A Response to Concerns about Population AssistanceISSUES IN BRIEF A Response to Concernsabout Population Assistance The preference of couples for small families—wellestablished in the United States, Japan and other industrializedcountries—is now evident throughout the world. While average familysize in the developing world is still very high by industrializedcountries' standards, couples clearly want, and are having, fewerchildren. It is a trend that transcends culture, religion, ethnicity and national origin. The trend has been supported by the rapid disseminationof information and knowledge about contraception and by the increasedavailability of family planning services. Since the 1960s, the United States has played a critical role in facilitating couples' desires for smaller families. Both the domestic family planning program, which provides subsidized services to the poor, and theinternational population assistance pr ogram were conceived about 30 yearsago, at the urging of Presidents John F. Kennedy, Lyndon Johnson andRichard Nixon and with the bipartisan support of Congress. Initially, some countries in the developing world rejected the viewthat there was reason for concern about the rate at which their populationwas growing. Many had regarded their own rapid population growth as adesirable or at least a neutral phenomenon. Over the years, however,governments from the developing and industrialized world alike have cometo recognize the mutually reinforcing benefits of slowing populationgrowth, supporting their peoples' desires for smaller families, improvingthe health o f women and children, and giving women and girls a chance toparticipate fully in the life of their communities and nations. This extraordinary consensus was evident at the 1994 UnitedNationssponsored International Conference on Population andDevelopment (ICPD), held in Cairo. Some 200 governments from every regionof the world affirmed the validity of demographic concerns, but stressedthat all population policies and programs must be responsive, first, tomeeting the needs and desires of individuals and families. They alsoemphasized that these policies must be considered and implemented in thecontext of overall deve lopment strategies and that, above all, they musttake into account the centrality of women in the family and in society. The United States played a major role in these deliberations and, evenprior to the Cairo conference, had acted to broaden the scope of its ownpopulation program. The premise of that program, now reflected in theworldwide consensus, is that the most eff ective strategy to reduceunwanted childbearing and slow rapid population growth is one that relieson family planning at its core but is closely intertwined and integratedwith other development strategies (see box). Population Aid Program The U.S. Agency forInternational Development (USAID) administers the U.S. populationassistance program. In 1994, USAID reorganized and created the Center onPopulation, Health and Nutrition to foster a closely coordinated andintegrated effort among its existing activities in these areas. Thecenter's priorities include family planning and reproductive health; basichealt h information and services for youth; maternal and child health andnutrition; child survival; human immunodeficiency virus and AIDSprevention; and environmental health. These programs are mutuallysupportive and highly interdependent. The population assistance component consists mainly of preventive,voluntary family planning activities, but also includes prevention ofsexually transmitted diseases, breastfeeding initiatives, reduction offemale genital mutilation, treatment for complications of unsafe abortionand provision of follow-up family planning. Population aid also includesdistribution of contraceptive supplies; research on new contraceptivemethods and into ways to promote gr eater program effectiveness; policyevaluation; training; and information and education efforts. By law, theUSAID program does not include support for abortion. However,just months after the ICPD officially embraced the importance ofpopulation and development as an issue and outlined key strategies toaddress it, Congress brought the U.S. program to a halt. Afterappropriating a record $547 million for population assistance in FY 1995,Congress slashed the program's funding by a third and imposed onerouslimitations that greatly exacerbated the funding cut: None of the fundsappropriated in FY 1996 were made available until July 1996, nine monthsinto the fiscal year, and once available, the money could only beallocated at the rate of 7% a month for the next 15 months. Essentiallythe same formula has been continued into FY 1997. The reasons for singling out this program for such harsh treatmentstem from the politics of abortion and concerns raised by skeptics ofpopulation assistance in general and family planning in particular. ThisIssues in Brief identifies and attempts to respond to concernsthat have been raised in the course of the ongoing debate. What Population Problem? The debate over whether there issuch a condition as overpopulation and, if so, what it means and what todo about it may continue for decades to come. It is clear, however, thatdilemmas involving population issues confront virtually all nations.Dependi ng on the country, these might include high rates of teenage andunintended pregnancy, migration across national borders, urbanization, anaging population (in industrialized countries) and