looking at the largest reproductive health care provider in the world, the
IPPF. IPPF alone is reported to lose $18 million in US funding each year from not
agreeing to work within the confines of the GGR. And, an additional estimated $43
million a year in US funding is not being distributed to family planning agencies
because President Bush has cut all UNFPA funding. Although those involved are
hoping that the SAAF might total up to $35 million, that figure would clearly not
meet the gap left by the lack of US funding.
The SAAF, which can be used toward advocacy, operations research, or
service delivery, is being administered by IPPF as appointed by the UK government.
Interestingly, the Fund can be used for safe abortion services, which are not funded
by either the US (even without the GGR) or UNFPA. The GGR eliminated funding
to a great number of family planning agencies that were not only unable to provide
abortions with their own, separate funding, but were unable to provide family
planning services, which would eliminate the need for abortion. An October 2006
submission deadline for the SAAF brought 172 proposals requesting over $41 million
in funding from NGOs wanting to provide services under the program. In May of
2007, forty-five projects at NGOs in thirty-two different countries were awarded
$11.1 million in funding for a two-year cycle (IPPF, 2007).
IPPF and the UK government's hope is that not only will the SAAF meet the
goals of IPPF and other SRHR NGOs, but that it will show the UK and other donor
governments' commitments to meeting the Millennium Development Goal regarding
maximizing maternal health and reducing maternal morbidity (due to unsafe abortion
in this case, which results in an estimated 70,000 deaths per year from an estimated
total of 19 million unsafe abortions) (IPPF. 2006a, p. 3). UK International
Development Minister Gareth Thomas stated in regard to the need for the Fund, We
work very closely with the Americans but we have a very different view from them
on abortion. We know from experience that the absence of sexual and reproductive
health services results in an increase in unintended pregnancies and, inevitably, a
greater number of unsafe abortions (Gultmacher, 2006).
40


Impact Reports
The SRHR movement has attempted to be more savvy in their response to the
negative political opportunity structures of the Bush era by employing researchers to
document the effects of funding reductions and restrictions from such measures as the
Global Gag Rule. Only two empirical studies had examined the impact of the Global
Gag Rule, but both looked only at the Reagan-George H.W. Bush era. Researchers
that examined the studies found that the studies could not fully assess the policy's
broad consequences for access to contraceptive or abortion services, much less for
womens health (Cincotta and Crane, 2001). Researchers and the media have also
said that the studies failed to look at the extent to which the policy did or did not
reduce the incidence of induced abortions (Mercier, 2003, March 10). As far as the
burden placed on women in regard to the loss of contraceptive supplies, Page (2006)
reports that a 2002 Johns Hopkins School of Public Health study estimates that each
SI million decline in contraceptive assistance results in 360,000 additional
unintended pregnancies, 150,000 more induced abortions, 11,000 more infant deaths,
and 800 more maternal deaths (p. 138-9).
In a Planned Parenthood Federation of America Report on the Global Gag
Rule in 2003, the organization stated,
It has never been easy to fully quantify the impact of the Gag
Rule. Its ramifications are insidious and have occurred over many
years. It is impossible to track how many deaths have been associated
with services that could have been provided in the absence of a Gag
Rule, how many advocates were silenced from speaking out about a
devastating public health issue, or how many organizations were
prohibited from working with their governments and other Non-
Governmental Organizations to meet the serious health care needs of
their own communities (IPPF, 2006a, p. 8).
The Global Gag Rule Impact Project, developed in 2002, conducts research
to document the effects of the Global Gag Rule. The Project is led by Population
Action International, in partnership with Ipas, Planned Parenthood Federation of
America, and the International Planned Parenthood Federation. Their field
researchers from Engender Health and Pathfinder International currently conduct
studies in nine countries and have produced reports on the impacts in each of these
countries, including Ethiopia, Ghana, Tanzania. Kenya, Zambia, Zimbabwe,
Romania, and Nepal. They distribute their reports via their website and in writing, as
well as a video entititled, Access Denied: US Family Planning Restrictions in
Zambia , which has now made its way to youtube on the internet (Global Gag Rule
41


Impact Project). (See upcoming section on work of Central Actor NGOs in regard to
the GGRIP).
In 2003, the Center for Reproductive Rights published a 43-page report
entitled Breaking the Silence: The Global Gag Rules Impact on Unsafe Abortion
which documents the grave effects of the Global Gag Rule that women (and men) in
the United States do not often see or hear about. Eunice Brookman-Amissah, a
Doctor in Ethiopia, says in the report, Contrary to its stated intentions, the Global
Gag Rule results in more unwanted pregnancies, more unsafe abortions, and more
deaths of women and girls. We who have seen those effects first-hand can no longer
tolerate silence about the Gag Rule's tragic effects (Center for Reproductive Rights,
2003).
Active in 182 countries, the International Planned Parenthood Federation
(IPPF) is the largest reproductive health care provider in the world. Because of the
GGR, they are losing at least $18 million a year in US funding and were forced to:
close 14 clinics in poor Bangladeshi neighborhoods; cut $700,000 in funding in
Nepal; cut $3 million in HIV/AIDS funding in Cambodia; close three clinics serving
56.000 clients in Kenya; and close clinics and reduce services for over 300,000
patients in Eastern Nepal (Hinrichsen, 2004). In February, 2006, the IPPF released a
twenty page report on the state of unsafe abortion worldwide entitled, Death and
Denial: Unsafe Abortion and Poverty". The report provided a thorough examination
of the effects of policies such as the Global Gag Rule, as well as other funding
restrictions that have contributed to the ongoing epidemic of unsafe abortion. The
report found that approximately 19 million women have an unsafe abortion each year,
with 70,000 of them dying from these unsafe procedures, mostly in the developing
world. IPPF also reported that, in countries where abortion is illegal or severely
restricted, some thirty to fifty percent of maternal deaths are from unsafe abortion
(Boseley, 2006, February 6). Due to the findings of the report, (as discussed earlier in
this chapter in the section on New Funders) the IPPF was able to work with the UK
government to convince them to create the Safe Abortion Action Fund, specifically
tailored to meet the funding gap created by the GGR and other funding losses.
Work of Central Actor NGOs
Foremost among the actors in the SRHR movement are the non-governmental
organizations (NGOs) that work on a daily basis to ensure and deliver SRHR to
women around the world. The agendas and foci of these organizations frequently
change depending on the macro socio-political environment of the time, as well as the
domestic politics of the countries they are headquartered in. Several of the US-based
SRHR NGOs have had to shift their agendas, tactics, and strategies since the Bush
42


