Who's calling the tune?

International | NAE's World Relief receives more than 60 percent of its overseas budget from Uncle Sam and helps advance Washington's family-planning objectives. This raises a hard question: What role does condom distribution play in the fulfillment of the Great Commission?

Issue: "Clinton: Final straw?," March 28, 1998

When the National Association of Evangelicals concluded its annual convention in Orlando earlier this month, the final word to the troops was delivered by Clive Calver, president of World Relief. Mr. Calver took up his post at the NAE's worldwide relief agency last year, after 14 years as head of NAE's counterpart in Great Britain, the Evangelical Alliance. He has become a popular draw for the organization, noted for being a visionary who wants evangelical witness to characterize overseas programs and who has brought order to the financial books. He is considered a steadying hand as NAE president Don Argue steps down in May. Mr. Calver's closing remarks capped a three-day meeting whose theme kept returning to the cause of evangelicals abroad. Following first-hand reports on the church in China and the fight against Christian persecution, it seemed appropriate for Mr. Calver to chasten American evangelicalism for being "too introverted." But that does not explain why evangelicals might experience a disconnect with World Relief's ministry. While billing itself as "the international assistance arm of the National Association of Evangelicals," and one that is "owned by and works through evangelical churches," less than half of World Relief's operating funds come directly from its constituency. Uncle Sam supplies more than 60 percent of the agency's overseas funding, according to government records. More surprising, a portion of that funding is in the form of overseas development grants linked to state-sponsored family-planning programs. World Relief's overseas programs total $24.7 million. It receives $2.4 million in grants from the U.S. Agency for International Development, $11.6 million in grants from other federal agencies, just over $1 million in support from other government or international organizations, and $9 million in private contributions and revenue. These figures are contained in USAID's 1997 "Report of American Voluntary Agencies." Funding from USAID, in particular, raises questions because the agency, while technically prohibited from funding abortion, advocates aggressive birth-control programs overseas as a way to curb population growth in Third World countries.Its 1998 budget report to Congress argues for "increasing contraceptive prevalence" and sets specific targets for lowering birth rates on a country-by-country basis. The funding of these programs in Latin America has not gone unnoticed. In February The New York Times ran a front-page story on coercive sterilizations of women in Peru. Last year 110,000 sterilizations, also known as tubal ligations, were performed on Peruvian women, and there is widespread evidence that many of the women were coerced into having the procedure through bribes or repeated visits from state health officials. In several cases women died from the procedure because it was performed under unsanitary and hurried conditions. U.S. officials are investigating whether USAID money was involved in the actual sterilizations, while acknowledging that U.S. funds have been used for training and management of these programs. "If you walk into USAID headquarters in Washington, you will see that among their five goals is population stabilization. It goes by many other names, like 'fertility reduction,' but all are about controlling the number of children women will have," Steven W. Mosher, president of the Population Research Institute, told WORLD. "This is problematic for any Christian organization to undertake, since we all agree that children are a blessing from God.... that was the ancient injunction of Moses, and it has never been revoked as far as I know." Mr. Calver describes himself as "rigidly pro-life," and he told WORLD: "My understanding is that we do not follow the Roman Catholic position. The use of non-abortive contraceptives is acceptable; and we can encourage birth controls that are non-abortive. I would want World Relief to be absolutely and emphatically square with the teaching of Scripture, which is absolutely unambivalent on this.... We will not take the line of compromise. I don't mind if it costs money in terms of funding." The evidence does not suggest that World Relief programs promote abortion or coercive sterilizations. A look at family-planning programs in Honduras, however, shows how easily well-intentioned programs may be compromised.There, the Population Research Institute is finding evidence of "a heavy-handed sterilization program" similar to Peru's, according to Mr. Mosher, who is Roman Catholic. World Relief Honduras is in the process of becoming an indigenous organization, managed by a local board and run by Hondurans who are "one step removed," according to Mr. Calver, from the thumb of headquarters in the United States. Nearly all of its funding, however, including USAID grants, is administered through the Wheaton office of World Relief. When WORLD asked Orestes Zúniga Rivas, director of health programs for World Relief in Honduras, if his agency is involved with sterilization of women, he replied, "Yes, all forms of family planning." Asked again about encouraging sterilizations, he said, "Every time you go closer to the problem, it is more complicated. The big problem we have is the Catholic Church, their policies on birth control. There's a lot of confusion with evangelicals regarding family planning. Honduran women should have the right to choose the strategy-whatever-all strategies." World Relief officials in the United States have a different story. Spokeswoman Linda Keys said, "The only contraceptive that World Relief makes available to women is the condom. For other contraceptives, which require medical oversight, women are referred to the health clinic in their community." Those referral clinics are usually run by the government's Ministry of Health or one of many non-governmental organizations (NGOs) that operate in Honduras. The government clinics are more likely to be free, but they are often short-supplied. In one locale, World Relief sends referrals to a clinic just outside Tegucigalpa run by the Honduran Family Planning Association. That organization is one of the largest recipients of USAID funds in Honduras. Martha deCasco, who heads the Honduran Pro-Life Committee and has been investigating questionable family-planning practices, said Honduran Family Planning Association is "the most responsible" for aggressive family-planning programs. One HFPA clinic in Tegucigalpa, she said, performed 2,000 sterilizations last year. Earlier this month, Mrs. deCasco testified before Congress on other family-planning abuses. She submitted evidence that women in Honduran hospitals were being administered birth-control pills just after birth. The pills, manufactured by U.S.