Population Matters

Re-Examining the Global Barriers to Reproductive Freedom

April 17th, 2014

Every woman in the world should be able to space or limit her births. At a minimum, that means every woman should have access to the contraceptive method of her choice, whether it’s a female condom, birth control pills, an IUD, sterilization or a long-acting injectable. But physical access to contraception does not guarantee reproductive freedom. For many women in the developing world the real barrier to the exercise of reproductive choice is male opposition, religious teachings, social norms, or misinformation about contraceptive options.

There has always been some truth to the idea that supply creates its own demand: make modern contraceptives more available and more women will want to use them. But in male-dominated societies where religious teachings or social norms promote large families, there are practical limits to how far supply will drive demand. And that’s particularly true in areas where child marriage is still prevalent. When a girl is married at an early age, and her husband demands a large family, the mere availability of contraceptives does not guarantee that she can exercise reproductive choice. In societies where violence against women is widespread the exercise of reproductive freedom can even result in physical violence or even death.

The problem is, and it’s a significant one, is that countries with the highest fertility rates and the lowest rates of contraceptive use tend to be male-dominated societies where gender inequality prevails and religious teachings or social norms dictate larger families. Add to that ignorance or misinformation about contraceptive options, and women, in practice, may have little or no reproductive choice… even if modern methods of contraception are available. Girl brides, in particular, seldom exercise any real degree of reproductive freedom; any decision about childbearing is effectively out of their control.

Demographic and Health Surveys (DHS),commissioned by USAID, underscore the scale of the problem. In Ethiopia, where women still have nearly five children on average, the 2005 DHS reported that less than 1 percent of young married women (ages 15-24) not using contraception cited lack of access to a contraceptive method as their reason for non-use. In fact, nearly one out of four said they wanted to have as many children as possible. 7.1 percent cited male opposition to contraception as a reason for non-use; 14.3 percent cited religious opposition. 12.8 percent reported health concerns or fear of side effects as their reason for non-use, and 16.9 percent indicated lack of knowledge.

Similar results are found throughout sub-Saharan Africa. The 2008-09 DHS in Kenya found that only 1.2 percent of married women (age 15-49) reported cost or lack of access as a reason for non-use of contraceptives. More than three out of ten cited health concerns (14.9 percent) or fear of side effects (15.8 percent) as their reason for non-use, while 9.0 percent cited religious prohibition and 6.0 percent attributed their non-use to their husband’s opposition.

In Sierra Leone, where women on average have five children, the 2008-9 DHS found that only 1.6 percent of married women (ages 15-49) attributed their non-use of contraceptives to cost or lack of access. One out of seven (14.4 percent) reported male opposition as their reason for non-use, while 9.3 percent cited religious prohibition. In Mauritania the most recent DHS survey indicated that one out of four women not using contraceptives were deterred by religious prohibitions. In Liberia, Ghana, and Uganda, a fear of side effects stops one out of four non-users from using contraception.

These findings do not diminish the importance of ensuring that women in developing countries have access to a wide array of contraceptives. As contraceptives become more widely available and women become more informed as to the benefits of spacing births, more women will opt to use a contraceptive method. But in many countries the cultural or informational barriers to contraceptive use loom much larger.

The United Nations has declared that access to reproductive health services is a universal right and, as part of the Millennium Development Goals (MDG5b), it set 2015 as the target year for achieving universal access. The target will not be met. While the MDGs have achieved great success in many areas, progress with respect maternal and reproductive health has been disappointing. Any hope of achieving universal access to reproductive health care anytime soon will require much greater investments on the part of donor countries.

But it will take more than expanded access to contraceptive services to ensure that all women are capable of spacing or limiting their pregnancies. So long as a woman’s reproductive freedom is constrained by her husband’s opposition, religious prohibitions, or misinformation, she will not be fully capable of exercising that freedom. And because reproductive choice is so important to a woman, her family, and her community, the empowerment of girls and women — a high priority in its own right — takes on added importance.

