Information on Population Programs and Funding
Changes in American Opinion about Family Planning, article by Clifford Grammich, Julie DaVanzo, and Kate Stewart in the September 2004 issue of Studies in Family Planning 35(3): 196–206
Implementing the ICPD Programme of Action: What a Difference a Decade Makes, article by Marianne Haslegrave in Reproductive Health Matters 2004:12(23): 12–18.
Contraceptive Use Is Key to Reducing Abortion Worldwide, article by Amy Deshner and Susan A. Cohen in the October 2003 issue of The Guttmacher Report
Global Gag Rule Revisited: HIV/AIDS Initiative Out, Family Planning Still In, article by Susan A. Cohen in the October 2003 issue of The Guttmacher Report
New Report Finds Global Gag Rule Contributes to More Unintended Pregnancies, Unsafe Abortion Overseas
Policy and Health in Asia: Financing and Allocating Public Expenditures: Policy brief from RAND
Financial Resource Flows for Population Activities in 2000: Comprehensive report from UNFPA
Global Forum Shows Disparities in Funding for Health Research
Statement to Parliament on Australia's Development Cooperation Program, September 2002
Global Forum Shows Disparities in Funding for Health Research
The Global Forum for Health Research was established in 1998 to help correct the 10/90 gap in health research, the fact that only about 10 percent of funding is targeted to the diseases that account for 90 percent of the global disease burden. The human end economic costs of such misallocation of resources are enormous, particularly for the poor. In pursuit of this objective, the Global Forum support public- and private-sector networks/partnerships focusing research efforts on diseases that represent the heaviest burden on the world's health.
In May 2002, the Global Forum published the 10/90 Report on Health Research 2001–2002, summarizing the efforts undertaken by a wide variety of actors in helping to correct the 10/90 gap. Chapter Six of this report summarizes the most recent information on the public and private resources invested in health research worldwide. To view the full report or order a printed copy, visit the Global Forum website at http://www.globalforumhealth.org/pages/index.asp.
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New Report Finds Global Gag Rule Contributes to More Unintended Pregnancies, Unsafe Abortion Overseas
Washington, DC, 24 September 2003—Ipas, an international organization dedicated entirely to ending the preventable deaths and disabilities caused by unsafe abortion, joined a coalition of groups today in releasing Access Denied, a new study documenting the harmful effects of the Bush Administration's restrictions on U.S. funding for international family planning, widely known as the Global Gag Rule. The policy prohibits U.S. family planning assistance to foreign nongovernmental organizations (NGOs) that use funding from any source to perform, provide counseling or referral, or lobby for abortion. The study examines the consequences of this policy in Ethiopia, Kenya, Romania and Zambia.
"By denying women access to a full range of reproductive health services—including safe abortion in circumstances where it is legal—the policy only leads to more unwanted pregnancies, more unsafe abortions, and tragically, preventable deaths and injuries to the world's most vulnerable women and girls," said Barbara Crane, Ipas Executive Vice President. "And by prohibiting doctors and others working in local U.S.-funded NGOs from speaking out to their own policymakers, the Global Gag Rule stands in the way of efforts to end this carnage."
Project findings indicate that the Global Gag Rule reduces access to vital family planning and related health services by:
- Forcing the closure of established family planning organizations and clinics
Study finding: Five clinics in Kenya that provide family planning as well as pre- and post-natal obstetric care for mothers and well-baby care for infants have been closed because of the U.S. Gag Rule policy.
- Blocking supplies of U.S.-funded contraceptives to groups that don't comply with the restrictions
Study finding: In Ethiopia, where the rate of maternal death is extremely high and women are often desperate for contraception, a rural clinic that provided 70% of its clients with Depo-Provera has no more stock and has been cut off by USAID.
- Derailing the provision of contraceptive information and services to women who have had abortions—an essential step to reduce repeat abortions
Study finding: In Romania, where abortion is widespread and unsafe abortion accounts for many maternal deaths and injuries, the Gag Rule has impeded efforts to provide post-abortion family planning counseling.
Some more findings from the report
Kenya
There remains a significant unmet need for family planning, especially in rural areas. Overall, 24 percent of married women in Kenya have an unmet need for contraception. USAID had contributed constant support to the nation’s Community Based Distribution (CBD) efforts, FPAK was forced to cut the number of CBD workers by 50 percent and has had difficulty getting adequate supplies of contraceptives to the remaining staff.
Two of the leading family planning NGOs have closed five of their clinics. These NGOs have also had to cut their staffing by as much as 30 percent, reduce services in remaining clinics, and raise fees in order to remain viable. FPAK has closed three clinics to date and laid off 30 percent of its staff. All three clinics had been supported entirely by the USAID Mission in Kenya prior to 2001, and each clinic had recently started offering PAC services. Collectively in 2000, these clinics served nearly 19,000 clients—roughly 1,560 women, men and children every month.
The combined loss of USAID and IPPF funds totaled 58 percent of FPAK’s budget—a huge blow, even for one of Kenya’s oldest and largest health care providers. Marie Stopes International Kenya (MSI Kenya) lost U.S. $600,000 in already-committed USAID funds. Seemingly overnight, MSI Kenya faced a 40 percent cut in its operating budget and would be hard-pressed to make up the loss quickly from other donors.
Fifteen percent of all adults (aged 15 to 49) are infected with HIV/AIDS, putting Kenya among the African countries hardest-hit by the epidemic. MSI Kenya was forced to close a clinic located in Kisumu, in a province where HIV prevalence is the highest in the country. In Kenya, women comprise 60 percent of HIV cases. The Kisumu clinic provided health services to approximately 400 women each month and also supported a cadre of community health care workers. When MSI Kenya’s Mathare Valley clinic closed, services for STI screening and treatment and HIV testing and counseling, along with other basic family planning and reproductive health care, ended for a community of 300,000 people—with no other clinic nearby.
