[Congressional Record Volume 142, Number 28 (Tuesday, March 5, 1996)]
[Senate]
[Pages S1512-S1514]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            MORNING BUSINESS

  Mr. LOTT. Mr. President, I ask unanimous consent that there now be a 
period for the transaction of routine morning business until the hour 
of 3:30 p.m., with Senators permitted to speak for up to 5 minutes 
each.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HATFIELD. Mr. President, I have recently expressed my concern for 
the harm done through the 85-percent cut in international voluntary 
family planning programs which is now law for this fiscal year.
  I wish to submit for the record a body of statistics which describe 
what is likely to happen in the aftermath of a 35-percent cut in 
voluntary family planning programs. Again, the cut in this fiscal year 
is 85 percent.
  These statistics represent the most conservative estimates of what a 
35-percent cut would mean. In sum, we can expect nearly 2 million more 
abortions, and a minimum of 8,000 more women dying in pregnancy and 
childbirth. One need not be a professional demographer to calculate 
what this year's 85 percent cut will mean for families across the 
globe.
  Mr. President, I ask unanimous consent that these estimates be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                         Methodological Summary

              (Prepared by the Alan Guttmacher Institute)

       The potential effect of a 35% cut in U.S. funding for 
     family planning is estimated by gathering and sometimes 
     reconciling information from a wide variety of sources, 
     ranging from national censuses and population estimates to 
     country-specific surveys of women of reproductive age to 
     special studies of contraceptive use and of pregnancy 
     outcomes. Detailed references and calculations are available 
     on request. The following outline describes the basic steps 
     in the estimation.
       Estimation of the impact of the funding cut starts by 
     determining how many of the couples who depend on U.S funded 
     family planning programs will lose their access to 
     contraceptives.
       Population censuses and estimates indicate an estimated 829 
     million women of reproductive age are living today in 
     developing countries other than China (which receives no U.S. 
     family planning program support).
       Surveys of women in developing countries show that roughly 
     247.5 million of these women and their partners use modern 
     methods of contraception to lengthen the time between the 
     births of their children or to avoid having more children 
     than they already have.
       Because of their poverty, 190.5 million, or 77%, of the 
     couples in developing countries outside of China who are 
     using modern contraceptive methods rely on public-sector 
     family planning programs for their contraceptive method.
       The United States contributes about 17% of all public funds 
     spent on family planning in developing countries other than 
     China, accounting for 32.4 million couples using modern 
     contraceptive methods. [Of these couples, 12.6 million are 
     estimated to be protected by contraceptive sterilization or 
     long-lasting methods including hormonal implants (such as 
     Norplant) and intra-uterine devices (IUDs).]
       On an annual basis, 19.8 million couples depend on U.S. 
     supported programs to obtain contraceptive supplies, such as 
     pills, condoms or injectables, or to start use of a long-term 
     method, such as voluntary sterilization, hormonal implants or 
     IUDs.
       A cut in program resources of 35% means that 12.9 rather 
     than 19.8 million couples will be able to be served in a 
     year's time, leaving 7.0 million couples without access to 
     contraceptive supplies or services.
       The second step is estimating what effect losing U.S. 
     supported family planning services will have on the couples 
     who were depending on them for contraceptive care.
       There are few other contraceptive choices in developing 
     countries for women who lack access to modern contraceptives. 
     A conservative estimate is that of the 7.0 million women 
     losing services because of U.S. funding cuts 2.8 million will 
     turn to traditional methods and 4.2 million will use no 
     contraceptive.
       Because pregnancy rates are so much higher among couples 
     relying on no method or on a traditional method than if they 
     use a modern contraceptive, 4.0 million more unwanted 
     pregnancies are expected in developing countries due to the 
     drop in family planning program resources.
       About 40% of these unintended pregnancies are likely to end 
     in induced abortion, even though it is often not legal and 
     performed in unsafe conditions--accounting for 1.6 million 
     abortions among the expected additional unwarranted 
     pregnancies.
       Some 47% of these unintended pregnancies are likely to end 
     in unwanted births with the remaining 13% resulting in 
     spontaneous abortions or miscarriages--accounting for 1.9 
     million unwanted births among the expected additional 
     unwanted pregnancies.
       Maternal mortality rates in developing countries are high, 
     about 4.1 deaths per 1,000 women giving birth, leading to an 
     estimated 8,000 additional deaths due to pregnancy among the 
     women facing additional unintentional pregnancies.
       In summary, it is estimated that, in a year's time as a 
     result of a 35% cut in AID funding, there will be:
       7.0 million couples in developing countries who would have 
     used modern contraceptive methods will be left without access 
     to these methods.
       As a result, there will be 4.0 million more women 
     experiencing unintended pregnancies, leading in turn to:
       1.9 million more unplanned births, and
       1.6 million more abortions (the remainder of the unintended 
     pregnancies ending in miscarriages); and
       8,000 more women dying in pregnancy and childbirth.

