Advancing Sexual and Reproductive Health and Rights
 
The Guttmacher Report on Public Policy
February 1999, Volume 2, Number 1
 
Issues and Implications

The United States and the United Nations Population Fund: A Rocky Relationship

By Susan A. Cohen

Thirty years ago, the United States was a driving force behind the establishment of what is now the largest multilateral population assistance agency in the world, the United Nations Population Fund (UNFPA, formerly known as the United Nations Fund for Population Activities). Today, the world's largest population assistance donor country stands as UNFPA's determined opponent. In a last-minute maneuver in the massive budget deal for FY 1999, instigated by anti-family planning activists in Congress, the United States suspended its entire contribution to UNFPA.

Both the U.S. policy and its timing could not be more ironic—coming as it does even as countries around the world, including the United States, are engaged with UNFPA in "Cairo Plus Five"—a five-year review and assessment of progress made since the 1994 International Conference on Population and Development (ICPD) in Cairo. In the period leading up to that historic meeting, the United States played a critical leadership role in promoting a ground-breaking reexamination of the issue of "population." The so-called Cairo consensus that resulted, which was to be implemented through the ICPD's Programme of Action, endorsed by 180 governments, ratified the notion that economic development and efforts to stabilize rapid population growth rates are inextricably linked—and that the promotion of individual well-being, with an emphasis on enhancing the status of women, lies at the center of both. The countries participating in the Cairo conference also acknowledged the need for increased financial resources to implement these large goals, and the United States, for its part, pledged to double its support for the worldwide effort

The ostensible reason for congressional hostility towards UNFPA is the agency's resumption of a program in China early last year. The facts demonstrate, however, that the China issue provides more of an excuse than a justification of Congress' actions.

UNFPA's Unique Role

In 1969, President Richard Nixon warned Congress that rapid population growth was "a world problem which no country can ignore, whether it is moved by the narrowest perception of national self-interes

In the ensuing three decades, UNFPA has lived up to Nixon's leadership challenge, complementing the work of USAID. And, in important respects, UNFPA's role as a population assistance donor remains unique. Because its budget comes from a vast array of different, mostly governmental sources, it cannot promote the views of any one country—only its own program and philosophy (see box). Accordingly, its presence may be more welcome in some instances than that of individual governments whose aid, whether in appearance or in reality, may be motivated also by geopolitical or strategic concerns.

UNFPA At-a-Glance

Its Program. In FY 1997, UNFPA provided assistance in 160 countries. About half of its $290 million budget that year supported the delivery of maternal and child health care and family planning services. A major supplier of contraceptives around the world, UNFPA also devotes substantial resources toward preventing the spread of HIV/AIDS and other sexually transmitted diseases, addressing the unique reproductive health needs of young people and enhancing the status of women. Finally, UNFPA engages in data collection, research and information and education efforts to inform population-related policies and improve programs.

Its Philosophy. UNFPA is committed to the principle first endorsed in 1968 and reaffirmed at all subsequent UN population conferences that "all couples and individuals have the right to decide freely and responsibly the number and spacing of their children, and to have access to the information and means to do so." Accordingly, UNFPA condemns all forms of coercion. The agency provides no support for abortion services or activities and does not consider abortion to be a method of family planning. Cognizant of the public health toll taken by unsafe abortion, however, UNFPA is active in the effort to reduce maternal deaths through more effective treatment of the complications of unsafe abortion.

Its Governance and Funding. Governed by an executive board comprising representatives of 36 member countries including the United States, UNFPA is supported by 88 governments (making contributions in addition to their regular UN dues). Most of UNFPA's donors are developing countries, although the largest contributors are Japan, the Netherlands, Denmark, Germany and—until its recent withdrawal—the United States.

Additionally, UNFPA can, and does, provide family planning and related assistance in certain countries where individual government donors, for political or other reasons, cannot. Indeed, UNFPA is obliged to respond to requests for aid from any country, regardless of that country's political orientation, so long as the program that results is consistent with UNFPA's mission.

Finally, because of its unique character, UNFPA never would, or could, intervene in matters of national sovereignty—as Republican leaders in Congress are attempting to do by using U.S. family planning assistance as leverage to export their antiabortion ideology overseas.

Playing the China Card

The current withdrawal from UNFPA is not the first time the United States has chosen to shun the agency. In the mid-1980s, opponents of U.S. population assistance latched onto its small program in China as an excuse to defund UNFPA. In 1985, they succeeded in passing legislation that prohibited U.S. funding of any agency that "directly or indirectly" supported coercive abortion or sterilization. While the Reagan administration concluded that UNFPA's own program supported neither abortion nor coercion in any way, it did agree with the sponsors of the legislation that the agency's presence in China was tantamount to its indirectly supporting coercive practices sanctioned by the Chinese government as a result of its "one-child-per-family" policy. President Reagan cut off the entire U.S. contribution to UNFPA—then about $36 million—as of FY 1986.

