One funder responding to the urgency of this issue is the Bill and Melinda Gates Foundation , which has supported family planning efforts and other pressing issues in global health, poverty, and education. “One of the most cost-effective public health interventions available today is family planning,” the Gates Foundation website states. “With fewer children, families are more able to invest in their children’s education and health…[therefore,] voluntary family planning is a critical lifesaving intervention that can significantly improve the health of women and their families.” It is significant for women’s health advocates that such a respected funder has recognized the importance of family planning not only to saving lives, but also to improving standards of living by reducing poverty and increasing opportunities for women and children. But is this effort sufficient?
Coming Up Short
The funding needed to provide adequate reproductive and maternal healthcare, according to the Guttmacher Institute, is far below the cost accrued by current medical care expenditures tied to unintended pregnancies and unplanned childbearing. The costs of providing prenatal, delivery, and newborn care, as well as treating post-abortion complications and obstetric emergencies, currently total US$183 million, significantly below the US$279 million required in the absence of modern contraceptive use.
The Gates Foundation itself has recognized the tangible benefits of modern family planning and has expressed concern that annual funding efforts worldwide decreased by 60 percent between 1994 and 2005, and that contraceptive research and development also dropped, while the number of couples hoping to prevent unintended pregnancies rose. Despite the benefits of investing in reproductive health, it is unlikely that sufficient budgetary allocations will soon be made, even by such vocal advocates as the Gates Foundation, because of the politicized discussion around family planning.
While the Gates Foundation has recognized the importance of birth control and healthcare meant to limit unintended pregnancies and nurture planned ones, the organization has not acknowledged the key role of abortion in the global fight for reproductive health, perhaps due to a fear of right-wing backlash, or a belief that the crisis in maternal mortality can be solved without increasing access to safe abortion. In remarks following a pledge of US$1.5 billion dollars to the cause of decreasing maternal and child mortality, Melinda Gates stated that she could not imagine being denied “the basic right to decide how many children to have.” However, she added that the Gates Foundation would direct its efforts “upstream,” suggesting that abortion is unnecessary when family planning is properly approached. Despite the laudable sentiment behind the pledge for maternal and child health, the Gates Foundation’s hesitant position on abortion may inhibit a more proactive and pragmatic approach to reproductive health.
Advanced planning can, of course, be vital for women who are sexually active and have access to modern methods of birth control. However, for women who lack access to contraception—whether due to poverty, distance to a clinic, ignorance of how contraceptives work, fear that their husbands will condemn their use of contraception, or other causes—abortion may be their only option. This is especially the case when women suffer rape, incest, or contraception failure, or when they lack the resources, health, or ability to offer a child sufficient care. Yet the abortion procedure, condemned by religious communities and banned by many governments, can be unsafe to obtain, particularly in those countries where it is prohibited. A recent report on unsafe abortion by the Center for Reproductive Rights linked high rates of maternal mortality to restrictive abortion laws. “Where access to safe and legal abortion is limited,” the report states, “women resort to unsafe abortion, with devastating consequences for their health, lives, and families.” The politicized nature of this public health issue has perpetuated constraints on women’s ability to cope with their own pregnancies.
Because of the controversy, a preventable cause for the deaths of thousands of women each year is ignored. For fear that their efforts to protect women will be denied by major funders, countless NGOs have altered their programmatic focus to avoid abortion and other family planning options. “These are women lost because the international community has allowed ideology to trump health,” writes Brook Elliott Buettner of the global feminist blog Gender Across Borders, adding that the failure to recognize this key area of reproductive health will affect other sources of funding as well. Major funders exert enormous power in setting global health agendas, Buettner writes. Removing abortion from the maternal rights equation will result in increasing numbers of preventable deaths in year to come.
Other funding projects as well, such as the Muskoka Initiative put forth by the G8 early in the summer of 2010, are reluctant to back abortion. Indeed, though Ban Ki-moon noted that an additional US$60 billion would be necessary to achieve the goals targeting maternal and child mortality by 2015, the G8 summit, which many hoped would come up with those funds, instead pledged a scant US$5 billion. Furthermore, Prime Minister Stephen Harper of Canada, the country hosting the summit, appeared to accept discussion of contraception only reluctantly, after backlash following a statement that family planning was not on Canada’s agenda. Debate on abortion was not wanted “here or elsewhere,” he said. Even with that key aspect of women’s health cast aside, the G8 countries’ contribution to the goal of fighting maternal and child deaths will not save nearly enough lives, nor, it seems, attempt to do so in the ways that could have most impact.