Q:  What do global warming and lack of access to reproductive health care have in common?

A: Midnight regulations that exacerbate both problems; dramatically increase the costs of cleaning up the mess; and violate women’s rights, in ways that are not even immediately apparent.

Among the parting gifts being left by President Bush for the American people is a policy severely restricting the ability of the Environmental Protection Agency (EPA) to regulate carbon dioxide emissions.  According to the Associated Press’s Dina Cappiello, outgoing EPA Administrator Stephen Johnson issued a memorandum last week that:

[S]ets an agency-wide policy prohibiting controls on carbon dioxide emissions from being included in air pollution permits for coal-fired power plants and other facilities [which] could give the agency a legal basis for issuing permits that increase global warming pollution until the incoming Obama administration can change it, a process that would require a lengthy rulemaking process.

Global warming is what many believe to be the most profound and encompassing challenge we face.  For the past 8 years we have done virtually nothing to accelerate the transition to a low-carbon economy.  The price of our inaction in the United States alone will far exceed today’s controversial bailouts.  According to a study by the University of Maryland’s Center for Integrative Environmental Research (CIER):

The economic impact of climate change will cost [individual] states billions of dollars, and delaying action will raise the price tag.

Our consume-now-pay-later-ignore-science-and-reality approach to energy use is costing us big-time.  The longer we wait to address the problem, the higher the economic costs we will pay, the more people displaced and environmental refugees created, the less sustainable the environment on which all human life depends.

Matthias Ruth, Director of CIER, states:

The national debate is often framed in terms of how much it will cost to reduce greenhouse gases, with little or no consideration of the cost of no response or the cost of waiting. Review and analysis of existing data suggest that delay will prove costly.

The same goes with health care.  The failure over the past 15 years to reform a broken health care system has left roughly 47 million Americans without health insurance, according to data from 2005 and increased, rather than decreased our health care costs.  The National Coalition on Health Care notes that:

our health care system is riddled with inefficiencies, excessive
administrative expenses, inflated prices, poor management, and
inappropriate care, waste and fraud. These problems significantly
increase the cost of medical care and health insurance for employers
and workers and affect the security of families.

Primary health care is in a shambles and access to reproductive health care declining, especially for lower-income women and youth.  Lack of investment and politicization of reproductive health care means it will take years of concerted effort to remedy the situation.  According to the Kaiser Family Foundation:

Experts predict that the current health care workforce will be insufficient to meet future health needs.  This is particularly a concern for services that are important to women such as primary care, mammography, obstetrics/gynecology, abortion and mental health.

In the face of these realities, what does the Bush Administration do?  It issues regulations that will actually further undermine women’s access to basic health care, and will spend at least $44 million dollars doing so.

In poorer countries, the situation is even worse.   Complications of pregnancy, childbirth, unsafe abortion and AIDS-related causes remain the leading causes of illness and death among women ages 15 to 49 throughout sub-Saharan Africa.  For all the money spent on HIV and AIDS by the United States, cuts in and politicization of international funding during the Bush Administration slowed progress on expanding access to basic reproductive and sexual health services, undermining already stressed health care systems.

With few choices outside marriage and childbirth, and lacking access to contraceptives, millions of women continue to face unintended pregnancy.  According to the Population Reference Bureau:

In sub-Saharan Africa, 23 percent of married women are using family planning—18 percent with a modern method and 5 percent with a traditional method.  However, an even larger percentage of women—25 percent—report having an "unmet need," meaning that they would prefer to stop having children or delay their next birth, but are not using any method of family planning.

The Bush Administration, for whatever kudos it has recieved on global AIDS, has utterly failed these women by denying them both the most basic of primary reproductive health services and the ability to make the most fundamental choices about their own lives.  What is more: Our global AIDS funding has been plagued by ideologically-driven "abstinence and faithfulness" programs that deny women the very access to information and services they need to avoid infection.

Noticing a theme?

Left unaddressed, unintended pregnancies due to lack of access to basic family planning services means fertility rates will remain unnecessarily high in many countries.  As tensions around the environment grow, population growth will once again become–indeed is already becoming–an increasingly prominent target.  Total global population is expected to grow from about 6.7 billion people today to over 9 billion in 2050.   In the seventies, eighties and nineties, many governments sought quick fixes to rapidly growing populations by turning to less-than-voluntary and sometimes outright coercive programs aimed at reducing birth rates….fast.  It is legitimate to seek to reduce population growth rates by attacking the root causes of rapid growth.  But having lost 8 more years in which we have largely failed to advance women’s rights, ensure equitable economic and social opportunities for women and girls, and provide basic reproductive choices, the essential factors driving population growth remain largely unaddressed.

In the absence of dramatic changes in our policies and our economy,
global warming will increase the burden of illness from infectious
diseases and respiratory illnesses, just one of the many ways in which
costs will rise.  Competition for the financial resources needed to
both catch up and keep up with healthcare and other economic and social
costs will undermine efforts to ensure all people have access to basic
preventive health care, including reproductive and sexual health health
care. 

This creates a vicious cycle.  It is all-too-easy for governments and politicians–and the public writ large–to forget what we did not do to avoid a problem in the first place, and instead turn their attention to the population growth (and immigration among other things) as *the* cause rather than a symptom.

We need bold action and uncommon partnerships to put solutions in place and quickly.  For much of the past 25 years the environment and reproductive
health communities have joined hands only intermittently and only then briefly,
like changing partners in a square dance meeting up and moving on.  But if we are all interested
in promoting human rights, public health and sustainability, we can no
longer address these problems in isolation.  History suggests that as
environmental problems get worse, women’s rights will suffer.

Can we avoid repeating history?  In the current environment, "bi-partisanship" means never having to bring to up difficult issues, making "sensible compromises" on women’s lives, and avoiding topics that might offend someone’s religious or moral objections (or in the case of global warming, might offend the drill-baby-drill and clean-coal contingents).  I worry if we continue on this path–addressing only the lowest common denominator forged by "compromise"–we will continue to ignore the root causes of our problems until it is too late.  This happened when we reauthorized US global AIDS policy and made compromises on women’s health to get "bipartisan support" to pass a bill we can’t fund now anyway.  It may happen on health care reform and foreign aid reform.  I hope not, but…

It is clear that progress in all of these areas will now be delayed even further by the time it will take to untangle the mess of regulations left behind by a weak and unpopular Administration in the midnight hour.  And unfortunately the knots are even tighter and more entwined than seems at first glance.  But beyond removing the immediate obstacles, aggressive action is needed across the board to get far beyond where we are today–on the environment, health care, and reproductive choice. 

We can’t revert to the silence on critical issues like reproductive health and rights and global warming to make sure "everyone is in the tent," ’cause the dirty secret is that women never got into that tent in the first place.  Our movements have to push to make sure we go well beyond "steady-state" funding for health care and frittering-around-the-edges changes in policy.  We can’t afford to see leave these issues in the silos in which they usually sit.  We need to take dramatic action and we need our new President to lead the way…without apologies for the fact that standing up for our core values is not "uncivil," even if others vehemently disagree.