the youth bulge (in thedeveloping world). These, among other factors, affect a key determinantof the quality of life: the balance between population growth and economicdevelopment. Indeed, it is just such a balance that countries are striving toachieve. The ICPD's Programme of Action summarizes the issue thisway: "Efforts to slow down population growth, to reduce poverty, toachieve economic progress, to improve environment al protection, and toreduce unsustainable consumption and production patterns are mutuallyreinforcing. Slower population growth has in many countries bought moretime to adjust to future population increases." The disconcerting fact is that the world's current population ofalmost six billion is growing by 81 million people each year (equivalentto about one-third the population of the United States), but economicdevelopment and the availability of renewable n atural resources are notkeeping pace with this growth. In addition, after years of rapidpopulation growth, a record number of people are about to enter thechildbearing years. Thirty-five percent of the population in thedeveloping world is under the ag e of 15 (as opposed to 20% in thedeveloped world); in Sub-Saharan Africa, about half of the population isyounger than 15. This means that even if all couples were to have only twochildren (enough to replace themselves), the world's population would continue growing for many years to come because of the large absolute numberof people having children. As Chart A indicates, the world's population isexpected to increase by 319 million people by the turn of the century. Chart a. From 1996 to2000, the world will gain 319 million people.  Source:T. McDevitt, World PopulationProfile: 1996, USAID and U.S. Bureau of the Census, Washington, D.C.,1996. The "population problem" also can bedefined in terms of women's self-described "unmet need" for high-qualityfamily planning services. An estimated 230 million women worldwide do nothave access to effective contraceptive methods and services, representingapproximately one in six women throughout the developing world. Thereasons for this unmet need include a lack of accurate information,poor-quality services and less than the full range of contraceptivechoices, as well as legal, cultural and economic obstacles. A compelling indicator of the failure to help women meet theirchildbearing goals is the 52 million abortions—half of themillegal—that occur worldwide each year, according to the World HealthOrganization. Another is the large number of pregnan cies that womenreport ending as unwanted or mistimed births: about 60% in Kenya; 50% inJapan, Mexico and the Philippines; and 40% in Egypt, Jordan and the UnitedStates. These indicators of a population problem do have solutions. Makingabortion less necessary can be achieved in large part through greateraccess to preventive family planning services. And that, in turn, could beexpected to significantly lower the staggering number of maternal deathsthat occur each year in connection with pregnancy and childbirth. In addition, reducing the rate of unintended pregnancy, and thereforeimproving women's ability to achieve their own childbearing goals, wouldnot only benefit the lives of individuals, but also have a significantimpact globally. If all unwanted births w ere prevented, the annual numberof births worldwide would drop from 130 million to 122 million—adecline of almost 19% in the global rate of population growth. Is Progress Possible? In light of the seeminglyoverwhelming size and scope of the population problem, ameliorating thesituation may appear impossible. There are encouraging signs, however. TheUnited Nations' recent announcement that the planet is growing by 81million peopl e annually may sound daunting, but the fact that it isonly 81 million more people each year means that global populationgrowth already is slowing down. Between 1985 and 1990, which was the peak period of population growthin human history, the world's population grew by 87 million peopleannually. The decline in the growth rate that has been observed morerecently has been attributed to the introduction of programs in the 1960sand 1970s that enabled people to begin to have the smaller families theywanted by increasing access to family planning services. More recentefforts to enhance women's economic power and social status have alsoplayed a key role. The drop in the population growth rate to about 1.5% per year (from2.5% in the 1960s) largely reflects a decrease in the average number ofchildren each woman is having. Over the last 30 years, average family sizein developing countries has dropped from 6.0 children to 3.3. This phenomenon also corresponds to improvements inrelated health and social indicators, such as lower infant mortality ratesand improved female literacy. Together, these results suggest that at boththe global and the individual levels, there has been enormous progress. Over the same period, developing countries gradually have begun toadopt formal policies addressing the issue of population growth. Of the125 developing countries that participated in the ICPD, more than halfreported that they already have policies in place. Further, virtually alldeveloping countries subsidize family planning programs, even if they havenot yet adopted a formal policy. The combination of financial andtechnical resources, political commitment, and laws and policies thatprotect and respect the rights and conscience of the individual andpromote personal