-based Wyeth-Ayerst, diminish both quality and quantity of breast milk and have other potentially serious side effects for a nursing baby. Mothers were typically given the pills without instructions. Printed warnings, she said, were removed from the packaging. Mrs. deCasco said that practice was halted by the Ministry of Health, but others persist. New mothers are asked to sign a consent form for sterilization just after delivery in many hospitals, and they are also pressed to consent to sterilization when visiting a social security office after birth. "A woman has to have a strong feeling against it in order not to fall into their hands on this," she said. World Relief's program in Honduras is funded through USAID's "child survival" program. It is a catch-all category that includes improving nutrition, treating diarrhea, and promoting vaccinations-all in an effort to reduce the child-mortality rate. (Infant mortality has declined, from 85 per 1,000 live births in 1979 to 42 in 1993.) "Maternal health" is another component of the child-survival program. Under that title, USAID funds condom distribution and other unspecified contraceptives because, according to its budget report to Congress, "Family planning has been a major factor in reducing infant and maternal mortality in Honduras." While USAID may give leeway to groups like World Relief in how those activities are carried out, the bottom-line goal is clear: USAID wants to reduce the fertility rate in Honduras. It declined from 5.1 live births per woman in 1991 to 4.9 in 1995. The USAID report sets an even lower target for 1998, to 4.5. In this environment, Mr. Mosher says, medical caregivers from private organizations become indistinguishable from government officials. Mr. Zúniga of World Relief in Honduras concurs. "We are an arm of the Ministry of Health. Their programs are correct in every sense," he said. World Relief trains women leaders in neighborhoods to train other mothers, most often in the subjects of nutrition, preventative care, and family planning. Emphasis in family planning is placed on breast-feeding and birth spacing, but all mothers of children under the age of five are given condoms. "Most want family planning because they are beginning to realize that their child has a better chance to survive if children are spaced at least two years apart," said Ms. Keys. World Relief provided to WORLD pages from the training manual it uses to teach volunteers in Nicaragua-who then instruct women in their communities. It includes guidelines for discussing sterilization. It was written by officials of the Nicaraguan Ministry of Health. The manual instructs the counselors to explain the tubal ligation procedure, along with possible complications and consequences. Candidates should sign a consent form. They also must meet several criteria: They must be at least 30 years old and have three living children, or they must have a "medical reason" for being sterilized. World Relief spokeswoman Keys said volunteers are to stress that husbands should support the decision to be sterilized, but that guideline is not written in the manual. The manual does say that the time just after delivery of a baby or a miscarriage "is a convenient and safe time for voluntary sterilization," even though women sterilized at that time are more likely to regret it later. Mr. Mosher calls that kind of instruction an example of the "linguistic deception" that has enveloped these programs. "There is an entire rhetoric that has grown up around this issue using euphonic, pleasing-to-the-ears terms," he said. "If you go into the home of a poor camposino [peasant] and show her your wares, that is intrusive. You are in her home. You may come back if she says she is not interested in contraceptives. If you are counseling her to use them, then you can't call it voluntary. Sterilization is called 'voluntary surgical contraceptive.' We should call it what it is. It is sterilization or tubal ligation. In the ears of an illiterate woman in the Third World, 'contraceptive' sounds reversible." Overlooked in the contraceptive controversy is primary health care-the traditional medical assistance to the impoverished, Mr. Mosher says. "It is being gutted because more and more money is being put into contraceptives and promoting abortion." Mrs. deCasco said, "I think you would be so hurt by the sight if you go to many health clinics." Visitors would find, she says, antibiotics, saline water, and preventative medicines in short supply, but "you will find a huge quantity of condoms and contraceptives and IUDs. The way in which birth control is being distributed exerts such pressure on our people. It is absolutely out of balance." World Relief is not alone among Christian groups using federal dollars to advocate contraceptives. World Vision, according to its policy paper on family planning, says that 10 percent of its programs involve family planning. In addition to condoms, World Vision distributes birth-control pills and copper IUDs. "The lure of generous government money is so compelling, you find Christians who would balk at any hint that they are engaging in anything disreputable," said Mr. Mosher. -Nat Belz, reporting from Tegucigalpa, provided information for this story.

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