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Frank E. Loy, Under Secretary for Global Affairs and Duff Gillespie, USAID Deputy Assistant Administrator for Population, Health, and Nutrition On-the-record briefing on international population policy and ICPD+5 Washington, DC, February 2, 1999.

Under Secretary Loy: Thank you. Iām going to be leading the U.S. delegation to The Hague International Forum, which will be held from February 8-12. I just want to talk a bit about that and its background. Our delegation is going to consist of experts from USAID, Health and Human Services, some of the people from the Census Bureau, and quite a few members of the NGO community, plus one Member of Congress, Representative Carolyn Maloney of New York. Also, we expect at least one other member representative, Cynthia McKinney, of Georgia, to attend at least part of the events in The Hague between February 8 and 12.

There we will be joining delegates from about 180 other countries who come to review the progress that we have made in the 20-year Program of Action, as itās called, that was agreed upon 5 years ago at something called the International Conference on Population and Development in Cairo, a process we somewhat fondly called ICPD. That happened in 1994.

As was mentioned, First Lady Hillary Rodham Clinton will deliver the keynote address at the forum. As you know, Mrs. Clinton has been an absolutely tireless advocate for population issues, for womenās reproductive health, and reproductive rights issues. Sheās traveled the world in that cause, and Iām very pleased that she will be at this quite critical conference.

With me today is Duff Gillespie, USAIDās Deputy Assistant Administrator for Population, Health and Nutrition; and Elizabeth Maguire, the Director of USAIDās Population Office; and Margaret Pollack, Director of the Population Office here at State. I think itās been said before -- itās important to say again -- that sustainable population is a very important goal of our foreign policy because so much turns on it. It is definitely an element in our national interest. We have found that economic prosperity and social progress can be undermined by rapid population growth, which will totally overwhelm the quality and the availability of public services, which will limit employment opportunities, which will contribute to environmental degradation.

The cornerstone of our international population policy is the advancement of a womanās right to have equal access to education and to jobs and to health services, and to participate fully in social, political, and economic affairs; in short, to let women take charge of their lives, including their reproductive lives. This policy is mirrored in the ICPD Program of Action.

We, in the United States, have been a leader in the international population field for more than 30 years. U.S. funding for international population and reproductive rights hit a high in 1995, right after Cairo -- weāre about $752 million. Since then, it has been cut somewhat, and it is somewhat smaller. But, nevertheless, we have committed, through USAID, more than $3 billion for population and reproductive health programs between 1994 and 1999. Weāre still the leader, but itās clear we should be -ö and I hope we will be -- doing more in the future. It is certainly my intent to work with Congress to see that we gain some additional support for these programs.

At The Hague forum, we have several objectives. First, weāre going to reaffirm the things that were decided on our commitment to the goals of the ICPD Program of Action. Just to make it clear, these goals are universal access to family planning services; reducing infant, child, and maternal mortality; and third, ensuring universal access to education, especially for women and girls. That is the essence of the Cairo plan.

Second, I think what will be for journalists, I hope, a good story ö- we will be sharing experiences as to whatās been working and what hasnāt been working to achieve all of this. I think those stories will come out from both governments and NGOs around the world, and they will be stories of successes and failures. But in the aggregate, I think it will give a picture as to how things have gone and how things might go in the future.

Basically, the Program of Action is working both here and abroad. I think, as these stories come out and as some of the statistics come out, you will see that a lot has happened since 1994. The historic consensus that was reached then that universal access to family planning and related reproductive health services is necessary and that it will empower women to decide for themselves how many children to have and when to have them; that, at the same time, prevention programs are needed to reduce the incidence of HIV and AIDS; and that education and equal opportunity will empower women to work outside the home, to be economically self-sufficient, to be in control of their lives -- those things are advanced and have been advanced since 1994.

Weāve had 5 years to test as to how all of this is working, and we will be reviewing that success -- and sometimes that non-success -- story, but, overall, I think, a pretty good story. We will be talking about what to do over the next 5-year period to further that program. I hope some of you will be able to join us at The Hague and actually get a flavor for what is at work here, because the overall result that weāre seeking is a product of these many stories that we will hear -- these many programs of governments and others. I think it will make a compelling story.

