EngenderHealth

EngenderHealth is a 501(c)(3) nonprofit organization based in New York, internationally active in contraception, HIV and AIDS, gender equity, obstetric fistula, sterilization, and other sexual and reproductive health (SRH) issues in 40 developing countries around the world.

Mission statement
From its website: "EngenderHealth works to improve the health and well-being of people in the poorest communities of the world. We do this by sharing our expertise in sexual and reproductive health and transforming the quality of health care. We promote gender equity, advocate for sound practices and policies, and inspire people to assert their rights to better, healthier lives. Working in partnership with local organizations, we adapt our work in response to local needs."

History
In the course of its existence, EngenderHealth has undergone changes in name and mission, reflecting internal debate, shifting policies, and adaptation to evolutions in public opinion and international awareness.

It was founded by Marion Stephenson Olden (née Norton), a eugenics-minded social worker, in 1937 as the Sterilization League of New Jersey (SLNJ) with the purpose "to aid in the preparation, promotion, enactment and enforcement of legislative measures designed to provide for the improvement of the human stock by the selective sterilization of the mentally defective and of those afflicted with inherited or inheritable physical disease."

Encouraged by the eugenic sterilization legislation enacted by Georgia in 1937, the SLNJ lobbied intensely, although unsuccessfully, between 1939 and 1942 for the passage of a state sterilization law in New Jersey and conducted an educational program of publications and exhibits designed to promote sterilization.

In 1943, the League was renamed Sterilization League For Human Betterment and decided to expand its activities nationwide. After objections from relatives of Ezra Gosney, founder of the Human Betterment Foundation, the name was changed again to Birthright, Inc.: a national, nonprofit, educational organization with the aim of promoting "all reliable and scientific means for improving the biological stock of the human race." When the Human Betterment Foundation was dissolved in 1943, its promotional activities for eugenic sterilization were continued through Birthright, which received most of the Foundation's records regarding its work on sterilization programs and also the (financial) support of such past Foundation-backers as C.M. Goethe, Paul Popenoe, and Lois Gosney Castle, who had succeeded her father in 1942 as head of the Foundation.

The Manhattan studio at the New York Academy of Medicine of Robert Latou Dickinson, who had been a member since 1943 and became the first chairman of the AVS Medical and Scientific Committee in 1949, served as new headquarters in 1950. That same year, Birthright was renamed the Human Betterment Association of America (HBAA).

After the Second World War, when the full scale of the Nazi eugenics program became apparent, organizations and persons promoting eugenic sterilization were under pressure to change their advocacy. This was also true for HBAA. Internally, the organization was nearly torn apart by debates, pitting eugenics-minded members against those who believed sterilization should be voluntary and available to anyone who wanted it, for personal or socioeconomic reasons. The latter philosophy prevailed, and in the 1950s the organization's mission changed to focus on rights, choice, and voluntarism. It discarded its eugenics rationale and condemned compulsion (legislative or otherwise) for sterilization.

In 1962, the organization's name was changed to the Human Betterment Association for Voluntary Sterilization (HBAVS). Although the organization attracted a number of prominent scientists and activists, its influence soared in 1964 when Hugh Moore, the wealthy inventor of the Dixie Cup and noted supporter of population control, threw his influence and money behind the group. Apart from financial support, Moore served as president from 1964 to 1969. Under his presidency, in 1965, the HBAVS was renamed the Association for Voluntary Sterilization (AVS). In 1969, AVS funded the first vasectomy clinic in the United States.

In the early 1970s, AVS supported the work of surgeons who were developing a new approach to tubal ligation (female surgical sterilization) called minilaparotomy, or "minilap." Prior to minilap, surgery for female sterilization often required women to remain in the hospital for up to a week. Minilap, however, could be performed under local anesthesia as an outpatient procedure, in basic health facilities without specialized equipment.

At the same time, AVS and its allies in the family planning movement launched an intensive campaign to promote sterilization. This led politicians and officials at the Office for Equal Opportunity to decide in 1971 to pay for sterilizations for low-income Americans, as well as inducing health insurance plans change previous policies and elect to pay for sterilization operations. Concurrently, AVS launched—together with the ACLU and Zero Population Growth—"Operation Lawsuit": a series of successful lawsuits against various U.S. hospitals for refusing to comply with patients' requests for sterilization. These campaigns resulted in the increasingly widespread acceptance in the medical profession that sterilization was an effective birth control method, and that sterilization decision making was purely a matter between patients and their physicians. AVS also worked to establish the first informed consent and client-counseling components in health services and produced one of the first manuals on family planning counseling.