Ghana
In Ghana, 697,000 Planned Parenthood Association of Ghana clients will lose access not only to family planning services, but also to voluntary counseling and testing, other counseling services, and HIV/AIDS prevention education.
Zambia
PPAZ is Zambia’s leading family planning organization, and the only NGO in the country that operates clinics. As a result of its stand on the gag rule, PPAZ has lost 24 percent of its funding and has had to cut back on clinic-based services and crucial community outreach programs to rural areas. The organization runs two clinics, in Lusaka and Kitwe, and has centers in rural areas that dispense information and referrals. In addition, PPAZ trains thousands of peer educators and community-based distributors, many of whom work in Zambia’s numerous hard to reach areas, providing information and supplies.
As the largest segment of the population and the most vulnerable to STIs, the youth community has an especially dire need for reproductive health services and HIV/AIDS prevention. PPAZ recognized this need and declared youth the primary focus of their work. The organization trained peer educators to both counsel youth and distribute contraceptives, reserved two days at its clinics for youth-only service provision and counseling, and generated considerable youth demand for a specially marketed condom called Success, the only youth-targeted condom. Its system of distribution booths, as well as youth-directed marketing campaigns, gave away roughly 2.8 million condoms at its peak in 1998.
Since the gag rule came into effect, marketing efforts for the condom have almost ceased, and booths have been shut down around the country. The condom has experienced considerable decline in its market share, with sales falling from roughly U.S. $6,900 in 2001 to $5,400 in 2002—a drop of nearly 19 percent.
Ethiopia
While nearly 70 percent of Ethiopian men and women say they would like to limit or space the number of children they have, only 8 percent of married women practice contraception, and only 6 percent use modern birth control methods. The Family Guidance Association of Ethiopia (FGAE), has a network of 18 comprehensive reproductive health clinics throughout the country, also runs seven workplace programs, 26 youth centers and 660 community-based reproductive health sites. Another major player is MSI Ethiopia, which works in five regions, with eight clinics in as many different towns offering a similar range of health care services for women and youth. MSI Ethiopia reaches rural Ethiopians through its well-established CBD initiative, which provides health information, counseling and contraceptive supplies through small health posts, schools and workplace programs.
FGAE lost a total of 37 percent of its funding, which severely affected the operations of 11 clinics. FGAE and MSI Ethiopia no longer receive USAID-donated contraceptives, and their outlook for supplies is uncertain. They were Ethiopia’s leading providers of the long-acting contraceptive methods Depo-Provera, Norplant and the IUD.
More than half of all pregnant teenagers have abortions, which are usually performed by nonprofessionals in dangerous, unhygienic conditions. The Ethiopian Society of Obstetricians and Gynecologists attributes a remarkable decline in mortality and morbidity to post-abortion care (PAC) services provided by Marie Stopes International Ethiopia (MSI Ethiopia) for hundreds of thousands of girls and women who have suffered miscarriages or undergone unsafe abortions.
Cameroon
In Cameroon, loss of U.S. assistance forced the Cameroon National Association for Family Welfare (CNAFW) to close one youth center. CNAFW's youth centers teach young people about responsible parenthood and sexually transmitted infections, including HIV/AIDS. In addition, family planning service delivery was eliminated in two branches: the North Province branch, where 9 percent of the 576,000 inhabitants live with HIV/AIDS, and the Western Province branch, where 6 percent of the 256,816 inhabitants live with HIV/AIDS.
Global
USAID is the most important single donor of contraceptives, procuring and delivering more than one-third of all donated supplies—an amount worth about U.S. $75 million per year. By 2002, the Global Gag Rule had ended shipments of USAID-donated contraceptives to 16 developing countries: Burundi, Cape Verde, Chad, Comoros, Gabon, Gambia, Lesotho, Mauritius, Sierra Leone, Solomon Islands, Sri Lanka, Swaziland, Tonga, Vanuatu, Western Samoa and Yemen.
Leading family planning agencies in another 13 countries are unable to receive USAID contraceptives because of their refusal to abide by the restrictions. The FPAs in Bangladesh, Benin, Cameroon, Ivory Coast, Ethiopia, Mozambique, Dominican Republic, Nicaragua, Togo, Uganda, Nepal, Zambia and Zimbabwe were major recipients of USAID supplies.
The World Health Organization estimates that there are some 20 million unsafe abortions each year, resulting in more than 70,000 women dying annually, more than 99% of them in the developing world.
"As an international organization working to protect women's health throughout the developing world, we are witness to the dangerous effects of the Gag Rule every day," said Barbara Crane, Ipas Executive Vice President. "It forces private providers of family planning and other health services to choose between accepting badly needed financial support from the United States and responding comprehensively to the health needs of the people they serve. Women suffer in either case."
For three decades, Ipas has worked with local partners throughout Africa, Asia and Latin America to provide training and medical equipment designed to prevent deaths and injuries from unsafe abortion, which claims the lives of nearly 70,000 women every year. Ipas is one of two U.S.-based nongovernmental organizations that stopped accepting U.S. government funding when the Global Gag Rule was announced.
The Global Gag Rule Impact Project was led by Population Action International, with Ipas and Planned Parenthood Federation of America as partners. Assistance in gathering evidence of impact in the field was provided by EngenderHealth and Pathfinder International.
The complete report, Access Denied: U.S. Restrictions on International Family Planning, is available online at www.globalgagrule.org.