administration came to power in 2001, bringing a more conservative-minded
government hostile to the goals of their movement. The following section examines
the agendas, tactics, strategies, actions of three prominent US-based SRHR NGOs
during the Bush era. Phone interviews were conducted with organizational
spokespersons from Ipas, Pathfinder International, and Population Action
International in August 2007.
Ipas is a thirty-four year old NGO which works to increase women's ability to
exercise their sexual and reproductive rights, and to reduce abortion-related deaths
and injuries (Ipas. 2007a). Ipas work is concentrated in training, research,
advocacy, distribution of equipment and supplies for reproductive health care, and
information dissemination. Ipas has Special Consultative Status with the Economic
and Social Council of the United Nations and maintains offices on five continents,
providing services to more than twenty countries. Ipas has recently created a
database to facilitate quick access to data related to providing high-quality abortion
and post-abortion care service delivery" (Ipas, 2007b). The database, named IDEAS
(International Data for Evaluation of Abortion Services) was created to provide a
standardized abortion database for researchers, funders, governments, and the public.
The site is divided into five categories: general demographic data: reproductive health
and abortion statistics; health workforce data; service delivery point data; and policy
and regulatory data (Ipas, 2007b).
An NGO with more than fifty years experience in facilitating SRHR throughout
the world, Pathfinder International currently works in 20 countries throughout Africa,
Asia, the Near East, Latin America, and Europe. Pathfinder actively works to
increase US support for international family planning programs while providing
services through other NGOs. In regard to family planning and reproductive health
services. Pathfinder "brings services to isolated rural areas by training community
members to function as volunteer health workers and by creating referral networks.
(They) improve and expand existing services in both urban and rural areas by
renovating clinics and training health care providers to offer a wider range of services
and contraceptive choices (Pathfinder, 2007). The organization produces several
research publications reporting on their local projects and SRHR issues and has a
small advocacy department that works on policy issues in the US and abroad. Issues
Pathfinder works on in their advocacy division include: women's empowerment and
gender equality; HIV/AIDS prevention; adolescent reproductive health; and the
environment. Pathfinder provides field researchers in conjunction with other NGOs
for the Global Gag Rule Impact Project (see upcoming section).
Population Action International (PAI) is a 40-year old NGO that performs policy
advocacy work to strengthen political and financial support worldwide for
population programs grounded in individual rights. PAI tries to serve as a bridge
43


between the academic and policymaking communities" by: disseminating strategic,
action-oriented research publications; participating in and sponsoring conferences,
meetings and seminars; and working to educate and inform policymakers and
international colleagues in related fields (PAI, 2007). They work directly with the
US Congress, the Executive Branch, the UN, other international agencies, and other
NGOs to reach their goals. One of the main issues PAI has been actively engaged in
since the beginning of the Bush administration has been their fight against the Global
Gag Rule. They have been a leader in researching the effects of the policy and
producing documents and videos to create awareness about the issue. (See upcoming
section on their partnership with the 'Global Gag Rule Impact Project.)
Confronting the Reality of a New Administration
With the election of George W. Bush and an anti-choice administration in
2000/2001. SRHR NGOs were forced to adapt to a different response coming from
the White House in regard to the movement's issues. Several tactics and strategies
the SRHR NGOs had utilized in the past stayed the same, but many had to be newly
developed to respond to an administration that didnt support their objectives. Craig
Lasher, Senior Policy Analyst with Population Action International (PAI) says that
his organization has basically had to play defense" since the Bush administration
took office in 2001. Lasher notes that although the commencement of the Bush
administration was tough on the movement, everything was not rosy under Clinton
in regard to Clinton compromises with the Republican Congress such as the
reinstatement of UNFPA funding in exchange for a modified Global Gag Rule.
Instead of making gains in the area of SRHR during the Bush era, Lasher says that
PAI has been forced to react to anti-choice Executive and Legislative branch actions
and frame their issues in ways that might expose the extreme approaches of those
entities.
Cara Hesse. Director of Public Affairs for Pathfinder International, notes that,
during the Bush era, her organization has worked on both gathering more evidence of
impact of negative international family planning policies such as the GGR and joining
with other SRHR NGOs to more effectively fight against restrictive policies and for
ensuring SRHR. For example, during the Reagan era Global Gag Rule, Pathfinder
did not have any resources or staff to gather evidence of impacts from the policy.
However, during the Bush era, Pathfinder has been actively gathering this type of
evidence in the field in conjunction with the Global Gag Rule Impact Project. To
more effectively fight for SRHR during the Bush era. Pathfinder has joined with other
SRHR NGOs to form and house the International Family Planning Coalition, which
now includes 40 different organizations. Hesse reports that PAI, The Guttmacher
44


Institute, and the Population Connection are NGOs that Pathfinder works especially
closely with in this coalition.
Barbara Crane, Executive Vice President for Ipas, feels that the SRHR movement
and her organization have had to disengage" from the US government since Bushs
election. Crane says that the Democrats in Congress have not been willing during the
Bush era to go out on a limb on international family planning issues because the
issues are too far out" for most Americans; the public doesnt understand the issues.
In response to this problem, Ipas has been trying to concentrate more on educating the
public and Congress on the issue of unsafe abortion. She notes that they have had to
look elsewhere for funding and leadership, finding much of both in European
governments.
Main Issues During the Bush Era
PAI and Pathfinder list fighting against the GGR and its elimination of
contraceptive supply donations; UNFPA funding cuts; PEPFAR and its anti-
prostitution pledge for NGOs; and abstinence-only funding and programming as the
main issues they have had to focus on in regard to international family planning
during this period. Ipas reports working against the Global Gag Rule and the Helms
Amendment and working on the 34 Million Friends of UNFPA campaign (see
upcoming section on the funding initative) as their main foci during the Bush era.
PAIs Lasher reports that their organization continues to work in Congress to push for
a dollar for dollar reduction of UNFPA funding for China in lieu of a total elimination
of UNFPA funding by the US. The Gates Foundation is currently funding an
initiative through PAI that will address the contraceptive supply shortfalls SRHR
providers experience under the Global Gag Rule. PAI has also been actively fighting
against the Bush administration policy that mandates that one-third of the funding for
PEPFAR, the US AIDS funding package, must go to abstinence-only programming.
The three NGO representatives interviewed have worked hard to ensure that the
Cairo programme has been kept alive. PAI was especially active in the ICPD+10
(Cairo programme) Review process of 2004 by coordinating, planning, hosting, and
facilitating other SRHR NGOs in regional and national-level UN meetings and
conferences. They were instrumental, along with other NGOs, in alerting other donor
countries to the fact that US governmental and anti-choice NGO representatives
planned to attend as many meetings and conferences as possible to register their
displeasure with the Cairo programme and try to change and reduce its goal of
universal access to SRHR. Several of these other major donor countries ended up
attending meetings and conferences that they had not planned to attend so that they
could re-affirm their commitment to the Cairo programme and SRHR funding in light
45


