In the recent budget battles in D.C. over funding of Planned Parenthood in the United States, similar lines were drawn. Now, supporters of overseas family planning programs are worried that USAID funding is also at risk.
The Council of Foreign Relations—an influential, independent, nonpartisan think tank—published a report in late April summarizing research by organizations like the World Health Organization, Population Reference Bureau, and Population Action International, and concludes that not only have USAID family planning programs reduced mother and child mortality rates, but they have also reduced the number of abortions.
The CFR hopes its report, “Family Planning and U.S. Foreign Policy: Ensuring U.S. Leadership for Healthy Families and Communities, and Prosperous, Stable Societies,” will be used to encourage the U.S. government to maintain funding for these programs.
“There is serious talk about drastically cutting international family planning, even though it is one of the most cost-effective foreign assistance programs the United States funds,” says the report.
Isobel Coleman, who co-wrote the report with and Gayle Tzemach Lemmon, spoke at a roundtable at the CFR on April 27 where she described the need for these programs.
Several years ago, she was in a rural village in Afghanistan observing a training session on economic opportunity for women. Afghanistan has one of the highest fertility, lowest contraceptive rates; maternal death during childbirth is high and the under-5 mortality rate is the highest in the world.
Suddenly, in the back of the room there was a commotion and her interpreter told her that a participant was saying, “What good is it to have job training [for women], if I don’t have birth control?”
Even in conservative, Muslim Afghanistan, “the women are aware of contraception and want it,” said Coleman. In Afghanistan, one out of seven women dies in childbirth, making delivery one of the greatest threats a woman faces.
In Sub-Saharan Africa that rate falls to 1 in 31; in the developed countries it is 1 in 4,300, according to Koki Agarwal, a roundtable panelist from Jhpiego, an affiliate of Johns Hopkins University, who also contributed to the report.
Voluntary Family Planning Successes
The use of voluntary family planning internationally, which the United States plays a leading role in, has exploded in the last 50 years. In the developing world, its use increased from less 10 percent in 1965, to 53 percent in 2005, says the report. This represents an increase from 30 million users in 1960, to 430 million in 2008. The result has been a worldwide decline in the average number of children a woman gives birth to from over six to just over three.
The report says that out of 818 million women in the developing world who want to avoid pregnancy, 74 percent now have the means (in 2008). There remains, however, an “unmet need” of 215 million women who want to space their pregnancies or avoid pregnancy altogether, but lack access to effective contraception.
To be clear, the family planning they refer to is voluntary—women making decisions for their families—not to confused with state family planning coercion, such as methods used in China and India.
The regions that have the highest unmet need are Sub-Saharan Africa at 24 percent, and South Asia at 15 percent for married women, aged 15–49 in 2005.
Yemen, with a fertility rate of six children per woman, has the highest unmet need for family planning in the world at 51 percent. The population has doubled in fewer than 20 years, and it has a very young age structure that taxes the country’s resources to provide education and employment.
By spacing births more than 24 months apart, rates of maternal and infant mortality and child mortality dramatically fall. Egypt provides a good success story, according to Agarwal.
Egypt’s health statistics had been similar to many other developing countries, when USAID programs targeted the desire to space births in the early 1990s. As a result, the under-5 mortality rate dropped to one-quarter the 1988 level, and the maternal mortality ratio today is 82, down from 174 per 100,000 live births in 1992–1993.
Read More... Family Planning and Abortion
Family Planning and Abortion
The report enters into more controversial territory when it asserts that access to quality family planning could significantly reduce abortions and abortion-related injuries. Voluntary family planning, it claims, could reduce abortions in developing countries by an estimated 70 percent.
However, Richard M. Doerflinger, deputy director of the Secretariat for Pro-Life Activities at the U.S. Conference of Catholic Bishops, points out that these claims are not based on “genuine findings,” but outputs of math models.
Certainly there is no guarantee that the use of birth control will eliminate abortions. The Alan Guttmacher Institute (AGI), the research arm of Planned Parenthood but
now independent, reported on abortions in the United States in January, and found that “54 percent of women who have abortions had used a contraceptive method (usually the condom or the pill) during the month they became pregnant.”
CFR panelist Mark R. Dybul argues that family planning has wrongly been conflated with abortion.
“Rather than seeing family planning as a very effective tool to reduce abortion, it has gotten to where it is [regarded as] abortion,” said Dybul, co-director of Global Health Law Program, O’Neill Institute for National and Global Health Law, Georgetown University.
“That is where the fundamental problem lies,” says Dybul.
But pro-life proponents are not comfortable with family planning organizations because they tend to also provide abortion services and counseling. While the 1973 Helms Amendment stipulates that U.S. money cannot be used to fund abortion services overseas, funding of family planning indirectly supports abortion, critics argue.
The debate on funding often centers around the Mexico City Rule, or the so-called Global Gag Rule, which withholds USAID funding from any organization that provides or talks about abortion services, even if the funds for those activities come from non-U.S. government sources. It was first introduced by Ronald Reagan in 1984 in Mexico City, to take the 1973 Helms Amendment a step further.
In 1993, the policy was rescinded by Bill Clinton, only to be reinstated by George W. Bush in 2001. In keeping with the partisan seesaw, it was again rescinded by Obama in 2009.
Mexico City Rule supporters argue that even if abortions themselves are not funded, funds given for family planning could free up other moneys in these organizations, which could then be used for abortions.
Dybul agrees that this is a fair argument and worthy of discussion. For him, the key is to get the two sides “out of their corners” so they can begin talking to one another.
In this year’s budget, “family planning took a hit, while other [health] programs did not,” said Dybul. But, he adds, compared to what is coming in 2013 and 2014, this fight was a “sandbox.”
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