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Endangered: U.S. aid for family planning overseas.

In the wake of groundbreaking international accords calling for greater political and financial attention to population and development issues, the United States is failing to fulfill its commitments. During the last two years, ultraconservatives in Congress have doggedly attacked U.S. participation in the International Conference on Population and Development in Cairo and the Fourth World Conference on Women in Beijing and have made U.S.-aided family planning programs a favorite target of their hostility. Cleverly using the divisive issue of abortion, they have attacked family planning efforts as promoting abortion by encouraging promiscuity, sabotaging parental authority and threatening family life.

Frustrated in their attempts to restore heavy-handed policies imposed on international family planning programs during the Reagan years, key members of the U.S. House of Representatives set out, instead, to undermine these programs through draconian funding restrictions. They succeeded: In 1995, while funding for most humanitarian aid was reduced by 20%, family planning was singled out for extra-ordinarily harsh treatment--a far deeper cut and a complicated allocation scheme that reduced even further the amount of funds actually available. Lawmakers gave no reprieve in 1996, as the disproportionate funding cut was extended for a second year. Another congressional test of this issue, however, is already slated for February 1997.

This Issues in Brief explores the political climate confronting family planning assistance. It describes the human toll that deep funding cuts will take in the form of more unplanned pregnancies and abortions, more women dying in pregnancy and childbirth, and more infant deaths. Finally, it discusses why U.S. leadership is critical to the global family planning effort and why it is fully consonant with American traditions and values.

The congressional elections of 1994 ushered into the House of Representatives a formidable bloc of antiabortion conservatives. Facing an electorate that is basically prochoice, however, they had few potential targets within their reach. Foreign assistance became an easy mark and the restoration of the so-called Mexico City policy became a rallying cry.

The Mexico City policy was first enunciated by the Reagan administration at the 1984 United Nations' population conference in that city; it was revoked by President Clinton nearly 10 years later. The policy deemed population growth a "neutral" phenomenon; to the extent it could be considered a problem, it would be solved by "market forces." The policy also declared that, henceforth, the United States would no longer "promote" abortion worldwide--something that, in fact, had been prohibited by law since 1973. The latter goal would be achieved by imposing strict new conditions on indigenous, private organizations abroad--conditions that could not be imposed on similar U.S.-based institutions. Under the Mexico City policy, these overseas organizations would be disqualified from receiving U.S. family planning aid if--with their own funds and in accordance with the laws of their own countries--they provided any abortion-related information or services.

The House endorsed the reimposition of the Mexico City restrictions on several occasions in 1995 but was rebuffed by the Senate each time. The Senate's refusal to reinstate these discriminatory and imperialistic restrictions, even after the House countered with varying versions, resulted in a lengthy showdown between the two chambers. As a consequence, a second--but equally devastating--assault by family planning opponents began to unfold: to decimate the program's funding.

In January 1996, almost four months into the new fiscal year and under immense pressure to head off a third governmentwide shutdown, both the Senate and the White House were forced to accept a self-described "compromise" proffered by the House leadership. As the price for dropping the Mexico City language, family planning would be stripped of much of its funding. First, an overall funding cut of 35%--a much deeper cut than that sustained by development assistance generally--was imposed. Second, to punish family planning even further, an unprecedented and complex set of funding rules would be imposed. No funds would be made available until July 1--a full nine months into the fiscal year--and, perhaps most severe of all, the funds, once released, could only be doled out in monthly installments over the next 15 months.

The fiscal 1997 budget process brought more of the same. Still stymied by Senate and White House opposition to the Mexico City restrictions, the far-right demanded an extension of the same funding conditions. However, another test of the issue was built into the equation. The new law requires Congress to vote--by February 28, 1997--on a presidential "finding" (itself to be delivered by February 1) as to whether the funding limitations are having "a negative impact on the proper functioning" of the international family planning program. Assuming the president reports that they are, and both the House and Senate agree, the fiscal 1997 money will be released on March 1 instead of July 1.

A Major Setback

Meanwhile, the impact on the lives of millions of women who are served by these programs, and on their families, will be profound. As nations head into the 21st century, the largest generation in history is just reaching adulthood. The choices these young women and men make about family size will depend greatly on the contraceptive and reproductive health services available to them, and will help shape their futures and the world's thereafter.

Moreover, given that women are the primary caretakers and household managers throughout much of the developing world, their health and well-being undeniably determines how their children--especially their daughters--will fare in life. In the immediate future, the relatively dismal state of women's reproductive health throughout much of the developing world can be expected to worsen as a direct result of the severe cutback in U.S. family planning aid.

According to a 1996 report from the United Nations Children's Fund (UNICEF), almost 600,000 women die during pregnancy and childbirth each year; 75,000 of these women die attempting to abort an unwanted pregnancy themselves or with the help of an untrained and unsafe provider. All told, these deaths render at least one million children motherless every year.

