During the Bush years the PEPFAR initiative began to provide drugs to those who are HIV-positive in Africa. However, the program did nothing to provide contraceptives to help slow the spread of the virus. Further, funding for family planning slowed during the Bush years.
The story makes the case that even though PEPFAR saved lives, the population boom made resources scarce for those lives to survive.
From McClatchy Newspapers, writer Shashank Bengali explains what effect the policy shift had on Africa's population.
Under President George W. Bush, the United States withdrew from its decades-long role as a global leader in supporting family planning, driven by a conservative ideology that favored abstinence and shied away from providing contraceptive devices in developing countries, even to married women.
Bush's mammoth global anti-AIDS initiative, the President's Emergency Plan for AIDS Relief, poured billions of dollars into Africa but prohibited groups from spending any of it on family planning services or counseling programs, whose budgets flat-lined.
The restrictions flew in the face of research by international aid agencies, the U.N. World Health Organization and the U.S. government's own experts, all of whom touted contraception as a crucial method of preventing births of babies being infected with HIV, the virus that causes AIDS.
The restrictions flew in the face of research by international aid agencies, the U.N. World Health Organization and the U.S. government's own experts, all of whom touted contraception as a crucial method of preventing births of babies being infected with HIV, the virus that causes AIDS.
The Bush program is widely hailed as a success, having supplied lifesaving anti-retroviral drugs to more than 2 million HIV patients worldwide.
However, researchers, Africa experts and veteran U.S. health officials now think that PEPFAR also contributed to Africa's epidemic population growth by undermining efforts to help women in some of the world's poorest countries exercise greater control over their fertility.
"It was a huge missed opportunity to integrate HIV/AIDS and reproductive health in ways that made sense," said Jotham Musinguzi, a Ugandan physician who heads the Africa office of Partners in Population and Development, an intergovernmental group that promotes sexual health in developing countries.
In some countries that received substantial PEPFAR funding, such as Uganda and Kenya, health surveys have found that fertility rates remained constant or even rose slightly over the past decade. In Uganda, where many men want large families and abortion is illegal except to save a woman's life, the average woman bears 6.7 children, one of the highest rates in the world.
This small nation of rolling hills and banana trees is at the epicenter of Africa's demographic boom. Uganda is roughly the size of Nebraska, but in 40 years its population is projected to triple to 96 million, surpassing Japan, according to the Population Reference Bureau, a Washington research center.
Stanching that tidal wave will require a dramatic increase in contraceptive use, currently practiced by only 18 percent of married women.
"There hasn't been a country in the world where the birth rate came down without it," said Carl Haub, a senior demographer with the population bureau.
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