Trends in retail sales of insecticide-treated nets and untreated nets in Tanzania: cross-section surveys.

BACKGROUND: The commercial sector plays a vital role in mosquito net ownership and access in Tanzania. The National Malaria Strategic Plan (NMSP) includes long-lasting insecticidal nets (LLIN) delivery through the commercial sector as a complementary mechanism. The NMSP aims to increase LLIN sales while decreasing untreated mosquito net sales. This survey aimed to track quantities, market share of different net categories, prices, and origins of mosquito nets in retail markets and to engage stakeholders to analyse market trends. METHODS: This mixed-method mosquito net retail outlet survey was conducted in mid-2021 in six and in mid-2022 in eight regions. Field teams identified net-selling outlets in major urban and peri-urban markets and used snowball sampling to identify additional outlets. A structured questionnaire was used, and photos of available mosquito net products were taken. Key informant interviews were conducted with wholesalers and retailers. The relative market share of a product was calculated by using the mean of each sales category as frequency weights. Qualitative data analysis was undertaken by summarizing common themes and observations based on the research question. RESULTS: A total of 394 and 1139 outlets were surveyed in 2021 and 2022, respectively. More than 96% of distributed brands in both years were untreated nets. The market share for untreated mosquito nets was 99.2% in 2021 and 88.3% in 2022. Bed net sales were seasonal, peaking in the rainy season and at the start of the school year. Leaked LLINs from the public sector comprised 0.3% of the market share in 2021 and 8.3% in 2022. Kigoma markets had the most significant frequency of leaked LLIN products. Legitimate LLINs were rare in 2021 (n = 2) and not found in 2022, despite the presence of a local LLIN manufacturer. A small number (n = 3) of untreated nets fabricated in China claiming to be LLINs were observed in 2022. CONCLUSIONS: Despite NMCP's strategic approach to increasing retail market share for legitimate LLINs, significant challenges remain. Efforts are needed to change the current situation given the context of large-scale public sector distributions of LLINs, the higher consumer cost of LLINs, the lack of bed net varieties. Improvement of registration process is recommended.

Exploring the increasing need for plasma collection: Perspectives of voluntary nonremunerated donors on payment for plasma in Canada.

OBJECTIVES: The aim of this paper is to understand how voluntary nonremunerated plasma donors in Canada view payment for plasma and the emerging commercial sector. BACKGROUND: There is a growing global demand for plasma, to produce plasma-derived medical products. Source plasma for these products is collected through voluntary nonremunerated donation, sometimes by a national blood service, or by a commercial plasma collector, remunerating donors. METHODS/MATERIALS: This paper presents findings from qualitative semi-structured interviews with source plasma donors in three new source plasma centres in Canada. Interview data were analysed using abductive analysis, an interpretivist approach that builds on grounded theory. RESULTS: This study indicates that there are a range of perspectives on payment for plasma and the emerging commercial sector, from disinterest in payment, to opposition to payment based on the belief that it could undermine donating to help others, and risk public health and safety. One fifth of participants are open to CBS paying donors if it is necessary to increase national sufficiency of plasma. Almost two thirds of participants are opposed to commercial plasma collection in Canada, claiming that it could undermine Canada's public healthcare system, raising questions about transparency and accountability of the commercial plasma industry. CONCLUSION: Findings point to important areas for future study, on publicly collected source plasma, the emerging commercial plasma sector, and the role of the donor as a social actor in a complex political system.

Reactions of industry and associated organisations to the announcement of the UK Soft Drinks Industry Levy: longitudinal thematic analysis of UK media articles, 2016-18.

