A report on AID population contractors’ compliance with the Mexico City policy, commissioned by the Agency for International Development, was released November 21. The study, done by the Population Technical Assistance Project (POP-TECH), found that the five AID contractors studied had conducted their overseas family planning activities within the guidelines set forth under that policy.1
But-there is much to suggest that the report is inaccurate, or, at the very least, incomplete. The review did not, for example, include one AID-funded agency known to have violated the policy, and those which were surveyed were apparently forewarned of the investigation.
Under the Mexico City policy, which was adopted in 1984, the United States formally rejected the use of abortion as a form of birth control. The policy holds that the U.S. will neither contribute money to foreign nations who include abortion in their family planning programs — except by providing funds to separate accounts which are not used for abortions — nor fund those non-governmental organizations that actively promote abortion as a means of limiting births. Organizations receiving population contracts are required to monitor the activities of their subcontractors, and to refrain from providing grants to any group that does not agree, in writing, to avoid active involvement in abortion.2
Exceptions include abortions performed to save the life of the mother and in cases of rape or incest, provided such procedures are lawful in the country in which the project takes place. Regulations also draw a distinction between “active” and “passive” promotion of abortion. While prohibiting such “active” abortion activities as counseling a client to have an abortion, it allows “passive” referrals, defined as providing to a woman who has already decided to have an abortion information about where to obtain one. The policy also forbids the lobbying of government ministries to permit abortion as a means of birth control by contracting agencies and their subcontractors. But the policy does allow their employees to do so as individuals, so long as the groups for which they work neither endorse nor financially support such efforts.3
The newly-released survey was conducted by two researchers, former Ambassador John Blanc and POPTECH research associate Matthew Friedman, between February and August of 1990. It included five family planning contractors: the Association for Voluntary Surgical Contraception (AVSC), the Centre for Development and Population Activities (CEDPA), Family Health International (PHI), International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), and the Pathfinder Fund. And it studied projects under the direction of these groups in Bangladesh, Brazil, Egypt, Kenya, Pakistan and Turkey.4
The purpose of the investigation, as stated in the report, was to determine whether the agencies are in compliance with the regulations, to find out if sub-project personnel understand the policy, and to assess the impact of the Mexico City policy on overseas population activities.5
The surveyors met with the project personnel in the countries visited, interviewed sub-project staff and examined documents. They also contacted AID mission officers in the six countries.6
The researchers also, according to the report, studied a number of projects which were not receiving AID funds “in an effort to collect information reflecting different perspectives on the status of abortion and attitudes towards abortion in each of the countries visited.”7
Friedman and Blane note in the published report that the vast majority of sub-project staff were aware of the abortion policy, with the exception of clinic workers in Kenya. There, they note, 64 percent of clinic personnel were unaware of the policy. Nonetheless, the writers concluded that these were “well aware that Kenyan law prohibits abortions” and that criminal penalties were attached to such activities. In Brazil, they add, one subgrantee stated that staff had been informed of the anti-abortion provision, but that “there was no need to monitor adherence to it.”8
The document concludes, however, that all cooperating agencies and their subgrantees “were found to be in complete compliance with the requirements of the Mexico City Policy,” and even that some had “reacted to the Mexico City Policy requirements … with an overcautiousness that extends to activities clearly permitted under the policy.” The POPTECH report suggests that the long-term effect of the abortion prohibition on population planning cannot be estimated in light of available evidence, and recommends “a more detailed assessment” of the policy’s impact.9
One group excluded from the study has had substantial problems with the Mexico City provisions. That organization, Family Planning International Assistance — a special subsidiary of the Planned Parenthood Federation of America that was created to receive AID funds for overseas population activities — recently lost a court case involving its noncompliance with the abortion guidelines. FPIA receives nearly all of its operating budget from AID grants and contracts.
According to a newsletter published by the SOMARC (“social marketing”) program of the Futures Group, the Second Circuit Court of Appeals ruled that the government may enforce its policy of withholding AID contracts from groups involved in abortion activities. FPIA had initially filed suit in 1987 charging that the policy violated its First Amendment rights. According to the SOMARC newsletter, FPIA is considering an appeal to the Supreme Court.10
The newsletter adds that, at the request of AID officials, “FPIA has filed a proposal for a new five-year agreement, but the provisions still do not comply with the Mexico City policy.” It is unclear, the publication added, “what specific effect defunding might have on regional offices or operations.”11
FPIA has also provided financial support to another organization that specializes in the promotion of abortion in developing countries. That group, the International Projects Assistance Services (IPAS), does not receive AID money directly, but includes Family Planning International Assistance in a list of major contributors that appears in its 1989 annual report.12
“IPAS works to assure that women throughout the world have access to the best, most up-to-date abortion-related care available,” says a message from IPAS president, Katie Early McLaurin, in the IPAS annual report. “Over the past five years, IPAS’ central focus has been training clinicians in the manual vacuum aspiration (MVA) technique for safe abortion-related care. During the past 18 months, more than 1,200 medical personnel and support staff have participated in IPAS-sponsored training programs learning to deliver safe and appropriate abortion-related services in the developing world.”13
The findings of the new POPTECH Mexico City report might also have been intentionally skewed by the contractors and AID officials themselves. A file of correspondence between AID’s Office of Population and one of its major contractors, obtained through the Freedom of Information Act, contains a “dear colleague” letter, dated Feb. 1, 1990, from AID Office of Population Director Duff Gillespie. The letter, part of a file on the Johns Hopkins University population communication project, was apparently sent to each of the cooperating agencies under review.
