By Rebecca Oas, Ph.D and Lisa Correnti | August 25, 2016
WASHINGTON, D.C., August 26 (C-Fam) World Leaders and the U.S. Congress claim to be united about at least one thing: ending preventable deaths in childbirth and infancy by 2030. But while pending U.S. legislation enjoys bipartisan support and avoids mention of the hot button issues of abortion or contraception, it would divert grants away from real maternal health programs, including faith-based, and funnel them to groups endorsing abortion.
The Reach Every Mother And Child (REACH) Act introduced in the Senate by Senator Susan Collins now with 25 co-sponsors falls short in prioritizing evidence-based interventions that prevent and treat the causes of maternal and child mortality. The REACH Act guidelines are based on an existing USAID initiative, “Acting on the Call,” which relies on implementing organizations mostly known for their population control and abortion practices.
This includes groups like Population Services International (PSI) that distributes millions of medical abortion packages overseas and PATH which developed a self-inject version of the harmful injectable contraceptive Depo Provera. Other partnering organizations include the global family planning initiative “FP2020” which prioritizes funding for Depo, and “FHI360” known for scaling up delivery of Depo through community health workers in developing countries, and Population Action International which lobbies against the Mexico City Policy, an executive order that prohibits US funding to groups that perform or promote abortion.
A glimpse at USAID’s “Acting on the Call” annual report for 2014 reveals a gross inequity in grants awarded to charitable organizations. Likewise, prioritizing family planning within the REACH Act could disqualify these faith-based organizations to the point of denying grants to those seeking to make pregnancy survivable, rather than merely avoidable, for mother and child.
Highly problematic is the measurement guidelines established within the REACH Act as it seeks to measure progress in terms of reducing the number of maternal and child deaths, as opposed to the ratio of deaths compared to the number of live births.
Proponents of family planning frequently claim that contraceptives save lives by preventing pregnancies. But making birth rarer does not necessarily make it safer.
The REACH Act calls for the measurement of lives saved, or “deaths averted,” which involves counting events that do not occur, yet for which the U.S. can claim credit. Rather than relying solely on vital statistics such as births and deaths, this approach uses statistical models that estimate the impact of packages of interventions on health outcomes in target countries.
But increasing contraceptive prevalence appears deceptively simple. Family planning advocates rely heavily on a flawed measurement of “unmet need” which is used to imply widespread lack of access to contraceptives, despite the fact that very few women claim they are unavailable or unaffordable. Furthermore, access does not mean use: many women with a purported “need” express concern about health risks and side effects of contraceptive use.
Reducing the number of pregnancies may decrease maternal deaths in terms of numbers, but women in poor countries deserve to give birth safely, not to be urged to avoid having children. As for the children, they deserve better than to be counted as “lives saved” by virtue of not being born at all: supporting materials for the REACH Act refers to this phenomenon as “child lives saved from demographic impact.”