BACKGROUND: The UK Soft Drinks Industry Levy (SDIL) was announced in March 2016, became law in April 2017, and was implemented in April 2018. Empirical analyses of commercial responses have not been undertaken to establish the scale, direction or nuance of industry media messaging around fiscal policies. We aimed to develop a detailed understanding of industry reactions to the SDIL in publicly available media, including whether and how these changed from announcement to implementation. METHODS: We searched Factiva to identify articles related to sugar, soft-drinks, and the SDIL, between 16th March 2016-5th April 2018. Articles included were UK publications written in English and reporting a quotation from an industry actor in response to the SDIL. We used a longitudinal thematic analysis of public statements by the soft-drinks industry that covered their reactions in relation to key policy milestones. RESULTS: Two hundred and ninety-eight articles were included. After the announcement in March 2016, there was strong opposition to the SDIL. After the public consultation, evolving opposition narratives were seen. After the SDIL became law, reactions reflected a shift to adapting to the SDIL. Following the publication of the final regulations, statements sought to emphasise industry opportunities and ensure the perceived profitability of the soft drinks sector. The most significant change in message (from opposition to adapting to the SDIL) occurred when the SDIL was implemented (6th April 2018). CONCLUSION: Reactions to the SDIL changed over time. Industry modified its media responses from a position of strong opposition to one that appeared to focus on adaptation and maximising perceived profitability after the SDIL became law. This shift suggests that the forces that shape industry media responses to fiscal policies do not remain constant but evolve in response to policy characteristics and the stage of the policy process to maximise beneficial framing.

"Conflicted" Conceptions of Conflict of Interest: How the Commercial Sector Responses to the WHO Tool on Conflict of Interest in Nutrition Policy Are Part of Their Standard Playbook to Undermine Public Health Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

Managing conflict of interest (CoI) among the interested stake-holders in nutrition policy is a vexed and controversial issue. This commentary builds on Ralston and colleagues' highly informative analysis of the 44 submissions to the World Health Organization (WHO) draft tool on preventing and managing CoI in national nutrition programs. The commentary proposes that the commercial sector actors are, by definition, too conflicted to objectively respond to the draft tool. The responses of the commercial sectors are predictable, as they mimic their positions during the prior negotiation for the development of the Framework for Engagement of Non-State Actors (FENSA). Their overall approach, and specific responses, are typical of the now standard methods of the ultra-processed food and beverage industry's 'corporate playbook.' In addition, Ralston et al's analysis raises a number of other issues, such as: why these corporations are so keen to be included in the world of multi-stakeholder partnerships, why so few member states responded to the draft tool, and problems with the term 'private sector.' The commentary ends with a suggestion for WHO to seek broader involvement from the 160+ member states who have yet to participate in the consultations regarding the draft tool.

Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool.

BACKGROUND: With multi-stakeholder approaches central to efforts to address global health challenges, debates around conflict of interest (COI) are increasingly prominent. The World Health Organization (WHO) recently developed a proposed tool to support member states in preventing and managing COI in nutrition policy. We analysed responses to an online consultation to explore how actors from across sectors understand COI and the ways in which they use this concept to frame the terms of commercial sector engagement in health governance. METHODS: Submissions from 44 Member States, international organisations, non-governmental organizations (NGOs), academic institutions and commercial sector actors were coded using a thematic framework informed by framing theory. Respondents' orientation to the tool aligned with two broad frames, ie, a 'collaboration and partnership' frame that endorsed multi-stakeholder approaches and a 'restricted engagement' frame that highlighted core tensions between public health and food industry actors. RESULTS: Responses to the WHO tool reflected contrasting conceptualisations of COI and implications for health governance. While most Member States, NGOs, and academic institutions strongly supported the tool, commercial sector organisations depicted it as inappropriate, unworkable and incompatible with the Sustainable Development Goals (SGDs). Commercial sector respondents advanced a narrow, individual-level understanding of COI, seen as adequately addressed by existing mechanisms for disclosure, and viewed the WHO tool as unduly restricting scope for private sector engagement in nutrition policy. In contrast, health-focused NGOs and several Member States drew on a more expansive understanding of COI that recognised scope for wider tensions between public health goals and commercial interests and associated governance challenges. These submissions mostly welcomed the tool as an innovative approach to preventing and managing such conflicts, although some NGOs sought broader exclusion of corporate actors from policy engagement. CONCLUSION: Submissions on the WHO tool illustrate how contrasting positions on COI are central to understanding broader debates in nutrition policy and across global health governance. Effective health governance requires greater understanding of how COI can be conceptualised and managed amid high levels of contestation on policy engagement with commercial sector actors. This requires both ongoing innovation in governance tools and more extensive conceptual and empirical research.

Microbial production of 2,3-butanediol for industrial applications.

