Washington  - If you don't talk about sex, you can't save lives.

But sex is complicated, and when it collides with politics and science it usually generates controversy.

Sexual and reproductive health are uncomfortable subjects - emotionally charged, morally loaded and politically sensitive - because they delve into the most intimate aspects of people's lives.

Public health experts are clear that all government actions must be based on scientific evidence, but say that for several years, reproductive health policies in the United States have relied more on morality than science.

They hope once president-elect Barack Obama takes office, he will reverse many of the regressive sexual health policies of President George W Bush's administration, which have damaged the reputation of the US at home and at abroad, and potentially put millions of lives at risk.

"With the election of ... Obama ... (we) look forward to an end to the Bush administration's relentless assault on women's reproductive health and rights," said Nancy Northup, president of the Centre for Reproductive Rights (CRR), a New York-based legal advocacy group.

"For eight years ... we have suffered under the yoke of an administration that has suppressed science to the detriment of health and has done damage to constitutional and human rights value," CRR wrote in a letter to Obama after his November 4 victory.

The US has an influential role in global sexual and reproductive health programmes. The President's Emergency Plan for AIDS Relief (PEPFAR) will give 48 billion dollars toward fighting HIV/AIDS worldwide over the next five years and makes the US the world's largest funder of anti-AIDS programmes.

There are expectations that Obama will repeal the "global gag rule," imposed by Bush in 2001, which bans any US-funded family planning groups based abroad from providing abortion services. Many organizations that have such services along with those for contraception and AIDS prevention, have been forced to close down, leaving hundreds of women with no reproductive health care.

"Dollars mean a lot. ... In Ethiopia, the amount of funds for HIV/AIDS coming from PEPFAR is just about equivalent of the Ethiopians' entire health budget," said Duff Gillespie, a professor of population, family and reproductive health at Johns Hopkins Bloomberg School of Public Health. "When a donor of that dominance coughs, people actually pay attention."

Researchers admit to leaving words such as "prostitution" and "sex work" out of their proposals to ensure that US government funding won't be withdrawn. They refer instead to "vulnerable" or "at-risk" women.

While each president drives a specific agenda, the problem with the Bush administration was that its "worldview ... is not only not evidence-based, it's counter to evidence," Gillespie said.

Studies have shown, for instance, that abstinence-only-until- marriage education programmes promoted by the Bush administration have little impact on sexual behaviour, fail to prevent pregnancies and don't reduce rates of sexually transmitted infections (STIs). An estimated 176 million dollars was allocated for this pet project last year.

These programmes teach that delaying sex until marriage is the only sure way to avoid STIs and unwanted pregnancies; contraception is not discussed. But a six-year study, released in 2007 by the US Department of Health and Human Services, found no evidence that such programmes actually increased rates of sexual abstinence.

The US is the only developed country with formal policies appropriating money to abstinence-only programmes, says the National Abortion and Reproductive Rights Action League.

"They are driven by ideology and politics, rather than by science or good public health policy. ... Most troubling, they represent a purposeful campaign to mislead, distort, stifle and censor and are part of a disturbing trend to politicize science," said Vania Leveille, legislative counsel at the American Civil Liberties Union.

To lower high rates of STIs and unintended pregnancies, CRR said Obama should promote reproductive rights at the United Nations and in foreign aid programmes.

Obama's judicial appointments will also be critical to the preservation of reproductive rights, CRR said, as several court decisions have narrowed the protections established by Roe v Wade, the 1973 landmark decision of the US Supreme Court that found a constitutional right to abortion.

Currently, only four of nine Supreme Court judges have expressed clear support for the Roe precedent. Legal activists say a change in the court's composition in 2005 spurred a groundswell of state legislation to reverse Roe - in the three years since, an unprecedented 38 abortion bans have been introduced in 17 states.

Abortion is a deeply divisive issue, and while acknowledging that in a presidential debate, Obama said, "Nobody's pro-abortion. I think it's always a tragic situation. We should try to reduce those circumstances."

"Abortion is a 'sexy' headline, but it shouldn't be used to hijack other reproductive health issues like fertility treatment, contraception - which should be covered by health insurance, but isn't - and sex education," cautioned Mary Jane Gallagher, president of the National Family Planning and Reproductive Health Association.

For seven consecutive years, the Bush administration has blocked Congress-approved funding for the United Nations Population Fund (UNFPA), amounting to 235 million dollars lost in US support. In 2008, about 39.7 million dollars was withheld.

The reason given was that UNFPA allegedly supports forced abortions and involuntary sterilization in China. But US investigative teams found no evidence to support such allegations.

The amount withheld every year could have helped UNFPA prevent 2 million unintended pregnancies, 800,000 abortions, 4,700 maternal deaths and more than 77,000 infant and child deaths. (dpa)