战略与国际研究中心-International-Family-Planning_21页_464kb

Summary of International Family Planning: A Common-Ground Approach to an Expanded U.S. Role

Core Content

This report by the CSIS Global Health Policy Center, authored by Janet Fleischman and Allen Moore in July 2009, explores the potential for the United States to expand its role in international family planning (FP) through a common-ground approach. It emphasizes the importance of FP as a critical global health priority, highlighting its role in improving maternal and child health, reducing infant and maternal mortality, and promoting economic and social development.

Main Viewpoints

• FP as a Global Health Priority: Family planning is a vital component of global health and development. It enables individuals to make informed decisions about their reproductive lives, leading to better health outcomes and greater economic stability.

• Common-Ground Approach: The report argues that the U.S. should focus on FP services that are universally accessible, voluntary, and based on informed consent, while avoiding the contentious issue of abortion. This approach is grounded in the recognition that FP is widely accepted in the developed world and can serve as a shared policy foundation.

• U.S. Leadership and Investment: The U.S. has historically been the leader in international FP, but its current level of investment is insufficient to meet global needs. The report calls for a doubling of U.S. FP funding to around $1 billion annually, aligning with the goals of the Millennium Development Goals (MDGs), particularly MDG 5, which aims to improve maternal health.

• Challenges and Polarization: The report acknowledges the deep political polarization in the U.S. around FP, especially due to its association with abortion. The 2008 PEPFAR reauthorization debate exemplifies how this polarization can hinder progress.

• Domestic vs. International FP Policies: U.S. domestic FP programs (under Title X) are more liberal, allowing access to a broader range of services, including abortion referrals. However, international FP programs are restricted by U.S. law, which prohibits funding for abortion-related services.

Key Information

U.S. FP Funding and Spending

• The U.S. traditionally provides about 45% of donor funding for FP programs.
• In FY2009, the U.S. spent $455 million on FP, with an additional $50 million for UNFPA (excluding China).
• The estimated cost to provide FP services to the 200 million women lacking access is $17 to $19.50 per woman annually, or $3.4 billion to $3.9 billion globally.
• The U.S. would need to contribute $510 million to $585 million to meet the new target of universal access to reproductive health by 2015.

FP Services and Their Impact

• FP services help reduce unintended pregnancies, which in turn reduce unsafe abortions and associated maternal deaths.
• FP is associated with significant secondary benefits, such as improved economic development, reduced environmental degradation, and better educational opportunities for women and girls.
• Studies show that every dollar invested in FP can yield up to four dollars in savings from other development areas.

Unmet Need for FP Services

• Over 200 million women in developing countries would like to delay or avoid pregnancy but lack access to FP services.
• Unmet need is influenced by socioeconomic factors, including education, employment, and geographic location.
• In sub-Saharan Africa, 24 million women would like to limit or space their children but are not using any contraceptive method.
• Teen pregnancies are a major cause of maternal mortality, with girls under 15 five times more likely to die from pregnancy-related complications than women in their 20s.

Policy and Legal Restrictions

• U.S. FP programs are subject to several legal restrictions, including the Helms Amendment, which prohibits funding for abortion-related services.
• The Mexico City Policy, which barred U.S. funding from organizations providing abortion-related services, was rescinded by President Obama in 2009.
• The report outlines various amendments in annual appropriations bills that restrict FP funding, such as the Biden, DeConcini, Helms, Kemp-Kasten, Siljander, and Tiahrt Amendments.

Role of PEPFAR and FP Linkages

• The PEPFAR reauthorization debate highlighted the tension between FP and HIV/AIDS programs, with strong opposition from conservative groups.
• The report suggests that FP and HIV/AIDS programs should be more closely integrated to improve cost-effectiveness and sustainability.
• Despite the controversy, the report emphasizes the need for sustained, high-level leadership from the U.S. government to achieve progress in FP.

Conclusion

The report concludes that a common-ground approach to international FP can lead to significant improvements in global health and development. It calls for increased U.S. investment, stronger collaboration with other donors, and a shift in the political discourse around FP to focus on its broader health and development benefits rather than its association with abortion. The 2009 ICPD anniversary provides an opportunity for the U.S. to reorient its policy and lead the global community toward universal access to FP services.