Posted by Robert J. Walker, president

Originally posted on the Huffington Post on April 16, 2014

Climate Change: The Least We Can Do

April 8th, 2014

As the IPCC’s Fifth Assessment Report makes clear, we are long past the point of avoiding climate change. The best we can do now is to avoid the worst effects. The situation is more dire than previously projected and the consequences of inaction more starkly drawn than ever before:

Warming of the climate system is unequivocal, and since the 1950s, many of the observed changes are unprecedented over decades to millennia. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, sea level has risen, and the concentrations of greenhouse gases have increased….Over the last two decades, the Greenland and Antarctic ice sheets have been losing mass, glaciers have continued to shrink almost worldwide, and Arctic sea ice and Northern Hemisphere spring snow cover have continued to decrease in extent (high confidence)…. Continued emissions of greenhouse gases will cause further warming and changes in all components of the climate system. Limiting climate change will require substantial and sustained reductions of greenhouse gas emissions.

In a perfect world, the IPCC’s report would summon forth our best efforts at mitigating climate change and its effects. We would be doing whatever is necessary and prudent to avoid a human and environmental catastrophe. By now, however, it is evident that governments — and the people they represent — are shrinking from the challenge. Hope for concerted global action on any kind of meaningful scale has largely evaporated.

Instead of asking what is the most that can be done to mitigate climate change and alleviate its consequences, perhaps we should be asking, “What is the least that can be done?”

The “least” we can do is to mitigate the scale of human suffering and displacement, and the single most cost-effective means of doing so is to prevent unplanned pregnancies. Nearly 40 percent of all pregnancies in the world are unwanted or unintended, and preventing them would make a valuable contribution to climate change mitigation and adaptation.

Giving every woman the power to avoid unwanted pregnancies would dramatically lower projected population growth rates. According to the latest UN population projections, world population, currently 7.2 billion, is likely to reach 9.6 billion by mid-century and continue rising, but if the total fertility rate (i.e. the average number of children per woman) were to fall by just half a child, world population would rise to only 8.3 billion and gradually decline during the second half of the 21st century.

It’s particularly important to prevent unplanned pregnancies in the United States, where our carbon footprints are, on average, nearly twice as high as they are in many European countries and twenty or more times higher than many developing countries. A study released five years ago found that the average “carbon legacy” of a child born in the U.S. would produce about 20 times more greenhouse gases than the mother or father would save by adopting a lower carbon lifestyle (i.e. driving a highly fuel efficient vehicle, using energy efficient appliances, etc.).

But even where carbon footprints are relatively small, no one should discount the contribution that birth control could make to lowering projected greenhouse gas emissions. A 2010 study of energy use and demographics by Brian C. O’Neill concluded that slowing global population growth “could provide 16-29% of the emissions reductions suggested to be necessary by 2050 to avoid dangerous climate change.” That is not insignificant.

Even if preventing unplanned pregnancies in developing countries contributed absolutely nothing to reducing future greenhouse gas emissions, there is a compelling moral case to be made for expanding international family planning services and information. That’s because women and children in countries like Mali, Niger, Somalia, Uganda, Bangladesh, and Ethiopia find themselves on the front lines of climate change. Subsistence farmers, in particular, are vulnerable to the crop damage that will be inflicted by heat, drought, flooding, and rising seas. Some of the most vulnerable and food insecure countries in the world — countries that are already in a struggle for survival — could likely see their populations double or even triple in the next half century. Denying women in these countries the ability to space and limit their pregnancies will compound the suffering that is likely to be caused by climate change. Large families in environmentally-stressed communities will be less resilient and inevitably suffer more from disease, food insecurity, and water scarcity.

Access to reproductive health services is recognized by the United Nations as a universal right, but in many parts of the developing world it is far from being a reality. Making that right a reality for women everywhere may not save the world from climate change, but it would go a substantial way toward alleviating the human suffering that will accompany it. The costs of empowering women and providing family planning services are trivial compared to the benefits that would result from giving women reproductive choice. It really is the least we can do…for climate change…and for the women and their families who will endure some of its worst effects.

