Family Planning & Reproductive Health

FY2018 Funding Recommendation:  
$622.5 million

 

Funding History

       Enacted   

       House/Senate FY2017 Request  

       InterAction's FY2018 Recommendation


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Justification

 Key Facts

For over 50 years, the U.S. Government, through USAID, has exercised global leadership in policy, information, and services to ensure countries meet the international family planning and reproductive health (FP/RH) needs of their people. We have expanded our reach through strategic investments in UNFPA who provides life-saving maternal and reproductive health services to the poorest communities in more than 150 countries including those impacted by Zika, humanitarian crisis and conflict. An estimated 225 million women in developing countries want to prevent or delay pregnancy but are not using modern contraception. FP/RH programs are key interventions which contribute to our shared global health, development and foreign policy goals, including reducing infant and maternal mortality and preventing mother-to-child transmission of HIV.

For FY2018, we recommend no less than $622.5 million for FP/RH, both bilateral and multilateral, with funding provided from the Global Health Programs account and the Economic Support Fund, as well as from the International Organizations and Programs account in order to provide a $37.5 million voluntary contribution to the United Nations Population Fund (UNFPA).

Appropriating at least this amount would be an important step toward meeting the U.S.’ fair share of the global need for these critical programs, which are cost-effective, save lives, and support our broader global health, development, and foreign policy priorities. The appropriate U.S. share is $1.2 billion1 out of the $9.4 billion estimated to be necessary to address the needs of the 225 million women in the developing world who want to avoid pregnancy but are not using modern contraception.

A total of $607.5 million2 (of which $32.5 million is designated for the UNFPA) is appropriated for U.S. assistance for family planning and reproductive health programs for FY2016. This level of funding makes it possible to achieve the following:

  • Provide 27 million women and couples with contraceptive services and supplies;
  • Avert 6 million unintended pregnancies, including 3 million unplanned births;
  • Prevent 2.3 million induced abortions (1.2 million of them unsafe); and
  • Prevent 11,000 maternal deaths due to complications during pregnancy and child birth.

Together USAID’s family planning and reproductive health program and UNFPA are critical to ending preventable maternal and child deaths, achieving an AIDS-free generation, and supporting women’s empowerment. Addressing the demand for access to reproductive health services, including a full range of contraceptive methods, will improve maternal and child health, decrease unintended pregnancies, lower HIV infection rates, enhance women’s and girls’ education, raise standards of living and reduce poverty, and support more economic growth and sustainable development.

Additional investments would yield tangible benefits. For each additional $10 million the U.S. invests in international family planning and reproductive health assistance:

  • 440,000 more women and couples would receive contraceptive services and supplies;
  • 95,000 fewer unintended pregnancies, including 44,000 fewer unplanned births, would occur;
  • 38,000 fewer abortions would take place (of which 30,000 would have been unsafe); and
  • 200 fewer maternal deaths would occur.

These investments not only save and improve lives, but are also highly cost-effective: every additional dollar invested in contraception yields $1.47 saved in pregnancy related care. Unfortunately, as the need has increased U.S. funding commitments have eroded. Since 1995, U.S. financial assistance has declined by one-third when adjusted for inflation. The number of women of reproductive age in developing countries has grown by more than 350 million during the same time period. In addition, the appropriated level for overseas FP/RH programs has fallen over $40 million or over six percent since FY 2010.  In FY 2011, the full House approved a cut from the prior year’s appropriation in excess of $200 million, and the Subcommittee has proposed slashing funding by about $150 million from the prior year’s appropriation to $461 million for the last six fiscal years (FY 2012—FY 2017).

 


1 This recommended level is the U.S.’ appropriate share of the $9.4 billion estimated to be necessary to address the unmet need for modern contraception of 225 million women in the developing world.  It is calculated by adopting the burden-sharing targets included in the 1994 International Conference on Population and Development’s Programme of Action, which specified that one-third of the financial resources necessary to provide reproductive health care should be furnished by donor countries and two-thirds by the developing nations themselves.  By applying the U.S. percentage share of total gross national income (GNI) of the developed world to its assigned one-third contribution to the total funding required to address the unmet need for contraception, the U.S. share of the cost, based on relative wealth, equals $1.193 billion.

2 This amount does not reflect the FY 2017 CR which reduced total discretionary spending, including base funding for international affairs programs, slightly below FY 2016 enacted levels due to a 0.19 percent across-the-board cut applied to match funding levels with previously enacted spending caps. 

Success Story

Community-Based Family Planning in Zambia

Zambia is facing a critical shortage of health personnel, especially in rural areas where access to modern family planning services is lowest. This lack of services and the high fertility rate of 5.3 births per woman can put heavy strains on families, affecting economic security, nutrition, and child development. One in five women (21%) who want family planning services does not have access to them.

In three districts, a USAID-funded grant1 enabled ChildFund International to introduce a new method of contraceptives to rural areas through community-based distributors (CBDs). To meet growing demand, the injectable contraceptive Dep-Provera was added as a third option to condoms and contraceptive pills. In the context of human resource shortages, the provision of family planning services at the community level has shifted from health workers to CBDs. The project established a learning site through which other NGOs could witness best practices for CBDs, which has facilitated broader distribution of Depo-Provera.

The CBDs program has been instrumental in increasing the uptake of family planning services, with the number of users increasing over six-fold in just four years – from 1,822 in 2012 to 11,700 users in 2015. Ruth Mushili, a 33-year-old woman from Kamoba village commented, “Access to family planning [before CBDs] was never easy. The distance to the facility used to discourage me and the area between my village and the nearby clinic gets flooded during rainy season. This would cut most of us off from accessing health services if there are no canoes to use. The other nearby health facility in Mandombe has elephants roaming and we could not access family planning because of fear of being attacked…”

The work of CBDs has greatly improved the health, social and economic status of families practicing family planning. Ruth noted, “I feel healthier and able to perform duties at home including selling fish in towns outside my district because I have a very small family that does not give me much pressure to take care of. We are able to send our children to school without a lot of pressure.” She also brags of having spaced her children two years apart and that family planning has helped to limit the size of her family to four children.

Ruth is now strongly motivating fellow women to have access to family planning services provided by CBDs in her village and beyond. Moreover, In February 2016, the government agreed to allow trained community-based health workers to provide injectable contraception. Scale-up of this task-sharing approach throughout the country was a major milestone and will specifically help rural women who otherwise would not have reliable access to this family planning method.

 

1 This publication (story) was produced by ChildFund International through Advancing Partners & Communities (APC), a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-12-00047, beginning October 1, 2012.

Photo: ChildFund International

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