health and well-being are equally key to the success thatworldwide efforts have seen so far. U.S. Interests and Funds In 1969, President Nixon toldCongress that investing in international population assistance isimportant to the United States "whether it is moved by the narrowestperception of national self-interest or the widest vision of a commonhumanity." Even then, it was becoming clear that stabilization of theglobal population growth rate would be critical to creating a climate ofeconomic and political stability. It was also apparent from the experienceof American women that access to family planning would co ntributesignificantly to the health of women and their children in developingcountries, and that giving these women more control over theirchildbearing decisions would afford them greater educational and economicopportunities. The population assistance program has shown itself to be in theeconomic interest of the United States by laying the groundwork for exportmarkets. Indeed, half of the top 35 consumer countries of Americanagricultural products are former or current recip ients of U.S. populationaid. More prosperous economies create the possibility of more consumers:U.S. exports to the developing world increased more than 14% in 1993alone, dwarfing exports to industrialized countries. Population growth also affects the U.S. interest in encouragingpolitical stability and building strategic alliances. Most analysts haveconcluded that rapid population growth, in conjunction with poverty andscarcities of natural resources, has been link ed to instances ofpolitical upheaval all over the world, particularly in Haiti, Mexico,Pakistan and, most recently, Rwanda. The international population aid program is also consistent with thefundamental American value of helping the most vulnerable members ofsociety and providing the tools for them to help themselves in the future.Experience has shown that increased use of family planning is associated with higher levels of education among womenand girls. Further, according to the U.S. Census Bureau, the eight millioninfant deaths that occur annually worldwide are likely to be cut in halfby 2020 if current programs continue, because of improvements in childsurvival and reductions in high-risk births. The United States initiated its population assistance program with allof these considerations in mind. Today, the developing countriesthemselves account for three-quarters of the $4 billion spent worldwideeach year on family planning services; it is impossible, however, forthem to absorb the full cost of this critical endeavor. Often, they mustrely on outside donors for technical assistance, supplies, training andeven direct services. Historically, the United States has been the largest donor country; in1994, it contributed almost 40% of the approximately $1.2 billion inpopulation aid given collectively to developing countries. But the totalU.S. per capita contribution, even at its peak, amounted to only$1.78—placing the United States fifth behind Norway ($9.47), Denmark($6.27), Sweden ($5.08) and the Netherlands ($2.85), and on a level withFinland, Germany, Australia and the United Kingdom. Put another way, the federal government spent $554 million in FY 1994in response to the needs of some 15 million American women for subsidizedfamily planning services. That same year, the United States allocated only$463 million toward family planning programs overseas in an effort torespond to the 230 million women in the developing world who needservices. For this small price, the U.S. population aid program over threedecades has acquired a unique role and vast capacity that cannot be easilytransferred or replicated by any of the existing donors without losingvaluable time and expertise. The United Stat es has established anextensive field presence, and it is the only donor that works widely bothwith the public and private sectors and with nonprofit as well asfor-profit entities—all of which are integral to the success andultimate self-sustainability of local programs. The U.S. Agency forInternational Development (USAID), which administers the populationprogram, is widely recognized for its high level of technical expertiseupon which other countries rely. Similarly, the United States is the only donor country that conductsresearch on new contraceptives and program operations, which not only areessential in guiding an effective family planning services program butalso sometimes directly benefit American women. It was USAID-fundedresearch, for example, that led to the two most recently approved majormethods of birth control in the United States: Norplant and Depo-Provera. Finally, to the extent that U.S. policymakers wish to have any realpolicy influence on the worldwide effort to stabilize population growthrates, the United States must remain a major financial player. Issues ofspecial concern to the United States inclu de the quality of familyplanning services, the availability of a wide range of method choices(including natural family planning) accompanied by full and accurateinformation, an emphasis on preventing unintended pregnancy and aninsistence that programs are truly voluntary and free of coercion. Concerns About Coercion Coercion and cultural imperialismare real and serious concerns that arise in connection with familyplanning programs; to protect against them requires ongoing vigilance. Notonly are both anathema from an individual rights perspective, butexperience has demonstrated