Melinda Gates and the Family Planning
Summit will waste 4.6 billion dollars on contraception for women in
third world countries instead of addressing the educational and
healthcare-related challenges pregnant mothers face.
A June 26 press release from Save the Children,
an international humanitarian organization, begins ominously:
“Pregnancy is the biggest killer of teenage girls worldwide, with one
million dying or suffering serious injury, infection or disease due to
pregnancy or childbirth every year.”
One million is a big number, and a friend who sent the press release
insisted that his jaw dropped when he read that, in his words, “teen
pregnancy is responsible for over 1 million deaths a year in the
developing world.”
There is a subtle, but important, discrepancy here. The report says one million teenage girls die or
suffer serious injury, infection or disease due to pregnancy, the
operative word being the conjunction. What our friend read was that one
million teenage girls die annually due to pregnancy, full stop. When we
read the email, before reading the press release, we were confused. According to the World Health Organization,
in 2010, 287,000 women died of pregnancy-related causes. Could Save the
Children be so brazen as to claim that the number of teenagers dying in
childbirth was nearly three and a half times the total number of
pregnancy-related deaths worldwide? We were intrigued.
It turns out that the actual report, Every Woman’s Right: How family planning saves children’s lives,
states that only 50,000 women ages 15 to 19 die every year of
pregnancy-related causes. Now that’s different. Although this figure is
terribly tragic, it represents only 5% of the one million that the press
release implies in its first line, “biggest killer…, with one million.”
Our friend can be excused for misunderstanding.
The Save the Children report was released as part of an effort to
draw attention to the Family Planning Summit organized by Melinda Gates
in London this month, which has now concluded with an enormous amount of
money—some $4.6 billion—secured to meet the supposedly unmet
need for contraception. The blustery rhetoric with which Save the
Children and other groups worked to prime the pump for the Summit is a
sure sign that we should be wary of the claim of nearly universal
consensus that more funding for contraception in the Third World is the
answer to the maternal mortality problem.
So do we need more money for family planning? USAID has budgeted fully $547 million
for family planning in 2012, and the Gates Foundation spent $437
million in 2009. With EU nations included, we are easily over one
billion dollars in family planning funds annually. That’s a lot of
money. We need more? Every dollar spent on family planning is a dollar
not spent on other urgent needs, like education, basic health care, and
infrastructure.
There is no question that it is a travesty when anyone dies of a
pregnancy-related cause, and it is particularly tragic when adolescents
do. But the vast majority of these maternal deaths are preventable.
Let’s look at how $4.6 billion could be used to reduce maternal
mortality.
First, the provision of skilled birth attendants is particularly critical to combat maternal mortality. According to UNFPA, providing skilled birth attendants to all women would reduce maternal mortality by 75 percent. Skilled attendance at birth has been shown to correlate with lower maternal mortality ratios. A survey of 58 countries
where 91 percent of maternal deaths occur shows that less than 17
percent of the world’s midwives are available in those countries. The
provision of midwives worked in Sweden in the 1800s, and it has worked recently in countries such as Sri Lanka, Malaysia, Thailand, and Egypt.
A large scale birth attendant training program would be a
straightforward, highly measurable, and long lasting intervention that
would significantly decrease the maternal mortality ratio. Gates’s $4.6
billion will not be spent on such a program.
In addition, access to education should be a major concern in efforts
to decrease teenage pregnancy and the maternal mortality ratio. More
educated women delay and space their pregnancies, which allows them to maintain their health, and education empowers women to determine for themselves how best to control their fertility.
The educational level of women is also highly correlated
to the maternal mortality ratio. The education a woman has represents
both the opportunities she has had and the opportunities she will have
in the future; it also “promotes increasing autonomy, awareness, responsibility and knowledge for self-care, healthy lifestyles and behaviours.”
An educated woman therefore will access the appropriate maternal and
reproductive health services, including skilled birth attendants,
greatly reducing her likelihood of maternal death. This affirms the
central role of education in combating maternal mortality. Also, because
women’s educational attainment means access to information about
appropriate prenatal and postnatal care and childbirth, it follows that
the maternal mortality ratio can decrease in areas where women typically
do not have a high educational attainment, so long as they are provided
with information about best practices related to their pregnancies.
Gates’s $4.6 billion will not be spent on primary and secondary
education for girls, either.
Adolescent girls and women also need access to basic and maternal
health care. When governments focus intensively on maternal and child
health, introducing health measures such as low-cost basic health care,
including prenatal, postnatal, and obstetric health care, and social
protection for the extreme poor, the maternal mortality ratio decreases
drastically. 4.6 billion dollars could also help improve the poor
medical infrastructures in countries with the highest maternal mortality
ratios.
The push for contraception as a solution to maternal mortality is
also problematic because many women won’t use it. The claim that 222
million women lack access to contraception is misleading. First, it is
not necessarily a matter of access. Many women have access to
contraception and choose not to use it. Social scientists and public
policy experts identify women as having an unmet need for contraception
even when those women have not expressed a desire to use contraception.
The idea of unmet need for contraception ignores the reasons for unmet
need that women express, such as concern about health and other side
effects of artificial contraception, and incompatibility with religious
and ethical beliefs. The fact that a woman is not using contraception is
not the same as an unmet need for contraception. The more relevant
datum would be the number of women who want contraception and cannot get
it. That number is much less than 222 million. Another helpful figure
would be the number of women who do not want to use contraception and do
not have access to other methods of family planning, such as
knowledge-based fertility education programs.
But even if we assume that it is true that 222 million women want
contraception and can’t get it, do we really need $4.6 billion more in
funding for contraception? That’s twenty dollars for each woman. A woman
whose education has not been improved; whose access to essential
healthcare has not been improved; whose very real and legitimate desire
for children has not been met; whose economic opportunities have not
been improved a whit. For this woman, Melinda Gates has one message:
“Here’s twenty bucks; don’t have babies.”
Even worse, the promise of more aid from the Gates Foundation
incentivizes local government officials and family planning authorities
to start pushing contraception on women even if they don’t want to use
it. This can lead to undue influence or coercion, eerily reminiscent of
the population control movement.
There is no question that there are vastly different ideas of the
value of human life at work here. The folks at Save the Children and
their friends at the Gates Foundation think human persons are better off
never existing than being born into poverty and dying before reaching
their full potential. There are also very different ideas of how population relates to economic development
that are quite germane to this controversy. Let that be. As a practical
matter, it seems unlikely that Gates and friends will be able to have
substantially greater success than decades of similar effort have had.
It is a tragedy that they won’t spend their enormous resources trying to
empower women who want to bring children into this world to do so
safely and with the support of the medical resources they need.
Those of us who value all human life, from conception to natural
death, should regret this terrible misallocation of resources, but we
should also work to defend and protect, and indeed empower, those women
whom Melinda Gates wishes to subject to her idea that contraception is
their single most important unmet need. Let’s not forget that this idea
is the same idea that underlies the population control movement, which
has promoted contraception for decades in an attempt to reduce the
population. The Family Planning Summit, which coincided with World
Population Day, may not have used this rhetoric, but the simple fact is
that women and men ultimately want to bring children into the world. Not
all the contraception on earth will change that. Rather than try to
prevent them from doing so, we should work to ensure they can do so
safely.
Greg Pfundstein is the Executive Director of the Chiaroscuro Foundation. Meghan Grizzle is the Research and Policy Specialist at the World Youth Alliance.
