Galton Institute Home Page September 1997 Newsletter Contents Newsletter Index

Non Governmental Organisations: the Framework of Successful International

Family Planning Aid
By Peter Diggory
After the second world war the newly developed antibiotics and other effective drugs for childhood diseases combined with agricultural reforms and with
improvement in food and transport resulted in better child health and thus to sudden explosions in third world populations with resultant overstrain upon their
limited economies and dire poverty. The need for such countries to attempt family planning became obvious and, in due course, western nations began to
recognise the importance of helping these governments tackle their family planning needs. By the 1960s such aid was beginning to flow on quite a large
scale. Unfortunately governments tended to give directly to other governments and the resultant bureaucratic incompetence, often combined with fairly
blatant venality, tended to negate the good intentions of both sides. Consequently for the last decade or so donor governments and donor charities have
tended to channel their help through non governmental organisations (NGOs) who are expected to possess the necessary technical expertise and, very
importantly, can be held accountable for the proper use of the monies subscribed.

Is state-sponsored contraception actually effective in developing countries? Measuring the true uptake of family planning programmes is always difficult. In
1994 the London School of Hygiene and Tropical Medicine, sponsored by the United Nations Population Fund, circulated a report " Population Policies and
Programmes: Determinants and Consequences in eight developing countries" which demonstrated convincingly not only that when modern contraception
had been made available it was effective, but also that the resultant fertility decline followed upon rather than preceded the initiation of such policies.

Demographic data from eight developing countries was surveyed comparing four country pairs, matched for socio-economic status, where one country of
the pair had a government supportive of family planning and the other did not. This study, in revised form, will shortly be published in Population Studies.
Meanwhile the original paper is available from Dr Louisiana Lush, Centre for Population Studies, London School of Hygiene & Tropical Medicine, London,
WC1E 7HT. The country pairs selected for survey and comparison were Thailand/Philippines, where Buddhism in Thailand was neutral on family planning
whereas Catholicism in the Philippines was strongly opposed. Bangladesh/Pakistan both being Muslim but in Pakistan the preceding, discredited regime of
Ayob Khan had been strongly supportive of population control. Tunisia/Algeria where again both were Muslim but emancipation of women and Family
Planning were central policies in Tunisia alone, and finally Zimbabwe/Zambia where Roman Catholicism was an important factor only in Zambia. The study
showed successful state promotion in Bangladesh, Tunisia, Thailand and Zimbabwe. It also showed that the falling birth-rate quickly allowed the country’s
wealth to be better distributed with a considerable rise in its living standards not matched by the non-contracepting pair.

The British government is an increasingly active supporter of family planning aid. In 1995 the UK spent £63 million on aid for population and reproductive
health, more than double the 1991 figure. As a proportion of total aid family planning expenditure also rose sharply to 3.0% of the total aid against 2.3% the
preceding year. In its 1995 annual report the ODA., now renamed the Department for International Development (DFID), claims that this aid is making a real
difference to:-

(1)  Accessibility of reproductive health services and of contraceptive usage in Bangladesh, Pakistan, India, 10 African countries and in parts of Eastern 
Europe and Latin America.

(2)  Family size in Bangladesh, Pakistan and Kenya.

(3)  Reproductive Health in Eastern Europe, especially to a reduction in abortion.

(4)  Reduction of HIV incidence in several African countries.

(5)  The capacity of UK organisations, both public and private to contribute to better reproductive health.

Great Britain is home to four NGOs whose primary aim is service in family planning and reproductive health. Firstly there is the International Planned
Parenthood Federation (IPPF) a large multinational organisation based in London and registered here as a charity. This body received core fund donations
from thirty governments including $19.2 million from Japan, $14.2 million from the UK, $10.8 million from Sweden, $10 from Denmark and $9 million from
USA as well as donations from 19 international charities. Total income in 1995 was $125 million. IPPF supports 127 national family planning associations
mostly in the third world but also in Eastern Europe and the former Soviet Union.

Marie Stopes International (MSI) is an extremely entrepreneurial and innovative charity, tracing its roots back to, and still on the site of Marie Stopes’
original clinic. MSI aims to provide all forms of family planning services, including provision of abortion and sterilisation for both sexes and it achieves this
aim within the UK although in some countries one or more facets of its programme are illegal. Affordable charges are made for these services and
ultimately it is planned that all clinics shall be self supporting but initially richer parts of the organisation must subsidise poorer. Total income for 1995 was
$25.3 million of which $24.3 million was distributed on global service provision costs, training and development, information, education, communication,
technical assistance, finance and infrastructure costs. The underlying philosophy is that of Robin Hood but care is taken to avoid restricting provision by
charges.

