A challenge to Clinton on GHI, family planning

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For US government officials, sometimes the most challenging questions don’t come from reporters. They also can come from US government workers.

At the second “Town Hall” meeting rolling out the Quadrennial Diplomacy and Development Review (QDDR), Secretary of State Hillary Clinton gave an overview on Friday to a large gathering at the U.S. Agency for International Development (USAID). She had earlier presented it to the State Department.

During the question-and-answer session, from the back row of an auditorium, Megan Schmitt, a fellow in USAID’s Bureau of Global Health, stood and said she had a question about the Obama administration’s Global Health Initiative.

On page 76 of the QDDR, she said, the document lays out the five pillars of the Global Health Initiative: disease prevention, health systems, maternal and child health, neglected tropical diseases, and increased research and development.

But why, she asked, was there no mention of family planning?

“Family planning has been, and remains, a key part of this agency’s work in global health and is also a key component of the GHI,” she said. “So I’m wondering, given that, and, Secretary Clinton, given your own demonstrated commitment to family planning and reproductive health issues, why family planning isn’t recognized here and, indeed, seems to sometimes be left out of public messaging around an initiative that is part of the QDDR.”

The audience applauded.

Clinton responded: “We consider family planning part of maternal and child health, and we think it’s important to make it clear it’s not some special program that we’re advocating for. It is an integral part of taking care of women and girls. And from my perspective when Raj (Rajiv Shah, USAID administrator) and I have talked about investments that could make a real difference quickly, family planning is at the top of the list.”

She continued: “So we are 100 percent committed to family planning, but we concluded  and we think we have a stronger case to make if we continue to say family planning is not something separate from taking care of women and girls. So that was the decision we made, and it was meant to actually more strongly embed family planning in our health agenda, because we also think it’s an economic issue, and it’s an empowerment issue, and it’s an issue that cuts across much of what we do in development work.”

Shah also responded: “I would take it to the next level and say if you look at the actual breakdown within the GHI of where we’re driving investments, the goal is to pick those areas that are most likely to generate the biggest return in terms of health and population well being. And family planning, maternal, child health is the single area that gets the biggest percentage increase, if you take nutrition out, because nutrition started at such a low base.”

Clinton wasn’t through, either: “In fact, one of the things that Raj and I have done is to change some of the policies we inherited to enhance the delivery of family planning and to make clear that family planning is a priority across all development missions. And there needs to be a lot more thought given as to how we effectively support family planning.”

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