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Family Planning and U.S. Foreign Policy

Author: Isobel Coleman, Senior Fellow and Director of the Civil Society, Markets, and Democracy Initiative; Director of the Women and Foreign Policy Program
April 28, 2011

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U.S. support for international family planning has long been a controversial issue in domestic politics. Conservatives tend to view family planning as code for abortion, even though U.S. law, dating to the 1973 Helms Amendment, prohibits U.S. foreign assistance funds from being used to pay for abortion. Indeed, increased access to international family planning is one of the most effective ways to reduce abortion in developing countries. Investments in international family planning can also significantly improve maternal, infant, and child health. Support for international voluntary family planning advances a wide range of vital U.S. foreign policy interests -- including the desire to promote healthier, more prosperous and secure societies -- in a cost-effective manner.

Saving Lives of Mothers and Children

More than half of all women of reproductive age in the developing world, some 600 million (PDF) women, use a form of modern contraception today, up from only ten percent of women in 1960. This has contributed to a global decline in the average number of children born to each woman from more than six to just over three. Despite these gains, an estimated 215 million women globally -- particularly in sub-Saharan Africa and southern Asia -- are sexually active but are not using any contraception, even though they want to avoid pregnancy or delay the birth of their next child. With the world's population poised to cross the 7 billion mark later in 2011, and expected to grow by nearly 80 million people annually for several more decades, global unmet need for family planning is likely to increase.

Studies (PDF) have shown that contraception could reduce maternal deaths by a third, from approximately 360,000 to 240,000; reduce abortions in developing countries by 70 percent, from 35 million to 11 million; and reduce infant mortality by 16 percent, from 4 million to around 3.4 million.

For a woman in the developing world, the lifetime risk of dying from pregnancy is still one of the greatest threats she will face. In developed countries, 1 out of 4,300  women will lose her life as a consequence of pregnancy, compared to sub-Saharan Africa, where that figure soars to 1 in 31, and Afghanistan, where the lifetime risk of dying from pregnancy is 1 out of 7.

Unsafe abortions are one factor contributing to high maternal death rates. As of 2008, 47,000 abortion-related maternal deaths occur annually, accounting for 13 percent of all maternal deaths. Filling the unmet need for modern family planning would lead to a reduction in mistimed pregnancies and a significant decline in abortions and abortion-related health complications. In 2000 alone, if women who wished to postpone or avoid childbearing had access to contraception, approximately 90 percent of global abortion-related and 20 percent of obstetric-related maternal deaths could have been averted.

Maternal mortality has a devastating and irreversible effect on children and families. Indeed, countries with the highest maternal mortality rates also experience the highest rates of neonatal and childhood mortality. When a mother dies, her surviving newborn's risk of death increases to 70 percent.

Family planning presents an opportunity to curb maternal and under-five deaths not simply by giving women of all ages the ability to determine their family size, but by enabling women to delay pregnancy until at least age eighteen and to space and plan their births. In this way, modern contraceptive methods help women avoid high-risk pregnancies. Studies (PDF) suggest that short pregnancy intervals (when the pregnancy occurs less than twenty-four months after a live birth) are associated with an increased risk of maternal and under-five mortality. In fact, if all mothers were to wait at least thirty-six months to conceive again, it is estimated that 1.8 million deaths of children under five could be prevented annually.

Enhancing International Security

While much of the developed world is experiencing population stability or even decline, many countries in the developing world continue to see rapid population growth. Population imbalances have emerged as a serious issue affecting economic opportunity, global security, and environmental stability. Ongoing civil conflicts, radicalism, weak governance, and corruption are endemic problems for many fragile states. While high fertility rates are not the cause of their problems, they do complicate the challenges these countries face in trying to reduce poverty, achieve per capita income growth, provide education and productive opportunities for youth, and address increasing shortages of natural resources.

With the world's population poised to cross the 7 billion mark later in 2011, and expected to grow by nearly 80 million people annually for several more decades, global unmet need for family planning is likely to increase.

Yemen, for example, has the highest rate of unmet need for family planning (PDF) of any country. Its population has doubled in less than twenty years, and it has the world's second-youngest population. High fertility -- around 6 children per woman -- taxes Yemen's infrastructure, education and health systems, and environment. In addition, its labor force is growing at a pace much faster than the growth of available jobs, resulting in high youth unemployment. Increasing access to family planning would help improve Yemen's long-term prospects for achieving per capita growth and stability. Conversely, continued high fertility rates will only deepen Yemen's current crises.

Many countries experiencing fast population growth -- like Yemen -- do not have the capacity to harness the potential of their young populations. In these cases, high fertility rates can lead to a vicious cycle of poverty at the community, regional, and national levels. Rapidly growing populations are also more prone to outbreaks of civil conflict and undemocratic governance. Eighty percent of all outbreaks of civil conflict between 1970 and 2007 occurred in countries with very young populations. Demographers have shown that the statistical likelihood of civil conflict consistently decreases as countries' birth rates decline.

Countries with the highest population growth rates face real resource constraints, particularly arable land and clean water. As of 2010, 40 percent of populations in more than thirty five countries have insufficient access to food, with the largest concentration in central and eastern sub-Saharan Africa. Given that many of these food-insecure countries will continue to experience significant population growth in decades ahead, malnutrition will remain a challenge.

Family Planning and Budget Battles

In the budget battle for fiscal year 2011, drastic cuts to international family planning were considered but ultimately avoided. (The final allocation declined only 5 percent, from $648 million in 2010 to $615 million.) Continued U.S. support for international family planning, however, remains vulnerable to ongoing ideological fights and budget battles. It will undoubtedly surface as an issue again in the next budget round.

Given its centrality to many pressing foreign policy concerns, international family planning is an area of assistance that deserves greater attention, not less. The United States should recognize family planning as a foreign policy priority, increase international family planning funding and access to programs, encourage political support for women's health within countries already receiving aid, and expand resources into countries with the highest unmet need.

*This brief is based on the report, Family Planning and U.S. Foreign Policy: Ensuring U.S. Leadership for Healthy Families and Communities and Prosperous, Stable Societies by Isobel Coleman and Gayle Lemmon. A full copy of the report can be viewed here.

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