The Bush administration has gained notoriety for using women's health as a pawn in catering to its ultra-conservative political base. Particularly noticeable is its attempts to narrow the scope in which international agreements and agencies address sexual and reproductive health and rights, such as attempting to remove references to reproductive rights and access to reproductive health services in UN documents, cutting off U.S. funding for UNFPA, and trying to restrict WHO positions on abortion and generic drugs. To this administration, women are always dispensable.

Most recently, the Bush Administration has used its appointees to the World Bank—Bank president Paul Wolfowitz and U.S. Executive Director to the Bank's board, E. Whitney Debevoise—as conduits to impose its ideology on Bank policy

At the same time Wolfowitz came under fire for the Riza pay-raise affair, the Government Accountability Project exposed a leaked draft of the Bank's Health, Nutrition and Population Strategy (HNP Strategy) with virtually no references to family planning or sexual and reproductive health and rights (SRHR). The draft was reportedly "censored" by Juan José Daboub, who was appointed by Wolfowitz as managing director of the Bank. Daboub, former finance minister of El Salvador and said to be a member of Opus Dei, is a strong supporter of the Bush administration's anti-family planning policies. In separate but related incidents, Daboub sought to remove references to family planning from the country assistance strategy for Madagascar and attempted to water down references to "climate change" in the Bank's key strategy paper on the environment.

News traveled quickly and the International Planned Parenthood Federation and Center for Health and Gender Equity organized letter-writing campaigns to foreign affairs, health and finance ministers, asking them to pressure Bank Executive Directors (EDs) to include references to SRHR in the new HNP Strategy.

Bank officials responded that the leaked draft had been revised, and language referencing SRHR was restored. This revision was thanks to Heidi Marie Wieczorek-Zeul the German development minister who is an expert on Cairo and Beijing and a gender champion for the Bank. She successfully garnered support from the Norwegians and the British to re-insert SRHR references into the document.

Understandably, the Bank reached out to groups to try to calm the storm that was brewing, sharing excerpts from the revised document that mentioned SRHR. Bank officials met with some groups to hear their concerns, and in turn, groups got to hear Wolfowitz's rhetorical support for family planning and Daboub's recitation of his dubious memo denying allegations of tampering with text.

The new language that was inserted, however, was extraordinarily weak and unacceptable to SRHR advocates. Organizations sent letters to the EDs calling attention to the weak language and urged them to reject any document without strong language and a clear Bank endorsement for SRHR. A few groups worked quietly behind the scenes with Bank staff to influence the language.

As a result of the continuous advocacy inside and outside the Bank, and especially the pressure from European advocacy groups and European parliamentarians, a group of European EDs sent an office memorandum (PDF) to the vice president and sponsor of the Strategy document, rejecting the document and threatened postponing the April 24 board meeting if language was not revised. Consequently, the Bank produced another draft, this time with clear endorsement for SRHR.

Mission accomplished? Not likely. Now that Daboub's efforts were foiled, in came the U.S. ED, Debevoise, with further attempts to role back Bank policy on SRHR. Debevoise sought to insert the phrase "age-appropriate reproductive health care," which the Europeans rejected immediately because of the implications for the health and lives of young women and adolescents in developing countries. Debevoise also sought to replace reproductive health "services" with "care" and reproductive "rights" with "health."

Advocacy groups made a final attempt to save SRHR language by sending another round of letters to the EDs.

In the end, the U.S. ED was defeated and on April 30, the World Bank's 10-year Health, Nutrition and Population Strategy (PDF), was approved by the Bank's Executive Board, reaffirming the Bank's longstanding endorsement of the Cairo consensus and ensuring that the Bank would continue to devote financial and technical resources to sexual and reproductive health.

There is no doubt this was a victory. However, it is the kind of victory that is far too common under this U.S. administration—one where we simply hold our ground rather than actually make progress. Given the short time frame and the level of crisis, we needed a coordinated advocacy effort that was focused. In this instance, it was to ensure not only that the Strategy included references to SRHR, but that those references would have serious and effectual implications in the Bank and the field.

As a consequence of this narrow focus, we were limited in our victory. Instead of moving the Bank forward to include progressive language—like explicit support for access to safe abortion services and reference to the role of gender-based violence in the spread of HIV—we held the line—a line established 13 years ago. While we embrace the principles of the ICPD Programme of Action, it did not go far enough in 1994, and in 2007, we should be demanding so much more than what we achieved in Cairo.

The challenge now is twofold. As an advocacy community, we must monitor application of Bank agreements at the country and regional level and ensure that at the core of each country strategy is an effort to promote SRHR and women's fundamental human rights. We also need to continue to build and expand advocacy for SRHR so that we can move away from defending SRHR to advancing SRHR.