Estimate of number of additional abortions resulting from a 35-percent 
 cut in USAID funding for family planning services for all developing 
                       countries excluding China

1. WRA......................................................829,000,000
2. Percent in union....................................................
3. MWRA................................................................
4. Percent MWRA using modern methods...................................
5. Percent WRA using modern methods....................................
6. Modern method users......................................247,473,000
7. Percent FP supplied by public sector..............................74
8. Percent of private sector subsidized..............................10
9. Modern method users relying on public sources............190,455,221
10. Percent of USAID share of total funding..........................17
11. Users protected by USAID.................................32,377,388
12. Percent users using long term methods............................43
13. New sterilization acceptors as percent of ster. users............10

[[Page S1513]]

14. USAID-funded users needing current protection............19,847,339
15. Percent of USAID budget cut......................................35
16. Current users left unprotected............................6,946,568
17. Proportion adopting traditional methods in percent...............40
18. New users of traditional methods..........................2,778,627
19. Percent of failure rate for traditional methods..................30
20. Unwanted pregnancies from traditional use...................833,588
21. Percent of pregnancy rate for those unprotected..................75
22. Unwanted pregnancies from those unprotected...............3,125,956
23. Total unwanted pregnancies from budget cuts...............3,959,544
24. Percent resorting to abortion....................................40
25. Additional abortions......................................1,583,818
26. Percent of pregnancies resulting in live births..................47
27. Additional unwanted births................................1,860,986
28. Maternal mortality rate.........................................410
29. Additional maternal deaths....................................7,630

           ESTIMATE OF NUMBER OF ADDITIONAL ABORTIONS AND MATERNAL DEATHS RESULTING FROM A 35-PERCENT CUT IN USAID FUNDING FOR FAMILY PLANNING          
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               Developing                                                                               
                       Date of DHS                          countries minus    Bangladesh 1993/      Ghana 1993      Philippines 1993     Peru 1991/92  
                                                                 China                94                                                                
--------------------------------------------------------------------------------------------------------------------------------------------------------
1. Women of reproductive age (WRA).......................        829,000,000         29,100,183          3,970,368         17,019,483          6,143,800
2. Percent in union......................................  .................                 79  .................  .................  .................
3. Married women of reproductive age (MWRA)..............  .................         23,076,445  .................  .................  .................
4. Percent MWRA using modern methods.....................  .................                 36  .................  .................  .................
5. Percent WRA using modern methods......................  .................  .................                  9                 15                 20
6. Modern method users...................................        247,473,000          8,353,673            369,244          2,569,942          1,222,616
7. Percent FP supplied by public sector..................               74.4                 79                 43                 70                 48
8. Percent of private sector subsidized..................                 10                 10                 10                 10                 10
9. Modern method users relying on public sources.........        190,455,221          6,774,829            179,822          1,876,058            650,432
10 Percent of USAID share of total funding...............                 17                 24                 40                 65                 57
11. Users protected by USAID.............................         32,377,388          1,625,959             71,929          1,219,437            370,746
12. Percent of users using long term methods.............                 43                 31                 16                 61                 37
13. New sterilization acceptors as percent of ster. users                 10                  6                 13                  7                  9
14. USAID-funded users needing current protection........         19,847,339          1,153,415             61,859            525,171            246,041
15. Percent of USAID budget cut..........................                 35                 35                 35                 35                 35
16. Current users left unprotected.......................          6,946,568            403,695             21,651            183,810             86,114
17. Proportion adopting traditional methods in percent...                 40                 40                 40                 40                 40
18. New users of traditional methods.....................          2,778,627            161,478              8,660             73,524             34,446
19. Percent of additional pregnancy rate with traditional                                                                                               
 methods.................................................                 30                 30                 30                 30                 30
20. Unwanted pregnancies from traditional use............            833,588             48,443              2,598             22,057             10,334
21. Percent of additional pregnancy rate for those                                                                                                      
 unprotected.............................................                 75                 75                 75                 75                 75
22. Unwanted pregnancies from those unprotected..........          3,125,956            181,663              9,743             82,714             38,751
23. Total unwanted pregnancies from budget cuts..........          3,959,544            230,106             12,341            104,772             49,085
24. Percent resorting to abortion........................                 40                 38                 40                 52                 43
25. Additional abortions.................................          1,583,818             87,440              4,936             54,481             21,107
26. Percent of pregnancies resulting in live births......                 47                 49                 46                 36                 43
27. Additional unwanted births...........................          1,860,986            112,752              5,800             37,718             21,107
28. Maternal mortality rate..............................                410                600               1000                100                300
29. Additional maternal deaths...........................              7,630                677                 58                 38                 63
--------------------------------------------------------------------------------------------------------------------------------------------------------

