"A change in leadership at
the highest level does not automatically translate into budgetary and
programmatic reality," declared Duff Gillespie of the Johns Hopkins
Bloomberg School of Public Health at the launch of Making the Case
for U.S. International Family Planning Assistance at the Woodrow
Wilson Center on
March 17. Gillespie and his co-authors – all former directors
of the U.S.
Agency for International Development’s
(USAID) Office of Population and Reproductive Health – presented forceful health, economic,
and environmental arguments for why Congress should more than double
spending on international family planning in the coming years. 

Making the Case recommends
that the USAID population budget be increased from $457 million in 2008
to $1.2 billion in 2010, growing further to $1.5 billion in 2014. The
authors argue that this increase is necessary to meet the "enormous
pent-up and growing unmet need for family planning"; stabilize population
growth rates, especially in Africa; and achieve the Millennium Development
Goal of universal access to reproductive health services. Though the
report and recommendations focus on USAID, the authors are clearly seeking
to influence other donors, including bilateral and multilateral agencies. 

Making the Case should
really be titled Making the Cases, as the authors present multiple
arguments for increasing family-planning funding:

• Gillespie showed
  that U.S. funding for family planning has been stagnant in real dollars
  since the late 1960s, despite the fact that there are 200 million women
  with unmet need for family planning; the global population continues
  to grow; and family planning could help achieve other development indicators,
  such as the Millennium Development Goals. He also noted that, without
  champions within USAID and the administration, the dollar amounts requested
  and appropriated for family planning are unlikely to increase.
• Joseph Speidel of
  the University of California, San Francisco, explained that a growing
  number of people, combined with stable or increasing rates of consumption,
  contributes to climate change and is unsustainable given our finite
  natural resources. Changes in behavior and technology-for instance,
  eating less meat or using clean energy-can contribute to improved
  environmental outcomes. But Speidel emphasized that absolute numbers
  still matter: Although population growth rates have declined, the global
  population continues to grow. Addressing the nearly one-half of pregnancies
  that are unplanned is just one step that would bring great benefits,
  he said.
• According to Steven
  Sinding of the Guttmacher Institute, although most economists and demographers
  agree that economic growth leads to lower fertility, there is still
  a debate over whether lower fertility leads to poverty reduction. Still,
  he argued that the "demographic
  dividend" generated
  by slowing population growth is a reality, and countries can benefit
  from it if their institutions are prepared to take advantage of it.

Interestingly, one of the most
persuasive sets of numbers presented in the report was neglected during
the event: Each additional $100 million in funding can help cover 3.6
million more family planning users; prevent more than 2 million unintended
pregnancies; prevent nearly 825,000 abortions; save the lives of 70,000
infants; and prevent 4,000 maternal deaths. Family planning is clearly
a cost-effective investment. 

Although the full impact of
the report is yet to be determined, it is clear that the authors and
other family-planning advocates have had some success communicating
their core messages. A July
2008 letter drafted
by Senator Barbara Boxer and signed by 12 other senators, including
then-Senators Barack Obama and Hillary Clinton, to the Senate Appropriations
Subcommittee on State, Foreign Operations and Related Programs, reflects
some of their positions. It argues that declining allocations for family
planning and reproductive health have led to deteriorating health for
women and children and "that unsustainable population growth plays
a role in the destruction of forests and the spread of deserts, the
pollution and overfishing of oceans and waterways, and increases in
emissions that contribute to global climate change." 

Ruth Levine of the Center for
Global Development urged the authors to avoid "preaching to the choir,"
and to reach out beyond the family-planning community for support for
their proposal. One way to do this would be to broaden the scope of
"population" to include not only family planning, but also migration,
urbanization, and other demographic issues. Convincing World Bank economists,
especially the Bank’s next president, of the connections between declining
fertility and poverty reduction should be a priority, said Levine, because
developing countries put a lot of stock in the Bank’s advice. 

"We know how to do family
planning, we know what it costs, and we know that it works," emphasized
Speidel. The key missing element, he said, is political will.