2,3-Butanediol (2,3-BD) has great potential for diverse industries, including chemical, cosmetics, agriculture, and pharmaceutical areas. However, its industrial production and usage are limited by the fairly high cost of its petro-based production. Several bio-based 2,3-BD production processes have been developed and their economic advantages over petro-based production process have been reported. In particular, many 2,3-BD-producing microorganisms including bacteria and yeast have been isolated and metabolically engineered for efficient production of 2,3-BD. In addition, several fermentation processes have been tested using feedstocks such as starch, sugar, glycerol, and even lignocellulose as raw materials. Since separation and purification of 2,3-BD from fermentation broth account for the majority of its production cost, cost-effective processes have been simultaneously developed. The construction of a demonstration plant that can annually produce around 300 tons of 2,3-BD is scheduled to be mechanically completed in Korea in 2019. In this paper, core technologies for bio-based 2,3-BD production are reviewed and their potentials for use in the commercial sector are discussed.

A total market approach for condoms in Myanmar: the need for the private, public and socially marketed sectors to work together for a sustainable condom market for HIV prevention.

BACKGROUND: Concerns about appropriate pricing strategies and the high market share of subsidized condoms prompted Population Services International (PSI)/Myanmar to adopt a total market approach (TMA). This article presents data on the size and composition of the Myanmar condom market, identifies inefficiencies and recommends methods for better targeting public subsidy. METHODOLOGY: Data on condom need and condom use came from PSI/Myanmar's (PSI/M's) behavioural surveys; data for key populations' socioeconomic status profiles came from the same surveys and the National Tuberculosis Prevalence Survey. Data on market share, volumes, value and number of condoms were from PSI/M's quarterly retail audits and Joint United Nations Programme on HIV/AIDS (UNAIDS). RESULTS: Between 2008 and 2010, the universal need for condoms decreased from 112.9 to 98.2 million while condom use increased from 32 to 46%. Free and socially marketed condoms dominated the market (94%) in 2009-11 with an increase in the proportion of free condoms over time. The retail price of socially marketed condoms was artificially low at 44 kyats ($0.05 USD) in 2011 while the price for commercial condoms was 119-399 kyats ($0.15-$0.49 USD). Equity analyses demonstrated an equal distribution of female sex workers across national wealth quintiles, but 54% of men who have sex with men and 55% of male clients were in the highest two quintiles. Donor subsidies for condoms increased over time; from $434,000 USD in 2009 to $577,000 USD in 2011. CONCLUSION: The market for male condoms was stagnant in Myanmar due to: limited demand for condoms among key populations, the dominance of free and socially marketed condoms on the market and a neglected commercial sector. Subsidies for socially marketed and free condoms have prevented the growth of the private sector, an unintended consequence. A TMA is needed to grow and sustain the condom market in Myanmar, which requires close co-ordination between the public, socially marketed and commercial sectors.

An 8-week web-based weight loss challenge with celebrity endorsement and enhanced social support: observational study.

BACKGROUND: Initial engagement and weight loss within Web-based weight loss programs may predict long-term success. The integration of persuasive Web-based features may boost engagement and therefore weight loss. OBJECTIVE: To determine whether an 8-week challenge within a commercial Web-based weight loss program influenced weight loss, website use, and attrition in the short term, when compared to the standard program. METHODS: De-identified data for participants (mean age 36.7±10.3 years; 86% female) who enrolled in the Biggest Loser Club (BLC) (n=952) and the BLC's Shannan Ponton Fast Track Challenge (SC) for 8 weeks (n=381) were compared. The BLC program used standard evidence-based website features, with individualized calorie and exercise targets to facilitate a weight loss of 0.5-1 kg per week (-500kcal/day less than estimated energy expenditure). SC used the same website features but in addition promoted greater initial weight loss using a 1200 kcal/day energy intake target and physical activity energy expenditure of 600 kcal/day. SC used persuasive features to facilitate greater user engagement, including offering additional opportunities for social support (eg, webinar meetings with a celebrity personal trainer and social networking) endorsed by a celebrity personal trainer. Self-reported weekly weight records were used to determine weight change after 8 weeks. A primary analysis was undertaken using a generalized linear mixed model (GLMM) with all available weight records for all participants included. Dropout (participants who cancelled their subscription) and nonusage (participants who stopped using the Web-based features) attrition rates at 8 weeks were calculated. The number of participants who accessed each website feature and the total number of days each feature was used were calculated. The difference between attrition rates and website use for the two programs were tested using chi-square and Wilcoxon Rank Sum tests, respectively. RESULTS: Using GLMM, including weight data for all participants, there was significantly greater (P=.03) 8-week weight loss in SC (-5.1 kg [-5.5 to -4.6 kg] or -6.0%) compared to BLC participants (-4.5 kg [-4.8, -4.2] or -5.0%). Dropout rates were low and consistent across groups (BLC: 17 (1.8%) vs SC: 2 (0.5%), P=.08) and 48.7% (456/936) of BLC and 51.2% (184/379) of SC participants accessed the website at 8 weeks, with no difference between programs (P=.48). SC participants accessed the discussion forums, menu plans, exercise plans, and educational materials significantly more than BLC participants (P<.05). CONCLUSIONS: Using a short-term challenge with persuasive features, including online social support with endorsement by a celebrity personal trainer, as well as a greater energy balance deficit, within a commercial Web-based weight loss program may facilitate greater initial weight loss and engagement with some program components. The results support the need for a more rigorous and prospective evaluation of Web-based weight loss programs that incorporate additional strategies to enhance initial weight loss and engagement, such as a short-term challenge.

