In the last week two troubling reports of coercive family planning programs in developing countries have surfaced. A mass sterilization program in India left several women dead and hospitalized. And accusations have been made by Catholic doctors working in Kenya that a fertility reduction program is being guised as a neonatal tetanus program to reach childbearing age women.
These reports warrant a closer look at what US policy could be doing to contribute to coercive family planning programs.
In 2011 USAID reinstituted a performance-based incentive (PBI) program for family planning. The US budget for family planning is close to $1 billion that we can trace. Many new funding streams have been established under the Obama administration with FP funded in multi-sectoral programs where it previously wasn’t.
USAIDs PBI for family planning offers cash incentives for new and continued use of modern contraceptives and establishes targets. It awards community health workers for offering modern contraceptives especially the prioritization of long acting contraceptives (LACs) — this program has been largely successful in scaling up the harmful injectable contraceptive Depo Provera throughout sub-Saharan Africa (under the name Sayana Press).
The cash incentive program to NGOs and public sector providers links financial rewards to attainment of annual targets for reducing FP discontinuation and increased FP utilization.
Establishing targets of increased uptake and reduced discontinuation is more about modifying women’s behavior than increasing their access to goods and services or meeting their existing demands. Much has been made of the figure that over 200 million women in the developing world have an “unmet need” for contraceptives. In fact, data published by the Guttmacher Institute shows that only between 4-8% of so-called “unmet need” is due to lack of access or prohibitive costs. In Africa, less than 2% of women surveyed say they lack access to modern contraceptives. Far more women expressed concern about adverse side effects – many of them based on experience. These side effects are an important driver of what population groups refer to as the “leaking bucket” phenomenon [see image at link], where women choose to stop using contraceptives and family planning advocates refuse to take no for an answer.
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The cash incentive program proposes “fiscal transfers from national to sub-national levels of government are linked to FP performance (Argentina, Brazil) and funding from donors to countries is partly conditioned on FP results (regional Initiative in Central America, India).”
With $14 billion available for “population assistance” each year through governments, UN agencies and rich philanthropists — coercive family planning programs in the developing world will happen, and are already happening. Cash payments for FP programs must end.
With family planning funding now so abundant, it’s time the US redirect its FP funds to maternal and child healthcare or WASH projects — 4,000 children die each day from disease related to the lack of clean water, sanitation and hygiene.
Reprinted with permission from Turtle Bay and Beyond.