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Women in all societies worldwide undergo unsafe abortion, regardless of
the legal status of abortion. WHO estimates that as many as 50,000 to 100,000 deaths each
year are due to abortion complications (Salter, Johnson and Hengen 1997). In a speech to a
preparatory meeting for the Cairo conference in 1993, the then Undersecretary of State for
Global Affairs Timothy Wirth stated that, "the abortion issue should be addressed
directly with tolerance and compassion, rather than officially ignored while women,
especially poor women, and their families suffer.…" (Partnerships,
Opportunities and Challenges 1994). In the spirit of tolerance and compassion, many
of you here today have been pioneers in working to decrease abortion-related mortality and
the tremendous cost to women’s health. As a result of your efforts, much progress has
been made over the last 7 years to design and implement PAC programs, building on existing
FP/RH services. Like the early days of FP, you have worked creatively, through windows of
opportunity, to overcome policy and program constraints. |
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What has happened over the last 7 years? In 1993, Ipas coined the phrase
"postabortion care" to include emergency treatment of complications of
spontaneous and unsafely induced abortion, provision of postabortion FP, and links to
other RH services (Ipas 1999). The PAC Consortium of cooperating agencies (CAs) formed the
same year adopted the phrase, and launched the PAC initiative with jointly developed PAC
training and communication materials, programming approaches and operations research. In
1994, the Clinton Administration overturned the Mexico City Policy, which prevented the
use of U.S. Government funds to support nongovernmental organizations (NGOs) providing
abortions or referrals for abortions, even if these activities were supported by other
funding sources. Although the Mexico City policy did not prohibit the use of USAID funds
for PAC, the policy was widely misunderstood and served as a deterrent to PAC
interventions (Ipas 1999). A 1994 State Department cable on the use of population funds
explicitly authorized the use of USAID population funds for postabortion treatment and
postabortion FP services (US Department of State 1994).
Use of USAID Funds for Population
Activities
FY 94 funds from the Population Account above the 21.5 % level (approximately
US$37 million) may, in addition to direct FP services, include supportive demographic
research and policy support, as well as certain RH activities. These activities can
include:
- selective interventions in insuring safe pregnancy services,
- prevention and management of STDs, and
- postabortion treatment and postabortion FP services.
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Source: US Department of State (Unclassified State Cable) 1994.
Due to the 1973 Helms Amendment still in effect today, however, USAID funding cannot
support abortion as a method of FP, biomedical research on methods of abortion as a
means of FP, or lobbying for abortion.
The 1994 International Conference on Population and Development (ICPD) in Cairo created
a more favorable policy environment through its Programme of Action, which positions PAC
as one of its priorities worldwide (ICPD 1994). The 1995 Fourth World Conference on Women
held in Beijing also positioned PAC as a priority (Fourth World Conference on Women 1995).
Use of USAID Funds for Population
Activities
- Help couples/individuals achieve desired family size
- Provide full range of safe and effective FP methods
- Ensure quality of care and informed choice
- Integrate/link with broader RH programs
- Involve/empower women
- Remove barriers to FP access and use
- Promote breastfeeding, PAC
- Strengthen contraceptive procurement and community-based services
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Office of Population Programmatic
Priorities, Post-Cairo
- Maximizing access and quality in FP (MAQ)
- Adding and linking, as appropriate, other selected RH interventions
- Addressing the needs of young adults
- Reducing women’s reliance on abortion and strengthening PAC
- Strengthening intersectoral linkages
- women’s education and empowerment
- population/environment
- Cross-cutting concerns
- sustainability
- NGO capacity building
- gender
- male involvement
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Just prior to ICPD, the USAID Office of Population developed new programmatic
priorities, which include reducing women’s reliance on abortion and strengthening PAC
(Maguire 1994). PAC clearly contributes to Strategic Objectives (SO)1 and 2 of the USAID
Global Bureau, Center for Population, Health and Nutrition (G/PHN). Strategic Objective
One (SO1) is increased use by women and men of voluntary practices that contribute to
reduced fertility. Strategic Objective Two (SO2) is increased use of key maternal health
and nutrition interventions (Figure 1). Maternal survival is the focus of SO2, with
PAC as a key intervention on SO2’s Pathway to Maternal Survival (Figures 2 and 3). |