American businesses unite to fight HIV spread in Africa.

PIP: This article focuses on the formation of a Corporate Task Force on AIDS in Africa and will attempt to examine the role of American corporations in preventing the spread of HIV infection. The HIV/AIDS epidemic in Africa threatens to destroy any significant economic gain and would continually affect any American corporation doing business in Africa. The task force would examine and propose various courses of actions for American corporations. Although the corporate sector cannot solve the problem alone, they are expected to sponsor some of the innovative and progressive work on AIDS in Africa. Likewise, American private sectors take on the leadership role in the fight against AIDS. The first role of the task force will be to propose a unified business approach to assist US companies to have a positive impact in this issue at home and abroad.^ieng

India Prime Minister urges more awareness to control HIV.

PIP: With an estimated 3-4 million people infected with HIV, of whom half are aged 18-40 years, India should consider its HIV/AIDS epidemic as a national problem and address it accordingly. The disease also needs to be treated as a societal issue which affects the productivity of both economic and social sectors. The control of HIV and AIDS figures prominently in a new health policy currently being developed. At a seminar on AIDS, Prime Minister of India Atal Behari Vajpayee asked industry to supplement the government's efforts to spread awareness about AIDS. He stressed that business and industry need to seriously acknowledge the reality of HIV/AIDS and act to increase awareness about AIDS by spreading the message about prevention. Awareness is the key to prevention. Millions of HIV-positive people in India are afraid to seek medical care because of undue guilt and stigmatization. Also, young people should be taught about healthy sexual behavior and its implications. Vajpayee urged the minister of health to explore the possibilities of urgently developing an indigenous vaccine for AIDS in the most cost-effective manner.^ieng

HIV vaccine development: would more (public) money bring quicker results?

PIP: Globally, $200-250 million/year are devoted to HIV vaccine research. Most of those funds pay for basic research rather than product development. Moreover, most of the funds are aimed at the HIV strain commonly found in the US and Europe, and not at the strains common to Africa and other developing countries. While US President Bill Clinton set in 1997 a 10-year target for the development of an HIV vaccine, that target date is looking increasingly unlikely. International vaccine and pharmaceutical companies typically drive vaccine research and development. However, concern over the ultimate profitability of developing and marketing an HIV vaccine, and the fear of major litigation should an eventual vaccine go awry have caused such firms to shy away from investing large amounts of money into HIV vaccine development. These companies somehow have to be attracted back into the field. A World Bank special task force is slated to present its report by mid-1999 on possible funding mechanisms to promote HIV vaccine development. It remains to be resolved whether public funds could and should be used, perhaps through a pooled international vaccine development fund. 2 new International AIDS Vaccine Initiative projects are described.^ieng

Medical aid schemes respond to AIDS.

PIP: The insurance and medical aid industries reacted strongly in the 1980s to alarmist predictions of the likely impact of HIV upon employee benefits. Actuaries and accountants moved quickly to contain the risk, and most medical aid trustees quickly implemented a total exclusion of HIV treatment from their benefits. For more than 1 decade, it was argued that HIV/AIDS is a self-inflicted illness, often categorized with other STDs. In response, healthcare providers simply bypassed insurance restrictions and compensation limits by masking patient diagnoses to reflect pneumonia or other ambiguous, yet fully reimbursable, illnesses. Now, common sense has finally prevailed as a few managed healthcare programs are stepping forward to break the impasse. The largest such program is Aid for AIDS, run by Pharmaceutical Benefit Management Ltd. for schemes within the Medscheme Group. The Group built an entirely new, secure unit off-site from their normal branches to guarantee the confidentiality of patients' records and diagnoses, while treatment guidelines have been issued to every practicing physician in the country.^ieng

HIV / AIDS in the workplace: principles, planning, policy, programmes and project participation.

