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Foreign Aid in a Grown Up World

September 12, 2002

Volume 4/ Number 22

Dear Colleague:

Global birthrates are falling fast, yet maternal and child mortality rates, largely caused by preventable diseases, remain high. We are not meeting the basic needs of mothers and children, while making every effort to surgically and chemically contracept women and reduce the numbers of children. The time has come to shift the basis of U.S. foreign aid policy from population control to meeting needs for food, clean drinking water, and primary health care.

Steven W. Mosher


Foreign Aid in a Grown Up World

The U.S. Census Bureau, in its World Population Profile, has some sobering news. For the past few decades, birthrates have fallen throughout the developing world and are dropping dangerously low. Populations are aging rapidly.

“Since the 1960s, the average number of babies born to women over their reproductive lifetimes,” the bureau notes, “has been declining in both more developed and less developed countries.” In both developed and developing nations, fertility rates are “actually lower than the level required for long run replacement of population in the world’s more developed regions.”(1)

Annual global population growth has declined from 2% in 1970 to 1.24% today, and is projected to drop to .43% by 2050.(2) The U.N. predicts that the world’s population could peak at under 8 billion by 2050 then begin to decline. Global fertility could fall below replacement as soon as 2015.(3)

The stark reality of global under-population can be seen in fertility trends over the past decade. In 1990, between 50 and 60 countries, mainly developed, had below-replacement fertility. Today, the bureau states, “79 countries, or over a third of all nations, have TFRs of 2.1 or less. And low fertility countries are increasingly likely to be found in the world’s less developed regions… TFRs will remain below replacement level in China, Eastern Europe… and the rest of the world during the next 25 years and will fall below replacement in Latin America and the Caribbean by


This alarming trend has been accompanied by increased funding for population control and unmet need for basic care to save the lives of children, while USAID funding for contraception in recent years has reached record levels.

But there is even greater need for life-saving survival programs, the funding of which has been paltry.

In 1998, 7.7 million children worldwide died before their first birthday, with over 90% of these deaths occurring in the developing world. From 1998 to the present, children under the age of five have died from preventable deaths by the tens of millions.

The unnecessary death of mothers is no less of a global calamity than child mortality. In Afghanistan, for example, an estimated 1,700 mothers die per 100,000 births.(5) (By comparison, the maternal mortality rate in the U.S. is 12 deaths per 100,000 births.)

In other regions where infant and maternal death rates are in crisis, it has been reported that U.N. bureaucrats have denied NGOs offering Child and Maternal care entrance into regions because they do not provide contraception services. Women and children have died as a result.

Aggressive, and even coercive, population control programs continue to occur on every continent, accompanied by huge disparities not only between the rich and the poor, but between basic health and contraception in foreign aid.

In Peru, for example, between 1997-2000, $49,062,000 was provided by USAID to non-governmental organization for population control, and only $13,965,000 was provided for other health care programs—approximately 3.5 times as much funding for population programs than for basic health.

The focus on foreign aid to Peru in the form of family planning persists despite an alarming need for basic aid and a rapid drop in birthrates over the past several decades. (Between 1950 and 2000, the total fertility rate in Peru dropped from 6.85 to 2.98 and is projected to decline to below replacement by 2010 and continue to decline.)(7)

In Peru, the need for basic aid is revealed by the statistics themselves: an estimated 52 children aged five years old or younger die per every 1000 live births; 48,000 people have HIV/AIDS; 16% of the population lives on less than $1 per day; 49% of the population is living below the poverty line; 23% of the population does not have access to safe water, and 24% of the population does not have access to adequate sanitation.(8)

Recently, the Peruvian congress indicted ex-President Alberto Fujimori for genocide; more specifically, for using coercive tactics including involuntary sterilization to lower the birth rates of Peruvian women, especially minorities; and both USAID and the U.N. Population Fund (UNFPA) have been named as primary supporters and collaborators of this crime.

Even if USAID-funded population control programs in Peru in no way involve coercion today, vast unmet needs exist for basic Child Survival and basic health programs. But while this need exists in many developing nations today, the U.S. Congress continues to far outspend Child Survival with Family Planning globally.

In a grown-up world, where birthrates are falling, and death rates are soaring, the focus of U.S. foreign aid policy must be on need.

The time has come to make the shift from population control to life-saving basics.


1. U.S. Census Bureau, World Population Profile, 1998.

2. Ibid.

3. UNPD, World Population Prospects, 2000 Revision.

4. Ibid., Census Bureau, World Population Profile, 1998.

5. Ibid.

6. Associated Press, “Afghan Women face Childbirth Risks,” 10 Sept. 2002.

7. UN Population Division, World Population Prospects: The 2000 Revision, Peru, Pp. 368-369.

8. American Red Cross, International Services, Country Overview: Peru, services/intl/initiatives/americas/peru.asp.

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