U.S. Funding for the United Nations Population Fund (UNFPA)

Obstetric Health Care

According to some estimates, every minute nearly 110 women worldwide experience a complication during pregnancy. Yet over 58 percent of all deliveries in the developing world take place without a skilled obstetric health care attendant of any kind present (UNFPA, 2000). This translates directly into a global loss of life. In 76 countries today, UNFPA provides obstetric training for health care attendants in all aspects of maternal care, prenatal care and emergency delivery room life saving procedures. This training includes hands-on instruction and reference materials covering emergency obstetric care, treatment protocols, record keeping, facility upgrading, delivery room procedure, postpartum complications, family planning services and obstetric referral systems.

Education Regarding Female Genital Mutilation (FGM)

UNFPA is currently the only government funded agency providing worldwide education about the dangers of female genital mutilation (FGM) – an area of special concern to my wife and I. Today this practice affects an estimated 130-137 million women worldwide (WHO, 2000; Epstein et al., 2001). An average of 13,000 girls and women are mutilated each day, and an estimated 168,000 immigrant women here in the U.S. are at risk. FGM most commonly impacts Third World teenage girls between the ages of 13 and 20. Typically, the practice involves the partial or complete removal of female genitalia with crude instruments such as knives, razors, scythe like cutting tools, fire, tin can lids, sharp stones, broken glass, and in some cases, even teeth. In some areas it is practiced in hospitals with modern surgical instruments (e.g. Egypt), but most commonly it is practiced in impoverished rural areas by professional “Circumcisors” without the benefits of anesthetics or hygiene (Davis, 2001). In many cutting rituals, common instruments are used on multiple girls, resulting in the passing of blood-born disease. In the most extreme form, known as infibulation (the form practiced in Somalia and Ethiopia), the girl is sewn back up again after being cut, sometimes almost completely. Subsequent intercourse and childbirth will forcibly reopen the wound, requiring it to be sewn once again (Bosch, 2001; WHO, 1995). Short-term health complications include shock, massive bleeding, local and systemic infection, lameness (crucial tendons are often cut inadvertently during the practice), and severe pain. Over 15% of cut girls die within two weeks of shock, infection, dehydration or blood loss. For those who survive, long-term consequences include infertility, incontinence, lameness, massive scarring (keloids), fistulae, dermoid cysts, chronic urinary tract infections (often leading to kidney failure), prolonged painful menstruation, Hepatitis B and C, HIV/AIDS (due to the sharing of instruments), death in childbirth, chronic pain and many other health complications (WHO, 1995; WHO, 2000; Perez-Williams, 1999; Morrison et al., 2001). Various folk myths about FGM are common in cultures that practice it. Among other things, it is believed to promote fertility, maintain cleanliness, prevent incorrigible behavior and prevent physical deformities (for instance, proponents of FGM among the Sabiny people of Uganda have told my anti-FGM colleagues and I that without it, the clitoris would grow to below knee length). It is also seen as a passage to womanhood. In every case, it is believed that the health consequences just described are not related to it and FGM practicing cultures genuinely believe they are doing something positive for their girls. Such beliefs underscore the critical need for education (Morrison et al. 2001).