PIP: 15 years ago, most business, labor, government, and nongovernment representatives would have had only a small idea of what AIDS was, and let alone why it should concern them. However, companies have since lost top managers, workers have lost colleagues, and considerable time, energy, and emotion have been spent upon issues of illness and loss. Entire families have collapsed, as companies struggle against a background of chronic poverty. The HIV/AIDS pandemic has forced a reconsideration of whether disease prevention and health promotion are business concerns. AIDS causes illness, disability, and death to workers, as well as severe economic and emotional disruptions to their families. It also increases the cost of doing business. As South Africa faces a large epidemic, business must take prompt and incisive action against AIDS. A list of 10 workplace principles is presented and a 3-stage process recommended to ensure optimal workplace HIV/AIDS/STD and tuberculosis policies and programs.^ieng

Enhancing the care of people with HIV.

PIP: 30% of South Africa's adults are infected with HIV. Of those who have been infected with HIV, many have died and left behind orphans, making South Africa's large number of orphans one of the country's most important problems. As the number of people infected with HIV in the developing world has grown dramatically, the cost of their care has quickly surpassed regionally available resources. In countries where the HIV/AIDS epidemic is exacting the heaviest damage, most people have no access to antiretroviral therapies and routine prophylaxes against opportunistic infections. The search for cost-effective methods to treat and care for the ill has therefore become a global imperative. The Enhancing Care Initiative (ECI), a multinational program recently launched by the Harvard AIDS Institute, aims to improve the care of all HIV-infected people living in resource-scarce countries. Funded by an initial 5-year grant from the Merck Company Foundation, ECI is coordinated by the Harvard AIDS Institute. The core of ECI is its AIDS care teams, groups formed by, composed of, and led by people from the countries involved. The teams are comprised of regional experts in clinical care, epidemiology, international health, human rights, behavioral science, economics, political science, and public health working to initiate meaningful changes in regional AIDS policies.^ieng

Key policies emerging to govern delivery of family planning in Medicaid managed care.

PIP: Originally enacted in 1965, Medicaid is a joint federal-state program under which the federal government sets broad parameters for the delivery of health care and family planning, while individual states control program administration. Recognizing the evolution of Medicaid over the past decade from a program based upon traditional fee-for-service payments to one dominated by managed care, Congress, as part of the 1997 Balanced Budget Act, freed states from having to obtain federal waivers before insisting that Medicaid enrollees obtain their care through managed care systems. That freedom was granted, however, on the condition that states meet uniform minimum national standards for Medicaid managed care. In September 1998, the Department of Health and Human Services' Health Care Financing Administration (HCFA) published proposed federal regulations to implement the uniform standards. Public input on the rule was solicited throughout the fall, and the agency is now making final policy decisions. The proposed regulations are discussed as they relate to freedom of choice and direct access to family planning services, cost sharing, informing enrollees of their rights as Medicaid recipients, and the provision which allows entire Medicaid managed care plans to refuse to provide, reimburse for, or provide coverage of a counseling or referral service based upon religious or moral grounds.^ieng

MMV: New Medicines for Malaria Venture.

PIP: New Medicines for Malaria Venture (MMV) is a public/private, nonprofit initiative to develop 1 new drug against malaria every 5 years. It will operate under the umbrella of Roll Back Malaria, a new project launched by World Health Organization (WHO) Director General, Dr. Gro Harlem Brundtland. The UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) helped establish the MMV through its product R&D unit, and there has been considerable industrial input. The World Bank and the Global Forum for Health Research are other international agencies involved in the initiative, while several philanthropic organizations such as the Rockefeller Foundation and the Wellcome Trust have also played major roles. MMV will create a fund and operate by financing and resourcing a limited number of projects in a manner compatible with industrial procedures. The fund is mainly supported financially by the public sector, while a funding commitment of US$15 million/year rising to US$30 million a year is being sought. Companies are providing mainly in-kind support.^ieng

Small enterprise opportunities in municipal solid waste management.