of the US's diminished support. PAI saw their crucial role at the meetings being one
in which they would fight to make the Cairo programme stronger or maintained and
consistently pushed for the term "reaffirm to be used, which denotes the strongest
and highest achievable level of support for a UN document. PAI is especially proud
of their accomplishment of official reaffirmation of the Cairo programme, with no
removal of any of its principles by the many opposition groups, including the Bush
administration (Lasher, 2007 and PAI, 2005). Ipas will be working to uphold the
Cairo programme and MDG tenets around safe abortion by co-sponsoring the "Global
Safe Abortion Conference this Fall (along with Marie Stopes International, an
international reproductive health provider, and Abortion Rights, a British pro-choice
action group).
Framing the Issues
The NGO representatives interviewed have all been aware of ways in which they
have purposefully framed their issues during the Bush era. Craig Lasher from PAI
states that his organization has worked to frame the issues in terms such as "evidence-
based, scientific", or prevention programming. He says that the goal of such
framing is to portray the opposition as extreme for opposing contraception (Lasher,
2007). Cara Hesse of Pathfinder says that her organization is trying to appeal to
moderates by advancing such frames as mak(ing) abortion more rare. Barbara
Crane of Ipas says that her organization has mainly worked to advance the frames of
unsafe abortion, maternal mortality, and safe motherhood.
In examining the ways in which NGOs may have tackled the Global Gag Rule
differently now than in its first phase during the Reagan era, Pathfinders Hesse says
that they have always been active in opposing the GGR, as its restrictions affect the
organizations they work with and its tenets violate their mission and principles.
Because Pathfinder is a US-based NGO that is a cooperating agency or
intermediary, for government funding, they are not subjected to the GGR. Pathfinder
has fought in US Courts to ensure that their private monies can be used however they
want and not be restricted by the GGR (Hesse. 2007). Barbara Crane of Ipas feels
that the GGR has had a chilling effect" on NGOs fighting for safe, legal, accessible
abortion. She maintains that many NGOs have now become unwilling to talk about
the specifics of abortion within SRHR because of the climate created under the
Global Gag Rule and the Bush administration. Crane notes that USAID now has
more involvement with NGOs than they did during the Reagan GGR period because
NGOs are now the major abortion service providers and receive the bulk of USAID
population assistance funds. These new funding channels in turn impact more
46


women because of the fact that so many receive their reproductive health care
through NGOs, rather than governments, who are not subjected to the GGR.
Combatting the Global Gag Rule
In both the Reagan- and Bush-era periods of the GGR, SRHR NGOs have
continually brought court cases challenging the legality of the policy, which have all
resulted in losses for the plaintiffs. Both Pathfinder and PAI actively fight the GGR
and its provisions in the US Courts and Congress. Congressional attempts to overturn
the policy throughout both periods have always come up short as well, with the
Senate acting as the lead body in initiating and supporting its repeal. Hesse says that
she feels that Pathfinder has probably been the most active among cooperating
agencies in challenging the GGR in the Courts and Congress. She says that a
supportive Board of Directors and mission have emboldened Pathfinder to challenge
their major funder on this issue: the US government. As a US-based cooperating
agency, Pathfinder receives 90% of its funding from US governmental agencies
(Hesse, 2007). Only about 10% of their funding is from private sources; large
foundations like Gates, Hewlett, and Packard and small donors. A small amount of
funding they receive is from other donor governments and UNFPA (Hesse, 2007).
Another strategy SRHR NGOs have utilized to combat the GGR has been to try to
provide firsthand knowledge of the policys impact in developing countries to US
policymakers. Prior to new Congressional ethics/lobbying rules enacted in the 2006
Congress, PAI hosted numerous Congressional trips to various developing countries
to US lawmakers and their staff members regarding the GGR. PAI would invite both
long-time SRHR supporters as well as those with mixed voting records to try to
increase their awareness of SRHR issues (Lasher, 2007). From 2001 to 2006 PAI
hosted its educational trips to the following countries: Guatemala; Peru; South Africa;
Morocco; Mexico; Bolivia; Madagascar; Zambia; Ghana; Ethiopia; Thailand; and
Puerto Rico (PAI, 2007).
An interesting turn of events in the Global Gag Rule fight can be found in the
successful lawsuit Pathfinder International pursued which allows them to still provide
abortions. Because Pathfinder is a US-based NGO, the Courts found that the Global
Gag Rule could not be applied to their services if they were using separate, private
funding for those services. They are currently the only US-based NGO that receives
US funding and still provides abortions while the Global Gag Rule is in effect,
because the courts have upheld their constitutional right (as a US-based NGO) to
provide services with their own, separate money. These monies are gained through
private foundations, individual donors, and other donor governments such as Sweden
and Denmark.
47


