|The Value of Family Planning Programs in Developing Countries (RAND, 1998, 98 p.)|
|Chapter Four - THE COST OF FAMILY PLANNING|
International donors play an important role in getting programs started, and also later in helping them expand. Donor funding typically increases over time - although government funding generally rises much faster - as a program tries to reach a larger clientele and becomes more skilled and sophisticated in doing so. Donor funding usually declines when a program is fairly mature and well-established.
In several ways, donors find family planning programs ideal humanitarian programs. These programs benefit the poorest in society, those unable to afford such a basic service on their own, and they benefit women in particular. They provide households not only with a concrete service but also with the opportunity to better their lot and improve the prospects for their children. Programs now have a record of success in many countries, but still have a long way to go and require much further assistance in others. Besides their personal benefits for individuals and households, programs also open up opportunities for societal development through the reduced dependency burden. By releasing some pressure on resources, they allow societies the time and opportunity to develop more sustainable modes of interacting with their environments.
Family planning assistance is not comparable in its immediate commercial benefits to "foreign aid" programs that directly promote exports, but the benefits it does provide may be wider and longer lasting.5 If developing countries can be assisted in achieving low population growth and progressive economies, the benefits to the donor countries of growing markets, increasing international division of labor, and expanded export and investment opportunities could be considerable. In the United States, the leading donor in this area, a third of economic growth in the past decade has been generated by exports (Bergsten, 1997), and strong economies overseas have been essential to this. The American "economic future is increasingly tied to growing foreign markets,"6 as the stock market gyrations in October 1997 demonstrated. In addition, strong economies in developing countries promote political stability and facilitate cooperation on international problems, from drugs and crime to global warming to uncontrolled migration.7
5And they could be potentially greater, if the other programs involve significant trade diversion rather than trade creation.
6Joe Lockhart, in explaining Bill Clinton's foreign travel (Wall Street Journal, 15 Oct 1997).
7A list of such arguments for tax-supported foreign aid is provided by Cohen (1997). Quantifying such benefits is largely a speculative exercise, but if one considers all foreign aid from all sources, the benefits in trade promoted, wars avoided, and environmental damage averted are reportedly thousands of times the cost of the assistance (O'Hanlon and Graham, 1997). With regard to migration, it is not being argued that reducing migration produces economic benefits. Within limits and with qualifications, the reverse appears to be the case (Smith and Edmonston, 1997). But a lawful, controlled process - though not necessarily a restrictive one - is desirable.
In line with its activist foreign policy, the United States has been the leading international donor in population and family planning, with about half of all contributions and an overseas staff and technical advisers who constitute the bulk of such donor expertise in the field in developing countries. However, the U.S. share of contributions diminished in the late 1980s and has not recovered to previous levels. In fact, U.S. population assistance fell 20 percent from FY 1995 to FY 1996 and fell a further 10 percent in FY 1997.8 How other donor countries will react to this is difficult to predict.
8Reported figures for these years are US$541.6 million, $432 million, and $385 million. For FY 1998, no change is expected.
As the United States has become increasingly engaged with the rest of the world - through expanding trade and alliances; through international agreements on security assistance, drug enforcement, environmental protection, etc.; and through the growing band of American expatriates, whose numbers have risen by 50 percent in the 1990s9 - its commitment to assisting needy countries appears to have actually diminished. The United States devotes less of its GNP to all official development assistance than any of the other 20 leading industrial economies. Per capita, U.S. official development assistance in all areas is equivalent to a contribution of US$0.70 per week from each American, as contrasted with US$2.00 from each Japanese and more than US$5.00 from each Dane and Norwegian.10 U.S. assistance is declining at the same time that assistance from all OECD countries combined is also declining: by 6 percent from 1995 to 1996, leaving the OECD countries less than half way to their target of devoting 0.7 percent of their GNP to reducing world poverty (Randel and German, 1997).
9Excluding soldiers and diplomats (Knowlton, 1997).
10Estimates of official development assistance are for 1994 (World Bank, 1997a, p. 304) and are compared with the 1995 population.
Relative to other countries, the United States puts more of its development assistance into population - 4 percent in 1993, 5 percent in 1994, and a reported 9 percent in 1995 (when reproductive health began to be counted by UNFPA [1997a], and all U.S. development assistance fell by one-fourth11). Even the sharply higher proportion in that single year, however, meant that support for population and reproductive health in developing countries costs each American only a penny a day.
11According to OECD, net U.S. official development assistance fell from US$9.9 billion in 1994 to $7.4 billion in 1995, then recovered somewhat to $9.4 billion in 1996.
These pennies have added up and made a difference, but the U.S. role has been much deeper than that of a program financier. Many of the ideas and initiatives that carried international family planning from a long-shot, almost desperate attempt to alleviate developing-country poverty to the levels of sophistication and success it enjoys in some countries found their inspiration in U.S. think tanks and universities and their implementation with the support and advice of American agencies. U.S. support for strong population policies has been ubiquitous, sometimes pushing governments farther than they have been ready to go. Subsequent technical assistance has helped build institutions in certain countries that can contribute in a lasting fashion. The commitment of the United States and other donor countries to human rights and democratic principles has also been important in ensuring the voluntary character of these programs wherever these donors have been involved.