Prepared Statement
Nicholas
Eberstadt
Henry Wendt Chair in Political Economy
American Enterprise Institute for Public Policy Research
eberstadt@aei.org
Presented at
“Mexico City
Policy:
Effects of Restrictions on International Family Planning Funding”
Hearings before the Committee on Foreign Relations
U.S. Senate
Washington, D.C.
July 19, 2001
Madame Chairman, members of the Committee, distinguished
co-panelists and guests: it is an honor to testify once again before this
Committee.
My remarks today address a somewhat technical, but
nonetheless very important issue: the question of the health and mortality
impact of the restrictions on U.S. international population assistance known as
the “Mexico City policy” (also called the “global gag rule” by its
critics).
As you know, the “Mexico City policy” was crafted to
deny US foreign aid funding to foreign non-governmental organizations that
perform abortions, or promote abortion as a method of family planning. That
policy was originally implemented under President Reagan, and was enforced under
President George H.W. Bush. It was
rescinded by President Clinton for the entirety of his tenure in office.
On his first day in office, however, President George W. Bush reinstated
the provisions of the “Mexico City policy” for US population assistance.
There is considerable apprehension among critics of this
policy that the restrictions on US population funding re-instituted by the
George W. Bush administration would have direct, adverse, and perhaps severe
consequences on recipient populations in developing countries: higher rates of
maternal and infant mortality, higher levels of unwanted pregnancy, and perhaps
even higher overall levels of abortion as well.
Determining the actual demographic consequences of these
restrictions, unfortunately, is not as simple and straightforward an exercise as
one might suppose. In much of the
developing world, vital registration systems are still rudimentary.
Typically, a low-income country’s statistical system is not capable of
providing relatively complete annual tallies of births, deaths or medical
events. Consequently, the concrete
data that we would need to for the careful evaluation of the health impact of
these new funding restrictions are simply not available for most countries that
receive U.S. population assistance.
However, as I will try to explain, the expectation that the
new Bush Administration restrictions on US international population assistance
will significantly and deleteriously impact maternal and child heath in
low-income regions is misguided. Those
apprehensions are misplaced. The
ultimate effect of those restrictions may be a slight increase in mortality and
unintended births—or, alternatively, a slight decrease in those deaths and
births. Or it may have no impact
whatever. No matter what the
impact, though, the result is unlikely to be large enough to quantify with any
confidence—and is also unlikely to be large in magnitude.
My assessment may sound curiously counterintuitive to some
listeners. Why do I come to this conclusion?
I may explain by way of analogy.
Over the past two decades, the United States government
has, in effect, already run a sort of “controlled experiment” with
restrictions on its international population assistance funding:
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Washington, remember, enforced the “Mexico City
policy” over the period from 1984 to 1993, and then overturned that policy
between early 1993 and early 2001.
Some critics of those past restrictions on population
resources warned at the time that those changes in US population assistance
would have striking—indeed devastating—repercussions on the health and well
being of vulnerable low-income populations.
In 1996, for example, Dr. Nafis Sadik, then Executive Director of the
United Nations Population Fund (UNFPA), had this to say about impending cuts in
U.S. population funding:
The way U.S. funding is going,
17 to 18 million unwanted pregnancies are going to take place, a couple of
million abortions will take place, and I’m sure that 60,000 to 80,000 women
are going to die of those abortions—just because the funding has been reduced
overnight.
Similarly, in June 1997 the Planned Parenthood Federation
of America warned that “maintaining the 35 percent reduction in funding for
U.S. population assistance will mean”:
Four million more women will
experience unintended pregnancies that will lead to 1.6 million more abortions,
8,000 more women dying in pregnancy and childbirth, and 134,000 more infant
deaths.
These cuts in U.S. population
assistance mean that many of the medical clinics providing basic and lifesaving
reproductive health care services will be closed, making it virtually impossible
to restore these crucially important medical services any time in the near
future.
But as we now know, those dire forecasts were also very bad
forecasts.
Although (as I have already noted) vital statistics for
low-income countries are highly incomplete, international demographic and health
experts did not detect any measurable upsurge in global birth rates, abortion
rates, maternal mortality rates, or infant mortality rates after the 1996 cuts
in US international population assistance. To the contrary: projections by the U.S. Bureau of the Census
trace out a series of continuous and uninterrupted declines in both fertility
levels and infant mortality rates for the grouping it labels the “less
developed countries” for the years 1995-2000.
