United States international family planning assistance dates back to 1965 when the Johnson Administration decided that lowering fertility rates must be part of the War on Hunger. Shortly thereafter, the United States Agency for International Development (USAID) started using funds to manufacture and distribute contraceptives to the developing world. The program received strong bipartisan support in its early years. In 1969, President Nixon described population growth as “one of the most serious challenges to human destiny in the last third of this century.” His administration established the Office of Population, which went on to become a leader in international family planning.
USAID has two objectives:
- To promote the rights of couples and individuals to determine freely and responsibly the number and spacing of their children by maximizing access to and improving the quality of family planning, with special attention to the reproductive health needs of women and young adults, and
- To reduce population growth rates to levels consistent with sustainable development.
USAID has a long history of success in voluntarily lowering birth rates through education campaigns, door-to-door delivery of contraceptives, and services provided at clinics. Their staff and the staff at the organizations that receive USAID grants work in more than 65 countries.
|A training exercise in Ngaoundere, Cameroon. A health care provider, left, practices communications techniques on a mock patient. Photo: JHPIEGO/Emile Mboudou|
The agency also supports the Demographic and Health Surveys (DHS), the most detailed and widely used source of demographic data by researchers and policymakers. The DHS has been collecting data from 70 countries since 1972. Without it we would have no idea how many people use contraception, how many people would like to use it, or what levels of overall health and nutrition people from different regions and ethnic groups experience within countries. The DHS is an important policy tool because it tells donors and policymakers what needs to be done and where in order to improve the health and lives of people in countries that receive donor assistance.
Since USAID started providing family planning assistance, the total fertility rate (TFR) of the less developed countries has dropped from 5.94 to 2.57 children per woman. The growth rate has declined from 2.54 percent to 1.26 percent per year. That’s an increase in doubling time (the length of time it would the population to double at present growth rates) from 27 to 55 years. In short, doubling time has doubled—a very promising trend.
USAID can boast many success stories. What follows are some excerpts, taken directly from the USAID website.
- Since 1965, the use of modern family planning methods in the developing world has more than quadrupled, from less than 10 percent to more than 40 percent. In the 28 countries with the largest USAIDsponsored programs, the average number of children per family has declined by more than one-third, from more than six to less than four.
- A campaign in Ghana to educate men about vasectomy resulted in more vasectomies in the six weeks after the campaign started than in the entire previous year. The no-scalpel vasectomy is an effective and relatively inexpensive (about $20) birth control solution for couples that want no more children.
- A project in Coast Province, Kenya trained nurse-midwives working at smaller clinics in postabortion care (often necessary after an unsafe abortion) so that women would no longer have to trave to a hospital. From January through November 2003, 329 postabortion care clients were managed at 52 facilities, with 220 (67 percent) receiving a family planning method. The project aims to reduce the need for unsafe abortion through increased access to family planning.
- In Malawi, a program to increase hospital referrals by rural birth attendants and improve the response time for women in labor who do come to the hospital reduced maternal mortality from 52 deaths in 2005 to 29 in 2006.
- Maternal mortality rates in West Africa are among the world’s highest. Too often, pregnant women are unable to access quality prenatal and delivery services, with tragic consequences. In Ngaoundere, Cameroon, and Kaedi, Mauritania, USAID and UNICEF have worked together to train more than 40 doctors, midwives, and birthing assistants in delivery and newborn care. Through training, health care providers learn to communicate better with patients, manage the third and final stage of labor when complications for the new mothers often arise, and prevent infection.
Mothers wait to receive family planning services at the Bako Clinic in West Shoa, Ethiopia. Photo: Pathfinder/Melesse Desalgn
Community-based distributors in Uttar Pradesh, India are responsible for the increased contraceptive prevalence rate to one-third of married women, twice as many as in 1993. Family size has gone from more than five children to fewer than four children—still higher than the two to three children couples say they want. More than 1.6 million clients have been served by this program.
- Indonesia “graduated” in 2006 from the USAID family planning program, after nearly 40 years of support, due to its success making family planning accessible and desirable. The average Indonesian couple has two children, compared with more than five in the 1970s when the program started. Indonesia’s total estimated population today is around 220 million people (2006 figure). Without its family planning program, the country’s population would likely have been nearly 280 million. This means that the world’s fourth most populous nation has 60 million fewer people today because of family planning. Infant mortality rates have also dramatically declined and the gender gap between boys and girls school enrollment has gone down.
- Bolivia is a landlocked country in South America that has poor maternal health indicators and a high rate of extreme poverty. The Bolivian contraceptive prevalence rate increased from 25 percent in 1998 to 35 percent in 2003. That resulted in a fertility decline from 4.8 to 3.8 children per woman. The IUD and injectables have become particularly popular methods. A new law in 2005 made health care, including family planning, free to all women of reproductive age.
- Of the nearly 70 million Ethiopians, over 80 percent reside in rural areas and have little to no access to public health facilities. In 2000, the contraceptive prevalence rate was 6.3 percent. Due to decentralization of health services, district officials were ill-equipped to plan and implement health services for populations residing one to two days walking distance from the nearest health center. To expand health and family planning services in Ethiopia, USAID funded a Community Based Reproductive Health Program under the authority of Woreda district officials. USAID provides assistance and training to improve the management and operation of the program through transparency and public accountability. All this has contributed to a contraceptive prevalence rate of over 35 percent.
- For the Ethiopians living in rural areas, a lack of access to information, counseling, and transportation to health facilities is a major barrier to seeking family planning services. “In meetings with our community health workers, they tell us there is a demand for more longterm family planning methods. ‘Do you have more?’ the mothers always ask. So, we designed service-based training,” said Ambaw Damtew, program coordinator in the Oromia Region for a USAID-funded training program in long-term family planning methods targeting rural communities. In addition to the birth control implants, the trainees provide clients with a full range of family planning methods. Nearly 200 health professionals in all six zones of Oromia and over 10,000 women have received training on long-term family planning methods. In addition, the program is also rolling out similar servicebased trainings and outreach services in the Amhara, Tigray and Southern Nations, Nationalities, and People’s Regions.
USAID provides 35 – 40 percent of donorprovided contraceptives to the developing world and supplies nearly 30 family planning programs in 20 countries with technical and logistical support.
Read more detailed success stories at www.popconnect.org/USAID_Stories
See the USAID timeline at www.popconnect. org/USAID