Posted by Robert J. Walker, president

Originally posted on the Huffington Post on April 7, 2014

Pope Francis and the Great Catholic Divide

March 13th, 2014

Perhaps more than any other pope in modern times, Pope Francis has done much to unify and reinvigorate the Catholic faith, but as he approaches the first anniversary of his ascendancy to the papacy, he still confronts a great divide. As confirmed by a recent international poll of 12,000 Catholics in 12 countries, many Catholics do not embrace the church’s teachings on family planning. Many, in fact, hope that Pope Francis will relax, if not reverse, the church’s longstanding opposition to the use of modern contraceptives.

The poll, which was conducted by Bendixen and Amandi International for Univision, found that support for family planning among Catholics is high, particularly in Europe and the Western Hemisphere. In five of the 12 countries that were surveyed, including the pope’s homeland of Argentina, nine out of 10 Catholics support the use of contraceptives. (The other four countries were Columbia, Brazil, Spain, and France.) In America, the poll found that nearly eight out of 10 Catholics (79 percent) were in opposition to church teachings on contraception.

If nothing else, Pope Francis is prepared to listen to concerns about family planning. Last fall the Vatican announced plans to gather information in preparation for the October 2014 Extraordinary Synod of Bishops on “The Pastoral Challenges of the Family in the Context of Evangelization.” The survey instrument, which was disseminated to dioceses around the world, asked Catholics to make known their views with respect to family planning, along with abortion, divorce, gay marriage and other issues affecting modern family life.

All of these issues are important to Catholic families, but what the Vatican ultimately decides to do on the question of contraception could also determine, to a considerable degree, whether the church makes significant progress on the concern that Pope Francis has made a centerpiece of his papacy: the fight against poverty.

While Catholic teachings on family planning have found very little resonance with Catholic laity in the developed world, they have served to reduce the use of contraceptives in some of the poorest countries in the world. The recent Bendixen and Amandi International poll found, for example, that only four out of 10 Catholics in the Democratic Republic of Congo (DRC) and Uganda support the use of contraceptives.

As long as women in the DRC and Uganda have six children on average, hopes are slim that any major progress will be made in reducing the stubbornly high prevalence of severe poverty in those two countries. In the DRC one out of seven children dies before the age of 5, school enrollment rates are actually declining, and less than half of the population has access to safe drinking water, but its population, currently at 71 million, is projected to reach 182 million by 2050. Uganda, with a per-capita income of less than $170 per year, is one of the poorest countries in the world, but its population, currently at 37 million, is projected to reach 113 million by 2050.

Many countries in the world have enjoyed an economic boom as their fertility rates have fallen. When women elect to have smaller families, child mortality declines, children receive a better education, and economic growth prospects enjoy a potential boost as the number of workers to dependents increases. But many of the world’s least-developed countries may never collect their “demographic dividend,” as it is often referred to. Unless fertility rates in those countries fall faster than currently expected, many countries will remain caught in a demographic trap.

In many of the world’s poorest countries today, the single most important contribution that the church could make to poverty reduction is a reversal of its position on family planning. High fertility is not the only impediment to reducing severe poverty, but it’s hard to imagine that much progress can be made absent a fall in birth rates. As recently noted by John May, a former World Bank demographer, there’s no guarantee that some countries in sub-Saharan Africa will ever collect their demographic dividend; their fertility rates are not falling quickly enough.

In the past the Catholic Church has shown some willingness to reconsider its opposition to the use of contraceptives. At one point in the 1960s, a papal commission recommended approving the use of birth control, but that recommendation was short-lived. The upcoming Extraordinary Synod of Bishops could recommend giving Catholic couples the moral license to use a modern method of birth control. In many countries that might make little practical difference, but in countries like the Philippines, where Catholic teachings on contraception have severely undermined public access to contraception, it could do a world of good. That would be truly extraordinary.

