Family Planning in Developing Countries: Why It’s Important for Congress to Fund USAID

Kiran Glass

Mr. Grossman

5.7.18
 Nineteen year-old Maheshwori lives in Nepal without money, food or work and had her

second child in a cowshed under horrible conditions. Before giving birth she said, “I am very,

very scared about my pregnancy. Everyone has been asking about it, which makes me even more

scared” (Gates Foundation). No woman should be scared about getting pregnant and raising a

child but sadly complications during pregnancy and childbirth in developing countries cause

303,000 deaths every year (KFF). The solution to addressing maternal mortality is one of the

many benefits of family planning. Supriya Madhavan, a former USAID employee specializing in

global family planning and reproductive health, describes family planning as “...a woman’s right

to plan her family and her right to achieve her fertility desires in a voluntary, safe and informed

way.” Family planning, in the form of development aid, includes resources for safe abortions,

contraceptives, family planning counseling, maternal care, ante and postnatal care, HIV/AIDS,

labor and delivery and child care services. Family planning and maternal health in the

developing world are critical for managing population growth, ensuring women’s access to

education and promoting prosperous economic development. Congress must continue to provide

sufficient funding for the United States Agency for International Development (USAID) to

continue its mission to provide development aid specifically for family planning and maternal

health abroad.

The current administration is not supportive of providing funding for abortion services or

any discussion related to abortion - known as the Gag Rule - because of domestic policies and,

therefore, has cut funding for organizations who provide them. Madhavan describes how “There

is a shortage of money in the health sector in the US and abroad including primary and pediatric

care and maternal health.” The government should continue to fund family planning even if
some programs include abortion related services because access to contraception can prevent up

to 35 million abortions and 76,000 maternal deaths every year (UNFPA). Since the International

Conference on Population and Development in 1994, “access to safe and voluntary family

planning methods has been recognized as a fundamental human right” (ICRW). A study done by

the National Center for Biotechnology Information underscores the importance of expanding

family planning services because “more than 900 million women are estimated to still face

unmet needs for contraception globally, and the potential improvements in child physical growth

... provide further evidence in support of expansion of family planning services” (Fink).

Worldwide, 214 million women do not have access to modern contraceptives causing many

unintended and high risk pregnancies (KFF). Congress needs to allocate more money to USAID

to ensure the well-being and safety of mothers and children worldwide.

For the 2018 fiscal year, USAID requested 1.5 billion dollars to be allocated towards

Global Health Programs including funds for maternal and child health (USAID). For the past 50

years, the US has been the largest contributor to family planning and reproductive health funding

globally but in recent years this support has declined as a result of a national debate on the value

of US support for family planning worldwide, and specifically initiatives that include access to

abortion related information and services (USAID). Many view the availability of family

planning resources as another from of population control especially when targeted at developing

countries causing resistance to the expansion of these programs. There was even a 2018

proposition to cut all funding for global family planning and reproductive health services under

the Trump administration but this was fortunately scaled back. This came after the gag rule was

once again put in place which prevents clinics and services in the developing world to provide
effective services if one of those services is abortion. The US is moving farther and farther away

from being a staunch supporter of women’s reproductive rights as shown in the recent move by

the State Department to remove reproductive rights in the language in the annual human rights

report (Toosi). As stated by Jagdish Upadhyay, head of UNFPA, “Evidence shows that women

who have access to family planning choose to use family planning, often resulting in smaller

families, higher educational achievements, healthier children [and] greater economic power as

well as influence in their households and communities.” The implementation of health services

and provisions has proven to ultimately help with population growth, women’s access to

education and the strengthening of economic development.

Stable and consistent access to family planning and reproductive health services is proven

to manage population growth in developing countries, resulting in numerous benefits for those

countries. It also decreases the risk for maternal and child mortality, allowing healthier and more

stable families. As part of its outlined benefits of family planning, USAID states that family

planning is an important factor in alleviating the impact of population dynamics as it pertains to

resources and state stability. In recent years, the use of contraceptives in developing countries

has increased so much that the population prediction for 2030 has been reduced by 1 billion and

smaller families are proven to have higher educational achievements and healthier generations

(Ford). Especially for poverty-stricken nations, the curtailing of population growth is essential in

maintaining economic and political stability and strengthening the public health infrastructure.

When there are fewer people to allocate resources to, health resources can be distributed and

used more effectively and result in better overall rates of mortality and public health among a

population (Madhavan). When the population cannot be managed by means of modern family
planning strategies, developing countries will be left with a larger population of unskilled and

poor youth (The Economist). CARMMA, Campaign on Accelerated Reduction of Maternal,

Newborn and Child Mortality in Africa, argues that the rapid population growth that is occurring

today in Africa is hindering the continent’s ability to develop and improve infrastructure thus

prompting the need for more family planning services (Olagunju). Additionally, having

unmanageable population size especially in developing countries can contribute to civil unrest

and a refugee crisis. With a heated debate on the refugee quota already gripping the nation, the

threat of more people seeking refuge should be enough motivation to sustain (or possibly even

increase) the budget for family planning. Despite the many benefits that could accompany a

decrease in population growth, some like Madhavan believe that it should be up to the countries

themselves to provide basic family planning services especially when the results are directly

impacting these countries. In other words, they should not be reliant on the funds that they

receive from the US for the basic needs of their people and they should take the lead in providing

for their people.

