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When Averages Mislead
In 2008, I began a journey to look at the broader issue of funding for sexual and reproductive health (SRH). It became apparent that providers of development assistance, including USAID, were abandoning Latin America as they turned their sights increasingly on Africa, and that they were reallocating aid for sexual and reproductive health on the basis of aggregate national statistics.
Latin America, as a region of “middle-income countries” has been steadily losing support, but it is also the most unequal region in the world in terms of the distribution of wealth and income. If you look beyond the aggregate statistics, specifically at things like contraceptive prevalence and fertility rate, you find that if you compare the top 20%, and the bottom 20% of the population, the gap is very, very large. In most countries, it is also the case that the rural areas are very much poorer and the indicators for indigenous populations in particular compare quite unfavorably.
IPPF/WHR and UNFPA Washington partnered to investigate the impact of this withdrawal of foreign aid for SRH and to examine in particular the graduation of Latin American countries from USAID population funding. We chose to visit Peru because it is fairly representative of many countries in the region, in that it has a rapidly growing economy, such that the aggregate data look very good, but on the other hand, it’s highly unequal – rapid economic growth comes with growing inequality, and very high levels of poverty.
While on the trip, we visited government clinics, UN agencies, local NGOs and the IPPF/WHR Member Association in Peru, INPPARES. We spoke to clients and providers, met with local officials, and visited several communities in 3 different regions to see what the situation looks like on the ground. One of the things we focused on was “contraceptive security,” a standard that USAID applies for “graduation,” which means that before funding is eliminated, modern methods of contraception should be widely available to whoever wants them, and they should not only be available, but also free or for an affordable price.
What we found was that in the public sector, there were no condoms to be found and also shortages of all types of contraceptives. Some had been out of stock for months, and they didn’t know when the next shipment would be arriving. The whole contraceptive supply chain was in fact breaking down, and the overall profile could hardly be said to resemble anything like genuine contraceptive security.
On January 20th IPPF/WHR and UNFPA jointly hosted an event on the Hill in Washington, DC with the aim of educating members of Congress, and to some extent a wider public, about this problem. We distributed an executive summary of what will eventually be published as a “White Paper” making the case for continued attention to SRH in LAC by the international community.
It’s not that we disagree that there are bigger needs in Africa, we just feel that cutting funding to Latin America and the Caribbean has been done too precipitously. In the end, the criteria and the standards that were established by USAID itself in its graduation program are not being met. They need to take another look at the timing, and think about maintaining funding levels.