Posted by Robert J. Walker, president

Originally posted on the Huffington Post on March 12, 2014

The Ultimate Reality Show: Man Versus Nature

February 20th, 2014

Chuck Duck Dynasty. Move over, Honey Boo Boo. Forget the Real Housewives. The ultimate reality show is here, and it is a colossal battle: Man Versus Nature. For centuries, it has been a dull, one-sided contest, with nature faring about as well as the Denver Broncos did against the Seattle Seahawks in Super Bowl XLVIII. Not anymore. Nature is mounting a fierce comeback with forest fires, soaring temperatures and raging storms. It could be the greatest comeback in all of recorded history.

Since the dawn of civilization 10,000 years ago, we have been steadily subduing nature, converting forests and grasslands into farmland and pasture, mining the earth for metals and minerals, cutting down trees for timber and fuel, building wells, constructing dams and even re-routing rivers. Sure, nature has put up some resistance along the way, but, until lately, with little success.

Humanity fields a formidable offense and our playbook is positively ingenious. Having substantially depleted many land-based resources, we are drilling for oil far beneath the ocean floor and dredging remote seabed for metals and minerals. Running short of arable land, we have been fiendishly clever at boosting crop yields through the development of hybrid seeds and the generous application of artificial fertilizers. When nature has produced insufficient rain, we have built dams and reservoirs and pumped water from deep underground aquifers. When we have effectively exhausted a natural resource, we have been resourceful at developing and exploiting substitutes that are more abundant.

For a long while, it appeared that humanity was virtually unbeatable; nature didn’t stand a chance against human resourcefulness. From time to time, nature would fight back. Loss of topsoil and nutrients would render some distant land unsuitable for agriculture. Deserts would encroach on farmland. Pollution would render the water from some rivers unusable, but man was still winning, and the final outcome never appeared to be in doubt, even as human numbers soared from 1 billion to over 7 billion in less than 200 years. Man, not nature, would prevail.

But the contest between man and nature, if it can really be described as such, is not a sprint. It’s not even a marathon. There is no finish line or timeline. The way things are going, it could be a fight to the death. If so, don’t bet against nature.

Sure, humanity is confidently ramping up its emissions of carbon and other greenhouse gases,but nature is raising global temperatures and increasing the frequency and intensity of drought and flooding. Yes, we are drilling deeper and deeper for water, but underground aquifers in many areas are now being exhausted. Our engineers are finding new ways to exploit metal and mineral resources, but the commodity prices for those resources have increased dramatically in the last decade. Farmers are still converting grasslands and tropical forests into farms and pastures, but in China and elsewhere desertification is gaining the upper hand. Dams in many areas are silting up. Reservoirs are drying up. Farmers are applying more fertilizers to sustain crop yields, but what we gain in agricultural output we are starting to lose in terms of ocean productivity thanks to the nitrogen runoff.

Here, at home, record droughts in the West are putting farmers and ranchers out of business, curtailing hydroelectricity and limiting growth prospects. In Southern Brazil, record heat and drought are curbing coffee production; in South Africa it’s the corn, and in Australia it’s the wheat. Around the world, from Northern India to Southern California, farmers who once made their fortunes, thanks to irrigation, are suddenly facing economic ruin. Even homeowners find themselves at elevated risk as the incidence and severity of forest fires increase.

For centuries, we have sown the wind with little or no regard for our impact on nature. Now, it appears we are reaping the whirlwind. Nature is fighting back. The once academic debates about the potential impacts of greenhouse gases and resource depletion are now taking on real life dimensions. An ecological peril once dimly perceived and often dismissed is now coming into sharper resolution.

Man Versus Nature: It’s the ultimate reality show, and we may not have to wait long to see who will be he ultimate loser. For except in our minds, humanity has never existed separate and apart from nature. The harm we inflict on nature we ultimately inflict in some measure upon ourselves.

Posted by Robert J. Walker, president

Originally posted on the Huffington Post on February 19, 2014

The Still Uncertain State of Reproductive Health in America

January 10th, 2014

In a few weeks the president of the United States will be giving a report on the state of the union, but it is not too early to take a look at the state of reproductive health in this country. This week the Population Institute released its second annual report card on reproductive health and rights in the US, and the results were not encouraging. Thirteen states received a failing grade, and the US as a whole received a “C-” for the second year in a row.

