A conversation with the Hewlett Foundation about Family Planning on July 15, 2013

Participants

Note: This set of notes gives an overview of the major points made by Hewlett Foundation staff.

Summary

Good Ventures and GiveWell spoke with the Hewlett Foundation as part of its shallow investigation into international family planning. Conversation topics included: the history of international family planning aid, the total resources allocated to international family planning, and opportunities for a new funder in the international family planning space.

History of international family planning aid

The relationship between population growth, the environment, and human welfare

Thomas Malthus’s work on overpopulation in the late 18th century, which argued that the human population would inevitably outgrow the Earth’s natural resources, generated interest in the potential link between population growth and human welfare. When concerns about overpopulation were reintroduced in 1968 by the influential book The Population Bomb, many aid organizations began to work on family planning as a way to slow population growth and preserve the world’s natural resources. Because of their interest in environmental and human welfare issues, the Hewlett Foundation was one of the first funders in this space.

Debate about the most effective means to slow population growth

Historically, the goal of international family planning aid has been to decrease population growth in countries with the fastest-growing populations, which have tended to be developing countries. There has been debate among aid providers, economists, and demographers about the most effective means to slow population growth. Supporters of international family planning aid argue that greater access to family planning slows population growth and that having a slower-growing population assists economic development. Others, such as the economist Lant Pritchett, argue that supporting the most efficient means to broad economic development is the best way to slow population growth because economic development causes parents to want to have fewer children.

Family planning and women’s autonomy

A newer perspective has argued that having control over one’s body and one’s fertility decisions is an essential part of women’s autonomy. From this view, improving access to family planning services abroad is a necessary part of respecting women’s rights, so family planning aid is not merely valuable for the sake of slowing population growth and encouraging economic development.

Funders avoid funding family planning programs that are potentially coercive.

Relationship between international family planning aid and HIV/AIDS

Backlash against coercive methods used in the initial stages of family planning aid and the severity of the HIV/AIDS epidemic in the 1980’s caused a significant shift in aid resources, both monetary resources and human resources, away from family planning services and toward HIV/AIDS. Today, total funding for HIV/AIDS far exceeds funding for family planning services.

Resurgence in international family planning aid

There has been renewed focus on family planning aid in the last few years. Part of the revival is attributable to the 2012 London Summit on Family Planning organized by the United Kingdom’s Department For International Development (DFID) and the Gates Foundation, an effort now known as FP2020.

Scope of the problem

A few key facts show the need for greater international family planning aid:

Reasons to fund international family planning from a “strategic cause selection” point of view

Funding for international family planning

Tracking funding for family planning services is complicated because spending on family planning services is often grouped with spending on HIV/AIDS, since both are considered to be “basic reproductive services.” Lags in reporting also make funding in this area hard to track.

Bilateral aid

Developed country governments provide significant international reproductive health services aid, which includes some HIV/AIDS funding. USAID is the largest bilateral government funder of family planning services, with a current budget of about $600 million per year. Nordic and European governments also fund reproductive health services, largely through support to multilateral agencies such as UNFPA and NGOs such as the International Planned Parenthood Federation.

USAID typically funds NGOs to provide family planning services, with significant funding used to purchase contraceptives.

The British government provides funding for family planning through both NGOs and “sector support” for health—money that recipient governments can spend as they wish within the health sector.  Other European governments also generally provide “sector support” for health, as opposed to earmarking funding specifically for family planning services. Recently, more bilateral funding has shifted toward sector support, which has decreased the amount of funding specifically for family planning services.

Private aid

Private foundations also fund substantial international reproductive health service aid. These commitments include:

Foundations that used to be large funders of international reproductive health services but have since exited include the Ford Foundation, the MacArthur Foundation, and the Rockefeller Foundation.

Private foundations usually fund NGOs and generally do not directly purchase contraceptives.

Total Spending

A Population Action International policy brief estimates that, as of 2010, total spending on family planning services—excluding HIV/AIDS—was about $572 million per year.  Those numbers are likely higher given the U.S.’s increase in family planning funding in subsequent years and pledges of increased funding at the London Summit in July 2012.