Health risks accompany teenage pregnancies and it is proven that family planning

intervention can eliminate those risks. Demographic and Health Survey data shows that the

percentage of stunting could be much lower if teenage pregnancy and short birth intervals could

be prevented both of which could be implemented through effective family planning programs

(Fink). The National Center for Biotechnology Information came to the conclusion that

“Postponing the age of first birth and increasing inter-pregnancy intervals has the potential to

significantly reduce the prevalence of stunting and improve child development in LMICs”

(Fink). According to a report by the US Census Bureau, the rates of children born HIV positive
are a result of infected mothers regardless of age, who have no adequate care and in many cases

did not plan on getting pregnant (PRI Staff). However, there are many, including the Population

Research Institute, who believe that women and children would be more well-off if they had as

much primary health care as so-called “reproductive health care.” PRI published a report in 2009

explicitly explaining how family planning has not helped women as much as it is thought to and

how “‘reproductive health care’ programs have failed to address the real health needs of

developing world women as they themselves perceive them” (Mosher). The overwhelming

evidence, however; supports the argument that put simply, access to family planning helps

countries to manage the size of their populations and, more importantly, ensure the well-being of

the people which would, in turn, help stabilize other sectors.

More US funding for family planning will also result in improving rates and access of

girls’ education. If women have the chance to delay childbearing, they have the opportunity to

get an education and become productive additions to the workforce (UNFPA). In many

countries, women are forced into marriage and motherhood without their consent, effectively

denying them education and other opportunities for the rest of their lives. A statistic shown by a

study focusing on the benefits of family planning has on child development, states that 37.5% of

mothers who had their first child in their late teen years, never attended any schooling (Fink).

According to the mission of UNFPA, United States Population Fund, family planning increases

women’s empowerment, improves gender equality and enables women to have an education.

More educated women will help the country develop through reductions in poverty. Moreover,

girls could also benefit from improved sex education which would include family planning.

Major organizations besides USAID promote the fact that access to family planning will
ultimately lead to a better educated population and healthier families. ICRW, the Bill & Melinda

Gates Foundation, Kaiser, UNFPA among other agencies, incorporate the necessity and

importance of education in their goals and outcomes of providing family planning services. It is

important to support and fund family planning efforts because it allows women to have a better

access to education resulting in a more productive workforce and a more stable country.

Perhaps the most appealing argument for the US government to continue to fund family

planning is the potential benefits to the US stemming from economic development in developing

countries as a result of women’s access to services. If more developing countries gain economic

stability, trade and national security for the US would be strengthened. Family planning

organizations and development aid agencies are advocates for the cause and effect argument

between family planning and economic development. At the UN Conference in Cairo in 1994, “it

was concluded at that family planning enhances the health of women, this improves any

country’s development - when mothers are healthy, society is far better for it” (Olagunju). When

fewer mothers and children need heightened amounts of medical care and resources as a result of

unsafe or unhealthy conditions, the limited medical services that USAID can provide for people

through other NGOs can go elsewhere. The Bill & Melinda Gates Foundation supports the

advantage of family planning for a country’s development. They argue the cost-effectiveness of

providing family planning for investing in their future because “every dollar spent on family

planning can save governments up to 6 dollars that can be spent on improving health, housing,

water, sanitation, and other public services” (Gates Foundation). For the US, funding family

planning has major advantages for the government and the investors. For every $1 invested in

family planning, there is an $8 return increasing the profits for American investors and, if quality
sexual and reproductive services becomes worldwide, the return is estimated at $120 for every

dollar invested (Kohler). Upadhyay states that “many countries, particularly those in West Africa

which have a high unmet need for contraception, could potentially reap the demographic

dividend: a boost to the economy that occurs when there are growing numbers of people in the

workforce relative to the number of dependents.” Through the simple service of providing

contraceptives to impoverished countries, the results can lead to immense economic boost for

those countries as well as the US through increased trade.

US support, made possible by Congressional allocation of money and administered

through USAID, has been critical to significantly improve the lives of women all around the

world. By providing family planning and maternal health care, population management is

feasible, women have better access to education and the country experiences economic growth.

Contraceptives, safe abortions, proper reproductive health care and investment in child health

decreases maternal, infant and child mortality rates worldwide. These advances have, in turn,

brought about a range of economic, social and political benefits for developing countries. Even

though there are strong voices pushing for Congress to reduce its support for family planning on

the basis that countries themselves should take care of their own people, women should not only

have the chance to plan their families but also have access to proper medical resources to ensure

a safe and healthy pregnancy. Congress must continue to allot sufficient money for USAID to

spend on family planning programs to ensure that deaths related to pregnancy become rare,

women have more freedom to pursue their dreams, population growth is kept in check and

countries are able to enjoy better economic development. The entire world can reap the rewards

that can result from adequate funding for family planning worldwide.