In the same period, AVS focused increasingly on the international scene. In the changing atmosphere of the late 1960s and early 1970s, when the importance of population control and family planning in the Third World for U.S. foreign policy was being stressed, AVS became in 1972 for the first time the recipient of funding from the U.S. Agency for International Development (USAID). In its subsequent international activities, AVS became instrumental in the widespread acceptance and utilization of surgical sterilization. It is in large part due to its pioneering work that this is the most prevalent method of contraception worldwide.

In the 1980s, AVS helped pioneer a new method of vasectomy called "no-scalpel vasectomy" (NSV), which had fewer complications and healed faster than traditional vasectomies, making it more attractive for men seeking sterilization. In 1985, AVS introduced the technique in the United States.

AVS was renamed the Association for Voluntary Surgical Contraception (AVSC) in 1984. The next year, the nonprofit published a landmark reference book, Voluntary Sterilization: An International Fact Book, a comprehensive source of information about contraceptive sterilization around the world. It included reviews of service delivery, usage trends, laws and policies, research gaps, and more. This was updated in 2002 as Contraceptive Sterilization: Global Issues and Trends.

AVSC launched an international postabortion care (PAC) program in 1993 to reduce injury and death among women who undergo unsafe abortions. Since then, the program has been introduced in more than 30 countries. (The organization has never provided abortions.)

The organization changed its name to AVSC International in 1994. In 1995, AVSC published COPE: A Process and Tools for Quality Improvement in Family Planning and Other Reproductive Health Services, the first of its COPE methodology books. Developed through work in Kenya and Nigeria in the late 1980s, the name means "Client-Oriented, Provider-Efficient", and is a process "[to help] health care staff continuously improve the quality and efficiency of services provided at their facility and make services more responsive to clients' needs." Since then, the COPE methodology has been expanded to many other health services and adapted by many other organizations.

In 1996, AVSC also launched its unique Men As Partners (MAP) program, working with men to promote gender equality, reduce gender-based violence, and recognize their important roles in the health of their families and communities. Since then, MAP has worked in more than 15 countries in Africa, Asia, and the Americas.

Also in that year, AVSC introduced "facilitative supervision," an approach to quality improvement in health care service delivery. This methodology promotes "mentoring, joint problem solving, and two-way communication", and was formally described in the 2001 Facilitative Supervision Handbook.

With support from the Bill & Melinda Gates Foundation, AVSC partnered with four other international agencies in 1999 to launch the Alliance for Cervical Cancer Prevention (ACCP). Other partners include the International Agency for Research on Cancer (IARC), JHPIEGO (an affiliate of the Johns Hopkins University), the Pan American Health Organization (PAHO), and the Program for Appropriate Technology in Health (PATH).

To reflect the fact that its mission had expanded beyond sterilization, in 2001 the organization changed its name to EngenderHealth, adding the tagline "Improving Women's Health Worldwide," and introduced a new logo. Also that year, with additional support from the Bill & Melinda Gates Foundation, EngenderHealth published interactive courses on infection prevention within medical service settings. Designed to train medical workers and students, particularly in low-resource situations, the free online course (also available in Spanish) is currently the Internet's most popular resource for infection prevention techniques.

In 2002, EngenderHealth was awarded the United Nations Population Award for its contribution to family planning and reproductive health care in resource-poor countries. In recognition of this honor, Mayor Michael Bloomberg declared July 1, 2002, as "EngenderHealth Day" in New York City, and presented a certificate to the organization.

With funding from the U.S. Agency for International Development (USAID), EngenderHealth became the managing partner of the large-scale ACQUIRE Project (which stands for "Access, Quality, and Use in Reproductive Health") in 2003. This global project works in more than 20 countries around the world to improve family planning, maternal health, and postabortion care services. Other partners in the project include the Adventist Development and Relief Agency International (ADRA), CARE, IntraHealth International, Inc., Meridian Group International, Inc., the Society for Women and AIDS in Africa (SWAA), and SATELLIFE.

In the same year, also with funding from USAID, EngenderHealth became the managing partner of the AWARE-RH Project ("Action for West Africa Region -- Reproductive Health"), which works with governments, donors, and private institutions to improve access to health services, lower the costs of health care, and strengthen existing medical institutions in 21 West African countries. Other partners in the project include Abt Associates, the Academy for Educational Development (AED), and Management Sciences for Health (MSH).