Let me now just ask Duff Gillespie to introduce a report by USAID that is very relevant to the things we have been talking about.

Deputy Assistant Administrator Gillespie: Thank you, Frank. Frank mentioned that the report and some other material have been circulated to you, so I wonāt try to summarize the materials that you have. Rather, what Iād like to do is just tell you some of the things that the U.S. Government has done as a result of the Cairo meeting 5 years ago and to mention some of the major challenges which I think we have before us.

The first thing I think is very important to remember. Iāve been in the international health area for almost 27 years, and Cairoās very unusual in that there are 180 countries and a very complex and, indeed, sensitive topic that reached a level of agreement that many people would have thought impossible just 6 years ago. Once that agreement was made, the immediate challenge was to try to translate it into programmatic action, because the Cairo Plan of Action basically presented a new perspective -- a new way of looking at development -- which is much more complex than was previously the case.

So part of the things that we did during this 5-year period was to try to develop new ways of delivering services, new ways of financing services, new ways of analyzing progress or the lack of progress. Some of the examples of how weāve done on that are contained in the report. The U.S. -- and I donāt mean USAID, I mean the U.S. -- has played an absolutely critical role in trying to make Cairo a reality. There are two things that have caused us to take this leadership role, in addition to being by far the largest bilateral donor in this area.

One is that unlike many other bilateral programs, USAID has, for a very long time, had a very strong relationship with non-governmental organizations and the private sector, in general. Around 70% of our funds go through non-governmental organizations. These organizations are much more flexible, much more willing and able to take a risk to experiment. So many of the lessons that we have learned in this 5-year period has been done through these various organizations, most of which will be at The Hague in an NGO forum.

The second thing is that we have, within the United States, one of the largest, most sophisticated research establishments ö- teaching establishment, training establishment ö- the world over. Through the two dozen schools of public health and a very strong research tradition, which places emphasis on international health, we have managed to develop new ways of doing new things and new ways of doing things that we have done in the past different ways.

Let me give you one example. In a study that we sponsored in Nepal, through a very simple supplementation program of vitamin A with women in a vitamin A-deficient population -- which is basically all of Nepal -- we were able to document a reduction in maternal mortality of 45%. Now that is a very, very dramatic and important finding. One reason it is very important is not just that we managed to do this in an experimental setting, but we have an intervention that, if we can replicate it, will allow us to scale up in order to cover a sufficiently large population to have a public health impact. We are in the process of trying to replicate those findings in five countries in the developing world.

Now I use the term "scale up." One of the challenges that the participants at The Hague will face is taking these lessons, most of which have been on a relatively small population, and to see if we can scale them up on a countrywide level, regional level, and, indeed, a global level so they can be translated into things that will have a broad-based, large population impact.

Now, in order to do that, we obviously need resources. The knowledge is just the first and very critical element; the second thing is resources. If The Hague is successful, it will be a catalyst to renew the pledges that people took in Cairo to try to generate stronger political will in the developed and the developing world. That, hopefully, will lead to greater resources.

In terms of programmatic challenges, I think, probably the most difficult one will be to address this growing population of adolescents, which will pose the risk of overwhelming all of our ability to provide social services, education, and create jobs. This, I think, will be a challenge that, for the next millennium, will be the one that will be the most difficult, because this has been, essentially, an ignored portion of the population.

The other thing that I think is important to remember is that the population of the world is growing. So even to maintain the level of, letās say, family planning usage that we have today in a country like Bangladesh, we will have to add, over the next 10 years, 60% more people using contraceptives.

So weāre in a very dynamic situation, a very challenging situation. But, as Frank said, this has been an extremely positive start. I think we can look forward, with some optimism, for the next 15 years of the 20-year Plan of Action

Thank you.

Under Secretary Loy: Questions?

Question: Population Action International put out a report you may be aware of last week about the United States and other countries and whether theyāre living up to their Cairo goals. According to that, the United Statesā contribution in 1996, for example, was one-third of the fair-share target set at Cairo, mentioning resources. How do you explain this shortfall?