America is at the crossroads with respect to reproductive health and rights. At the federal level we continue to see improvement. Within the past year the Department of Health and Human Services (HHS) ruled that Plan B One Step should be made available over-the-counter without an age restriction, and, thanks to the Affordable Care Act (ACA), women are now able to access family planning services without a co-pay requirement. In addition, expanded Medicaid eligibility is ensuring that millions of more women will be able to access reproductive health services.

At the state level, however, reproductive health and rights remain under vigorous assault. While the ACA paved the way for Medicaid expansion, 25 states have refused to expand their Medicaid eligibility, denying millions of women improved access to health care, including reproductive health services. In addition, several states have restricted funding for Planned Parenthood and other family planning providers, while also enacting abortion restrictions that will further serve to limit women’s access to family planning clinics.

Legal challenges are also clouding the picture of reproductive health and rights in the United States. As a result of pending cases, the US Supreme Court this year will hear a challenge to the HHS ruling that insurance companies, under the ACA, must provide coverage of contraceptive services when religiously affiliated hospitals and schools refuse to provide such coverage for their employees.

This year’s report card on reproductive health and rights ranked each of the 50 states and the District of Columbia using nine criteria:

• Thirty percent of the grade is based on measures of effectiveness. This includes the latest available data on the teenage pregnancy rate (15 percent) and the rate of unintended pregnancies (15 percent).
• Twenty percent of the grade is based upon prevention. This includes mandated comprehensive sex education in the schools (15 percent) and access to emergency contraception (5 percent).
• Thirty percent of the grade is based upon affordability. This includes if states are expanding Medicaid under the Affordable Care Act (10 percent), Medicaid eligibility rules for family planning (10 percent), and funding for family planning clinics serving low-income families (10 percent).
• The final 20 percent of the grade is based upon clinic access. This includes abortion restrictions (10 percent) and percent of women living in a county without an abortion provider (10 percent).

Based upon their scores, each state received a “core” grade (A, B, C, D or F), but some states received an additional “plus” or a “minus” for factors not reflected in the core grade, such as pending changes or legislation.

Only 17 states received a B- or higher. Just four states (California, Maryland, Oregon and Washington) received an “A.” Oregon received the highest composite score. Thirteen states received a failing grade (“F”). States receiving a failing grade included Georgia, Idaho, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, South Dakota, Tennessee, Texas, Utah, and Wyoming.

The ACA was designed to produce a nationwide improvement in access to reproductive health care services, but the failure of 25 states to expand their Medicaid eligibility has severely undermined the potential progress. With so much happening and so much at stake, it is imperative that people who care about reproductive health and rights keep apprised of what is happening in their state.

All of the hard-earned gains that have been made with respect to reproductive health and rights over the past half-century, along with the advances that were made with the passage of the ACA, are not to be taken for granted. As aptly demonstrated by what is happening in half of the 50 states, this is no time for complacency. America remains at the crossroads.

Rates of teenage and unintended pregnancy in the United States remain unacceptably high. Indeed, despite continuing declines in adolescent pregnancies, the rate of teenage pregnancy in this country is still the highest among industrialized nations, and nearly half of all pregnancies in the United States remain unintended. When it comes to reproductive health and rights, America is still not making the grade.

Posted by Robert J. Walker, president

Originally posted on the Huffington Post on January 9, 2014

When in Doubt Fallback to the War on Women

September 30th, 2013

Saturday night House Republicans decided to double down on their idea that they would not fund the government unless Obamacare was defunded for a year, an idea previously rejected by the Senate. However they did not stop there, they added in a “conscience clause” that would allow employers and insurers to opt out of preventative care for women if they find it objectionable on moral or religious grounds. While the provision is clearly aimed at contraceptive coverage, it would also affect any preventative care for women that the employer/insurer finds morally objectionable.

