The capability to determine family size and child spacing can dramatically improve the economic and health conditions of those in the developing world. Due to their limited resources, however, many rely on foreign assistance to exercise such choices.
The largest intergovernmental organisation that aims to address the lack of access to family planning is the United Nations Population Fund (UNFPA). The UNFPA “supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.”
Historically, the United States of America (US) has played a significant role in supporting initiatives to curb unwanted population growth and address issues of reproductive health.
Despite its status as a founding member and once the largest financial contributor to the UNFPA, the US since the 1970s has moved from prominent supporter to at times vocal dissident, arguing against foreign assistance in reproductive health. Such a curb in support first surfaced with the enactment of the Helms Amendment.
Initiated in the same year that Roe v. Wade legalised abortions domestically, the Helms Amendment prohibits US overseas financial assistance “for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.”
The Mexico City Policy, described as the Global Gag Rule by its opponents, tightens the restrictions of the Helms Amendment regarding US assistance for foreign family planning. The policy affected NGOs not only by denying any funding for abortion, but also by forbidding funding to organisations that either perform or promote abortion.It does make exceptions for abortion operated in response to incest, rape or life-threatening pregnancy.
Since its initial implementation, the Mexico City Policy has been rescinded by Democrats and reintroduced by Republicans, making the pertinent issue of reproductive health in developing countries a political tug of war.
Although the wording of the Mexico City Policy indicated an aim to restrict US funding for abortion related services, the policy’s actual effects were far broader. In Kenya, for example, a country where 24% of women have unmet contraceptive needs, HIV infects 6.3 percent of those aged between 15-49 and the average number of birth per woman is just below 5, the high need for reproductive health services is left unmet.
When reinstated under George W. Bush, the Mexico City Policy ended US funding for the Family Planning Association of Kenya (FPAK) and Marie Stopes International (MSI), two of Kenya’s leading NGOs. MSI had to close two of its clinics, increasing its prices and reducing its staff whilst FPAK was forced to close six of its 15 clinics. It is estimated that these closures resulted in at least 9,000 people being left with limited or no access to reproductive healthcare. Both MSI and FPAK were also providers of community outreach programmes. In addition to delivering reproductive health services, FPAK was a key provider of child vaccinations and Pap smear tests for the underprivileged. For some women and children, these clinics were their only contact with medical healthcare professionals.
In addition to hampering NGO activities, the Mexico City Policy restricted the work of the Kenyan government. As the first African nation to develop its own family planning programme, the Kenyan government was seen as undertaking a proactive approach to reproductive health.
Before the Mexico City Policy’s reinstatement, USAID had been assisting the Kenyan government in producing an integrated reproductive health care service called AMKENI (meaning ‘new awakening’ in Swahili). The reinstatement of the Mexico City Policy, however, severely curtailed this initiative. The US’s refusal to fund FPAK and MSI, resulted in their forced withdrawal from the project. It was described by a US NGO staff member as “a huge blow. They were the ones meant to do outreach services. There is no replacement.”
In line with the political tug of war, few days after the inauguration of President Obama, he rescinded the Mexico City Policy. The politicisation of family planning leaves NGOs funding contingent on US presidential elections, a situation that severely compromises the long-term planning and effectiveness of such organisations.
The economic and sociological consequences of continued rapid population growth are huge. As well as not reducing fertility, the Mexico City Policy’s limit to contraceptive availability has played a large role in reversing previous improvements made in reducing mortality rates and the sense of female empowerment arising from the ability to determine family size and spacing. With the presidential elections nearing, a change in power could again disrupt family planning initiatives in countries that need them the most.
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