Interview with Dr. Anne Peterson
Assistant Administrator, Global Health
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| SOURCE:
USAID |
USAID’s Assistant Administrator
for the Global Health Bureau, Dr. Anne Peterson,
MD, MPH, spoke about the important role of
health in development assistance in general,
and the importance of family planning to women,
their families, and their communities in specific.
Dr. Peterson is the
Assistant Administrator for the Bureau for
Global Health for the United States Agency
for International Development, a position she
has held since 2001. Prior, she was commissioner
of the Virginia Department of Health. She also
has worked as a consultant for CDC and WHO
in health education, program evaluation, training
in epidemiology and social marketing, and she
has served as a medical doctor, both internationally
and in the U.S., spending almost 6 years in
sub-Saharan Africa on community development,
AIDS prevention, and epidemiology training.
Q. Why is health
care an important component in the development
process?
A. Strong, effective
health systems are important to U.S. development
efforts because of the inseparable links between
health and poverty, health and a productive
society, and health and social stability. Knowledge
and services lead to better overall health.
Q. Why are
family planning programs
part of the U.S.’s development efforts?
A. Few development programs
have made as significant a contribution to reducing
poverty and improving the quality of life around the
world as family planning. As access to family planning
has improved, women have been able to reduce the health
and mortality risks posed by pregnancy and childbirth.
In the US, birth is a normal process, we don’t expect
women to die. In the developing world, the risk of
dying because of complications from pregnancy is high.
This is because women in the developing world not only
have poorer health than do women in this country, but
also poorer health care. An estimated 15 to 20 million
women suffer painful and debilitating complications
from pregnancy and childbirth that impact the quality
of their lives and impede their contributions to their
families and communities. A healthy pregnancy, safe
childbirth and access to modern contraception are closely
associated with improved survival and health of mothers
and children.
The link between healthy mothers
and healthy children can’t be overlooked. Women in
the developing world, particularly if they are in poor
health or if they have their children too closely together,
are far more likely to have tiny, ill babies. If a
mother dies during or soon after childbirth, the odds
are overwhelming that her child will die before its
first birthday. The orphans that do live too often
receive inadequate care and are more vulnerable to
exploitation.
Family planning should be an
integral component of every comprehensive primary health
care package; it is a life-saving health intervention
and therefore is fully consistent with protecting life
and keeping families whole. The significant health
benefits associated with delayed pregnancy, birthspacing,
and the prevention of births to women who have had
many children or who are older are widely recognized
in the medical and public health communities. President
Bush himself has acknowledged that voluntary family
planning services are part of our nation’s proud history
of providing international health care assistance.
Q. Why is ensuring women’s
health important?
A. Women are the backbone of
most societies – as mothers, caregivers, household
managers, as participants in civil society, and as
contributors to formal and informal economies. In fact,
in the developing world, women do 90 percent of the
work, including most of the agricultural work. Without
good health care, and this must include reproductive
health care, they cannot make these contributions to
their families and their communities. With good health,
women can obtain a basic education and can pursue the
opportunity to earn income. Then a mother is more likely,
and better able, to provide these same advantages for
her children.
Women’s health is also an important
contributing factor to child health. When our investments
ensure these future citizens and leaders are healthy,
then they are more likely to be educated, productive,
and engaged in their country’s development. We can
start by ensuring children’s survival. USAID does a
great deal of work in preventing childhood diseases
that kill. But family planning, as I’ve mentioned,
plays a role too. Through family planning, women are
able to space their births for optimum mother and child
health. Birth spacing improves infant and child survival.
We’ve done interesting new research on this that shows
the benefits of spacing births. The research shows
that a child born 3 to 5 years after the birth of its
sibling is:
- about 2 ½ times more likely
to survive than children born at shorter intervals
- less likely to be malnourished
during infancy and through age 5
- suffer less from stunting (short
height for age) and underweight.
Other research shows that when
siblings are born too close together, less than 1 year
apart, both are at increased risk, with the older child
having a 77% higher risk of dying before age 5 than
when the younger one is born at least 2 years after.
Additionally, children born close together have higher
rates of malnutrition, which alone accounts for half
of all child deaths in developing countries.
Children born to teenagers are
more likely to die before their first birthday, and
children born to women over 40 and to women with 3
or more previous births are more likely to die before
the age of 5. In many countries, women marry while
still in their teens. Through access to contraceptive
services, women can delay their first birth and decrease
teen pregnancy, allowing them to give birth during
their healthiest reproductive years, between 20 and
40.
Family planning also can contribute
to strengthening families. Some of our very best examples
of improved communication in marriage have come from
our family planning programs. I saw dramatic examples
in Bolivia where men requested their own support groups
so they could learn about women’s reproductive issues
to better understand their wives and make their marriage
better.
Men and women in the developing
world want the same thing for their children as we
do: to have happy, healthy children who will grow strong
and live productive lives.
Q. Should family planning
programs be a funding priority during the HIV/AIDS
pandemic?
A. In Africa, half of new HIV
infections are in the 15-24 age group, with young girls
and women accounting for 75% of these. With a health
crisis as severe as HIV/AIDS, it is important that
all public health services be used in the fight. Integrating
HIV/AIDS prevention efforts into the existing family
planning programming makes sense for many reasons.
Women most often connect with healthcare through either
family planning or pregnancy services. Integrating
family planning and HIV/AIDS prevention will help us
reach women, who now comprise nearly half of all infections.
In addition, the HIV/AIDS burden
challenges weak national health systems. Protecting
women’s health and preventing HIV/AIDS transmission
through family planning and other health programs can
help slow the epidemic which is stressing fragile public
health systems.
Prevention is a powerful weapon
for fighting the HIV/AIDS virus. Family planning programs,
which serve millions of women in the developing world,
can help women and couples protect themselves through:
- Counseling young people to delay
sexual initiation
- Counseling sexually active women
and couples to reduce the number of partners
- Helping with risk assessment
and advising sexually active women and couples
to use condoms when appropriate.
Women, especially young women,
not only are at risk of contracting infection, they
also bear much of the burden of caring for HIV-infected
family members and risk passing HIV on to their infants.
They often also have the least control over their risk
of contracting AIDS, for both cultural and economic
reasons. Because of this, many of our programs address
economic and social issues that make women vulnerable,
we involve men as well as women in supporting the health
and welfare of women and girls, and we have engaged
women's organizations in the fight against AIDS. Programs
need to bring about positive social change that eliminates
stigma and links health, gender, vulnerable lives,
and human legal rights in new and productive ways.
Q. What challenges lie
ahead?
A. There are many, but I’ll
mention two.
Sustainability. The poor may
always be with us. How do countries become independent
of foreign aid and develop the capacity to support
the health care needs – including family planning reproductive
health care – of their citizens? How big a percentage
need public funding – ours or host government- and
what kind of sustainable financing in public or private
sector can free countries from need for family planning
assistance in foreign aid?
I also am deeply concerned about
the impact of violence against women. Violence, and
the threat of violence, compromises women’s ability
to make decisions or to follow through on reproductive
health. The decision to space children or protect oneself
from HIV/AIDS shouldn’t result in physical harm. A
study in South Africa showed that that 1 in 6 sexual
acts begin in violence among married women. This is
astounding and awful. Women’s vulnerability to violence
is an area where we need to do much more learning and
programming.
March 2003
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