Aside from their legal challenges to the GGR, both Pathfinder and PA1 have been
working during this phase of the policy to gather more evidence of the impact of the
policy. They are major partners along with Ipas and several other NGOs in the
Global Gag Rule Impact Project' (GGRIP) (see upcoming section on the project).
Although Pathfinders Hesse and Ipas' Crane note that it is virtually impossible to
document how many abortions weren 7 performed because of the policy, they report
that the project has instead focused on impacts such as clinic closings, losses of
contraceptive supplies, and the like. Hesse says staff at Pathfinder were shocked
how widely the material (from the GGRIP) was used around the world and reports
that it is especially utilized in Europe to demonstrate how US-based SRHR NGOs
have mobilized against a restrictive SRHR policy. Ipas' Crane reports that the
GGRIP data has been the only research of its kind to have been consistently utilized
throughout the world to report on the impacts of the GGR. Crane reports that the
success of the GGRIP has spawned follow-up efforts of other Bush-initiated SRHR
policies to demonstrate their impacts. Hesse notes that when the GGRIP was
developed in 2001, Pathfinder was concerned about the political ramifications it
might produce under the Bush administration, but they have been pleasantly surprised
at how well documenting the impacts has worked in influencing policymakers,
private funders, and other donor governments.
Work with Funders
The NGOs interviewed for this study identified several different current sources
of funding for international family planning funding. As noted in the previous
chapter, private foundations have continued to be major benefactors with the Gates,
the Hewlett and the Packard foundations being listed as the most instrumental during
this period. The NGOs interviewed point to a number of funding sources the SRHR
movement has turned to in lieu of US funding: other donor governments (especially
the Europeans); measures such as the Safe Abortion Action Fund implement by the
UK government; increased donations to UNFPA by other countries; and individual
donors.
Work at the U.N.
The changing climate at the UN during the Bush era has been widely documented
in regard to SRHR (Benen, 2004, Buss and Herman, 2003, Chappell, 2006). PAI's
Lasher says their organization has gone from partnering with the US delegations to
the UN to a 180 degree change" whereby the US delegation consists of anti-choice
governmental representatives teamed with like-minded NGO staffers while pro-
48


choice NGOs are left on the sidelines. Lasher lists Concerned Women for America
and Focus on the Family as two of the major anti-choice NGOs that regularly team
with US governmental delegations to the UN. Hesse from Pathfinder reports that her
organization has not noticed many climate changes at the UN, where they mainly
work with UNFPA. Crane from Ipas says that she feels that the UN has not been
intimidated by Bush in regard to international SRHR issues. Crane feels that the
challenges have been found more in the UNs trend toward integrating HIV/AIDS
funding and programming with other SRHR, which Ipas is against because of its
shortchanging of focus and dollars for the two issues.
Within the UN, the UNFPA is a distinct organization with its own leadership
changes and socio-political challenges during the Bush era. Barbara Crane from Ipas
reports that her organization's interaction with UNFPA has actually increased during
this era and that UNFPA has recently become more liberal on abortion after trying,
unsuccessfully, to get their funding reinstated by the Bush administration by taking a
more conservative approach during the first four or five years of the administration.
She says that European donor governments have pushed hard for UNFPA to be in line
with the Cairo programme. Crane reports that UNFPA is now tackling such
progressive issues as combating sexual violence in Latin America and promoting
miscarriage and post-abortion care through Manual Vacuum Aspiration, a highly
affordable and safe procedure promoted within the SRHR movement. However,
Crane is concerned that, with the new UN leadership and reform process after
Secretary General Kofi Anans departure, UNFPA may be left with less autonomy.
She reports that there is discussion among SRHR movement actors to establish a new
women's agency at the UN that could tackle these and other issues.
Successes
PAIs Lasher and Ipas' Crane note several successes that they feel the
movement has experienced during the Bush era: the UK and 1PPF creating the Safe
Abortion Action Fund; other donor governments increasing their UNFPA
contributions and their funding of NGOs; and support from the Gates, Hewlett, and
Packard foundations. Lasher adds the following successes for his organization:
heading off the application of the GGR to PEPFAR funds and getting progressive
language into this year's foreign appropriations bill that addresses the need for
increased family planning funding, the elimination of donated contraceptive supplies
under the GGR, and the abstinence-only earmark under the PEPFAR AIDS plan.
Crane adds as major victories during this period: getting the World Health
Organization to include RU-486, the early abortion pill, on their approved
49


medications list and the WHO endorsing Manual Vacuum Aspiration as a viable
early- and post-abortion method.
Cara Hesse from Pathfinder says that successes have been few and far
between during the Bush era, but one that her organization has celebrated has been
their successful lawsuit against the anti-prostitution pledge in PEPFAR funding in
2006. Due to the fact that so many SRHR and H1V/AIDS NGOs work with
prostitutes to try to stop the spread of HIV/AIDS, NGOs were vehemently opposed to
the Bush administrations policy that NGOs that received PEPFAR funding had to
take an oath to be against prostitution (and, some would say, against prostitutes
themselves). As a result of Pathfinder's lawsuit, US-based NGOs will now be able to
speak out against the policy, work with prostitutes, and not have to make an anti-
prostitution pledge if they provide services to prostitutes with their own private
funding. The government was ordered by the Court to develop regulations for these
NGOs to work with these clients through a separate organization with non-
government funding.
Work in the New Congress of2007
In this year's Congress, Pathfinder and PAI have been fighting to exempt
contraceptive supply cuts from the GGR through the Foreign Appropriations Bill,
finally getting the issue further advanced in the new, Democratic-controlled, pro-
choice majority Congress of 2007. Other legislation that both NGOs are fighting for
this year include the elimination of restrictions on PEPFAR (AIDS) funding that call
for one-third of the funding to be restricted to abstinence-only programming and the
reinstatement of UNFPA funding from the US, possibly with a measure that excludes
funding for China. President Bush has vowed to veto any and all legislation that
would include these measures. Cara Hesse from Pathfinder sees a veto by Bush as an
opportunity for the SRHR movement to get the message out about the extreme
positions of the administration. Barbara Crane of Ipas feels that many SRHR allies
lobbying against the SRHR restrictions in the Foreign Operations Bill this year played
into the conservatives' perspective by taking the more moderate position of focusing
on family planning and not being willing to talk about abortion. She says that this
kind of watering down' occurs frequently with other policies and funding issues,
demonstrating the split between organizations such as Ipas who feel that SRHR
advocates should not deviate from pushing for full SRHR, including abortion, and
those that feel they are being more strategic by fashioning their message for a more
conservative era. Ipas Crane is hopeful that abortion rights might be advanced in
this years Congress through the Boxer-sponsored Global Democracy Protection
Act, which essentially repeals the Global Gag Rule. Both Crane from Ipas and
50