PIP: Most developing countries are rapidly urbanizing, with growing urban populations fueling demand for more and better urban services which many cities simply cannot provide given the current financial constraints. With the public sector unable to service the needs of expanding cities, small businesses are moving in to fill the vacuum. Such fledgling private sector initiatives have often prevented problems from becoming crises, while also demonstrating that private sector enterprises have an important role to play in meeting the demand for municipal services. Waste collection and processing is an area which could benefit from private sector involvement and greater public-private coordination. The authors examine the progress to date of an action-research initiative led by the Collaborative Group on Municipal Solid Waste Management in Low-income Countries which is developing best practice guidelines for expanding the involvement of micro- and small enterprises in municipal solid waste management.^ieng

The AIDS threat and the private sector.

PIP: While commercial sector managers throughout southern Africa have invested considerable funds to ensure that reaching the year 2000 does not disrupt the routine functioning of their computer systems, they are failing to address the considerable damage which HIV/AIDS will likely inflict upon companies' human resources. How these managers address AIDS in the workplace will determine whether their companies survive the first decade of the 21st century. Based upon the most recently available statistics, the Metropolitan-Doyle model, developed in 1988 to produce estimates of the progression of HIV/AIDS in South Africa, projects that as of 1999, 11% of South Africa's work force is infected with HIV and an estimated 0.6% are sick with AIDS. The percentages of the country's work force projected to have HIV and to be sick due to AIDS in 2010 are 21% and 2.9%, respectively. The direct costs of AIDS will be felt through rising employee benefit and medical insurance costs, and there will also be numerous indirect costs in the workplace. Management and labor need to work together to find a proactive, holistic solution to the AIDS crisis facing South Africa. The indirect costs of HIV/AIDS to the commercial sector and the elements of a holistic solution to the AIDS problem are discussed.^ieng

Aid for AIDS: an innovative solution?

PIP: Available data suggest that more than 3 million people in South Africa are infected with HIV. According to the 1998 South African Health Review, just under 20% of the population belongs to a medical aid scheme. With so many people in South Africa infected with HIV, many members of such schemes, or their dependents, are probably infected with HIV. However, the country's medical schemes have, until recently, ignored the problem. HIV/AIDS is either excluded completely, or if benefits are made available, they are far from adequate and rarely applied for because of fear of a lack of confidentiality. Few schemes seem to be aware that they are already paying for undisclosed HIV/AIDS-related conditions, and that substantial costs are involved. As South Africa's HIV/AIDS epidemic grows, medical schemes will either continue ignoring the problem and face certain financial disaster or provide for managed access to reasonable benefits. Pharmaceutical Benefit Management (PBM), an independent managed health care company, has adopted this latter approach in launching its Aid for AIDS (AIA) program in May 1998. The program was designed and launched to facilitate the clinical and financial management of each patient by a medical practitioner, by providing a comprehensive and confidential benefit management program with access to reasonable benefits within the budget of given medical schemes. 15 medical schemes with more than 1 million members and dependents have thus far joined AIA.^ieng

Paying for family planning.

PIP: Both houses of the US Congress have passed bills to require that all health plans for federal employees which pay for prescription medications also cover prescription contraceptives approved by the US Food and Drug Administration (USFDA). Of these, the five most commonly prescribed are contraceptive pills, implantable levonorgestrel (Norplant), long-acting injectable medroxyprogesterone acetate (Depo-provera), IUDs, and the diaphragm. Differences between the two bills are now being worked out by a joint House-Senate committee and passage seems almost certain. If a compromise joint bill is passed by both houses, it would cover plans which insure more than 1 million reproductive age women. However, the Equity in Prescription and Contraceptive Coverage (EPICC) Act requiring all US private health plans to cover contraceptive prescriptions is less certain to eventually become legislation. Currently, only 49% of traditional indemnity plans and 39% of health maintenance organizations cover the five most commonly prescribed reversible methods of contraception, while many health plans cover no form of contraception, other than sterilization. The passage of EPICC would expand contraceptive choice for another 45 million US women of childbearing age. Opposition to both bills has come mainly from health insurance and business groups, as well as conservative groups which oppose funding for family planning. Supporters of legislation to expand contraceptive choice for US women should understand that the right to reproductive health and contraceptive services extends beyond US borders, and pressure Congress to bolster US financial support for international population control programs.^ieng