Population Concern (PC) started as a development of the International Office of the UK Family Planning Association gaining independence and registered
as a charity in 1991. The Duke of Edinburgh is Patron and David Bellamy President. PC uses high publicity profile and one of its main aims the education
of adolescents mainly within the UK in the need for and techniques of family planning. It also supports a number of smaller projects world wide. Total
income for year to March 1996 was approximately $2.76 million with expenditure $2.66 million.

International Family Health (IFH), was established six years ago but is growing rapidly. This charity deals with all forms of family planning and also with
AIDS prevention. It acts as DFID Resource Centre for Family Health matters. IFH is involved in advising potential donors of suitable consultants able to
carry out preliminary surveys of needs and/or administrating projects in the field. Since inauguration it has approximately doubled its income annually and
for year ending 31st May 1996 income was approximately $1 million with expenditure $51,000 less. Key projects include a highly innovative community
based social marketing venture in Southern India aiming to provide not only an efficient and acceptable distribution of contraceptives but also adding a
financial incentive to those using its facilities to earn by recruiting friends and colleagues, ultimately putting money into the community. IFH also works
within a community of prostitutes aiming to improve their quality of life as well as providing contraception and AIDS prevention and has another similar and
highly successful project targeting long distance truck drivers who meet prostitutes at stopover points. In collaboration with the Christian administered
hospitals in Nigeria it inaugurated a training scheme to treat the complications of illegal abortions by the use of hand-held vacuum aspiration syringes. This
has proved successful and, with support from the Packard Foundation will now be expanded into several African Countries.

AIDS prevention, or at least reduction in incidence of the syndrome, is an extremely complex subject in the Western World. In the developing countries it is
excessively simple, all treatment is far too expensive so education and condom use encompasses the totality of feasible aid. Sexually active women are at

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 risk both from unplanned pregnancy and from AIDS and they realise that condom use is doubly protective. Education against this disease is an obligatory
and well accepted task for all concerned with family planning in the developing world. The threat of AIDS is ever present and vividly acknowledged in almost
all African countries thus condom contraception has wide theoretical acceptance, though in practice its usage is poor. Women are probably more
accepting of condom use than men but this is of limited value since only in Japan and some other parts of Asia are women the main purchasers of
condoms.

The whole future of family planning aid may well be revolutionised as and when Europe awakens to its responsibilities. The Scandinavian countries, Holland,
Germany and the UK are all currently active in the field but the remainder of the EU lags far behind. If the UK now begins to take a more active part within
the EU our influence may well work to the good of the third world in this respect. At present the bureaucratic obstacles against a UK NGO being able to
raise funds from the EU are very considerable and only the large charities have the resources to maintain adequate agitation for such donations and
involvement.

At the time when Family Planning NGOs first came into existence America was funding about 90% of all family planning aid. The growth and development
of the NGOs concept occurred primarily in the USA but in the last decade or so similar organisations have developed in the UK and in many other western
nations. It is becoming apparent that the advantages of widespread NGO growth is far greater than mere financial accountability. Each NGO has its own
individual philosophy and administrative expertise and can offer specialised techniques for individual problems and may be able to quote and perform more
rapidly and cheaply when such problems are encountered. Each will have its own list of suitably qualified potential consultants with their own individual
expertise and experience. The existence of competing NGOs gives donors a choice to match their needs whilst bearing in mind the selected NGOs
reputation for reliability and technical expertise in facilitating such operations. The existence of this free market of NGOs and consultants is of enormous
benefit to donors and to the smooth and efficient planning and delivery of family planning aid world wide.

Each of the four NGOs described above owes an historical debt to the Galton Institute. The Eugenics Society was instrumental, largely through the
determination of Dr C P Blacker and of Vera Houghton, in establishing the IPPF which in its early years was housed within the offices of the Society. The
National Birth Control Association, which in 1939 became the Family Planning Association, was supported by annual grants from the Eugenics Society
and given low cost accommodation in the Society’s Eccleston Square premises. Marie Stopes International acknowledges its historical continuity with the
clinic founded by one of our most illustrious Fellows and, following her death, operated as a legal subsidiary by our Society. International Family Health
was founded by two long serving members of the Institute’s Council.

In supporting the programmes of these organisations from the earmarked funds of its Birth Control Trust (see Newsletter, No. 23, p.4) the Galton Institute is
thus continuing its long involvement, albeit through these other agencies, with one of the most intractable problems of the twentieth century.

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