Defunding UNFPA – beyond the talking points

By Rebecca Oas, Ph.D. | April 6, 2017

The United States’ recent decision to stop donating to the United Nations Population Fund has set off hysterics in the usual places.  In what should by now feel like a well-practiced ritual, the UNFPA dusted off its 2002 press release and updated it with a few more recent facts and figures, including the following:

With support from the United States, UNFPA in 2016 was able to:

  • Save the lives of 2,340 women from dying during pregnancy and childbirth;
  • Prevent 947,000 unintended pregnancies;
  • Ensure 1,251 fistula surgeries
  • Prevent 295,000 unsafe abortions.

They don’t specify exactly what interventions that support was used to provide, but the press release also says:

“With previous United States contributions, UNFPA was combatting gender-based violence and reducing the scourge of maternal deaths in the world’s most fragile settings, in areas of conflict and natural disasters, including Iraq, Nepal, Sudan, Syria, the Philippines, Ukraine and Yemen.”

The 2002 press release contains a similar itemized list of accomplishments, as does the UNFPA Supplies website, which gives us these figures:

Contraceptives provided through UNFPA Supplies in 2016 had potential to avert an estimated:

  • 7.1 million unintended pregnancies
  • 20,000 maternal deaths
  • 126,000 child deaths
  • 2.2 million unsafe abortions

Note the phrasing about “potential”: these are impossible to track in real terms since they are estimates of events that never occurred, but otherwise might have if not for UNFPA’s interventions.  Note also that these were all said to be accomplished by contraceptives through the prevention of pregnancies, which would be separate from maternal health programs which serve women who are already pregnant and prevent deaths by ensuring safe childbirth.

Since both lists of statistics cover the same period (the year 2016), it’s possible to do a few comparisons.  According to the UNFPA Supplies data, averting 7.1 million unintended pregnancies in turn averted 20,000 maternal deaths.  That’s one maternal death averted per 355 averted pregnancies.  It follows that for every 947,000 pregnancies averted (the number credited to U.S. funding), 2,668 maternal deaths would have the potential to be averted.

The only problem is that UNFPA only credits U.S. funding with averting 2,340 maternal deaths.

Bear in mind that while UNFPA focuses mainly on family planning, maternal health and safe childbearing also falls within their mandate. It would therefore make sense for U.S. funding to go toward maternal health interventions as well as contraceptives.  If so, we might expect to see a higher number of maternal deaths averted with U.S. funds than could be accounted for by averted pregnancies alone.  Instead, we see the opposite.  Even if the entirety of the U.S. contribution went to contraceptives instead of violence prevention or maternal health, why does U.S.-funded contraception apparently prevent fewer deaths?  And what of those who are giving birth in difficult circumstances?  Not much use for contraceptives there.

To recap, the numbers released by UNFPA to shame the U.S. from defunding them would seem to suggest that a) U.S. funding to UNFPA didn’t save any women’s lives apart from through contraception, and b) U.S. funding to UNFPA saved women’s lives through contraception at a lower level of efficacy than what UNFPA could accomplish with the combined funding of other donors.

And of course, it didn’t actually save any lives at all, but “had the potential” to do so, since nobody ever died directly from a lack of family planning, but due to maternal health complications such as sepsis, hemorrhage, or hypertension, or as the result of a botched abortion.

But let’s not quibble over “saved lives” vs. “potentially and indirectly averted deaths” in 2016, because International Planned Parenthood Federation’s European office Tweeted this little gem:

So many assumptions and misunderstandings packed into so few characters. To list a few:

  • Presumes no reduction in maternal mortality from one year to the next;
  • Presumes that UNFPA is the only possible entity that could provide maternal health/family planning to those women;
  • Presumes that the U.S. is the only possible entity that could provide sufficient funding to UNFPA to reach those women;
  • Presumes that the U.S. won’t fund maternal health initiatives through means other than UNFPA.
  • …and so on.

So much of the purported “crisis” in family planning funding is hype with very little substance.  UNFPA and its billion-dollar budget will undoubtedly emerge from this just fine.  If anything, women in poor countries could come out of this better off if the U.S. redirects the funding formerly earmarked for UNFPA toward its own maternal and child health programs that have more oversight and accountability to the American taxpayer and are subject to the Mexico City Policy, unlike UNFPA.

Family planning groups are very fond of these little lists of potential impacts (Marie Stopes International put one out immediately after the reinstatement of the Mexico City Policy), because it’s a very effective way of saying “if you cut my funding, the poor lady dies.”  But in a world where the market for family planning is increasingly saturated, yet maternal mortality remains a stubborn problem in some regions, it’s less about saving lives than clever advertising and cynical self-preservation.  Perhaps the most telling sign of all is the way UNFPA gives short shrift to its own maternal health interventions when tallying up the impact of past U.S. contributions to its coffers.