that the most successful programs are purelyvoluntary, promote maximum choice of family planning methods and areprovided in a culturally sensitive manner in response to what women saythey want. Coercive family planning practices are expressly prohibited by U.S.law under both the domestic and the international programs. This is not tosay that coercion has not occurred or will not occur in the future, eitherhere or elsewhere, but it is condemne d as a matter of policy. As with anylaw, constant attention is required to assure compliance. This isespecially true since coercion can manifest itself directly as well asindirectly. China's one-child-per-family policy, for example, has been associatedwith instances of forced sterilization and abortion that have warrantedworldwide opprobrium. Limiting the range of available contraceptives,which occurs in some family planning progra ms, is a more subtle form ofcoercion. Ensuring full and informed consent and true choice in thedecision on whether to use family planning services is neither easy norsimple, but is necessary and of the highest priority from both the U.S.and the international perspectives. As for the specter of cultural imperialism, preventivevoluntary family planning programs are specifically designed withthe full input and participation of indigenous groups, women inparticular. The charge that these women are availing themselves of contraceptive services as a result of the imposition of Western valuesis belied by worldwide survey data. Indeed, women in developing countriesare seeking out family planning services and having fewer children becausethey want smaller families. Over the past 30 years, what people consider ideal family size hasdeclined steadily, according to extensive surveys of married women ofreproductive age. Kenyan women in the 1980s, for example, said they wantedabout seven children, but today they say they want no more than four. Thesame downward trend is evident in every region of the world, regardless ofreligion and culture, and in such diverse places as Senegal, Egypt,Morocco, Bangladesh, Colombia and Peru. While overall fertility rates havealso fallen over the same period, large gaps remain between the number ofchildren women say they want and the number they actually have. Large proportions of women throughout the world report that their mostrecent birth was unplanned—either unwanted or mistimed: 2540%in much of Asia, North Africa and the Middle East, and 5065% in someLatin American countries. The same phenomenon is also evident in severalareas of Sub-Saharan Africa, even though women there generally want largerfamilies than in other parts of the world. Maternal and Child Health Given that infant mortality isone of the world's most glaring and preventable tragedies, it has beenargued that increasingly scarce U.S. resources might be better spent iffamily planning funds were redirected toward prenatal care, childhoodimmunization and disease control progra ms. The reality is that familyplanning is as integral to an effective maternal and child health strategyas these other necessary activities. The facts show that family planningsaves lives, of women and children. Infants born less than two years after their sibling are almost twiceas likely to die as those born after a longer delay. This occurs becausethey are more likely to have a low birth weight, making them morevulnerable to illness. Births too close togeth er frequently affect theolder children as well; premature discontinuation of breastfeeding, forexample, can lead to malnutrition, dehydration or infection. Further,illnesses in a family with many young children can spread rapidly and besevere, especially in poor countries with inadequate sanitation andcrowded living conditions. Birthspacing is one of the main reasons cited for the promotion offamily planning in developing countries. In many such countries, one infive infant deaths could be averted by birthspacing alone. No one issuggesting the abandonment of other available programs known to help savethe lives of children; rather, the data show that further progress inchild survival would only be impeded if investment in such a low-cost,low-tech strategy as family planning were not sustained. If family planning's contribution toward lower infant mortality andbetter child health were its only health rationale, that would be enough.It is not, however. The tragedy of maternal death and disease receives farless attention than the plight of children, but its impact reverberatesthroughout the developing world. Increased access to family planning cango a long way toward helping women avoid pregnancies that too often and intoo many countries are still life-threatening. The World Health Organization estimates that close to 600,000 womendie each year of causes related to pregnancy and childbirth; 99% of thesewomen live in developing countries. Among them, 75,000 die from unsafe,illegal abortion—often self-induced& #151;that leads to infection orhemorrhage. Furthermore, as the United Nations Children's Fund (UNICEF)points out, for each woman who dies, about "30 more...incur injuries,infections and disabilities which are usually untreated and unspoken of,and whic h are often humiliating and painful, debilitating and lifelong." UNICEF notes that "the first and most obvious step towards reducingthe toll of maternal mortality and morbidity is to make high-qualityfamily planning services available to all who need them.... Meeting onlythe existing demand for