On family planning, US vs. much of the world

De-emphasis on contraception runs contrary to global goals

The world's rising disapproval of US foreign policy stems in part from opposition to the war in Iraq and the "with us or against us" tone of the world's only superpower.

But beneath the focus on geopolitics, such hot-button social issues as family planning and women's reproductive rights are also demonstrating America's shifting stature in the world - especially as the Bush administration seeks to placate its socially conservative base.

In a series of regional meetings on population and development, the US has pressed other countries to back down from goals in family planning and women's reproductive rights, targets set in tandem with development plans and adopted with strong US support a decade ago. At the most recent meeting in Santiago, Chile, earlier this month, 40 countries rejected a US move to stress abstinence over contraception in a declaration, and thus bring it more in line with Bush administration priorities.

US proponents of the administration's redirection of international family policy say the US is simply running up against foreign elites bent on the status quo. Those elites, they insist, do not reflect the interests of developing countries.

But critics emphasize contrary evidence in lopsided votes against the US at international progress-report meetings.

"It's one of the most drastic examples of US isolation," says Sharon Camp, president of the Alan Guttmacher Institute, an international reproductive-rights organization. Pointing to the Santiago meeting, she adds, "When every country, and in such a Catholic-dominated region, votes against your position, that's a remarkable defeat."

America's solitary stance on reproductive rights and international aid for family planning joins other factors in US isolation - among them, withdrawal from the Kyoto Protocol and rejection of an International Criminal Court.

But proponents of administration policy say the apparent isolation is due to the US emphasis on primary healthcare over an outdated focus on population control. If the US is isolated, they say, that isolation is only from a global family-planning community the US itself has built up over the past four decades.

"I don't see the US as isolated, I see it as prescient," says Steven Mosher, president of the Population Research Institute (PRI), a Virginia-based organization that monitors population-control abuses worldwide. "The US was in the vanguard back in the 1960s when the focus was the population bomb, and it is leading the way again as the focus shifts from population control to primary healthcare."

As for the 40-1 vote against the US in Santiago and rejections of US positions in other regional meetings, Mr. Mosher says, "The 40 [votes] represent non- governmental groups that have been nurtured by the US in the past and still get funding from the UN Population Fund. I can see that it must seem strange to them that the US is now saying we've gone too far down the population-control road."

Under this administration, the US has cut off funding to the UN Population Fund (UNFPA), citing claims that the agency condones forced abortions and sterilizations in China. A team sent to China by the White House in 2002 found "no evidence" of UNFPA knowledge of or support for such measures, but the funding was still halted.

More broadly, the debate over international family-planning assistance has become part of a tug of war on women's rights in developing countries. One side says international policy is suppressing the yearnings of motherhood, at a time when population growth has slowed. The other side says unmet contraception and family-planning needs keep maternal and infant mortality unnecessarily high.

Congressional supporters of the Bush stance on family-planning aid have called the UNFPA and the "consensus" of the 1994 Cairo meeting "anti-woman" and "Taliban-like" for their emphasis on reducing unplanned pregnancies.

But in a recent report, the Guttmacher Institute said developing countries' "unmet [contraception] need" - deduced from the number of women using "traditional methods" or no contraception at all - translates to 52 million unwanted pregnancies each year, bringing on 1.5 million maternal deaths and more than 500,000 motherless children.

"We also estimate that about one-third of [unwanted pregnancies] result in abortion, and about half of those in unsafe abortion," says Ms. Camp. The fact that developing countries cover 75 percent of their own family-planning costs suggests that reproductive policies are a priority, the Guttmacher Institute says.

Critics of the Bush administration's new emphasis of marital fidelity and de-emphasis of condoms say those policies ignore the fact that the fastest-rising segment of HIV-AIDS victims in parts of Africa are young women prized as brides for older men. Others point to what they see as the irony of White House emphasis on its international record of advancing women's rights - primarily through the liberation of women in Afghanistan and Iraq - when so many women's organizations around the world oppose US policy.

But perhaps the bigger irony is that proponents of both sides say the No. 1 priority for women in developing countries should be basic healthcare. "I hope that five years down the road we're taking all the money [for family planning] and putting it into women's primary healthcare," says PRI's Mr. Mosher.

Yet as even proponents of the US position admit, that won't be easy if the US loses credibility on reproductive issues.