Cecile Richards, President of Planned Parenthood Federation of America, explains why this is such a problem in an op-ed in Politico:

Think about what that means. If a retail chain is bought by someone who doesn’t believe women should have access to immunizations or screening for the human papillomavirus, then potentially lifesaving treatment that is proven to help prevent cervical cancer would not be part of the insurance coverage for any women at that company. If a woman works at a bank owned by a man who opposes contraception, her birth-control prescription would no longer be covered by her health-insurance plan. Same thing for breastfeeding support, domestic violence counseling, HIV testing and other preventive care.

The health of women should never be used as a bargaining chip. Luckily the Senate has rejected this bill, but the House by this action has made it clear that it will not waste any opportunity to wage a war on women. With no clear path to preventing a government shutdown or a breach of the debt ceiling, supporters of contraceptive health care coverage must be ever vigilant that the House does not carry on this senseless assault on women and their reproductive health.

Posted by Jennie Wetter, Director of Public Policy

A See Change?

September 25th, 2013

Last week Pope Francis shocked the world with comments saying that the Catholic Church had become “obsessed” with abortion, gay marriage and contraception:

“It is not necessary to talk about these issues all the time. The dogmatic and moral teachings of the church are not all equivalent. The church’s pastoral ministry cannot be obsessed with the transmission of a disjointed multitude of doctrines to be imposed insistently.

We have to find a new balance; otherwise even the moral edifice of the church is likely to fall like a house of cards, losing the freshness and fragrance of the Gospel.”

While his comments do not represent a formal change in church policy, they could represent a changing tone on these issues that would be more reflective of the beliefs of its membership, particularly in the United States. Polling has shown that 82% of Catholics believe that birth control is “morally acceptable” and 63% of Catholics opposed overturning Roe v. Wade and support maintaining a woman’s right to choose.  More surprisingly, perhaps, 98% of Catholic women who have had sex have used a contraceptive other than natural family planning.

Unfortunately what the Catholic faithful think and what the church hierarchy thinks are not always the same. This dynamic has played out in the United States in numerous ways with the most recent iteration being the passage of the Affordable Care Act, which among other things would ensure that women have access to birth control with no co-pay. While most Catholics find birth control “morally acceptable,” and have used contraceptives, the Catholic bishops have fought tenaciously to prevent as many women as possible from accessing this benefit.

On an international level the Catholic Church has a huge impact at the United Nations where since 1964 the Holy See, the diplomatic representative of the Catholic Church, has had non-member state status. The Catholic Church is the only religion to be granted this status, with other religions only allowed to participate as non-governmental organizations. This enables the Holy See to have a disproportionate impact at the United Nations. As most policy is adopted by consensus at the U.N., dissent by the Holy See can easily throw a monkey wrench into international deliberations. The Holy See has been particularly intransigent on issues related to reproductive rights and LGBTQ issues. Recently the Holy See almost prevented final approval of a consensus outcome document at the Commission on the Status of Women that focused on violence against women.

While I am sure the Pope’s comments do not mean a change in church doctrine, particularly in light of the comments that he made on Friday to a group of Catholic gynecologists, they may mean the Holy See will be less obstreperous on these issues.  That would be particularly welcome news at the United Nations, where member countries are starting to formulate a post-2015 development agenda. The new development goals must include women’s rights and access to reproductive health services.

So will Pope Francis’s comments represent a real See-change or will we see more of the same? Stay tuned.

Posted by Jennie Wetter, Director of Public Policy

Immigration Bill Means Waiting 15 Years for Family Planning and Reproductive Health Benefits

August 15th, 2013

The immigration reform bill proposed and passed by the Senate in June would offer nearly 11 million people a path to legal status. If enacted into law, long-time residents of the US will gain the right to vote, the chance to seek lawful employment, opportunities for college financial aid, and legal recognition within our communities. But regardless of your opinion on the bill, there is one glaring deficiency: it would do nothing to meet the immediate family planning and reproductive health needs of immigrant women.

