How will a Biden presidency influence reproductive and women’s health and development on the African continent?

How will a Biden presidency influence reproductive and women’s health and development on the African continent?
How will a Biden presidency influence reproductive and women’s health and development on the African continent?

Seamus Heaney, as quoted by US Presidential candidate, Joseph R. Biden, 21 August 2020, Democratic National Convention. While the combined histories of the United States and the countries Africa have been radically transformed over the past four centuries; the deepest continental connection has probably happened during the Presidency of Barack H. Obama, son of Kenyan father and an American mother. Obama’s Vice President and now President-Elect Joseph R. Biden and his Vice President, Kamala Harris – herself a daughter of Africa – will arrive in Washington, DC, with positive attitudes towards Africa that we expect to be reflected in a renewed US commitment to the continent.

History reminds us that from America’s original sin of enslaving Africans to more enlightened development alliances, the shifts and turns often reflect presidential leadership. For decades, the US has been the largest donor to the World Health Organization (WHO), the World Bank, United Nations health-related organizations; and has provided important leadership through Department of State Programs, the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC). In stark contrast, during the past four years, the Trump Administration dismantled Obama-era foreign policy, including funding for development and aid programs and retraction of the CDC’s global role in disease prevention and control. As President, Trump was uniquely disrespectful to the countries of Africa and his foreign policy motivations were nationalistic and isolationist.

Biden’s win signals to both the American people and the world at large a sea of change in political, economic, health, and global discourse. To start with, it is mostly likely that the Biden Administration’s tone towards Africa will mirror that of President Obama. However, Biden and Harris must move beyond Obama-era policies as Africa – like the rest of the world – recovers from the crippling COVID-19 pandemic; a scourge that is likely to carry with its widespread famine, further disease, and potentially, conflict. It is thus relevant to consider and track how the Biden Administration’s foreign policy will impact maternal and child health on the African continent. Biden and Harris bring to the Office decades of experience in the Senate and the White House. They are neither outsiders nor populists. The Biden-Harris Administration will most likely follow a moderate Democratic playbook, not dissimilar to President Barack Obama’s Administration. Joe Biden brings to the presidency a keen interest and solid background in foreign policy.

As a longtime member of the Senate Foreign Relations Committee, he is recognized as comfortably internationalist and a confidante of democratic leaders across the world. Of particular interest is how a Biden presidency will approach global diplomacy, health, climate, and development, primarily through the Department of State’s programs, but also through legislation that impacts the NIH international programs in the Fogarty Institute and the global reach of the US CDC. First and foremost, Biden will re-join the WHO; the Paris Climate Accord; return global status to the CDC; and work in consort with the World Bank, the UN, and other international programs. Of great import, Biden will lift the so-called “global gag rule,” which prevents foreign organizations receiving US aid from providing information, referrals, or services for abortion or advocating for access to abortion services in their country. Because abortions and post-abortion hemorrhage and sepsis are a major, yet preventable, killer of women in the African region, maintenance of access to skilled abortion can save women’s lives. During his campaign, Biden told the independent, non-partisan Council on Foreign Relations how the US should approach Africa, explaining that the US must resurrect programs to engage Africa’s youth, while prioritizing Africa’s economic growth by strengthening trading relationships; empowering African women; and demonstrating the American model of democracy1.

Also, President-Elect Biden’s wife, Dr. Jill Biden, has long held an interest in the health and education of African women and girls. She, accompanied by Catherine Russell, US Ambassador-atLarge for Global Women’s Issues, visited the Democratic Republic of the Congo, Sierra Leone, and Zambia in 2014. In 2016, they visited Ethiopia, Malawi, and Niger. They sought to engage government and civil society partners on issues for women and girls. They also focused more generally on girls’ education, hunger, and food insecurity. Joe and Jill Biden have clearly stated their belief in the importance of girls’ education, literacy, and leadership. US African policies, including President William J. Clinton’s African Growth and Opportunity Act, President George W. Bush’s Emergency Plan for AIDS Relief, and President Obama’s Power Africa program, and others, are generally considered to be successful in improving trade, health, and infrastructure. However, in the coming decades, a broader strategy is required as the world transitions to a green economy and peaceful management of China’s growing role on the African continent. In the next four years, President Biden will support renewed financial and moral commitment, although he will likely face debate from Republicans in Congress.

Even if there is a Democratic majority in the Senate, there are strident isolationist members who may use their perceived political mandates to either decrease or otherwise restrain international funding. A major task for the Biden Administration will be to reinvigorate the depleted Department of State to ease allies supportive of global health, and sustain funding for the US Agency for International Development (USAID), the Peace Corps, and the Fulbright Program. To this effect, Biden has already nominated the experienced former Deputy Secretary of State, Antony J. Blinken as Secretary, and a still-to-be named Assistant Secretary of State for Africa. The New York Times predicts that the credentials of Biden’s foreign policy team will calm US diplomats and global leaders. While we do not yet know who Biden will nominate as Assistant Secretary of State for Africa, Susan Rice held the office early in the Obama Administration. As recently noted by former Secretary of State Hillary Clinton, climate and global health are major international challenges, complicated by the effects of the COVID-19 pandemic3. To move forward, the State Department must rebuild its ranks by retaining and rehiring civil staff and hiring more Foreign Service Officers.

Similarly, Biden must reassemble the CDC’s Pandemic Response Team, created by President Obama in response to the Ebola epidemic. Biden, Rice, Blinken, and Biden’s other foreign policy advisors recognize the predatory nature of Chinese and Russian post-colonial interests in Africa. This understanding signals that the Administration will encourage development that supports African countries, including reinstatement of financial support to the African Union. In addition to rejoining the WHO, President Elect Biden and Vice President Harris will authorize funding and promote the work of major international institutions such as the UN Population Fund, UNICEF, and the International Planned Parenthood Federation. Over the years, these organizations have provided considerable succor to the most deprived citizens of the world. Only through tangible, measurable results in improving social justice and gender equality will the premise upon which Biden was elected become permanent. Public health experts are optimistic about how the new Administration will behave within the domains of modeling democratic behavior by working towards global health and development, social justice, racial equity, and gender equality; all issues that featured prominently in both the Biden campaigns and that of other Democratic legislative campaigns in 2020. Biden’s views on these issues anchored his victory and that of Democratic legislators. It can also be argued that the Biden win was a mandate against racism and sexism in the US and the world.

Taken as a whole, the Biden Administration’s policies can support overarching African development in tangent with maternal and child health programs. It will be crucial for the Biden Administration to understand the effect of the COVID-19 pandemic across Africa. At this writing, two or possibly three vaccines are likely to be approved and ready for worldwide distribution. A revised and re-structured CDC can be positioned to work with the WHO and non-governmental organizations to ensure distribution across the African continent.

This writer, in concert with the African Journal of Reproductive Health staff, welcomes the new administration, and is optimistic about how the US will engage with the world to reduce maternal and infant mortality and promote reproductive freedom and the reduction of violence against women, including abduction and slavery.