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Monday, May 05, 2008

Family Planning in the Philippines: A Global Wake-Up Call for Policymakers

Family Planning in the Philippines: A Global Wake-Up Call for Policymakers
By Tod Preston on April 24, 2008 10:21 AM

“Birthrates Help Keep Filipinos in Poverty” – that’s the headline of an April 21, 2008 Washington Post article highlighting the plight of a growing number of poor women in the Philippines who lack access to one of the most basic forms of health care: family planning (FP) and reproductive health services. The article, which mentions that the U.S. is scaling down its FP program in the Philippines, should be a wake-up call for policymakers about the global impact of declining FP assistance on the lives of hundreds of millions of men and women in the Philippines and other developing nations.

U.S. investments in international family planning have been one of the most successful and cost-effective ways to improve maternal and child health, ease population pressures on the environment, and help countries fight poverty. But despite the achievements of recent decades -- including an increase in use of contraceptives among married women in the developing world from 10 percent to 60 percent since 1960 and a decline in average fertility rates from about six children per woman to three children per woman -- significant needs remain. For example, only one-third of married Filipino women use modern contraceptives.
The reality is that family planning remains out of reach for hundreds of millions of women and men. In fact, more than 200 million women in the developing world want to space or limit their childbearing but are not using modern contraception. In some countries such as Haiti, Pakistan and Uganda, one-third or more of married women have this “unmet need” for FP.

Nonetheless, in recent years funding from the U.S. -- a long-time leading donor of FP/RH assistance -- has declined significantly when accounting for inflation and the growing demographic demand. And FP/RH assistance from other donor nations has also declined.

Current U.S. funding for int’l FP (about $460 million) represents a cut of $300 million or 40 percent (adjusted for inflation) from what the U.S. provided for these programs back in 1995. Had the Bush Administration gotten its way and Congress not intervened in the past two years, U.S. funding for these programs would have been reduced by an additional 25 percent. Making matters even worse, the Bush Admin has withheld all U.S. funding (nearly $200 million) for the U.N. Population Fund (UNFPA), which provides FP/RH assistance in more than double the number of countries the U.S. does.

So what does this downward U.S. funding trend mean for a country like the Philippines? As you’d probably suspect, it’s not good. In its budget request to Congress last year, the Bush Administration proposed spending only $5.2 million for FP/RH assistance in the Philippines -- less than 1/7 of what the U.S. spent in that country in 1995 ($37 million in inflation-adjusted dollars). That’s despite the fact that 25 percent of Filipinas ages 20-24 have an unmet need for family planning -- and these rates are even higher among uneducated women. So funding is going down and contraceptive shipments are ending while the need and demand remain high. And remember, the backdrop for all of this is a country in which more than 40 percent of its people live below the poverty line.

Ironically, this meager funding request for FP in the Philippines was proposed in the same budget in which the Administration acknowledged to Congress the connection between high birth rates and poverty in the country. In its FY 2008 foreign assistance Congressional Budget Justification, the Administration stated that “[the] Philippines struggles to provide sufficient jobs, infrastructure, health services, and education for its rapidly growing population.” (PDF, p. 348)

Just how fast is the population of the Philippines growing? It’s doubled since the late 1970s and -- if access to family planning does not increase and current fertility rates remain static -- it will double again from 86 million today to 170 million in the next thirty years. That’s a lot of additional mouths to feed, especially in a nation that’s recently acknowledged it has a serious shortage of rice and faces the threat of food riots.

Make no mistake, because of declining funding USAID has had to make very difficult choices of where it allocates its limited FP dollars. One of those choices is to scale back its family planning program in the Philippines and to end shipments of contraceptives -- contraceptives that we know many Filipinos desire. Tragically, this story isn’t limited to the Philippines. The U.S. has scaled back FP assistance to a number of countries, some with even higher unmet need than the Philippines. Kenya is one example, with troubling implications for maternal and child health and its development prospects.

The great tragedy in all of this -- “outrage” might be a more accurate term -- is that the cuts in FP funding are depriving women and men, many of them impoverished, of something they fundamentally want: that most basic ability to choose how many children to have and when to have them. And by depriving them of this reproductive right, we’re contributing to an increasingly unsustainable and impoverished world.