UNICEF further estimates that for every woman who dies, "approximately 30 more incur injuries, infections and disabilities which are usually untreated and unspoken of, and which are often humiliating and painful, debilitating and lifelong." Improving access to quality family planning services, notes UNICEF, is paramount to improving maternal and child health in developing countries. It is well documented that mortality rates for women and children are highest when births are spaced too close together, when a woman has many children (more than four) and when births occur too early or too late in a woman's life. Yet the campaign by abortion opponents to decimate government-supported family planning services only assures that women and their families in the developing world will know more suffering and death.

Measuring the Impact

In early 1996, a consortium of expert organizations undertook an effort to quantify the impact of the steep reduction in family planning aid. Their calculations, which take into account only the 35% cut to the program's overall funding level, are conservative by design (see Methodology). Excluded from the analysis is the combined effect of the nine-month moratorium and the monthly "metering" of funds, which only adds to the financial hardship.

Based solely on the one-year, 35% cut, the consortium estimates that:

* 7 million couples in developing countries who would have used modern contraceptive methods will not have access to these methods.

* As a result, 4 million more women will experience unintended pregnancies, leading in turn to:

** 1.9 million more unplanned births and 1.6 million more abortions (the remainder of the unintended pregnancies will end in miscarriages);

** 8,000 more women dying during pregnancy and childbirth, including from unsafe abortion; and

** 134,000 more infant deaths.

Unmet Needs The devastating cuts to U.S. family planning assistance abroad come at a time when increased access to family planning and related reproductive health care is crucial. Although progress has been made, the unmet need for quality contraceptive services remains considerable.

Over the last three decades, the size of the average family has fallen from roughly six children to about three. By having fewer children, parents are in a better position to provide for them and improve the family's quality of life overall. However, while women are striving--and succeeding, albeit with great difficulty--to have smaller families, a gap still exists between the number of children women say they want and the number they actually have. Many women give birth before they and their partners feel they are ready to care for a child, and substantial proportions of women--more than 50% in some countries--say their last birth was mistimed or unwanted. (see Chart 1).


The use of effective contraceptive methods has increased rapidly over the past 30 years throughout the developing world. Yet nearly 230 million women worldwide--roughly one in six women of reproductive age--are still in need of modern contraceptive methods to postpone or avoid future childbearing (see chart 2).


The high level of unmet need for family planning is a key reason why women have great difficulty in spacing their pregnancies and bearing the number of children they want. Determined to avoid an unplanned, unwanted birth, many women--in the absence of family planning or following a contraceptive failure--resort to unsafe abortion. Worldwide, more than one-quarter of pregnancies--about 52 million annually--end in abortion, often performed clandestinely and under unsanitary conditions.

Meeting the Challenges

Helping women narrow the gap between their child-bearing desires and what they actually experience is at the heart of U.S. family planning assistance. Enabling women to have the number of children they want, and when they want them, is central to the quality of their lives and the well-being of their families. And women's success in achieving their reproductive goals has important implications for the social and economic welfare of the communities and nations in which they live and, ultimately, for the future of the world.

Rapid population growth severely reduces the likelihood that developing societies can move out of poverty or that women can contribute to development on an equal footing with men. Providing women with the means to control their fertility, primarily through improved access to quality family planning services, is, therefore, fundamental to human progress.

In this light, it is important to recognize that the impact of deep cuts to U.S. family planning aid will extend well beyond the delivery of contraceptive and reproductive health services to women and couples. On-going U.S. efforts to improve literacy rates and primary school education of girls, promote good nutrition, improve maternal and child health, and enhance women's participation in the economic and political spheres of society will feel the sting as well.

On the ground, these programs rarely operate in a vacuum, independent of each other. Rather, over the years, they have become increasingly integrated, partly to maximize resources but largely because such efforts naturally complement and reinforce one an other. The extensive cuts to family planning assistance inevitably will affect other development endeavors.

U.S. Leadership

Currently, about three-quarters of the roughly $4 billion spent to provide family planning services in developing countries is borne by the countries' own governments and by the women and men who use these services. The remainder is contributed by developed countries. Financial support from developed country governments--both to other governments directly and to indigenous nongovernmental organizations (NGOs) working in those countries clearly plays a pivotal role in meeting the rapidly increasing contraceptive needs of couples in the developing world. And, it is no exaggeration to say that the U.S. program is the anchor of the global family planning effort on which other countries' contributions depend for stability and direction.

Should U.S. support for international family planning continue to erode, it is unrealistic to expect that other donor countries will--or could--make up for the loss of U.S. government funds. No other country, nor international organization for that matter, has the extensive field presence nor the vast array of technical resources and experience that the U.S. family planning effort has developed over the decades.

Moreover, American leadership has been crucial to forging alliances among governments and the private sector so that family planning and related social services are provided in a more integrated manner.