Lasher from PAI think that the most impactful future occurrence for the SRHR
movement in regard to international family planning would come in the form of
having a pro-choice Democrat in the White House, with Lasher noting the possibility
of (pro-choice) Republican presidential candidate Rudy Guliani.
Conclusion
This chapter provided an analysis of the Movement Action Strategies the
SRHR movement utilized during the George W. Bush era. The three categories of
frames the SRHR movement has utilized during the Bush era to advance their issues
have run the gamut from a more conservative- and neo-liberal- minded approach
designed to speak the language of the Bush administration to the more progressive
frame of challenging the administration's approaches to SRHR by demanding a focus
on results and scientific data. The SRHR movement utilized four main action
strategies to advance their cause during the Bush era: fighting for their cause in the
US Courts and Congress; working within the UN system; obtaining new funders; and
producing research impact reports. Many NGOs within the SRHR movement had
success with obtaining new funders and maintaining their presence at the UN and in
international activities while most made little progress (until the new, Democratic-
controlled Congress of 2007) in the US Courts and Congress. Producing research
reports of impact from restrictive international family planning policies and funding
decisions, such as the Global Gag Rule, were proven to be a powerful tool for several
NGOs who gained media attention and support from non-US donor governments
because of their findings.
51


CHAPTER 4
ACHIEVEMENTS, CHALLENGES, AND THE FUTURE
In this paper, I have utilized social movement and political process theory to
examine how a social movement has responded to extremely negative political
opportunity structures. In the social movement literature, the political context in
which a movement operates within is referred to as the political opportunity structure,
a concept that emphasizes the opening up and closing down of a social movement's
opportunities for action within a particular political context (Tarrow. 1998, Me Adam,
et al, 1996). In Chapter Two, I explored the setting in which the SRHR movement
has operated within during the George W. Bush era. I defined and described three
key components of political opportunity structures for this study: changes in political
alignments and conflicts; access to institutions; and influential allies and opponents.
Strongly conservative, patriarchal, religious fundamentalist worldviews from
both the Bush administration itself and on the international stage have forced the
SRHR movement to operate in a predominantly reactive nature. The election of a
religious fundamentalist, neo-liberal conservative in George W. Bush and the
concurrent international trends toward an era of increased globalization, growing neo-
liberalism, and a rise in religious fundamentalisms were significant factors in the
era's political alignments and conflicts. Access to institutions for the SRHR
movement greatly diminished during this time, both in Washington and at the UN.
Influential opponents far outnumbered allies, with the Right to Life movement
being greatly enabled by the Bush administration, the largest opponent to SRHR. The
SRHR movement was able to keep and even expand many of its allies during this
time, namely domestic pro-choice congresspersons, private donor foundations, and
foreign donor governments. The SRHR movement was able to effectively team with
these allies because the Bush administration did not have a great deal of influence
over these entities as a group.
The political opportunity structures that have existed during the Bush era, as
described in Chapter Two, have in turn very strongly shaped the tactics, strategies,
and responses that the SRHR movement has utilized. In Chapter Three, I explored
the mobilizing or movement action strategies that the SRHR movement utilized to
frame their issues and advance their cause during the Bush era. This included an in-
depth description of the key actors in the SRHR movement during this time, as well
as the strategies and actions they have employed to strive for their goals. Research
conducted in this area included phone interviews with spokespersons from three
NGOs who serve as central actors in the SRHR movement.
52


The three types of frames' the SRHR movement has utilized during the Bush
era to advance their issues have run the gamut from a more conservative- and neo-
liberal- minded approach designed to speak the language of the Bush administration
to the more progressive frame of challenging the administration's approaches to
SRHR by demanding a focus on results and scientific data. The SRHR movement
utilized four main action strategies to advance their cause during the Bush era:
fighting for their cause in the US Courts and Congress; working within the UN
system; obtaining new funders; and producing research impact reports. Many NGOs
within the SRHR movement had success with obtaining new funders and maintaining
their presence at the UN and in international activities while most made little progress
(until the new, Democratic-controlled Congress of 2007) in the US Courts and
Congress. Producing research reports of impact from restrictive international family
planning policies and funding decisions, such as the Global Gag Rule, were proven to
be a powerful tool for several NGOs who gained media attention and support from
non-US donor governments because of their research findings.
In this final Chapter, 1 will explore the achievements and ongoing challenges
of the work of the SRHR movement during the George W. Bush era. I will identify
and describe the main successes the movement experienced during this time, as well
as the ongoing challenges they face in the future. 1 will then explore the future
outlook for the movement, including the potential impacts of the new Democratic-
controlled Congress, the impact of a pro-choice President being elected in 2008,
possible alternative strategies for dealing with the restrictions of abortion policies
such as the Global Gag Rule, and the movement's work to be done on the
international stage, especially at UN conferences.
Movement Achievements
As evidenced in the phone interviews with spokespersons from several central
actor NGOs, successes have been few and far between for the SRHR movement
during the George W. Bush era. Perhaps one of the most significant shortcomings of
the movement during the Bush era has been their inability to overturn the Global Gag
Rule. However, there have been notable exceptions, as reported in the phone
interviews and in the literature documenting the movement's actions. These
successful exceptions have come in the form of countering further Bush
administration anti-choice policies, encouraging alternate sources of funding for
SRHR. finding and cultivating SRHR allies on the world stage to impact international
documents, and producing research studies documenting the adverse effects of the
Global Gag Rule. One of the major successes during this era was the revision of the
Millennium Development Goals (MDGs) to include universal access to reproductive
53


