Despite significant success, U.S. family planning assistance has failed to address unsafe abortion

USAID has been legally barred from helping countries provide women with safe, legal abortion care.

Photo courtesy of Liba Taylor, Panos Pictures.

The 40th anniversary of the U.S. Agency for International Development (USAID) family planning program provides an opportunity to reflect on the successes of the program but also to acknowledge the opportunities that have been missed.

According to Elizabeth Maguire, President and CEO of Ipas, who directed the USAID Office of Population from 1993 to 1999, “The USAID family planning program has been one of the great success stories of U.S. foreign assistance. With a comparatively small investment, this program has had an enormous impact on the lives of women, their families and their communities in poor nations around the world.”

The program has helped train hundreds of thousands of health workers, develop new family planning methods and support innovative strategies to ensure that couples receive accurate information and quality services.

Since the program was started in 1965, the use of modern methods of contraception has more than quadrupled and the average number of children per family has dropped from six to less than four. When couples are able to plan their families, they are also able to save for their futures and protect the health of both mothers and children. Millions of lives have therefore been saved, and no doubt, increased use of modern contraception has prevented many unintended pregnancies and abortions.

Prior to joining Ipas, Maguire worked for the U.S. population program for 22 years, including six as Director of the Office of Population. She left USAID in 1999 to work on an issue long ignored by the program.

“Along with great success,” continued Maguire, “there have been tremendous missed opportunities. The program has overlooked one of the leading and most easily preventable causes of maternal death—unsafe abortion.”

Every year, 19 million women risk their lives to end an unwanted pregnancy. Many are poor, chronically ill or malnourished, or sexually abused. Annually, 68,000 women die unnecessarily, and hundreds of thousands more are injured. In spite of these many deaths and injuries, the U.S. program has been legally barred from helping countries provide women with safe, legal abortion care.

The restrictions began in 1973 with the Helms Amendment, which ordered that no U.S. funding be used for abortion services. It was expanded under the Reagan administration and the current Bush administration by the Mexico City Policy, now called the Global Gag Rule. Under this rule, private foreign organizations receiving U.S. family planning assistance must agree not to provide legal abortion services or even to counsel their clients about the availability of safe abortion services— even if the organizations undertake these activities with non-U.S. funds . Further, they cannot talk to their own government about the need for safe abortion care, although unsafe abortion risks the lives of the clients they serve.

These restrictions are all the more ironic and sad in light of USAID's own history in this area. In the early 1970s, USAID funded development of manual vacuum aspiration (MVA) instruments—portable, handheld devices that can be used in a wide range of health-care settings to provide safe, early abortions. The World Health Organization endorses MVA as a safe and effective way to treat women with incomplete abortions as well as to provide induced abortions.

If the United States had devoted resources over the past 30 years to safe, legal abortion care, preventing as many as 20 percent of the total deaths from unsafe abortion each year, the lives of an estimated 400,000 women in developing countries would have been saved. Such efforts could also have prevented tens of millions of women from suffering injuries and lifelong disability, including infertility, and could have helped hundreds of thousands of families who lost a mother.

Maguire added, “Women are the core of families and communities, and promoting their well-being is central to global health and stability. In 1994, I was proud to be part of the U.S. delegation to the landmark International Conference on Population and Development (ICPD). The Programme of Action adopted by the world's governments at the ICPD called on nations to address the public-health crisis posed by unsafe abortion and to provide safe abortion care where it is legal.”

“It is a sad testament that for the past five years under the Bush administration, the U.S. government has turned its back on this call.”

Maguire left USAID in 1999 to work on the critical but neglected problem of unsafe abortion.

“I am proud of my 22 years with the U.S. population program,” she concluded. “Our government has truly been a leader in promoting family planning to save the lives of millions, pull families out of poverty and protect the environment. But I look forward to the day when our government will comprehensively address the reproductive-health needs of women and families both here and abroad with the forthrightness, tolerance and compassion that they deserve.”

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258