Reflecting American Values

Making family planning services widely available to all who want them is one of the surest ways to foster self-sufficiency, promote preventive health care and basic education, nurture strong and healthy families, and enhance the quality of life for all of us. In many ways, family planning reflects the core values that most social conservatives--indeed, most Americans--hold so dearly. It is ironic that the strongly held antiabortion views of some conservatives have been extended into the realm of family planning, which has long enjoyed strong bipartisan support in Congress and around the country as a means to reduce the incidence of abortion.

The American public supports humanitarian assistance--family planning and reproductive health services, child survival, education, environmental protection--not only as a necessary price for world leadership but also as the right thing for a weal thy country to do. In a recent nationwide poll conducted by the University of Maryland, those surveyed felt that 5% of the national budget was an appropriate level for the U.S. to spend on development assistance. Currently, less than 1% of the federal budget is earmarked for international aid, and less than half of that amount goes to humanitarian assistance.

Contributing "our fair share" to alleviate poverty and promote better health and nutrition among developing societies is a strongly held American value, one that has driven U.S. international assistance for many decades. And making quality family planning services available to all who want them has been a central tenet of American humanitarian aid. Clearly, it must remain so if our efforts are to succeed in improving the lives of women, supporting families worldwide and benefiting our own lives here at home.


The potential effect of a 35% cut in U.S. funding for family planning is estimated by gathering and sometimes reconciling information from a wide variety of sources, ranging from national censuses and population estimates to country-specific surveys of women of reproductive age and special studies of contraceptive use and of pregnancy outcomes.

The estimates that follow reflect the knowledge and expertise of the following organizations: The Alan Guttmacher Institute, The Futures Group, Population Action International and the Population Reference Bureau, in consultation with the Population Council. The basic steps in reaching the estimation are as follows.

The first step in estimating the impact of the funding cut begins with determining how many of the couples who depend on U.S. funded family planning programs will lose their access to contraceptives.

* Population censuses and estimates indicate an estimated 829 million women of reproductive age are living today in developing countries other than China (which receives no U.S. family planning program support).

* Surveys of women in developing countries show that roughly 247.5 million of these women and their partners use modern methods of contraception to lengthen the time between the births of their children or to avoid having more children than they already have.

* Because of their poverty, 190.5 million, or 77%, of the couples in developing countries outside of China who are using modern contraceptive methods rely on public-sector family planning programs.

* The United States contributes about 17% of all public funds spent on family planning in developing countries other than China, accounting for 32.4 million couples using modern contraceptive methods. [Of these couples, 12.6 million are estimated to be protected by contraceptive sterilization or long-lasting methods including hormonal implants (such as Norplant) or intrauterine devices (IUDs).

* On an annual basis, 19.8 million couples depend on U.S. supported programs to obtain contraceptive supplies, such as pills, condoms or injectables, or to start use of a long-term method, such as voluntary sterilization, hormonal implant or IUDs.

* A cut in program resources of 35% means that 12.9 rather than 19.8 million couples will be able to be served in a year's time, leaving 7 million couples without access to contraceptive supplies or services.

The second step is estimating what effect losing U.S.-supported family planning services will have on the couples who are depending on them for contraceptive care.

* There are few other contraceptive choices in developing countries for women who lack access to modern contraceptives. A conservative estimate is that of the 7 million women losing services because of U.S. funding cuts 2.8 million will turn to traditional methods and 4.2 million will use no contraceptive.

* Because pregnancy rates are so much higher among couples relying on no method or on a traditional method than if they use a modern contraceptive, 4 million more unwanted pregnancies are expected in developing countries due to the drop in family planning program resources.

* About 40% of these unintended pregnancies are likely to end in induced abortion, even though it is often not legal and performed in unsafe conditions--accounting for 1.6 million abortions among the expected additional unwanted pregnancies.

* Some 47% of the unintended pregnancies are likely to end in unwanted births with the remaining 13% resulting in spontaneous abortions or miscarriages--accounting for 1.9 million unwanted births among the expected additional unwanted pregnancies.

* Maternal mortality rates in developing countries are high, about 4.1 deaths per 1,000 women giving birth, leading to an estimated 8,000 additional deaths due to pregnancy among the women facing additional unintentional pregnancies.

* Infant mortality rates in developing countries are high, with about 7.2% of all babies born dying before their first birthday, leading to an estimated 134,000 additional infant deaths among the women facing additional unintentional pregnancies.

Major Sources

The Alan Guttmacher Institute, Hopes and Realities: Closing the Gap Between Women's Aspirations and Their Reproductive Experiences, New York, 1995.

The United Nations Children's Fund (UNICEF), The Progress of Nations, New York, 1996.

This Issues in Brief, written by Wendy R. Turnbull, was made possible with the support of The Pew Charitable Trusts/Global Stewardship Initiative.
COPYRIGHT 1996 Guttmacher Institute
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1996 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:due to increasing conservatism in Congress
Author:Turnbull, Wendy R.
Publication:Endangered: U.S. Aid for Family Planning Overseas
Article Type:Topic Overview
Geographic Code:1USA
Date:Jan 1, 1996

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