[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
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Developing
Date of DHS countries minus Bangladesh 1993/ Ghana 1993 Philippines 1993 Peru 1991/92
China 94
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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
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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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