At the 2012 London Family Planning Summit, donor governments, recipient governments, and foundations pledged $4.6 billion to get new users on contraception.

Foundations’ advantages in funding family planning

Foundations have a number of comparative advantages over government funders in this area, because they can:

The Hewlett Foundation’s international family planning programs

The Hewlett Foundation is a major player in the field due to its significant funding for the cause and its long-term involvement in and commitment to it. The Hewlett Foundation supports 13-15 core family planning organizations, in addition to a number of other grantees for project-focused work totaling about 100 active grants. Its work focuses on sub-Saharan Africa.

The Hewlett Foundation spends about a third of its international family planning budget on advocacy. Advocacy funding typically goes to organizations who encourage governments to make family planning a government priority and support more family planning spending. In the past, advocacy had been largely aimed at getting developed country governments to spend more international aid on family planning, however Hewlett’s new strategy is shifting toward supporting advocacy and developing the capacity of family planning advocates within developing countries.

The rest of the Hewlett Foundation’s funding in family planning goes toward research and service delivery. Sometimes the Hewlett Foundation pursues projects that are a combination of advocacy, research, and service delivery.

The Hewlett Foundation often provides unrestricted funding to strong organizations, as well as funding for specific projects to core grantees.

Two examples of current Hewlett Foundation family planning projects are:

  1. Working with IDEO.org and Marie Stopes International to increase family planning services for young women, using strategies from human-centered design.
  2. Applying insights from behavioral sciences to understand family planning decisions in order to improve the delivery of services.

Funding opportunities in international family planning

Hewlett Foundation staff said that despite the large amount of money in international family planning and reproductive health aid, there is still a significant funding gap. They gave several examples of projects that a new donor could work on.

Increasing access to safe abortions

Because abortion is a politicized issue, especially in the U.S., there is variation in what kinds of reproductive health programs donors are willing to fund. For example, the U.S. government will not fund abortion services abroad. This policy also affects all organizations that get money from the U.S. government, like the United Nations Population Fund (UNFPA). Some major private funders also are not willing to fund abortion-related programs. However, European governments and foundations like the Hewlett Foundation and the Packard Foundation do provide funding for abortion services and advocacy. Some foundations entering the field are also considering adding additional funding to this area.

One promising initiative is funding greater availability of an abortion pill, which is especially important for helping women in low-resource environments control their fertility decisions since no medical procedure is required.

Increasing access to family planning for under-served groups

Young people in developing countries are a group with particularly little access to family planning services. There is a need for research, experimentation, and advocacy around getting family planning services to young people. For example, a project might work on ways to allow people to use social media to rate the quality of family planning services they receive and measure whether this increases uptake.

Other groups not being reached by family planning services include people in rural areas, the extremely poor, and people who are discriminated against for various reasons. Though they might be more expensive to reach, a funder could look into interventions that would assist these groups.

Geographically, the area most in need of family planning services is Western Africa, which has the highest maternal mortality rate and the highest fertility rate of any area in the world. Relative to their needs, Western Africa has too little funding, so a new donor could make an impact in this region. One reason for underfunding is that the largest funders are English-speaking and Western Africa is largely French-speaking.

Advocacy

Advocacy initiatives are largely underfunded. Research on how to do advocacy for family planning at the country level could be impactful.

A new donor could work with organizations that traditionally focus on women’s empowerment issues and are not yet working on family planning. This strategy was effective for increasing women’s access to education.

It would also be worthwhile to work on increasing attention on family planning among young people in the U.S. and other developed countries, in order to develop a donor-base for the cause.

Funding research

A new funder could support a round of impact evaluations through the International Initiative for Impact Evaluation (3ie). For example, evaluations could focus on and contribute to the evidence base about how to reach young people.

The Partners in Health model of using "accompagnateurs" to ensure proper usage of HIV medication has been very successful; a donor could fund research to see if this model would work for family planning as well.

Finally, there has not been enough behavioral economics and behavioral psychology research on social norm formation issues, like the impact of social networks on people’s perceptions of how many children to have and what types of contraceptives to use. A new funder could support research in this area.

Other organizations for Good Ventures to talk to