While the Senate bill provides a path to citizenship, it would require a wait of 15 years or more before an immigrant would become eligible to receive Medicaid benefits, including family planning and reproductive health. Such a wait would effectively deny many women in this country the kind of reproductive health care that we seek to provide—through international assistance— to women in developing countries.

If the Senate bill passes through the House without change and is signed into law, it would allow undocumented immigrants already living within the US borders to step forward and begin the process of attaining citizenship. People who have been residing in the US prior to December 21st, 2011, would be eligible to apply for citizenship under the law, but it would be a long process. First, they would have to change their status to become a “registered provisional immigrant (RPI).” Then, after a ten year waiting period, an RPI could adjust their status to “lawful permanent resident.”

During the 10-year waiting period as an RPI, immigrants are barred from receiving nonemergency Medicaid and also remain ineligible for assistance from the Affordable Care Act. Private insurance is astronomically expensive for low- and middle- income families without the federal subsidies put in place by the Affordable Care Act. RPIs cannot receive tax credits from the Affordable Care Act, and, thus, they will likely remain uninsured throughout the 10-year waiting period.[1] RPIs can only access limited public programs, such as WIC (supplemental nutrition programs for women and children).1 These programs alone are inadequate because they do not provide preventative care or comprehensive sexual and reproductive health services.

Following the achievement of lawful permanent residency, there is an additional “five-year bar” that would prevent legal American residents from receiving aid from federal benefit programs such as Medicaid.[2]  That means, in effect, a fifteen-year wait to receive health care. This is especially detrimental for young women of reproductive age who are pregnant or who need access to contraceptives. Currently, the cost of giving birth in a hospital is an average of $32,000 for a vaginal delivery and $51,000 for a C-section.[3] Just for this common medical procedure, the costs are impossibly high. Undocumented immigrants, however, who want to avoid an unplanned pregnancy and the associated costs of bringing a child into this world, would be ineligible for Medicaid family planning services.

The U.S. is a major provider of family planning and reproductive health care services to women in developing countries. The U.S. spends over $600 million a year in support of the UN’s goal of ensuring “universal access to reproductive health care.” If women in developing countries need access to family planning and other reproductive health care services, the same reasoning should apply to women in this country, regardless of their immigration status.  

Posted by Grace Benson, Public Policy Fellow


The Unintended Consequences of the War on Women

July 30th, 2013

Wars as a rule are not exercises in critical thinking.  Still, legislators who are busy waging an unrelenting attack on women and their reproductive health should take time to read the latest Guttmacher Report, “Contraceptive Needs and Services, 2010”.  They might discover that their war on abortion and family planning is creating some collateral damage.

State legislators in recent months have been working overtime in their effort to restrict a woman’s access to abortion services. Some states have set a limit on how late in a pregnancy a woman can get an abortion; other states have enacted TRAP laws (targeted regulation of abortion providers) that are designed to put clinics out of business by enacting burdensome laws that single out abortion providers from other medical service providers. The TRAP laws are not just stopping women from accessing abortion services; they are also restricting a woman’s access to pap smears, cancer screenings, and birth control.  At the same time several states have been slashing funding for family planning services, while Congress has been trimming Title X, the federal program that funds family planning services for low-income households.

One of the unintended consequences of these assaults on family planning and reproductive services is an increase in unplanned pregnancies…and the demand for abortions. According to the Guttmacher Institute report in 2010 8.9 million women received publicly funded contraceptives, and they helped prevent 2.2 million unintended pregnancies, which would have resulted in 1.1 million unplanned births and 760,000 abortions. The report estimates that without publicly funded contraceptive services the national levels of unintended pregnancy, unplanned birth and abortion among all women would be 66% higher overall and 73% higher among teens.

That’s not the end of the collateral damage that results from cutting family planning services.  Guttmacher’s report also shows how these cuts actually increase government spending. Publicly-funded family planning services in 2010 produced savings of $10.5 billion.  The return on investment for federal and state governments?  A whopping $5.68 for every $1 spent on family planning services.  