Recently we traveled to Uganda with the US-Uganda Godparents Association to work with girls at risk from FGM. While we were there, we received support and information from UNFPA’s REACH program. REACH has been providing FGM education to rural areas of Uganda for years, directly addressing many of the myths and poor health care practices previously described. Our experiences there brought us face to face with what this horrifying practice does to the hearts, minds and bodies of its victims. The US-Uganda Godparents Association maintains a high school in Kampala that provides safe haven and education for girls who are at risk. In FGM practicing cultures such as the Kapchorwa District Sabiny in Uganda, girls who do not submit to the practice have few options. The Sabiny practice polygamy and the giving of dowries. Uncut girls are considered “dirty” and unmarriageable. Given their poverty (per capita income in Uganda is less than one American dollar per day), the potential loss of a bride price can put tremendous economic pressure on a Sabiny family, which will then feel compelled to have its girls cut. Many of these families wish the practice to end but feel trapped by such circumstances. Uncut girls are denied access to community resources and have few options. Some are pursued by their families and forcibly cut against their will. Similar situations are common among other African FGM practicing cultures (Morrison et al. 2001). The provision of room, board and a high school education, allows these girls and their families to gain economic independence from their villages. Thus, they can make life choices that allow them to reject the practice. Funding comes from American donors who may sponsor a girl’s education for an annual fee of $325. Our goddaughter is named Chesha Juliet. She is a striking young woman, 16 years old, with an infectious smile and a gentle laugh that melted our hearts when we first met her. Today, because of the efforts of UNFPA’s REACH program and organizations like the US-Uganda Godparents Association, girls like her can live free of fear and build a life for themselves.

UNFPA’s Presence in the People’s Republic of China

UNFPA has had a presence in China since 1979. Their latest program there, the Fourth Country Program, began in 1998. It has provided a badly needed baseline health survey and needs assessments for many rural Chinese population segments. Though the Chinese government still maintains demographic targets and a one-child policy, they have agreed to lift acceptor targets and birth quotas as a matter of policy in each county where UNFPA operates. Though formally agreeing to such policy shifts does not guarantee their immediate widespread implementation, or preclude rogue behavior by isolated offices, it is a huge step forward, and is a direct result of pressure from UNFPA. With UNFPA’s assistance, China is beginning to shift from demographic targets to client-oriented services. This includes maternal health care, treatment of reproductive tract infections and sexually transmitted diseases, education and provision of contraceptives. UNFPA has also launched pilot projects on adolescent reproductive health education in urban areas UNFPA, 2002a). UNFPA has also put pressure on China to cease the circulation of steel ring IUD’s because of the health risks they present. These efforts have largely been successful and benefited millions (Kristof, April 26, 2002).

UNFPA has also recognized the critical need for expanding civil freedoms and economic status for poor women in China. They have launched a program to provide access to credit for 15,000 women in 13 Chinese provinces. This project has been running since 1999 with the cooperation of China’s Dept. of International Trade and Economy/Ministry of Foreign Trade and Economic Cooperation (DITEA/MOFTEC). Access to credit gives poor women a chance to form cottage industries and move toward economic self-sufficiency. The success of such programs elsewhere in the world has been clearly demonstrated (Yunus & Jolis, 1998).

The Case Against UNFPA

Despite these efforts and their many successes, UNFPA has been under attack since 1985 from several pro-life advocacy groups for allegedly supporting abortion and sterilization in the third world. Recently the most vocal of these groups, the Virginia based Population Research Institute (PRI), and a few of their allies gained the ear of several members of Congress. In 1998 the U.S. House Subcommittee on International relations heard testimony from a former Chinese population program official and representatives of the Laogai Foundation (U.S. House, 1998). In September of 2001 a team of investigators lead by PRI went to China and returned with evidence of a wide range of abuses, including coerced abortion and sterilization, coerced use of intrauterine devices (IUD’s), fines, confiscation of property and psychological torture. In October of 2001, The House Committee on International Relations heard testimony from representatives of PRI, including PRI president Steven Mosher and Ms. Josephine Guy, regarding their findings on this trip. In this testimony it was alleged that UNFPA was aware of, and directly cooperated with, coercive enforcement of China’s one-child policy (U.S. House, 2001). The presentation before the House included videotaped testimony of victims as well (U.S. House, 2001). As a direct result of this testimony, a bipartisan group of 55 members of Congress led by Rep. Chris Smith (R-NJ) sent a letter to President Bush in January of this year formally requesting that the United States withdraw its funding of UNFPA (Smith et al, 2002). He responded by suspending allocation of $34 million for UNFPA until further notice.