                           sources and notes

       1. Population Division, 1995, World Population Prospects: 
     The 1994 Revision. New York: Department for Economic and 
     Social Affairs, United Nations. ST/ESA/SER.A/145. All figures 
     are for 1995.
       2. DHS country reports.
       3. WRA [1] percent in unions [2].
       4. DHS country reports.
       5. DHS country reports.
       6. For specific countries modern method users are 
     calculated by: WRA [1] percent WRA using modern methods [5] 
     if data are available, otherwise MWRA [3] percent MWRA using 
     modern methods [4].
       For all developing countries, the number of modern method 
     users is derived from: W. Parker Mauldin and Vincent C. 
     Miller, 1994. Contraceptive Use and Commodity Costs in 
     Developing Countries, 1994-2005. Technical Report Number 18. 
     New York; United National Population Fund, p. 17. This source 
     gives the total number of modern method users in the 
     developing world in 1995 as 460,673,000. Modern method users 
     in China (213.2 million) were subtracted to estimate users in 
     the rest of the developing world. The estimate for China is 
     based on contraceptive prevalence of 83 percent of MWRA 
     (World Contraceptive Use 1994, United Nations Department of 
     Economic and Social Information and Policy Analysis, 
     Population Division, New York.) The number of MWRA in China 
     is estimated to be 256.9 million, based on a 1990 estimate in 
     World Contraceptive Use 1994 of 222.7 million and an annual 
     growth rate of WRA of 2.9 percent (World Population 
     Prospects).
       7. For individual countries figures are from DHS reports 
     for users of reversible methods.
       For the developing world excluding China the figure is 
     based on an estimate of users supplied by government sources 
     for all developing countries of 86.3% from Contraceptive Use 
     and Commodity Costs in Developing Countries, 1994-2005, p. 
     30. Assuming that all users in China are supplied by the 
     public sector, the estimate for all developing countries 
     excluding China becomes 74.4%: (460.6 million users 86.3% 
     public--213.2 Chinese users)/247.5 million users in LDC-
     China.)
       8. According to Contraceptive Use and Commodity Costs in 
     Developing Countries, 1994-2005, p. 30, 4.4% of all private 
     sector services are provided by NGOs. Other private sector 
     services, such as social marketing, are also subsidized. We 
     have estimated that 10% of all private sector services are 
     subsidized by the public sector.
       9. Modern users relying on public sources=Modern method 
     users [6] percent public [7] + modern method users [6] 
     percent private percent of private sector subsidized [8]. 
     Percent private=1-percent public [7].
       10. Estimates for individual countries are from Population 
     Action International (unpublished tabulations).
       For the developing world excluding China estimates are 
     based on three different approaches.
       The first approach is based on the following assumptions 
     and calculations by Population Action International: total 
     family planning expenditure in the developing world is $4-5 
     billion, expenditure in China is $1 billion, USAID 
     expenditure in FY 1995 was $547 million, thus USAID 
     expenditure is 14-18% of all expenditure outside China.
       The second approach is based on commodities distributed. In 
     FY 1995 USAID provided 608 million condoms, 3.1 million IUDs, 
     52.5 million cycles of oral contraceptives, 14.8 million 
     vaginal foaming tablets, 82 thousand units of Norplant and 
     2.9 million units of Depo-Provera. (NEWVERN Information 
     System, special tabulation provided by JSI). This translates 
     in 19.6 million couple-years of protection for these methods 
     alone. According to Contraceptive Use and Commodity Costs in 
     Developing Countries, 1994-2005, p. 24, total couple-years of 
     protection for all methods except sterilization is 212.4 
     million. Chinese users account for 46 percent of all modern 
     method users (213.2/460.7), so the remaining countries have 
     54 percent of these couple-years of protection, or 115 
     million. The USAID figure of 19.6 million is 17 percent of 
     115 million.
       The third approach assumes that official development 
     assistance accounted for 25% of total funds spent on family 
     planning; private payments by users accounted for another 25% 
     and governments of developing countries funded the remaining 
     50% (R. Bulatao, 1993. Effective Family Planning Programs, 
     Washington, DC: World Bank). Thus, 75% of funds are from 
     public sources. USAID contributes about 50% of all foreign 
     assistance family planning dollars. Thus it contributes 17% 
     of public funding for family planning: 50%25%/75%=16.7%.
       11. Modern method users relying on public sources [9]USAID 
     share of funding [10]. This estimate coincides well with an 
     estimate based on commodities distributed. USAID provided 
     19.6 million couple-years of protection based on all methods 
     other than sterilization (see 10 above). In the developing 
     world, 56 percent of users rely on these methods, the other 
     44 percent use sterilization (Contraceptive Use and Commodity 
     Costs in Developing Countries, 1994-2005, p. 20). If the same 
     ratio applies to USAID-supported users, then total USAID-
     supported users would be 19.6 million/0.56 or 35 million.
       12. Figures for individual countries are from DHS. They 
     refer to sterilization users. In countries with significant 
     reliance on the IUD, 70 percent of IUD users have also been 
     included as long-term use (based on an average duration of 
     use of about 3.5 years). For all developing countries the 
     estimate is calculated as the weighted average for the 18 
     countries with the largest USAID programs (weighted by the 
     number of USAID-supported users).
       13. Calculated as 1/(45--mean age at sterilization). 
     Estimates of mean age are from DHS and/or AVSC. Average for 
     all developing countries is from John Stover, et 
     al., Empirically Based Conversion Factors for Calculating 
     Couple-Years of Protection, The EVALUATION Project, 1996, 
     draft.