family planning would reduce pregnancies in the developing world by up to a fifth, bringing atleast an equivalent reduction in maternal deaths and injuries." Prevention or Abortion? Family planning means pregnancyprevention. Since 1973, U.S. law has expressly prohibited federal fundsprovided under the Foreign Assistance Act from being used to perform oradvocate abortion as a method of family planning. Confusion persists,nonetheless, about the international family planning program'srelationship to abortion. There is no evidence, however, nor any crediblereason to suspect, that U.S. funds are being used contrary to the dictatesof the law. Instead, the argument has shifted to one that alleges "indirect" support for abortion or the "promotion ofabortion." Program skeptics even claim that family planning causes more,not fewer, abortions. It is indisputable that increased reliance on effective contraceptionresults in fewer abortions. Common sense leads most people to thatconclusion, and so does the research. The only question is how quicklylower levels of abortion are attained. That question pertains becausethere are situations where both contraceptive prevalence and abortionrates rise, creating confusion about cause and effect. In reality, whatthis phenomenon reflects is the strong desire for smaller families, whichthen motivates people to seek out all available means to achieve theirdesired family size. As preventive family planning programs become betterestablished in the culture, and as couples begin to shift to moreeffective contraceptive methods, recourse to abortion declines. The experiences of cities in Mexico and Colombia illustrate the point.For example, as contraceptive use rose from the mid-1970s onward in MexicoCity, so did the abortion rate, which peaked in the mid-1980s at 41 per1,000 women aged 1549. As the culture of effective contraceptiveuse has taken hold, however, the abortion rate has declined to 25 per1,000 women. A similar pattern has been observed in Bogotá, wherethe abortion rate has fallen from 50 per 1,000 women to 30 per 1,000 sincethe mid-1970s. The highly organized national family planning programs in these twocountries may be credited with the current downward trend in abortionrates. This trend is in stark contrast to the situation in Brazil, whereno national family planning program exists but desired and actual familysize are relatively small. The abortion rate, now 39 abortions per 1,000,is likely to remain high until Brazil too makes the transition to thewidespread availability and more effective practice of contraception. The states of the former Soviet Union present a compelling case forhow the introduction of high-quality contraceptive services can reduceabortion rates dramatically. In Russia, abortion is legal and has beenused—in the absence of any contraceptive s—as the major methodof birth control. In fact, it was the only choice available in answer tothe prevailing desire for smaller families. While abortion rates are stillvery high, the recent introduction of family planning has already resultedin a significant drop in the abortion rate (see Table 1). Similarly,abortion was the primary means of birth control in Hungary until the late1970s, by which time contraceptive use had risen to about 50%. Oncereliance on family planning became more the norm in Hungary, the abortionrate dropped by more than two-thirds. Table 1. Russian TrendsMeasure19901991199219931994% of women usingcontraceptives*1920222324Abortions per 1,000women109100908276*Data are from the Russian Ministry of Health andrepresent pill and IUD use only; statistics for barrier methods areunavailable, and statistics for oral contraceptives understate actualprevalence, since the pill is also sold over the counter. Source L.Thomas, International Planned Parenthood Federation, London, personalcommunication, 1996. These patterns suggestreason for concern about the impact of suddenly withdrawing familyplanning programs just as contraception is beginning to replace abortion.It is especially troubling for regions such as Africa, where the fertilitytransition is in its earliest stages. As increasing numbers of people feel more stronglyabout having fewer children, the absence of quality family planningservices will inevitably encourage more abortions—legal or not, safeor not. Public Support for Aid A recent survey confirms thatforeign aid is unpopular among Americans, apparently because most peoplethink the United States is spending far more than it actually is. Mostpeople questioned estimated that the United States is spending 15% of thefederal budget on foreign aid, 15 times the actual amount of 1%. When asked whatthey thought the appropriate amount should be, most respondents indicateda level that turned out to be five times the present spending level. Lessthan half of the 1% the federal government spends overseas is reserved fordevelopment aid, which provides support for population, health, nutritionand environmental programs. Americans cite protection of the global environment as one of the mostcompelling reasons for the United States to support developmentassistance. And "overpopulation" is often volunteered as a significantfactor contributing to environmental degradation. So, international population aid should be, according to most Americans,a central component of U.S. humanitarian programs overseas. Indeed, thisrationale supports the U.S. position that its population program is thecornerstone of its approach to sustainable