health by 2015" which was in line with the agreements made at the Cairo conference
in 1994. In light of the extremely negative political opportunity structures of the
Bush era, it seemed that the MDGs, as originally written with a lack of SRHR, would
be destined to turn back the clock' on SRHR in the developing world. However, the
success of the SRHR movement lobbying for and finally getting the revision in
2005/2006, shows the powerful impact that a resilient movement can have when
faced with overwhelming obstacles from one super powerful nation. In getting the
MDGs in line with Cairo, even four years after their original implementation, the
SRHR movement was able to undo some of the six years of damage the Bush
administration had tried to effect at UN conferences and in UN documents.
A few notable successes for the SRHR movement during the Bush era have
come in the form of successful lawsuits against the administration and actions taken
to impact Executive Branch policies. Perhaps the most successful legal action
occurred in 2006 when Pathfinder International (with others) was able to win a
lawsuit against the Bush administration regarding the anti-prostitution pledge in
PEPFAR (AIDS) funding (as discussed in Chapter 3). As a result of Pathfinder's
lawsuit, US-based NGOs who receive PEPFAR funding will now be able to speak out
against the policy, work with prostitutes, and not have to make an anti-prostitution
pledge if they provide services to prostitutes with their own private funding.
Although the decision leaves NGOs' work under US funding in a gagged' position,
the Courts decision can be seen as a small victory considering NGOs can use private
funds to do the work instead. SRHR NGOs are hoping that, in having the Courts
affirm that such policies violate US-based NGOs' first amendment rights, the Courts
might eventually hold that these types of policies are a first amendment violation
even for non-US-based NGOs who receive US funding.
Another success for the SRHR movement during the Bush era also involves
PEPFAR (HIV/AIDS) funding. Several of the central actor NGOs in the SRHR
movement worked furiously during the Bush era to make sure that the Global Gag
Rule would not also be applied to foreign NGOs who received PEPFAR funds. Due
to the fact that so many foreign HIV/AIDS NGOs who receive PEPFAR funding also
deal with family planning and abortion issues, this restriction would have put an
undue burden on an even greater number of NGOs who receive US funding, this time
in the form of PEPFAR funding. The World Health Organization, The World Bank,
the European Union, and even USAID were cited by the movement as expert sources
that maintained that the co-mingling of HIV/AIDS services with family planning
services is the international standard of care that should be followed (GGRIP, 2004b).
Many of these NGOs are already severely impacted by the loss of family planning
funds due to the GGR; a loss of PEPFAR funding would ensure a severe drop in
HIV/AIDS services because the US is such a major funder in that issue area as well.
54


SRHR NGOs were able to take a pro-active approach and publicize the grave
consequences of such a policy decision and ensure that it was not instituted.
Finally, and perhaps most importantly in our world of results- and outcome-
driven funding and programming, the SRHR movement successfully conducted and
presented empirical research regarding impacts from the Global Gag Rule. The
movement was able to mobilize a coalition of SRHR NGOs that included researchers
and ground-level staffers to implement comprehensive impact studies in more than
nine different developing nations that depend on US population assistance funding.
They were then able to use the findings to spread the word about the impacts of the
policy to the general public, the media, private funders, developing nation
governments, and other donor governments. Their work was probably more
successful during this era due to increased access to the low-cost media of the World
Wide Web and video and DVD technology. Due to the work of the Global Gag Rule
Impact Project, many non-US donor governments were willing to increase their
funding in several areas. First, to UNFPA to make up for the shortfall caused by the
elimination of US funding (although UNFPA does not fund abortions, they trust that
the NGOs they fund will use separate monies for abortion services). Secondly, many
non-US donor governments as well as private funders, increased their funding to
individual NGOs to make up for the shortfall caused by the GGR. Lastly, several
European donor governments teamed with the UK and IPPF to create the Safe
Abortion Action Fund to fund the lack of abortion and family planning services
created by the shortfall from the GGR.
Ongoing Challenges
The SRHR movement has several challenges they must face during the
remaining year and a half of the Bush era and possibly beyond, if another anti-choice
President is elected in 2008. Chief among those challenges is the continuing
existence of the Global Gag Rule. As yet, none of the movement's Court cases
against the policy have managed to overturn it, and Congress has not managed to pass
any legislation to overturn the policy. While the policy is in effect, millions of
women in developing nations are being affected every day by reductions in funding
for SRHR NGOs resulting from the Global Gag Rule. Leaders from the SRHR
movement argue that unsafe abortion, pregnancy, and childbirth are leading causes of
death in the developing world, and if healthcare providers cannot provide safe
abortions, women are dying. Until George W. Bush is out of office, it is highly
doubtful that the Congress could pass veto-proof legislation to overturn the Global
Gag Rule. Only when and if a pro-choice President is elected, can the movement
have any chance of overturning the policy. Even in that case, a pro-choice majority
55


in Congress is virtually required, because of their power to enact similar legislation if
they so wish.
It is doubtful that the movement will have much success in diminishing the
influence of the Bush administration in regard to international family planning
funding before 2009. Thus far. Congress has been unable to reinstate UNFPA
funding or donated contraceptive supplies under the Global Gag Rule. They have
also not been able to remove the abstinence-only restrictions on one-third of PEPFAR
funding nor reinstate any US funding for abortion services, which is restricted under
the Hyde Amendment (see upcoming section on the work of the 2007 Congress). The
Bush administration will most likely continue to push their anti-SRHR agenda at the
U.N. and in international forums, although their message looks like it might be met
with more resistance by an increasingly educated (international) public that is finding
itself at odds with the administration over several facets of US foreign policy.
Future Outlook
2007 Congress
The SRHR movement has reason to be excited by the 2006 elections that
changed the face of Congress to represent a Democratic, pro-choice majority. All of
the NGO spokespeople interviewed for this study expressed optimism that the new
Congress might be able to make some headway in turning back some of the
restrictions the Bush administration and the Republican-controlled Congress had
supported. However, at this juncture, after the 2007 Congress is almost through their
session, funding for international family planning under Bush does not look like it
will change. In President Bush's federal 2008 budget request, submitted in February
of this year, he called for a 25% decrease in funding for international family planning
and reproductive health, while US funding has decreased 41% since 1995 when
adjusted for inflation and the number of women in reproductive years in the
developing world has grown exponentially (Americans for UNFPA, 2007, PAI, 2007,
February 12).
Even though the new. Democratic-controlled Congress of 2007 now has a pro-
choice majority, it is seemingly not enough to override a Presidential veto. Despite
this fact, at the end of September, the Senate joined the House by passing their own
legislation on the Foreign Operations Appropriations bill that would reinstate donated
contraceptives to family planning providers under the Global Gag Rule and repeal the
mandate that one-third of PEPFAR funding go to abstinence-only programming. The
Senate bill went even further by adding a provision that would repeal the GGR
entirely. These actions represent the first time in either the first or current phases of
56


