Former USAID Population Directors Call for Increased International Family Planning Funding

"A change in leadership at the highest level does not automatically translate into budgetary and programmatic reality," declared Duff Gillespie of the Johns Hopkins Bloomberg School of Public Health at the launch of Making the Case for U.S. International Family Planning Assistance at the Woodrow Wilson Center on March 17. Gillespie and his co-authors - all former directors of the U.S. Agency for International Development's (USAID) Office of Population and Reproductive Health - presented forceful health, economic, and environmental arguments for why Congress should more than double spending on international family planning in the coming years. 

Making the Case recommends that the USAID population budget be increased from $457 million in 2008 to $1.2 billion in 2010, growing further to $1.5 billion in 2014. The authors argue that this increase is necessary to meet the "enormous pent-up and growing unmet need for family planning"; stabilize population growth rates, especially in Africa; and achieve the Millennium Development Goal of universal access to reproductive health services. Though the report and recommendations focus on USAID, the authors are clearly seeking to influence other donors, including bilateral and multilateral agencies. 

Making the Case should really be titled Making the Cases, as the authors present multiple arguments for increasing family-planning funding:

• Gillespie showed that U.S. funding for family planning has been stagnant in real dollars since the late 1960s, despite the fact that there are 200 million women with unmet need for family planning; the global population continues to grow; and family planning could help achieve other development indicators, such as the Millennium Development Goals. He also noted that, without champions within USAID and the administration, the dollar amounts requested and appropriated for family planning are unlikely to increase.
• Joseph Speidel of the University of California, San Francisco, explained that a growing number of people, combined with stable or increasing rates of consumption, contributes to climate change and is unsustainable given our finite natural resources. Changes in behavior and technology-for instance, eating less meat or using clean energy-can contribute to improved environmental outcomes. But Speidel emphasized that absolute numbers still matter: Although population growth rates have declined, the global population continues to grow. Addressing the nearly one-half of pregnancies that are unplanned is just one step that would bring great benefits, he said.
• According to Steven Sinding of the Guttmacher Institute, although most economists and demographers agree that economic growth leads to lower fertility, there is still a debate over whether lower fertility leads to poverty reduction. Still, he argued that the "demographic dividend" generated by slowing population growth is a reality, and countries can benefit from it if their institutions are prepared to take advantage of it.

Interestingly, one of the most persuasive sets of numbers presented in the report was neglected during the event: Each additional $100 million in funding can help cover 3.6 million more family planning users; prevent more than 2 million unintended pregnancies; prevent nearly 825,000 abortions; save the lives of 70,000 infants; and prevent 4,000 maternal deaths. Family planning is clearly a cost-effective investment. 

Although the full impact of the report is yet to be determined, it is clear that the authors and other family-planning advocates have had some success communicating their core messages. A July 2008 letter drafted by Senator Barbara Boxer and signed by 12 other senators, including then-Senators Barack Obama and Hillary Clinton, to the Senate Appropriations Subcommittee on State, Foreign Operations and Related Programs, reflects some of their positions. It argues that declining allocations for family planning and reproductive health have led to deteriorating health for women and children and "that unsustainable population growth plays a role in the destruction of forests and the spread of deserts, the pollution and overfishing of oceans and waterways, and increases in emissions that contribute to global climate change." 

Ruth Levine of the Center for Global Development urged the authors to avoid "preaching to the choir," and to reach out beyond the family-planning community for support for their proposal. One way to do this would be to broaden the scope of "population" to include not only family planning, but also migration, urbanization, and other demographic issues. Convincing World Bank economists, especially the Bank's next president, of the connections between declining fertility and poverty reduction should be a priority, said Levine, because developing countries put a lot of stock in the Bank's advice. 

"We know how to do family planning, we know what it costs, and we know that it works," emphasized Speidel. The key missing element, he said, is political will.