development, a process whoseobjective is to enhance the quality of life for people today withoutunduly compromising the resources necessary to sustain future generations. Many public opinion surveys have shown that population growth is anissue of concern to most Americans. A 1994 Time-CNN poll found that55% of Americans view "overpopulation" as a "very serious" problem; anadditional 31% view it as "somewhat serious." Four-fifths of thosesurveyed believe this is a problem that will eventually affect the UnitedStates. Perhaps for this reason, 72% of Americans support U.S. subsidies "tomake birth control and family planning" more available in developingcountries. Why do so many people support family planning assistance, evenassistance overseas? According to a 1994 survey conducted for the PewGlobal Stewardship Initiative, 91% of Americans do so because they believethat "all men and women in the world who want birth control should be ableto get it." The Future at a Crossroads Even though the world'spopulation growth rate appears to be slowing down, the world's populationpromises to continue to grow significantly over the coming decades as thelargest cohort in history enters its reproductive years. The greater thedegree to which women's increasingly prevalent and ever-stronger desirefor smaller families can be addressed today, especially through betteraccess to effective contraceptive services, the more likely that worldpopulation will stabilize at fewer than 10 billionpeople by the middle of the next century. The United States has played a major role in raising worldwideawareness about individual family planning needs and global populationtrends, and through its strong financial and policy leadership, hasestablished its prominence in addressing those challenges. Its relativelysmall investment pays significant dividends in strengthening the globaleconomy, protecting the environment and saving the lives of women andchildren throughout the developing world. As First Lady Hillary RodhamClinton noted recently in La Paz, Bolivia, in reaction to that country'sextremely high maternal mortality rate, "Family planning campaigns at workin Bolivia and elsewhere represent sensible, cost-effective and long-termstrategies for improving women's health, strengthening families and lowering the rate of abortion." Despite being a program that is popular with Americans and one thatprovides services that people in the developing world need and want, thisworldwide effort is in doubt. U.S. participation in the internationalprogram has been under siege over the lasttwo years, largely in the name of opposition to abortion. It is a sadirony, since the research shows unequivocally that family planning leadsto fewer, not more, abortions. Indeed, a consortium of researchorganizations (including The Alan Guttmacher Institute) concluded that therecent cuts imposed by Congress could be expected to result in 1.6 millionmore abortions. Thus, whether the motivation is reducing abortion, improving thehealth of women and children, enhancing women's status, helping toalleviate world poverty, promoting economic development overseas,protecting the global environment or pursuing the economic self-interestof the United States, restoring a strong U.S. commitment to internationalpopulation assistance will be essential to future progress. Information Sources Adamson, P., "A Failure ofImagination," in The Progress of Nations: 1996, United NationsChildren's Fund (UNICEF), New York, 1996. Alan Guttmacher Institute (AGI), Hopes and Realities: Closing theGap Between Women's Aspirations and Their Reproductive Experiences,New York, 1995. Conly, S., and J. Rosen, "International Population Assistance Update:Recent Trends in Donor Contributions," Population ActionInternational, Washington, D.C., 1996. Gelbard, A., "Global Population: An Overview," Population ReferenceBureau, Washington, D.C., 1996. Klitsch, M., and S. Singh, "Are Women Achieving Their ChildbearingGoals?" Issues in Brief, AGI, Nov. 1996. Kull, S., "Americans and Foreign Aid: A Study of American PublicAttitudes, Summary of Findings," Center for the Study of Policy Attitudesand Center for International and Security Studies at Maryland, CollegePark, MD, 1995. McDevitt, T., World Population Profile: 1996, U.S. Agency forInternational Development (USAID) and U.S. Bureau of the Census,Washington, D.C., 1996. Population Reference Bureau, Family Planning Saves Lives,second ed., Washington, D.C., 1991. Singh, S., and G. Sedgh, "Trends in Abortion, Contraception andFertility in Brazil, Colombia and Mexico," International FamilyPlanning Perspectives, Vol. 23, No. 1, 1997 (forthcoming). Sollom, T., R.B. Gold and R. Saul, "Public Funding for ContraceptiveSterilization and Abortion Services, 1994," Family PlanningPerspectives, 28:166173, 1996. Special Programme of Research, Development and Research Training inHuman Reproduction, World Health Organization (WHO), ReproductiveHealth Activities in WHO, Geneva, 1994, p. 7. Turnbull, W.R., "Endangered: U.S. Aid for Family Planning Overseas,"Issues in Brief, AGI, Nov. 1996. United Nations Population Division, "World Population Growing MoreSlowly but Could Still Reach 9.4 Billion by 2050," press release, NewYork, Nov. 4, 1996. USAID, The Role of Family Planning in Preventing Abortion,Washington, D.C., 1996. This report was written by Susan A. Cohen. It was preparedwith thesupport of The Pew Charitable Trusts/Global Stewardship Initiative.© 1997, The Alan Guttmacher Institute, 1/97 |
|