“The Office of Population is initiating a study to determine how well its Cooperating Agencies are complying with the clause in grant and cooperative agreements that implements the U.S. Government’s Mexico City policy,” the letter begins. It lists the five contractors whose activities were reviewed, as well as the five of the six countries (excluding Turkey) in which the investigation was conducted. The letter also names the two researchers, gives the approximate dates of their study, and notes that the final result will address the question of “whether recipients of grants and cooperative agreements and their sub-recipients are complying with the requirements.”14
In closing, the letter suggests recipients contact the Office of Population for further information. “We ask for your full cooperation in conducting this study and thank you in advance,” Gillespie wrote.15
The findings of this study, whether accurate or not, should inspire little enthusiasm on the part of abortion opponents. The contraceptive ideology promoted under these population projects is largely conceptual. The programs succeed only when they stimulate, first of all, a desire among potential family planning acceptors to have fewer children, and second, acceptance of the idea of separating sex from procreation. And these concepts are as appropriate to abortion as they are to measures intended merely to prevent pregnancy.
In a November 1967 paper titled “Policy Determination: Population and Family Planning Programs,” cited in a May 1990 Government Accounting Office report to the Senate Subcommittee on Foreign Operations, AID wrote: “Family planning seeks to influence human behavior. Motivation is therefore an important part of any approach to the population problem. This requires understanding of cultural, social, psychological and economic forces … To accomplish behavioral changes and provide contraceptive methods, a substantial, effective and well-organized family planning program is necessary .…”
Such special “motivational” activities, inherent even in ordinary contraceptive clinic operations, did not come into their own until the mid-1980s, when they became a major part of AID’s foreign population program and were established as separate so-called ‘information, education and communication’ or ‘IEC’ projects.
These mass media ‘IEC’ campaigns are seldom method-specific, and therefore tend to promote whatever methods happen to be available.
The Seattle-based Program for Appropriate Technology in Health (PATH), which receives money from AID’s health branch, notes in a recent issue of its publication, Outlook, (October 1989), that menstrual regulation, “performed within a few weeks of a missed menstrual period, has proven to be an especially safe and culturally appropriate means of providing early abortion services in some countries where access to abortion is restricted.”16
The article adds, “Restrictive abortion laws often are interpreted to pertain only to procedures performed on women who are demonstrably pregnant.” Thus, it says, “information and education programs must convey to women that menstrual regulation must take place soon after a missed period.”17
Several non-AID-funded programs provide abortion or menstrual regulation services directly. IPAS, for example, offers such services and training in several countries where abortion is either illegal or severely restricted, including Mexico, Nicaragua, Ecuador, Kenya, Nigeria, Zaire and Zambia.18
And Development Services International, a private population group based in Ontario, Canada, has assisted numerous illegal abortion programs. Among its recent activities are research projects on herbal abortifacients in the Philippines and Sri Lanka; training programs to teach abortion/menstrual extraction procedures to midwives in Egypt, Ecuador, Gambia, Honduras and rural Mexico; schooling a provider for an abortion clinic in Lesotho; supporting the operations of an abortion counseling service for women in Colombia; providing consultant services for a Venezuelan clinic specializing in the treatment of incomplete abortions; and procurement of equipment for several similar projects.19
One of AID’s most aggressive “IEC” projects is intended to create “a broad political and social constituency supportive of family planning …[and] significant attitudinal changes favoring smaller family norms.”20
That such “significant attitudinal changes” might result in increased frequency of induced abortion is virtually indisputable: An appendix to the POPTECH report reveals that there was a five-fold increase in the incidence of illegal abortion in Kenya between the early 1980s and 1988.21
1 Population Technical Assistance Project, Nov. 21, 1990, “Mexico City Policy Implementation Study: Occasional Paper #5,” (Virginia, Dual & Assoc., Inc.), p. 29.
2 Ibid., pp. 1–2.
3 Ibid., pp. 16–17, 2, 3.
4 Agency for International Development, Feb., 1, 1990, letter from Duff Gillespie, Agency Director for Population.
5 Population Technical Assistance Project, “Occasional Paper #5,” Intro., p. v.
6 Ibid., pp v, vi.
7 Ibid., p. 8.
8 Ibid., pp. 13–14, 15.
9 Ibid., pp. 29, vi.
10 The Futures Group, Social Marketing Forum: A Progress Report on international Social Marketing Programs in Family Planning. Fall 1990, #19. “Family Planning International Assistance Loses Policy Change. Faces Aid Funding Loss,” p. 2.
12 International Projects Assistance Services (IPAS) Annual Report 1989, p. 25.
13 Ibid., pp. 6–7.
14 USAID letter, Duff Gillespie.
16 Program for Appropriate Technology in Health (PATH) Newsletter Outlook, Vol. 7, Number 3, Oct., 1989, “The Impact of Unsafe Abortion in the Developing World,” p. 6.
17 Ibid., pp. 6–7.
18 IPAS Annual Report 1989, pp. 15–17.
19 Development Services International of Canada, Family Planning Projects Completed, p. 4.
20 Johns Hopkins University Communications Services Contract #620-0001-C-00-8013-00, Effective date, Mar. 15, 1988.
21 Population Technical Assistance Project, Appendix p. B4.