21. PopulationThe U.S. international population assistance program has been recognized throughout its more than 30-year history as one of the most successful components of U.S. foreign assistance. We remain the largest bilateral donor in the world, with programs in more than 58 countries. These programs enable couples to choose the number and spacing of births, enhance maternal and child health, reduce the incidence of abortion, and enable parents to better provide for their children. More than 50 million couples in the developing world use voluntary family planning services because of U.S. Government assistance. To clearly separate U.S. Government support for family planning assistance from abortion-related activities, U.S. Agency for International Development抯 family planning assistance only goes to foreign organizations that do not perform or actively promote abortion, with the clearly stated exception of post-abortion care.
In 1994, the United States helped forge a consensus at the International Conference on Population and Development (ICPD) on a comprehensive approach to achieve a healthy and sustainable world population. As part of our policy response to the ICPD, and at its 5-year review in 1999 (ICPD+5), the U.S. Government works with other nations to provide reproductive health care, including family planning, to women and men around the world; improve the status of women; and enhance educational opportunities, especially for girls. Our concern for the quality of life of each of the earth抯 more than six billion citizens makes ensuring a healthy and sustainable world population a vital U.S. foreign policy interest.
Every day, at least 1,600 women die from the complications of pregnancy and childbirth. Voluntary family planning saves lives and can reduce up to a quarter of the 515,000 annual pregnancy-related deaths around the world. In addition, each year more than 50 million women experience pregnancy-related complications, many of which lead to long-term disability. And when a mother dies, her family and community also suffer, and surviving children face higher risks of poverty, neglect, or even death. Avoiding unintended pregnancy through voluntary family planning reduces maternal mortality. So does antenatal care: 30 percent of women living in less developed countries do not even receive a single antenatal checkup. And only one-half of all deliveries in developing countries take place with a skilled birth attendant.
Studies show that educating women and girls raises every index of development. An estimated two-thirds of the 300 million children without access to education are girls, and two-thirds of the some 880 million illiterate adults are women. Female education is strongly linked to health: infant mortality is much higher梥ometimes two to three times higher梐mong children of uneducated women compared with women with at least some secondary education. Family planning use also increases with education.
Within the Department, the Bureau of Population, Refugees and Migration has the lead responsibility to promote the ICPD and ICPD+5 goals on access to reproductive health care, including voluntary family planning and safe motherhood and education for girls. State/Population, Refugees and Migration takes the lead in international forums to review lessons learned, share best practices, and reexamine benchmarks and indicators vital to monitoring global efforts to achieve a healthy and sustainable world population. State/Population, Refugees and Migration represents the United States in the governing bodies of relevant international and multilateral organizations to guide them in their own efforts to promote the ICPD and ICPD+5 goals. State/Population, Refugees and Migration works in close cooperation with the U.S. Agency for International Development and international organizations to help developing countries meet these goals. State/Population, Refugees and Migration also works to increase national and international awareness of population issues and integrating these issues into broader economic growth and sustainable development strategies.
National Interest |
Global Issues |
Performance Goal # |
PO-01 |
Strategic Goal |
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Achieve a healthy and sustainable world population. |
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Outcome Desired |
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Sustainable national population growth rates worldwide supported by national political, economic, and social development strategies, leading to improved reproductive health and reduced maternal and infant mortality rates. |
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Performance Goal |
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Improving reproductive health, including improved access to voluntary family planning, safe motherhood services, STD prevention information, and girls' education. |
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FY � RESULTS AS OF 9/30/01 Current data on fertility and reproductive health in developing countries indicate that actual fertility exceeds desired fertility by nearly one child per woman. There is ample evidence to demonstrate that family planning programs are the most effective means to close the gap between actual and desired fertility.
In FY �, we have increased motivation for the adoption of voluntary practices that contribute to higher contraceptive prevalence rates. We have also increased awareness of and demand for family planning and reproductive health interventions by improving the policy environment, public information and communication, and spousal communication on family planning and reproductive health issues.
In FY �, we have continued to focus on four areas of intervention that are important for maternal health and survival: promotion of improved nutritional status; birth preparedness; management of complications; and safe delivery, postpartum and newborn care.
The Department continues梩hrough such forums as UN meetings and conferences and national workshops梩o mobilize national leadership at all levels to promote girls' education and to identify and address the major barriers to girls' education.
Through USAID, we have created 揅ountry Initiatives for Girls' Education� in Egypt, Guatemala, Guinea, Mali, and Morocco. These initiatives are promoting local ownership of the problems and solutions to the education of girls. These initiatives are also providing technical knowledge skills and training on effective use of national human and financial resources for increasing girls' school participation. In partnership with USAID, we are developing a system to monitor the results of these girls� education initiatives as well as other such initiatives throughout the world
Despite important family planning successes, a great deal of work remains to be done. Although modern contraceptive prevalence in the developing world has increased dramatically from roughly 10 percent in 1965 to 39 percent in less developed countries (FY � baseline), approximately 150 million women have an unmet need for family planning today. We must continue to stay the course. |
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FY � RESULTS AS OF 9/30/01 (cont抎) Programs must involve men more fully in family planning. More communication and shared decisionmaking on family size and family planning matters between partners needs to be encouraged, and male responsibility for sexual health, fertility, and child-rearing must be fostered. Our family planning advocacy work will be expanded in FY � to focus on the important role men play in family planning matters.
Demographic and Health Surveys (DHS), funded by the U.S. Government, continue to provide excellent sources of data on contraceptive knowledge and use, maternal mortality and girls' education. These surveys continue to be the primary source of information on reproductive health behavior in the developing world.
