700,000 women died due to reductions in family planning, a global study says

Maternal health survey faults cutbacks

By John Donnelly, Globe Staff, 9/26/2002

WASHINGTON - The steep drop in worldwide family planning funds from the United States and unmet pledges from other wealthy nations contributed to more than 300 million unintended pregnancies and the deaths of an estimated 700,000 pregnant women between 1995 and 2000, according to a global study on maternal health released yesterday.

The report, the first of its kind, found that more than one-third of the deaths were from problems associated with pregnancy, labor, and delivery. A majority of the deaths, an estimated 400,000, were from complications resulting from abortions carried out in unsanitary and often illegal conditions.

The study, carried out by the Global Health Council, the largest membership organization on global health issues, was launched to assess progress made since the 1994 International Conference on Population and Development in Cairo. At the conference, delegate nations, including the United States, committed to spending $17 billion annually for reproductive health care for women.

After the conference, the Clinton administration immediately substantially increased funding to $580 million. But then two factors caused funding to drop: a Republican-led budget-cutting revolution and a push from antiabortion groups to enforce the so-called Mexico City policy that bars US funds for any foreign organization that promotes or performs abortions.

The level of US funding for maternal health care - nearly $500 million - still does not approach the 1994 levels.

Timothy E. Wirth, who as undersecretary of state for global affairs led the US delegation at Cairo, said the Clinton administration had internally set a goal of $1 billion annually for family planning within a few years. "The ideological war against the Cairo plan of action has turned out to be massive war against women and against protection from AIDS" due to the lack of availability of condoms, he said.

Two months ago, the Bush administration withheld $34 million in funds from the United Nations family planning organization because it works with Chinese authorities who are alleged to coerce women into undergoing abortions and sterilizations.

"Unfortunately, since 1994, the collateral victims were the women of the developing world," said Nils Daulaire, president of the Global Health Council, a nonprofit group based in Washington and White River Junction, Vt. "This is a totally preventable tragedy. We have the technology, the means, and the cost is incredibly cheap.

"For 35 years, the US led the world in supporting voluntary family planning everywhere around the world. Both from our side and other donors' side, it is clear this is one of the best investments one can make in reducing the death toll around the world."

Daulaire was a key player in the Clinton administration on health issues, serving as the senior health adviser to the head of the US Agency for International Development.

The Bush administration has said it will cut off funding to any groups associated with programs that force women to have abortions. Population Research Institute of Fort Royal, Va., an antiabortion group, has taken the lead in criticizing family planning organizations, saying that some groups coerce women into having abortions. In particular, the group sent undercover workers to Peru in 1998 and China this year. Scott Weinberg, director of governmental affairs for the group, said that they found in China "forced abortion, forced sterilization, destruction of homes for noncompliance, and imprisonment for noncompliance." In Peru, they said, the United States was funding a program in 1998 that promoted massive sterilization.

The World Health Organization, a United Nations body, annually estimates numbers of maternal deaths, pegging the number at more than 549,000 deaths in 2000. The Global Health Council narrowed its focus to unintended pregnancies, an extremely difficult task largely due to poor reporting in many countries. They did it by taking statistics from the US Census Bureau, UN agencies, country reports, and private surveys; focusing on abortion rates and mothers dying from unwanted births; and compiling a profile of all 227 countries in the world.

Daulaire and other global health experts yesterday described the estimates derived in the council's report as conservative. Their reasoning is that since abortions are illegal in much of the world, many cases are not reported.

Allan Rosenfield, dean of Mailman School of Public Health at Columbia University, reviewed the report prior to publication and said the data is "very difficult to obtain, is not straightforward, and no one collects these data adequately."

But, he added, "Most of us feel the data are underreported."

Global spending now is $11 billion for maternal health care, part of which goes for HIV/AIDS programs, according to Population Action International. Donors are contributing $2.6 billion, or 46 percent of the Cairo target. Poor countries are spending 74 percent of their 1994 target. "This report provides an interesting way to answer the question of what is the price of doing too little," said Sally Ethelston, vice president for communication at Population Action International, an independent group that advocates universal access to reproductive health care.

The report's country analyses highlights the lack of spending and adequate programs in several countries. Most notable is India, which by far led the world with an estimated 159,143 deaths from unintended pregnancies. The United States had 349 deaths during the six-year period, said the report.

John Donnelly can be reached at donnelly@globe.com.

Copyright 2002 Globe Newspaper Company.

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