Making the Case for Family Planning

1. Making the Case for Family Planning Duff Gillespie Professor and Senior Scholar Johns Hopkins Bloomberg School of Public Health The Bill and Melinda Gates Institute for Population and Reproductive Health dgillesp@jhsph.edu Unfinished Agenda for Family Planning The World Bank, HNP – Brown Bag Lunch Series Washington, D.C. May 6, 2009, 11:00am– 1:00pm

2. Presentation – Three Parts • Country to Global Pathways Project • Importance of the United States • Making the Case for International Family Planning

3. Country Global Pathways Project • IPPF and Gates Institute Collaboration • In Nigeria, Tanzania, Brazil, Mexico and Indonesia • Follow-on Projects are Planned

4. Why Country to Global? “ We hear from European Governments. We hear from NGOs from the North. We don’t hear from the South, from the countries most affected by our decisions.” European Diplomat to the UN

5. Country to Global Pathways UN Regional Organizations CURRENT Donor Governments G7 Global Fund International NGOs EU IFIs NATIONAL GOVERNMENT RH Champions Budget PRSPs SWAPS Loan Requests Local NGOs

6. Country to Global Pathways UN Regional Organizations DESIRED Donor Governments G7 Global Fund International NGOs EU IFIs NATIONAL GOVERNMENT RH Champions Budget PRSPs SWAPS Loan Requests Local NGOs

7. Some Lessons from Country Global Pathways • Decentralization makes advocacy more difficult • A focused advocacy effort can be effective • RH organizations will initially resist participation • MDGs are organizing template, MDG-5b is still missing • Donors’ policies still influence country programs • Donors perceived as not serious about FP, not to mention SRHR • Donorship to ownership not seen as inherently good

8. External and Internal Population Funds* by Region, 2002 Number of Countries (17) (11) (9) *includes family planning, reproductive health and HIV/AIDS Source: UNFPA/NIDI, Resource Flows, Index. Data for 2003 is estimated. http://www.resourceflows.org/index.php/articles/c31/

9. U.S. is the Dominant Donor No matter what administration, the United States has remained the dominate donor in reproductive health, especially family planning, since the 1970s. This dominance has sometimes been a positive force, sometimes a negative force.

10. Statement of Sen. Hillary Rodham Clinton “I believe that American leadership has been wanting, but is still wanted.” Nominee for Secretary of State Senate Foreign Relations Committee Testimony on January 13, 2009

11. Primary Funds of Donor Countries for Population and AIDS activities, 2004* *estimated Source: UNFPA/NIDI,Resource Flows, Real Time Estimates for Donor Assistance for Population and AIDS Activities, 2004

12. USAID’s HIV/AIDS Program Profile 2001

14. The Great Divide – 2002 Edition • “All people should be able to have a satisfying and safe sex life. This includes women, lesbians, gay men, bisexuals and transgender persons.” • Mona Sahlin, Minister for Democracy, Sweden • “The United States is unable…to endorse the…statement [because it] includes the concept of ‘sexual rights…” • Kelly Ryan, Deputy Assistant, Secretary of State

15. The Great Divide – 2009 Edition • “Sanger’s prolific writings dripped with contempt for those she considers to be unfit to live. Sanger was an unapologetic eugenicist and racist…as I think you know, in 2000 alone, Planned Parenthood killed over 305,000 children by abortion in the U.S. alone, and millions more worldwide.” • Rep. Chris Smith (R, NJ) • “We, obviously, have a profound disagreement. When I think about the suffering that I have seen of women around the world, I’ve been in hospitals in Brazil where half the women were enthusiastically and joyfully greeting new babies and the other half were fighting for their lives against botched abortions…we have a very fundamental disagreement and it is my strongly held view that you are entitled to advocate and everyone agrees with you should be free to do so anywhere in the world, and so are we…the Administration happens to think that family planning is an important part of women’s health and reproductive health includes access to abortion, that I believe should be safe, legal and rare.” • Secretary of State, Hillary Clinton Source: Transcript of Senate Hearing at HFAC, April 2009

16. Reagan Bush Clinton GW Bush Obama Senate 50-50 House

17. Making the Caseis An evidence-based advocacy initiative Focused on increasing the funding level of USAID’s family planning program Complements larger advocacy efforts Funded by the David and Lucile Packard Foundation and the Bill and Melinda Gates Institute at Johns Hopkins University

19. Making the CaseStrategy and Tactics Are the product of consultations with advocacy community, congressional staffers, lobbyists, public relation experts, and international survey of reproductive health communities Have a narrow focus reflecting comparative advantage of former directors Will appeal to broadest spectrum of policy makers who control funding Exclude non-funding related messages, e.g., elimination of Global Gag Rule, women empowerment, etc.

20. The “Billion Dollar Ask” Letter Excerpt of a July 15th, 2008 letter signed by 13 U.S. Senators and addressed to Chairman Patrick Leahy and Ranking Member Judd Gregg of the Subcommittee on State, Foreign Operations, and Related Programs, Committee on Appropriations “This continuing population growth is a major contributor to resource scarcity and hinders efforts to combat climate change. Unsustainable population growth plays a role in the destruction of forests and the spread of deserts, the pollution and overfishing of oceans and waterways, and increases in emissions that contribute to global climate change.”

21. Message Flow Making the Case AUDIENCE Congress White House Donors International Community Executive Branch AdvocacyCommunity Media Opinion Leaders

22. How can MTC best be used to increase support for family planning? • MTC Report • Activities of the Former Directors • Complement and supplement other advocacy groups • Overseas activities

23. Slide Source: Making the Case for International Family Planning, January 2009. http://www.jhsph.edu/gatesinstitute

24. Slide Source: Making the Case for International Family Planning, January 2009. http://www.jhsph.edu/gatesinstitute

25. Slide Source: Making the Case for International Family Planning, January 2009. http://www.jhsph.edu/gatesinstitute

26. Slide Source: Making the Case for International Family Planning, January 2009. http://www.jhsph.edu/gatesinstitute

27. Slide Source: Making the Case for International Family Planning, January 2009. http://www.jhsph.edu/gatesinstitute

28. Issues Confronted in MTC Process • Economic Crisis – Getting Air Time • Second Tier Political Appointees Not in Place • Access Outside SRHR Community • Former Directors’ Limited Availability • Maternal Health “Push Back” • USAID Effective & Rapid Use of Funds

29. Approval of Barack Obama’s Actions as President • Naming special envoys for • Middle East, Afghanistan, Pakistan • Tightening ethics rules for • administration officials • Limiting interrogation • techniques on prisoners • Instituting higher fuel • efficiency standards • Making it easier for workers • to sue for pay discrimination • Ordering Guantanamo Bay • prison be closed • Allow funding for overseas family • planning groups that provide abortions 76% 76% 74% 74% 66% 44% 35% Source: Jan 30 – Feb 1 USA today/Gallup poll

30. USAID Effective & Rapid Use of Funds • -Expand Existing Programs • -Expand Contraceptive Security • -Accelerate Contraceptive Development • -Diffuse Successful Country Programs • -Use NGO Network • -Refund IPPF & MSI • -Start Donorship to Ownership Process

31. U.S. leadership is more than the U.S. government, but the economic crisis makes USAID programs even more important.

32. “Contrary to the Malthusian view that population will grow to the limit of how ever many kids can be fed, in fact parents choose to have enough kids to give them a high chance that several will survive to support them as they grow old. As the number of kids who survive to adulthood goes up, parents can achieve this goal without having as many children.” Bill Gates, Annual Letter, 2009, page 6

33. Thank You