For sexual and reproductive health advocates across the globe the inauguration of President Obama promised great things. The Bush Administration’s policy line on sexual and reproductive health and rights at home and abroad has seen funding restrictions that undermined good public health policy and breached legal rights in other countries. Breaking news from the US appears to suggest that President Obama is taking the kind of bold leadership that has the potential to vastly improve sexual and reproductive wellbeing.

Access to safe abortion services
Unsafe abortion accounts for an estimated 13% of maternal deaths. It leaves many more women unwell and disabled. Under the Bush Administration the Mexico City Policy, or Global Gag Rule, mandated that US funds for family-planning services could not go to organizations that advocated, counselled or offered safe abortion. As a result many organisations stopped offering this service and an unquantified number of women turned to unsafe abortion. Every eight minutes a woman dies somewhere in a developing country due to complications from an unsafe abortion. She most likely had little money or support to obtain safe services. She probably first tried to induce a termination herself. Failing that she would have turned to an unskilled, but relatively inexpensive, provider.

An evidenced approach to HIV prevention
According to the 2008 UNAIDS report on the Global AIDS Epidemic there are approximately 33 million people living with HIV worldwide. Under the Bush Administration the President’s Emergency Plan for AIDS Relief has promoted abstinence only programmes for young people that have denied communities access to crucial information about HIV and AIDS and access to condoms. Condoms are key for protection from the sexual acquisition of HIV and they also help prevent other sexually transmitted infections which also cause ill health, including those that trigger cervical cancer, and can kill. Condoms also prevent unwanted pregnancies and the complications that arise from them. Other Bush Administration policies have prevented financing for needle and syringe exchanges for injecting drug users and forced organisations to sign up to ‘anti prostitution pledges’ that have led to a denial of access to medical services and encouraged stigma and discrimination against these already marginalised groups.

Change we quite like!
Breaking news from the US leads us to believe that one of Hillary Clinton’s first acts has been to ask Mark Dybul, US Global AIDS Coordinator, head of the office in charge of the President’s Emergency Plan for AIDS Relief, to submit his resignation. For more on this see Jodi Jacobsen’s blog on the website. On Friday President Obama, just like his predecessor President Clinton, overturned the Mexico City Policy by executive order. Further refinement of US policy related to sexual and reproductive health and rights – particularly as it relates to injecting drug use and sex work – would herald a welcome shift to evidence informed policy. As Ivan Lewis, Minister in the UK Department for International Development, commented yesterday in a meeting in London, President Obama is, “Sweeping away some of the ideological baggage that has got in the way of health education and prevention.”