Any way you look at it, the War on Women is producing a lot of unintended casualties.   Maybe it is time for these legislators to call a retreat.

Posted by Jennie Wetter, Director of Public Policy

World Population Day and ‘Failing States’

July 11th, 2013

On July 11, without much public fanfare, the world will observe World Population Day. There will be no celebrations, no fireworks, and no formal ceremonies. Established by the United Nations in 1989 as a means of raising public awareness of global population issues, the observance has largely faded into obscurity. Decades of declining birth rates have assuaged fears of a “population bomb.” Those fears have been replaced, in part, by warnings of an impending “birth dearth.” In reality, however, we keep adding another billion people to the planet every 12-13 years, and the concerns that gave birth to the original World Population Day have not gone away. They are very much with us.

If you think concerns about population today are overblown, you should take a look at the 2013 Failed States Index (FSI) that was formally released by the Fund for Peace and Foreign Policy magazine at a Washington, D.C. press conference on Tuesday. The annual ranking of countries that are struggling against great odds to maintain functioning governments reads like a “Who’s Who” of countries with rapidly growing populations. Large parts of the world have made–in full or in part–the demographic transition from high fertility, high mortality, and rapid population growth rates to low fertility, low mortality, and stable or declining populations. Dozens of countries, however, have failed to make that transition, and, almost without exception, these countries rank very low in contraceptive usage and very high in terms of hunger, poverty, disease, and political instability.

The populations of the 20 countries that had the worst scores in the 2013 Failed States Index currently total 813 million. According to the latest UN population projections, their numbers will more than double in the next 37 years. Unless fertility rates in these countries fall faster than presently anticipated, their populations will total 1.7 billion by 2050. Today these 20 countries constitute 11 percent of world population; by 2050 they could account for 18 percent. And without an increased and sustained commitment on the part of the U.S. and other donor nations to international family planning assistance, the UN’s latest population projection could turn out to be an underestimate.

Expanded access to contraceptives would help to lower fertility in these countries, but unless more girls stay in school and delay marriage to adulthood, the decline in fertility could easily stall. In some countries, it already has. In many countries, the adolescent pregnancy rate is rising. The mere fact that most countries in the world have undergone a demographic transition does not guarantee that all countries will.

In many of these struggling countries, forty percent or more of the population is under the age of 15, and these children will soon be entering their reproductive years. The population of Somalia, which topped this year’s FSI, is projected to rise from 10.5 million to 27.1 million by 2050. The population of Democratic Republic of Congo (DRC), which came in second on the index, is projected to rise from 67 million 155.2 over that same time period. Sudan, which came in third, is projected to jump from 38.0 million to 77.1 million. The population of Yemen, already suffering from acute water scarcity, is projected to rise from 24.4 million to 42.5 million. The populations of war-torn Iraq and Afghanistan are also on the rise. Iraq’s population could climb from 33.8 million to 45.9 million by mid-century, while Afghanistan’s population could jump from 30.6 million to 56.6 million. But none of these projections are written in stone. Even small declines in fertility rates could dramatically lower these long range population forecasts. But will they?

By any fair measure, providing contraceptive services is not expensive. What’s really costly is failing to provide women with contraceptives choices and denying them the freedom to choose how many children to have and when. Reproductive freedom, as it turns out, is crucial to the future of failing or potentially failing countries. Without it, many of these countries will never complete the demographic transition to lower fertility and lower mortality, and they will have great difficulty in reducing poverty, eliminating hunger, and maintaining political stability.

When women everywhere enjoy gender equality and access to family planning and reproductive health services, World Population Day will be a cause for universal celebration, but we are not there yet. The UN set 2015 as the target year for achieving universal access to family planning and reproductive health services, but far too little progress has been made. Over 200 million women in the developing world want to avoid or delay a pregnancy, but are not using a modern method of contraception. Empowering these women and giving them access to a range of contraceptive services is crucial to their health and the wellbeing of their families and their country.

Originally posted on The Huffington Post on July 9, 2013.

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