The maternal mortality ratio is best utilized as an indicator of the magnitude of the problem for the purposes of advocacy. However, it is unsatisfactory for measuring program progress over intervals of less than 10 years. The Department will continue to strive to identify appropriate indicators for which data can be collected annually. These short-term population goal indicators are generally process and output indicators, and may include both qualitative and quantitative measures. Mid-term indicators (2�years) might include changes in service use and the percentage of births attended by a skilled health provider. It is important to remember that the kind of changes being sought may not be measurable with accuracy within such short timeframes. In all timeframes, we will seek those indicators that are currently available, and those that are cost-effective, in assessing impact in future years. Increasing secondary school enrollment rates is one of the key goals in the 1994 International Conference on Population and Development (ICPD) Program of Action and is an important indicator to measure education outcomes. But they can be rife with errors, as they do not reflect actual rates of attendance or dropouts during the school year. |
| Performance Indicator
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FY � Baseline |
FY � Actual
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FY � Target |
FY � Actual |
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Availability of modern family planning and other reproductive health care for individuals requesting such services. |
Contraceptive prevalence rate (CPR) in less developed countries is 39 percent (modern methods). |
Successful: at least 10 countries increase CPR (modern methods) by 2 percent.
Minimally effective: at least 5 countries increase CPR (modern methods) by 1 percent. |
Successful: an additional 10 countries increase CPR (modern methods) by 2 percent.
Minimally effective: an additional 5 countries increase CPR (modern methods) by 1 percent. |
22 less developed countries increased CPR (modern methods) by (at least) 2 percent. These countries were Kenya (+4 percent), Madagascar (+5), Tanzania (+3), Cameroon (+3), Ghana (+3), Niger (+3), Togo (+3), Philippines (+3), Vietnam (+12), Bangladesh (+2), India (+6), Pakistan (+4), Jordan (+11), Haiti (+9), El Salvador (+8), Guatemala (+5), Nicaragua (+12), Bolivia (+8), Colombia (+5), Ecuador (+6), Paraguay (+7), Kazakhstan (+6). |
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Verification |
Source: National demographic reports; U.S. Census Bureau/ United Nations population data sheets
Storage: National planning and/or census agencies; U.S. Census Bureau/ United Nations Population Division/ United Nations Population Fund
Validation: Embassy/U.S. Agency for International Development Mission reporting; U.S. Agency for International Development-funded Demographic Health Surveys (DHS); NGO publications |
| Performance Indicator
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FY � Baseline |
FY � Actual |
FY � Target |
FY � Actual |
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Maternal mortality at the national level. |
Percentage of births assisted by a skilled birth attendant in the less developed countries is 53 percent. Maternal mortality rate (MMR) in less developed countries is 500 deaths per 100,000 live births (500/100,000). |
Successful: where maternal mortality rate (MMR) is over 500/100,000, 10 countries increase births assisted by a skilled attendant by 2 percent.
Minimally effective: where MMR is over 500/100,000, 5 countries increase percentage of births assisted by a skilled attendant by 2 percent. |
Successful: where maternal mortality rate (MMR) is over 500/100,000, 10 additional countries increase births assisted by a skilled attendant by 2 percent.
Minimally effective: where MMR is over 500/100,000, 5 additional countries increase percentage of births assisted by a skilled attendant by 2 percent. |
Two countries, where MMR is over 500/100,000 live births increased by at least 2 percent the number of births assisted by a skilled birth attendant. These countries were Laos and Bhutan. |
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Verification |
Source: National demographic reports; WHO
Storage: National statistical offices; WHO Validation: Embassy/U.S. Agency for International Development Mission reporting; U.S. Agency for International Development-funded Demographic Health Surveys (DHS); United Nations Population Fund (UNFPA) reporting |
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Performance Indicator |
FY � Baseline |
FY � Actual |
FY � Target |
FY � Actual |
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Secondary school enrollment rates among girls. |
63 countries have a girls� secondary school enrollment rate of < 50 percent. |
Successful: 10 countries where girls� secondary school enrollment rate is < 50 percent increase enrollment by 2 percent.
Minimally effective: 5 countries where girls' secondary school enrollment rate is < 50 percent increase enrollment by 2 percent. |
Successful: an additional 10 countries where girls� secondary school enrollment rate is < 50 percent increase enrollment by 2 percent.
Minimally effective: an additional 5 countries where girls secondary school enrollment rate is < 50 percent increase enrollment by 2 percent. |
No countries where girls� secondary enrollment rate is < 50 percent increased enrollment by 2 percent. |
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Verification |
Source: UNESCO
Storage: National education ministries/national statistical offices; UNESCO Statistical Yearbook/World Education Report series
Validation: Embassy/ U.S. Agency for International Development Mission reporting; UNFPA reporting; nongovernmental organization publications |
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Countries |
U.S. Agency for International Development population program countries; countries where TFR > 3.0 and/or CPR < 50 percent (modern methods); countries where births assisted by skilled birth attendants is < 30 percent; countries where girls secondary school enrollment rate is < 50 percent; China |
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Complementary U.S. Government Activities (non-Department of State) |
U.S. Agency for International Development-funded population and women-in-development programs. |
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Lead Agency |
Department of State (PRM, with IO, regional bureaus, IIP) |
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Partners |
U.S. Agency for International Development, U.S. Bureau of the Census, Health and Human Services, United Nations Population Fund (UNFPA), United Nations Division of Population, nongovernmental organization partners |
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