[[Page S1514]]

       14. Users protected by USAID [11] x (1-percent using long 
     term methods [12] + percent using long term methods [12] * 
     New ster acceptors as % of users [13]).
       15. Assumed to be 35 percent.
       16. Users needing current protection [16] x percent of 
     budget cut [17].
       17. This is an estimate of the percent people who lose 
     their family planning services due to USAID budget cuts that 
     would adopt traditional methods as an alternative. Since the 
     people losing their services are committed users, many would 
     adopt traditional methods. However, traditional methods 
     require the active participation of both partners, so many 
     would probably not adopt these methods. One approach to 
     estimating this figure has been developed by The Alan 
     Guttmacher Institute. This approach uses DHS data to 
     determine traditional method use as a proportion of all women 
     either using a traditional method or having an unmet need for 
     family planning. The average of 36 developing countries for 
     which data are available shows that 20 percent of these women 
     use traditional methods (Alan Guttmacher Institute, 1995. 
     Hopes and Realities; Closing the Gap Between Women's 
     Reproductive Aspirations and their Reproductive Experiences, 
     AGI, New York, Appendix Table 7). This is likely to be an 
     under-estimate since there are many reasons other than lack 
     of access for women to have an unmet need (lack of knowledge, 
     religious objections to family planning, spouse opposes 
     family planning, fear of side effects). Therefore, to be 
     conservative, we have doubled this figure to 40 percent.
       18. Users left unprotected [18] x percent adopting 
     traditional methods [19].
       19. Failure rates for withdrawal and periodic abstinence in 
     developed countries are reported to be around 20% 
     (Contraceptive Technology, 16th Revised Edition, Robert A. 
     Hatcher, et al., New York: Irvington Publishers, Inc. 1994, 
     p. 652). For developing countries there is very little 
     information. One study used DHS data to calculate that 16% of 
     users of withdrawal had a birth in the first years of use 
     (Lorenzo Moreno and Noreen Goldman, 1991. ``Contraceptive 
     Failure Rates in Developing Counties: Evidence from 
     Demographic and Health Surveys.'' International Family 
     Planning Perspectives, 17(2), June 1991, pp. 44-49.) The 
     number of pregnancies (rather than births) due to traditional 
     method failure would be even higher (Elise F. Jones, 
     ``Contraceptive Failure and Abortion.'' International Family 
     Planning Perspectives, 17(4), December 1991, p. 150) Also, 
     this study was based on respondent recall. There is a 
     tendency, especially with traditional method users, to forget 
     or not report use immediately before a pregnancy. Therefore, 
     we assume that the annual pregnancy rate among traditional 
     method users is about 40%. For users of modern methods the 
     pregnancy rate is about 10%. (It is estimated to be about 14% 
     in the U.S. among users of reversible methods. [Elise F. 
     Jones and J.D. Forrest, 1992. ``Contraceptive failure rates 
     based on the 1988 NSFG,'' Family Planning Perspectives, 
     24:12-19.] but this number is high because there is little 
     use of the IUD. For USAID-supported users, the IUD accounts 
     for about half of all couple-years of protection provided by 
     reversible methods.) Therefore, the additional pregnancy rate 
     due to users switching from modern methods to traditional 
