The United States Agency for International Development (USAID) will spend over $400 million on population control over the coming year, much of this in countries where the total fertility rate (TFR) is only slightly above replacement. Women must average 2.1 children for populations to sustain themselves, but in countries ravaged by infectious disease and AIDS, the average number of children must be higher lest numbers fall.
Instead of protecting people and saving babies, USAID’s focus continues to be on reducing populations. This makes no demographic sense. USAID needs to graduate countries from population control, not continue signing five-year, multimillion-dollar contracts with organizations for more of the same.
The Dominican Republic
USAID has recently obligated millions of dollars for population control in its $18 million Health and Population project which will run through 2007. The stated goals of USAID programs in the DR are to “increase access to sustainable, effective, reproductive health/ family planning services” and to “provide technical assistance to increase the sustainability of the three leading family planning NGOs whose services are reaching the most vulnerable populations.”1
The “most vulnerable populations,” of course, are those which are losing the most children for lack of basic aid. Yet U.S. funds will go to “leading” groups like PROFAMILIA, which operates in Santo Domingo, and which concentrates its efforts on sterilizing the poor. Its programs have been denounced by none other than the Cardinal Archbishop of Santo Domingo, Nicolas Cardinal Lopez Rodriguez, who criticized “USAID death-squads” organized by PROFAMILIA which were reportedly sterilizing large numbers of poor Catholic women.2
Not only do many people in the Dominican Republic not want USAID programs in their neighborhoods, these programs no longer make any demographic sense. Currently, in the DR, about 4 million women are of reproductive age (15–49) but will have only 2.7 (TFR) children on average throughout their lifetimes.
The U.N. projects that the TFR will drop to 2.1 by 2025, at which time the DR’s population will peak at just over 10 million, then begin to decline. But since child and infant death rates in the Dominican Republic are still alarmingly high, the net fertility rate is already much closer to replacement than the current TFR of 2.7 would indicate. Tens of thousands of children under the age of five will die this year from preventable diseases. About 3% of the 200,000 babies born in the Dominican Republic this year will die, largely for lack of basic aid.
The Dominican Republic should be graduated from USAID population control programs today.
There is sufficient demographic evidence of rapidly falling fertility rates to graduate Peru now from USAID-funded population control programs. Peru’s TFR, at 2.6, is just above replacement. High infant death rates in Peru pull the net fertility rate even closer to replacement, Over 30,000 children under age five in Peru will die this year for lack of basic aid.
Yet the programs appear to be continuing regardless. USAID recently reported that “Family planning services will be strengthened .…” by USAID in Peru, in a $45 million Improved Health for Peruvians project, for 2002–07.3
This renewed emphasis on strengthening population control programs is particularly unconscionable given that the Peruvian Congress has just indicted ex-President Fujimori for genocide. Fujimori’s “population policy,” the Peruvian Congress reports, “was induced and financed by international organizations, namely USAID.” Over 300,000 women were sterilized, most under duress. Given this history of abuse, carried out in large part by population control groups that received USAID funding, shouldn’t USAID consider withdrawing altogether from population control in Peru?
It will take a long time for Peruvian minorities targeted for forced sterilization to recover demographically. The U.N. predicts that the population of Peru will begin to shrink in 2045, but well before that date Peru’s TFR will have fallen below 2.1. (The U.N. predicts an anemic 1.6 from 2020 on.) But given Peru’s high infant mortality rate, and the fact that so many women of childbearing age have already been sterilized, the country’s birthrate is already rapidly closing in on replacement rate fertility.
Let’s graduate Peru from “family planning.”
In Africa, fertility rates still appear to be well above replacement. But extremely high child mortality rates, along with the scourge of AIDS, pull net fertility rates downwards.
Kenya and Tanzania
In the three countries of Kenya, Tanzania and Ghana, USAID has obligated $140 million for population control programs for the period 2002 to 2004. USAID’s expressed goals in these countries are to “reduce fertility;” provide “contraceptives, as well as technical support for managing procurement and distribution of these commodities;” “expand family planning social marketing;” “support media campaigns” and increase the number of contraceptive providers.4
In Ghana, USAID boasts that “The number of Norplant acceptors increased by 290 percent over a two year period, and 145 nurses were trained to insert Norplant.”5 Yet, according to reports from the field, Ghanaian women are not being adequately informed of risks.
Still, USAID appears to be achieving its objective of reducing fertility rates in Africa more rapidly than anyone would have imagined possible 20 years ago. In all these African nations, the TFR is expected to fall to replacement within the next couple of decades.
But is this a reasonable goal? No, because it ignores the fact that over 1 million children under age five die each year in Kenya, Tanzania, and Ghana combined — largely from preventable diseases. AIDS sweeps away many hundreds of thousands of people more, most at the very beginning of their reproductive lifetimes. Because of their high mortality rates, these nations’ net reproduction rate is currently much lower than their TFR.
If aggressive USAID-funded population control programs continue very much longer, especially if AIDS continues to spread, then the populations of many African nations may simply collapse. This would be a tragedy of the first order. Instead of onerous, controversial, unwanted and oftentimes coercive population control, the United States should be investing in basic health care programs that save lives.
Clearly, the time has come for USAID to graduate Kenya, Tanzania and Ghana from population control.
3 Congressional Budget Justification, 2002, Peru, USAID MISSION: Peru, “Improved Health For Peruvians;” “Improved Health for Peruvians at High Risk,” 527–011.
4 USAID MISSION, Tanzania, Strategic Objective: Increased Use of Family Planning, Maternal Child Health, and HIV/AIDS Preventive Measures; Kenya, Strategic Objective: Reduce Fertility and the Risk of HIV/AIDS Transmission Through Sustainable, Integrated Family Planning and Health Services; Ghana, Strategic Objective: Improved Family Health.
5 USAID, “Health and Family Planning Overview: GHANA,” July 2002.