In August 2005, another international family planning organization, DKT International, filed a lawsuit against USAID over a federal requirement that organizations receiving funding for HIV and AIDS work must adopt policies "explicitly opposing prostitution and sex trafficking." This policy was introduced in the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, and was commonly referred to as the "anti-prostitution loyalty oath" (or "pledge"). In its suit, DKT asserted that this requirement was unconstitutional, and a violation of its First Amendment rights. EngenderHealth participated by providing a detailed court statement in support of DKT. In 2006, U.S. District Court sided with DKT, ruling the requirement unconstitutional; however, this was overturned in March 2007 by a U.S. Court of Appeals. DKT continues to fight the decision.

Also in 2005, EngenderHealth was the subject of an investigation by the Office of the Inspector General (OIG) of USAID, for improper management of government funds. The nonprofit denied wrongdoing. However, it entered into a settlement with the OIG: first, to repay the U.S. government for the amount in question, and second, to join an Organizational Integrity Agreement with the OIG and work with an independent monitor to oversee compliance. By 2007, the OIG had concluded that EngenderHealth was in full compliance and withdrew the oversight.

EngenderHealth's Men As Partners program continued to expand during this time. For example, at the XVI International AIDS Conference in 2006, EngenderHealth was one of five finalists nominated for the Red Ribbon Award: Celebrating Community Leadership and Action on AIDS for its MAP work in South Africa to engage men in HIV and AIDS prevention and reducing gender-based violence. Also that year, EngenderHealth and Instituto Promundo founded MenEngage, an international alliance to promote "research, advocacy, and interventions that encourage men and boys to increase gender equality."

In 2008, EngenderHealth recognized its 65th anniversary. The organization also launched a new logo, visual identity, and tagline: "for a better life."

Also in 2008, both USAID and EngenderHealth announced that the nonprofit had become the managing partner of the Fistula Care project, the largest international project ever to focus on the treatment and prevention of obstetric fistula.

Current program areas

 * Family planning
 * Informed choice and consent
 * Long-acting and permanent methods (LAPM) of contraception
 * Obstetric fistula prevention and treatment
 * Postabortion care
 * Eclampsia and pre-eclampsia prevention and treatment
 * Prevention of mother-to-child transmission (PMTCT) of HIV
 * Emergency obstetric care
 * Postpartum hemorrhage prevention and treatment
 * Cervical cancer prevention and treatment
 * HIV and AIDS prevention and treatment (also other sexually transmitted infections (STIs)
 * Reducing stigma and discrimination against HIV-positive individuals
 * Male circumcision as a way to reduce HIV transmission
 * Integrating HIV, AIDS, and STI counseling/treatment services with family planning services
 * Improving gender equality and reducing gender-based violence
 * Improving the quality of health service delivery
 * Advocating in the U.S. and elsewhere for policies supporting this work

Prominent members

 * Margaret Sanger, birth control activist.
 * Robert Latou Dickinson, gynecologist and sex researcher.
 * Alan Guttmacher, American physician.
 * Joseph Fletcher, pioneer in the field of bioethics.
 * John Rock, one of the inventors of the birth control pill.
 * Paul R. Ehrlich, entomologist and author on the subject of human overpopulation.
 * Brock Chisholm, first director-general of the World Health Organization and honorary president to the AVS in the early 1960s.
 * Paul Blanshard, American journalist.
 * Harry Emerson Fosdick, American clergyman.
 * Hugh Moore, American entrepreneur.
 * Isaac Asimov, author and professor of biochemistry.
 * Mary Dent Crisp, co-chairwoman of the Republican National Committee.
 * Millicent H. Fenwick, Republican representative from New Jersey and U.S. ambassador to the United Nations Agencies for Food and Agriculture.
 * Garrett Hardin, ecologist and microbiologist.
 * Abigail Van Buren, author of the "Dear Abby" syndicated personal advice column.
 * Edward P. Morgan, journalist and anchor of the ABC Evening News.
 * Allan G. Rosenfield, MD, Dean of the Mailman School of Public Health at Columbia University.
 * Nafis Sadik, MD, Special Advisor to the UN Secretary General and former head of the UNFPA.
 * Janice Hansen Zakin, MD, associate at NASA Ames Research Center.
 * Brenda Jackson Drake, JD, director of the Public Health Trust.
 * Rosemary Ellis, editor-in-chief of Good Housekeeping magazine.