the Global Gag Rule that both houses of Congress have passed legislation to modify
or repeal the policy (PAI, 2007a). The White House has said the President will veto
the entire $34 billion Foreign Operations Appropriations bill if these provisions are
included (PAI, 2007a).
One of the measures SRHR NGOs had hoped might be victorious this year
was the reinstatement of UNFPA funding. Many NGOs and Congresspersons had
been pushing for the reinstatement with a compromise measure of a dollar for dollar
reduction of the total for the China contribution, where Bush maintains the
government is engaged in coercive population practices. This dollar for dollar
reduction would have allowed all other UNFPA funded countries to receive US
funding, but exempted China, where the Bush administration takes issue.
However, at the beginning of September, the Senate was unable to block the
Kemp-Kasten amendment7 from being attached to the Foreign Operations
Appropriations bill, and the President subsequently announced that he would again
deny all funding to UNFPA (Bromage, 2007, September 27, Hunter. Melanie, 2007,
September 14). The President instead re-directed the $34 million in funding
Congress had appropriated for UNFPA to USAID, which is in charge of
implementing the Global Gag Rule (Hunter, 2007, September 14). Interestingly, with
a very narrow Democratic majority in the Senate, the Kemp-Kasten amendment won
by only three votes while four 2008 Democratic Presidential candidates skipped the
vote (Bromage, 2007, September 27). If the Senators had voted against the
amendment, the President would not have had the legal recourse to withhold UNFPA
funding. Representative Carolyn Maloney (D-NY) said of Bush's action, A decision
to reverse five years of erroneous decisions to de-fund UNFPA could have restored
U.S. leadership in the eyes of the world on this critical issue. Instead, the Bush
administration has once again turned its back on the planets poorest and neediest
women" (PlanetWire, 2007, September 7). The total Congressionally appropriated
UNFPA funding eliminated to date by George W. Bush totals $195 million
(PlanetWire, 2007, September 7).
7 The so-called Kemp-Kasten Amendment, which was first introduced to block UNFPA funding in the
Foreign Operations Appropriations bill in 1985, stipulates that no funds can be allocated to any
organization or program which supports or participates in the management of a program of coercive
abortion or sterilization". It was first introduced in Congress in reaction to allegations of coercive
population policies by the Chinese government. (See Chapter Two for further discussion)
57


Pro-Choice President in 2009?
Most of those working in the SRHR movement are anxiously awaiting the
Presidential election of 2008 when George W. Bush cannot run again, and there is a
possibility to elect a Democratic, pro-choice President. If a Democrat were to win
office, Craig Lasher, senior policy analyst with NGO Population Action International,
foresees the now tradition continuing of a new, pro-choice President reversing all of
the tenets of the Global Gag Rule on their first or second day in office, on the
anniversary of Roe v. Wade, as was done in 1993 with Clinton (Lasher. 2007). A new
pro-choice President would also have the ability to once again make the US a global
leader in SRHR, standing firm on the promise of the Cairo Programme and now the
MDGs. However, without a concurrent pro-choice majority in the US Congress,
UNFPA funding would probably not be restored and the Hyde Amendment
prohibiting funding of abortions for poor women and other women receiving
federally funded healthcare would not be reversed. With a pro-choice Congress and
President, the SRHR movement would not have to worry about a Presidential veto
blocking legislation and funding passed by Congress, as they have for the past six
years.
New Technologies
Several actors within the SRHR movement have high hopes for the promise of
new technologies to combat illegal, unaffordable, and/or unsafe abortions. Manual
vacuum aspiration (MVA), sometimes called menstrual extraction is an early
abortion method in which lay people can be easily trained to perform the procedure
with low-cost equipment and without the need for or cost of general anesthesia. In
addition to using MVA in countries w'here early abortion is legal, MVA is also used
in the developing world to remedy complications from incomplete abortions or
miscarriages. The World Health Organization recommends MVA in the developing
world over the more involved, risky, clinic- or hospital-based, and prevalent abortion
method of dilatation and curettage (WHO, 2003). MVA equipment has been refined
in the past few decades so that it is safe, effective, and low-cost. Many of those on
the more progressive, or radical side of the SRHR movement wonder if future relief
from restrictions such as the Global Gag Rule and lack of funding for abortion
services might come in the form of new technologies such as MVA. MVA is seen by
some as a promising technological advancement for getting around national-level
laws and funding restrictions limiting abortion access.
Others wonder if relief from restrictive laws and funding restraints might come in
the form of pharmaceutical abortion. RU-486, or Mifeprex, is the early abortion pill
58


that has been available from France since 1988, China since 1992, and the US since
2000 (Wikipedia, n.d.). Mifeprex is available in several former Soviet block
countries, India, and several Asian countries, but South Africa and Tunisia are the
only African countries to allow it and is not approved in any South American or
Central American countries, or in Mexico (Wikipedia, n.d.). The advantages of
Mifeprex are that it is low-cost, heat stable, non-injectable, and is now listed on the
approved medications list of the World Health Organization after extensive lobbying
by the SRHR movement. Mifepristone, one half of the RU-486 treatment, is also an
incredibly effective agent to stop obstetric hemorrhaging after childbirth. The San
Francisco Chronicle reports, There are 14 million obstetric hemorrhages a year,
killing an estimated 128,000 women, almost all in the developing world, where most
births happen at home without skilled medical care. Severe postpartum bleeding is the
number 1 cause of maternal mortality worldwide: One woman dies every four
minutes (Wells, 2006, June 4). However, because of the fact that Mifeprex can also
be used for a non-surgical abortion, it is either not available or is severely restricted in
many developing countries.
Many individuals and organizations within the SRHR movement view these
abortion methods as being able to pul the power back into the hands of women, who
were the only reproductive health care providers for centuries prior to M.D.s entering
the field in the 20lh century. Barbara Crane. Executive Vice President with NGO Ipas
and a former US State Department family planning program staffer, sees promising
alternatives to the restrictions of the Global Gag Rule via MVA and pharmaceutical
abortion alternatives. She says that the evolution of technology changes the picture
so that it is harder for anti-choice actors to impose their agenda on women in the
developing world. Crane says that the more (MVA) instruments that are out there,
the better (Crane, 2007). She notes that manual and pharmaceutical methods result
in greater affordability, accessibility, and safety for women in developing countries.
It remains to be seen, however, whether women and/or practitioners will be willing to
use new technologies to circumvent the law if abortion is illegal in a particular area.
The prevalence of unsafe abortions and high maternal mortality in the developing
world may provide a breaking point at which women and providers are willing to do
whatever it takes to ensure that women avoid death and disability.
SRHR at Beijing+15 in 2010
Much of the progress made in the area of SRHR has occurred at UN womens
and population conferences since the mid-1970's. Of course, the Cairo programme is
the pre-eminent document for the SRHR movement, striving for universal access to
reproductive health care by 2015. Now that the MDGs have been aligned with Cairo,
59