Deputy Assistant Administrator Gillespie: Well, of course, the one level of explanation is that Congress hasnāt appropriated the funds. But thatās not the question youāre asking. Your question has asked why has that happened?

There are two things. One is the trend not only in this country, but worldwide, to give less money for overseas development activities. There are some notable exceptions to that, principally in the Nordic countries. But, in general, with the end of the Cold War, thereās actually less official development assistance overseas. That has many, many complex things that have nothing to do with development ö- balancing the budget and a variety of other things that you, having covered the international scene, are probably better aware than I am.

The second is that there are many demands on what foreign assistance we have. For example, on malaria, thereās 500 million new cases of malaria each year, and 2 million people die of malaria each year. That puts pressure on host country governments, budgets, donor budgets, etc. So thereās a lot of pressure on what limited resources we have.

Within that context of budgetary constraints, I think itās important to remember that the United States devotes more of its development assistance to implementing the Cairo Plan of Action than any other donor. Itās around 25% to 26% of all of our development assistance that goes for those activities which are directly concerned with the Cairo Plan of Action. And, indeed, we scored very high on that part of the Population Action International scorecard.

Question: Are there any particular success stories you can point to with respect to stabilizing population growth since Cairo that you could say was an outgrowth of the 1994 conference? Or are there countries which are particularly troubling in this regard that you could also point to?

Under Secretary Loy: Iām not acquainted with all the stories weāre going to hear. I think in the United States ö- and I donāt want to say itās necessarily a direct product of Cairo ö- but we have several success stories in the United States in the area of teenage pregnancy; particularly where we have made very substantial gains in the last few years.

I donāt want to sound coy, but to some extent I think weāre going to have to wait for Cairo -- for The Hague and listen to those stories and try to understand them. We know that the isolated cases are going to be very dramatic success stories, as Duff says. One question we will have is whether they can be replicated on a larger scale. I would hesitate right now to draw sort of a bottom line as to whether ö- how good those are.

In the aggregate, from what we know, thereās going to be quite a bit of good news in a race that is a terrible race, and in a race that you canāt say, in the aggregate, weāre winning at the moment, because our population numbers in the aggregate are still unsustainably high. Theyāre almost all in the Third World, of course.

Question: Mrs. Clinton will be there. Will she be there for the whole conference or just to go and make a speech and leave? If so, what is the date of her speech or --

Under Secretary Loy: She will definitely be there for more than just to deliver the speech. She will participate in some of the other activities. At the moment, I think she is going to be there on Sunday, the 7th ö-

Off Mike: -- through Monday the 8th. She will also be speaking at a forum -- [inaudible] ö- 800 non-governmental organizations Sunday afternoon from around the world. About 50 of them are from the United States, and the rest are from around the world. Sheāll speak to the government forum on Monday, the 8th.

Under Secretary Loy: Monday morning -- I think she expects to participate in some other parts of the program.

Question: What will be done by USAID, especially at this conference, to promote, say, traditional, cultural, not only values but methods of proper courtships and the like that will promote family that is going to be stable? And then, what about the argument that is often used by Catholics that the use of natural rhythm control in family planning is a tool thatās not being pursued? Are you pursuing it?

Deputy Assistant Administrator Gillespie: Yes, we have a policy that we offer as wide a choice of all methods which are legal and acceptable in the countries that we work in, and that includes natural family planning. Weāve done that for 20 years. In some countries, such as the Philippines, natural family planning is a very significant method, and, as a result, we spend more resources in the Philippines than we would in, letās say, Kenya, where itās a very minor method.

In addition to that, let me just go back to an earlier question about just, at large, whatās been the impact of Cairo on, I believe, it was, specifically, the population. I think thereās a different way of looking at Cairo, which is other things building on the experience of family planning programs, which in many cases have been one of the stronger elements in the developing countries and a much greater increase of quality of services, which actually relates also to your point, too.

Thereās a couple of examples of this in the handout. One I would point out to you as one of our larger programs is in Egypt ö- Cairo -- in which there was a very concerted effort by USAID and the Government of Egypt to improve quality of services and to have sort of a vetting service ö- a scorecard for clinics. Those clinics that met these requirements were then given a plaque indicating to potential clients that they have met a certain degree of standards.