(Though those Census Bureau’s numbers cannot promise pinpoint accuracy,
the steady downward tendency for both fertility and infant mortality in
low-income regions faithfully reflects current state-of-the-art expert thinking
about those trends for the period in question.)
Nor, incidentally, has evidence been adduced that the prophesied shutdown
of medical clinics and cutback in health services actually came to pass.
Conversely, no acceleration in health progress for women
and children in developing regions has been detected or claimed for the period
in the early 1990s when US international population was rapidly increasing, and
“global gag rule” strictures were annulled.
Why not? Put
most simply, the world is a more complicated—and perhaps also a more
human—place than those critics of restrictions on US population assistance
pessimistically assumed. In the
vast and complex dynamic that shapes family formation and family health trends
in low-income areas, the role of U.S. population assistance in determining
ultimate outcomes may be far less important than many in the “population
community” seem to assume.
But what of the health implications of
“Mexico City policy” itself? There are three reasons to expect that
the new restrictions on U.S. population assistance will have a limited
demographic and health impact:
First, the restrictions themselves are in fact not nearly
so draconian as some seem to imagine.
According to a March 2001 report by the Congressional
Research Service, the newly implemented regulations contain the following
exceptions:
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referrals for abortion as a result of rape, incest, or
where the mother’s life would be endangered, or for post-abortion care are
permitted.
USAID will further be able to continue to support, either
directly or through a grantee, to foreign governments, even in cases where the
government includes abortion in its family planning program…
Given the rather broad leeway that can be read into those
regulations, and the fact that the Bush Administration is committing itself to
maintaining and even increasing the overall level of US international population
funding, any restrictive impact from the new changes in US family planning
policies would seem likely to be distinctly less strict than impacts that have
already been recorded and experienced in the relatively recent past—and those
impacts, as we have noted, were not detectable in standard reference demographic
accounts.
Second, U.S. population assistance is only one component of
the total resources used in family planning in low-income regions—and while
the US may be a major international funder, it is by no means the dominant
funder.
In FY 2001, the United States committed $450 million to
international population activities. By
the reckoning of the UNFPA, total international for population activities in
developing countries currently amounts to about $2 billion a year.
If the UNFPA’s estimate is correct, US funding today accounts for less than a
quarter of all Western population aid—almost four-fifths comes from other
Western sources.
And a still greater pool of family planning funds is raised
by low-income countries themselves: UNFPA places that annual total at about $7.5
billion. If those numbers are
accurate, US population assistance amounts in aggregate to only 6 percent of the
resources for population programs that developing countries are already
mobilizing for themselves.
Given the truly international network of sponsors for
population activities in low-income areas, restrictions or shortfalls in U.S.
population funds may be offset through applications of additional funds from
other sources. The European Union,
for example, has indicated that it may increase its international population
funding as a reaction to the new U.S. policy. (If current events follow the
course witnessed earlier with US restrictions on funding for the UNFPA, other
donors would end up not only fully compensating for any US shortfall, but
actually augmenting overall resource levels.)
And it is by no mans inconceivable that low-income
governments, or private individuals in low-income countries, may reveal their
own preferences for family planning services or population activities by
expending more funds for them on their own.
Third, and most important, the correspondence between
public health spending and personal health outcomes, far from being precise and
mechanistic, is in reality only broad and rather diffuse. This is true for
family planning expenditures and family planning outcomes as well.
There are many reasons for this, but one of them is that the women and
parents in question are independent actors in this drama.
They take actions to safeguard and improve the health of their families
irrespective of government programs and resources.
Third World women, Third World adults, do not behave as passive, helpless
agents in matters of central importance to their families—nor do they believe
that babies are born under cabbages.
In the final analysis, I would submit, there is both good
news and bad news about the expected health and demographic consequences of the
newly re-instituted “Mexico City policy”.
On the one hand, these new restrictions are unlikely to
have any significant impact on the global level of abortion.
And it is most unlikely that these restrictions will tangibly reduce the
rate of abortions in the regions affected by the new restrictions—as
proponents of the “Mexico City policy” intended and hope to do.
At the same time, as I have indicated, the fear that these
restrictions will lead to palpably higher levels of maternal and infant
mortality can be assuaged. There is
no reliable evidence to suggest that this will be the case, reasonable though
that apprehension may seem to some. Claims
of dramatic adverse health consequences from the “Mexico City policy” are
undocumentable and unsupportable. Until
evidence to support such claims becomes available, those charges should be
regarded as political theater.