the years following 2015 should provide major checkpoints to assess the success of
Cairo. There are two large SRHR conferences scheduled back to back this Fall in
London, the Global Safe Abortion Conference" and the Women Deliver"
conference, which will focus more on safe motherhood and SRHR in general.
Women Deliver" is co-sponsored by the UN and UNFPA as well as several NGO
central actors. The last major UN womens conference was held in Beijing in 1995,
but it was not succeeded by the usual large follow-up conference at its ten-year
anniversary due to the prevailing neo-liberal, religious fundamentalist world climate,
as discussed in chapter two. After the disappointment of the MDGs and the small
Beijing follow-up, many within the SRHR movement are questioning whether they
should abandon UN forums all together, while others are pushing for official
recognition of NGOs within the UN conference structure, to gain legitimacy for non-
governmental entities. There is quite a bit of talk within UN circles and NGOs that
work with the LIN about forming a womens agency at the UN, so that women's
issues are not left off the table when dealing with other UN issues. With the fifteen
year Beijing anniversary coming up in 2010, the SRHR movement is actively
contemplating what the worlds geo-political climate might hold at that time,
especially from the US. It will be interesting to see whether the movement decides to
hold a large follow-up conference at that time or once again downplay or abandon the
UN conference structure.
Conclusion
In this paper, I utilized social movement and political process theory to
examine how a social movement has responded to extremely negative political
opportunity structures. In regard to the Bush administration, the SRHR movement
was continually denied access to this most important institution. This lack of access,
and in fact, strident opposition to their cause, resulted in a standstill for the movement
as well as a fight to try to win back earlier gains. One significant exception to this
lack of progress during the Bush administration involved heading off the application
of the Global Gag Rule to PEPFAR/AIDS funding by enlisting the power of allies
within Congress, the World Health Organization, the World Bank, the European
Union, and USAID, among others. In this achievement, the movement was able to
see the power of enlisting allies from other social movements to advance their cause.
During most of President Bush's tenure, the Congress has been Republican-
led, which did not allow any room for the SRHR movement to make progress. Even
with a pro-choice majority in the Congress, there was not sufficient support to
override a Presidential veto. Starting in 2007, the movement had some opportunities
to make impacts in Congress, with the new, Democratic-controlled Congress. There
60


have been several bills drafted and moved through both houses that are reflective of
the movements goals, but it is doubtful that even this new Congress will be able to
override Bush's veto power.
During the Bush era, the UN has experienced a great deal of change and
turmoil, including the strong presence of neo-liberal and religious fundamentalist
actors. This climate was perhaps most clearly illustrated in the drafting of the
Millennium Development Goals that not only did not expand on the movements
goals, but didnt even include the Cairo programme agreed to by 180 countries only
six years earlier. If the tenets of Cairo had been included with the original MDGs, the
SRHR movement would have been able to spend more of their time working to meet
Cairos goal of universal access to reproductive health care by 2015 and less in
fighting to win back already-agreed upon commitments. With a great deal of vocal
opposition and work at subsequent UN conferences and meetings, the SRHR
movement achieved a monumental success in 2005/06 when they were able to revise
the MDGs to be in line with the Cairo programme.
Lastly, the movement was able to find some successes in exploring new
strategies to combat negative political opportunity structures. The US courts
represented one institution in which the movement was able to find success with
several lawsuits. The courts ruled in favor of movement actors when they were US-
based NGOs and had constitutionally protected rights, but did not extend favorable
rulings in matters of foreign policy and funding for non-US-based NGOs. The
movement is still striving for ways to ensure that these NGOs will have the same
rights to free speech and association that they enjoy. Another strategy the movement
found some success in during this era involved the acquisition of new funders.
Foreign donor governments and private foundations proved to be strong allies who
were willing to stand up to the Bush administration and increase their funding to
SRHR movement actors.
This study has shown that, regardless of the existence or lack of negative
political opportunity structures, a strong social movement can survive and even
thrive. The negative environment may, in fact, challenge the movement to pursue
additional actors and avenues for change that they might not have, had they been
operating during a time of positive, supportive political opportunity structures. A
negative environment can also allow a social movement to plan and strategize for
future action in an era of increased opportunity. Further study of eras of positive and
negative political opportunity structures for a particular social movement is needed in
order to fully assess their impact on a particular movements actions and success or
failure.
61


APPENDIX A
LIST OF ACRONYMS
C-FAMCatholic Family and Human Rights Institute (a non-profit)
CR UNChristian Right at the United Nations
DAWNDevelopment Alternatives with Women for a New Era (an NGO)
GGRGlobal Gag Rule; common name now used by SRHR activists for the
Mexico City Policy instated in 1984 at the UN International Conference on
Population in Mexico City.
GGRIPGlobal Gag Rule Impact Project
GNPGross National Product
ICPDInternational Conference on Population and Development (Cairo, 1994)
IFPInternational Family Planning
IPPFInternational Planned Parenthood Federation (an NGO)
MDGsMillennium Development Goals
NARALNational Abortion and Reproductive Rights Action League (as in
NARAL Pro-Choice America, the group's current title; a non-profit)
NGONon-Governmental Organization (usually referred to as non-profit
organizations in the US and NGOs elsewhere)
PAIPopulation Action International (an NGO)
PEPFARPresident's Emergency Plan For AIDS Relief (US funding program)
PPFAPlanned Parenthood Federation of America (a non-profit)
POSPolitical Opportunity Structures
PRIPopulation Research Institute (a non-profit)
RLMRight-to-Life Movement
RRAReproductive Rights Alliance (an NGO)
SRHRSexual and Reproductive Health and Rights (also used in reference to the
SRHR Movement)
UNUnited Nations
UN CRUN Christian Right (term used to characterize Christian Right social
movements work at and with the UN)
UN INSTRAWUN International Research and Training Institute for the
Advancement of Women
UNFPA United Nations Population Fund (formally UN Fund for Population
Assistance)
USAIDUS Agency for International Development
WGNRRWomens Global Network for Reproductive Rights (an NGO)
WHOWorld Health Organization
62


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