In addition to that, this building on successful population programs ö- perhaps the most dramatic and perhaps also the most important in the future is the integration of sexually transmitted disease services and information and counseling to family planning and other types of maternal and child health care programs. This, obviously, is going to be a make-or-break problem in Sub-Saharan Africa with HIV/AIDS ö- 6 million new cases of HIV last year.

You have countries in Sub-Saharan Africa where 25% of the population is HIV positive. That means 25% of the population will die from AIDS within a period of 8 to 10 years. So thereās much to be hopeful about, but there are also some real challenges.

I think that one of the things that Cairo did was to expand our vision and the things that we need to be concerned about, to take a much more holistic view of development -- and, most importantly, as Frank indicated, the plight of women throughout the developing world.

Under Secretary Loy: Just one add-on to the last point that Duff made. I think one of the key things that happened at Cairo was an agreement that, for various reasons ö- one, because itās right and two, because in the long run it is an essential element in gaining sustainable population growth -ö is to focus on the status of women.

I think in that area, you will see quite dramatic changes, because I think that was not part of a population strategy before Cairo. There will be, I think, important cases and evidences that relate, for example, the number of years of education of women to the number of children she will have. Thatās relatively new stuff in terms of -- as a focus for persons interested in sustainable population growth. There, I think, you will have some very clear new stories that you would not have had absent Cairo 5 years ago.

Question: Can I get to a point Mr. Gillespie made earlier? You say one of the basic problems is that Congress is not coming up with the money. Is the executive branch, though, coming to the Hill with requests for the full targeted amount, government commitment at Cairo and then it gets hacked away? Or are you just anticipating that youāre not going to get it, and you just come in low balling?

Deputy Assistant Administrator Gillespie: Well, I donāt think itās accurate to say weāre coming in and low balling. I think the Administration has come in with realistic figures, which have actually exceeded what Congress has actually appropriated. The request level for Cairo activities has been higher every year than Congress has appropriated under this Administration.

The first year funding occurred under a Clinton Administration but a Bush budget. So, no, we have not remade the request using the formula of Population Action International that you alluded to earlier. But we have requested more money than Congress has appropriated. Frank, you might want to add anything to that?

Under Secretary Loy: No, I think the targets that Population Action International sets are not the numbers that have been requested by the Administration. But we have requested, as Duff says, numbers that we havenāt quite been granted by the Congress. One example is, we have, in the past, requested funding in this current year for a UNFPA, the United Nations Fund for Population. We didnāt get any funding for that this year. We are asking for $25 million in the budget that the President just released. There are efforts to generally increase from where we have been, but they wonāt quite reach some of the target numbers that weāve talked about.

Question: Within Congress, is it the anti-abortion caucus -- Chris Smith and his people -- who are whacking away at it, or is there a general disinclination on the part of a Republican majority Congress to give these funds?

Under Secretary Loy: Well, there certainly are specific members who are very diligent in looking at specific programs. Sometimes, if they donāt like the programs, they are cut. The UNFPA -ö the appropriation that I mentioned a moment ago ö- was one such case. But I think the problem is a little bit more along the lines that Duff said earlier. We are dealing with an overall development assistance program that has been under budgetary stress. An important part -- what we see in the population field -- is a product of that rather than something thatās more specific.

Deputy Assistant Administrator Gillespie: It would be wrong to ö- just to reinforce what Frank said ö- that this is anti-population -- the result of hostility toward one part of our program; clearly, thatās known. But the Cairo Plan of Action includes things that enjoy support from all points of the political spectrum. Itās not just reproductive health or family planning. It also includes HIV/AIDS; it includes maternal health; it includes some child survival activities. We donāt count that as some countries do. If we were to do that, our contribution would be even much larger than it is now to the Cairo Plan of Action.

So itās more complex than just being a family planning, pro-/anti-situation.

Question: Could I just check? Did I hear you correctly? There are 500 million new cases of malaria every year?

Deputy Assistant Administrator Gillespie: Thatās correct ö- 500 million new cases each year, and 2 million people die each year from malaria.

Under Secretary Loy: Thank you very much.

[End of Document]

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