Family planning advocates asserted, meanwhile, that the issue for the U.S. government should be the merits of UNFPA's worldwide program. They argued that the other countries in which UNFPA works should not be punished for the totalitarian policies of the Chinese government—a government, moreover, with which the United States maintains full diplomatic and trade relations. Eventually, this became the majority view in Congress, but President Bush still refused to renew a contribution. Funding remained suspended until 1993, when President Clinton made a new determination that UNFPA neither directly nor indirectly supports coercion—in China or anywhere else.

Although the U.S. relationship with UNFPA was restored, Congress did attach conditions to its contribution—purportedly to demonstrate condemnation of the coercive practices of the Chinese government. First, the U.S. contribution was to be maintained in a segregated account, none of which could be used in China. Moreover, for every dollar of another donor's money UNFPA spent in China, the U.S. contribution would be reduced by a dollar.

This unprecedented punishment—applied to no other agency (such as the World Health Organization or UNICEF) working in China and receiving U.S. support—still was not enough for UNFPA's determined congressional opponents. Led by Rep. Chris Smith (R-NJ), they agitated against contributing to the agency even during the time, between 1995 and 1998, when it did not have a China program. Although they failed to achieve a complete cut-off, the U.S. contribution declined from a peak of $40 million in FY 1995 (approved on the eve of the Cairo conference, in the last year of a Democratic-controlled Congress) to $20 million in FY 1998.

UNFPA's New China Program

With the advent of UNFPA's new four-year program in China last year, however, Smith successfully exploited the complicated politics of U.S.-China relations—compounded by animosity among conservative ranks toward both family planning and the UN in general—to pass legislation blocking all U.S. aid to UNFPA and removing any discretion on the part of the administration to do otherwise. Ironically, UNFPA's new China program is a model that could not have been designed any more meticulously to demonstrate the effectiveness of voluntary family planning practices and the value of informed consent.

Negotiated in the wake of the Cairo conference, the new program reflects the core principles of the ICPD, including the absolute rejection of coercion. The $20 million, four-year program provides aid directly to 32 Chinese counties—not to the central government—and focuses on expanding the range of available contraceptive methods; training health workers in interpersonal counseling skills, informed consent procedures and family planning methods; expanding and improving maternal and child health services; and strengthening efforts to prevent sexually transmitted diseases. Rigorous safeguards against coercive practices, including the use of incentives or the imposition of birth quotas, are an integral part of the program. A county family plan ning project will be terminated immediately upon a finding that it did not adhere strictly to the principles of voluntary participation. Indeed, the built-in monitoring of these demonstration projects will most likely result in the most scrutinized program of any kind in China.

The fact is that UNFPA's presence in China is intended by UNFPA's executive board to demonstrate to the Chinese that coercive practices not only violate basic human rights but also are less effective in ultimately slowing population growth rates than respecting and facilitating the rights of individuals to determine for themselves whether and when to have children. As such, it could be seen as a prime example of "constructive engagement"—the very policy the U.S. government has toward China, at least on all issues other than population. Indeed, isolating China, whether as a trading partner or diplomatically, repeatedly has been rejected not only by President Clinton but also by Presidents Reagan and Bush before him—as well as by most of the same members of Congress who insist on isolating UNFPA because of its association with China.

Future Prospects

UNFPA's China program is only just taking shape, but apparently changes for the better are already in evidence. U.S. Undersecretary of State for Global Affairs Frank Loy said recently that many "rural women are receiving reproductive health care for the first time—and from someone they could trust. And doctors are better equipped to act in the best interests of their patients." Loy pledged that refunding UNFPA will be one of his top priorities, a commitment reflected in the Clinton administration's fiscal 2000 budget request of $25 million for the agency.

Loy said that refunding UNFPA should be an urgent national priority, warning that the U.S. withdrawal from UNFPA will have "terrible, immediate human consequences." Indeed, according to UNFPA, the cut-off will, in one year alone, be responsible for depriving 870,000 women of effective modern contraception, resulting in turn in 200,000 more abortions, 234,000 unwanted births, 1,200 maternal deaths and more than 22,000 infant deaths.

The prospects for restoring a U.S. contribution to UNFPA this year, however, are uncertain at best, though prominent Republican and high-ranking House Appropriations Committee member, Rep. John Porter (IL), has called U.S. policy towards UNFPA "nonsensical." And, the incoming Democratic co-chair of the Congressional Caucus for Women's Issues, Rep. Carolyn Maloney (D-NY), intends to introduce legislation early this year aimed toward educating members of Congress about the invaluable work of UNFPA around the world, especially in China, and restoring a U.S. contribution.

Meanwhile, the fact remains that with governments worldwide currently engaged in the "Cairo Plus Five" assessment process, U.S. leadership in critical population and development issues once again is in doubt. As Undersecretary Loy puts it, given the UNFPA cut-off and the precipitous decline in U.S. support for family planning and population assistance overseas through USAID from $540 million in FY 1995 to $385 million this fiscal year, the United States risks being the "biggest Cairo deadbeat of all."