     methods is 30% (40%-10%).
       20. New traditional method users [20] x failure rate [21].
       21. The annual pregnancy rate for those couples using no 
     method is 85% (Contraceptive Technology, 16th Revised 
     Edition, Robert A. Hatcher, et al., New York: Irvington 
     Publishers, Inc. 1994, p. 652). Subtracting the 10% pregnancy 
     rate for couples using modern methods (note 19) leaves an 
     additional pregnancy rate of 75%.
       22. (Users unprotected [18]--new traditional method users 
     [20] x pregnancy rate [23].
       23. Unwanted pregnancies from traditional method failure 
     [22] + unwanted pregnancies from users left unprotected [24].
       24. Estimated to be 40%. Estimates are based on the 
     following information:
       The number of unintended pregnancies is the sum of 
     abortions, unintended births and unintended pregnancies that 
     end as spontaneous abortions (estimated as 10% of abortions + 
     20% of unintended births).
       The main source of data on abortions is World Health 
     Organization, 1994. Abortion: A tabulation of available data 
     on the frequency of unsafe abortion, Geneva: WHO. These 
     figures are also supported by S.K. Henshaw, 1990. ``Induced 
     abortion: A world review'', Family Planning Perspectives, 22, 
     76-89 and The Alan Guttmacher Institute, 1994. Clandestine 
     Abortion: A Latin American Reality, New York: AGI.
       The number of unintended births is obtained by applying 
     regional average proportions of all births that are 
     unintended, to UN estimates of the total number of births in 
     each region. Estimates of the total number of births that are 
     unintended are obtained from DHS surveys done in the late 
     1980s/early 1990s. The weighted average for countries that 
     have surveys, in a given region, is assumed to apply to the 
     region as a whole. These proportions are based in women's 
     reports of the wantedness status of each birth in the five 
     years prior to the survey. Regional distributions of all 
     pregnancies by planning status were published in chart form 
     in Hopes and Realities: Closing the Gap Between Women's 
     Reproductive Aspirations and their Reproductive Experiences, 
     p. 25). These data were used to recalculate the distribution 
     of unintended pregnancies by pregnancy outcome (that is, 
     excluding wanted births and that proportion of wanted 
     pregnancies that end as spontaneous abortions).
       Country or region specific numbers were used for the 
     individual countries. For Peru estimates are from: The Alan 
     Guttmacher Institute, 1994. Clandestine Abortion: A Latin 
     American Reality, New York: The Alan Guttmacher Institute. 
     Other country estimates are based on regional data (The Alan 
     Guttmacher Institute, unpublished tabulations).
       25. Unwanted pregnancies [25] percent resorting to abortion 
     [26].
       26. Estimated as 47% for all developing countries. (Alan 
     Guttmacher Institute, unpublished tabulation.) For Peru 
     estimates are from: The Alan Guttmacher Institute, 1994. 
     Clandestine Abortion: A Latin American Reality, New York: The 
     Alan Guttmacher Institute. Other country estimates are based 
     on regional data (the Alan Guttmacher Institute, unpublished 
     tabulations).
       27. Unwanted pregnancies [25] percent resulting in live 
     births [28].
       28. The Progress of Nations: 1995, UNICEF, pp. 52-53.
       29. Additional live births [25] maternal mortality rate 
     [26] / 100,000.

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