The receptionist taking calls at Andean Rural Health, Inc., sounds more Appalachian than Andean. The storefront for this multimillion-dollar, private, non-profit relief agency is a converted residence facing Lake Junaluska, a retreat center in the North Carolina mountains owned by the United Methodist Church, where Andean Rural Health has its roots.
With 16 years of health care experience in Bolivia, Andean Rural Health is beginning its fourth contract with the State Department's U.S. Agency for International Development (USAID). The contract runs four years as a matching grant. USAID gives $1 million under its child survival and disease program for Andean Rural Health to treat medical needs in the altiplano, or high plains, regions of Bolivia. An additional $1 million comes from individual Methodist churches, some Presbyterian and Lutheran congregations, and private donors. Andean Rural Health keeps fewer than 10 employees in North Carolina, its U.S. headquarters, with 90-100 employees in Bolivia. Program director Sara Espada is circumspect about the agency's long-standing work with the government: "The AID grant is in some ways restrictive, but it fits with our organization's mission: improving the health of rural people in the Andes."
Even so, Andean Rural Health is part of a dozen international relief organizations that have joined pro-life members of Congress to change the way Washington hands out the money. In the same motion, their effort, if successful, would cut the amount of taxpayer money going to overseas population-control programs and groups that press for liberalized abortion laws in other countries.
The amendment to upcoming foreign operations funding, proposed by U.S. Rep. Joseph Pitts (R-Pa.), would shift $100 million from controversial population-control programs to child-survival programs. Groups like Andean Rural Health want to distance themselves from the controversial side of USAID work, the population control programs, and get back to basics: providing clean water and sound advice about nutrition and health care. After all, who can be against child survival?
For starters, the Clinton administration.
Photo-ops of First Lady Hillary Clinton touring the orphanages of the Third World aside, President Clinton has proposed cuts in child-survival spending for the last three years. At the same time, the administration has sought to increase federal spending for population-control programs. It also has renewed its support for the UN Population Fund. This year the UN agency launched a four-year demonstration project in China. The project claims to promote "voluntarism" in family planning throughout China, in spite of evidence that China's communist regime continues to perform forced sterilizations and other coercive types of "family planning" (see WORLD, June 27, 1998).
In contrast, child-survival programs focus on preventing diarrhea, acute respiratory infection, measles, malaria, and malnutrition. All are leading causes of death among children under five in the developing world. Health officials say 12 million of those deaths each year are preventable.
The groups petitioning Congress for the change include heavy hitters like World Vision, Catholic Relief Services, and the Salvation Army. Other church-based organizations include World Relief, the Adventist Development & Relief Agency, and Andean Rural Health Care. Also signed on are Christian Children's Fund, Esperanca, Food for the Hungry, Project Concern, Project Hope, and the International Eye Foundation.
"What we are trying to do is get a little bit more money for these things, which are very, very cheap," Mr. Pitts, who is founder of the Congressional Life Forum and a member of the House Pro-Life Caucus, told WORLD. "Population-control programs are expensive, and we keep hearing reports of contraceptives stacked to the ceiling while they can't get a simple pill in some health clinics."
Mr. Pitts continued, "I am not a fan of population-control monies. I think there is a lot of waste and money is fungible. It is going to organizations who use it to promote abortion."
He is also concerned about fungible terminology. Groups supporting aggressive population-control programs increasingly use child-survival programs, for instance, to advance their agenda. Counseling on the use of contraceptives and distributing them as well are done under the rubric of "birth spacing" and "maternal health," components of child-survival packages. "This addresses that issue by defunding it," said Mr. Pitts. "It represents rearranging priorities."
But that may be more than relief agencies are counting on, because even the most broadly evangelical ones-to varying degrees-are part of the population-control groupthink.
World Vision, the largest Christian relief and development organization, participates in USAID family-planning programs in its overseas operations, which include more than 4,000 programs in nearly 100 countries. World Vision has distributed condoms as part of AIDS prevention programs in Africa and controversial "post-conception" contraceptive devices in some of its health clinics. These include IUDs (intra-uterine devices) and Norplant injections and are regarded by many Christians as causing abortions.
World Vision also faced criticism for a 1997 letter campaign to Congress protesting cuts to the international family-planning program. Then-president Robert Seiple defended the campaign, joined by CARE and Save the Children, as necessary to improve the health of women and children in Third World settings.
None of the agencies WORLD spoke with want to distance themselves entirely from family-planning programs, even though they have signed onto the Pitts amendment and are aware of criticism from pro-life and Christian organizations. They say the cycle of poverty and the AIDS epidemic call for a different set of standards.
"We support the distribution of condoms because we believe it is wrong in the eyes of God for children to be born HIV positive," said Tim Dearborn, an ordained Presbyterian Church USA pastor and associate professor at Fuller Theological Seminary. He consults with World Vision on ethical issues. "Somehow we've got to get both of these right, to be pro-life for the unborn as well as for the born. It is a different set of issues that exist in the developing world. These are not junior-high girls [receiving contraceptives]; they are 13-year-olds married to a 27-year-old and they may be his second or third wife. It's a very different context."
Mr. Dearborn is leading what World Vision calls "an in-house think tank" to revise the agency's 10-year-old policy statement on contraceptives. Some of that process is clear-cut. "World Vision continues to be totally opposed to abortion," he said. "That is clear and unchanging."
The policy relating to IUDs is less so. It states that World Vision "will not distribute nor support the distribution nor counsel in the distribution of a proven abortifacient in its normal operation," according to Mr. Dearborn. But to implement a new policy, Mr. Dearborn told WORLD, is difficult because World Vision works through 50 offices worldwide and often through other local groups. Requests for contraceptives, in some places, are referred to clinics with a different policy. One part of the new policy, he said, will be "a referral protocol" that will give stricter guidelines to World Vision workers.
Ms. Estrada expressed frustration with the lexicon of providing birth control, "what we used to call family planning," she said. "'Reproductive health' is now the buzzword rather than family planning." Andean Rural Health provides contraceptives, "if requested," she said, but they are finding the products-in this case condoms or Depo-Provera-a dwindling part of the agency's mission. "In this area, modern family planning is not very well accepted. Actual percentages who use it are low."
World Relief, operating under the National Association of Evangelicals, is reworking its policy on IUDs and any "post-conception intervention." An interim policy provided to WORLD reads: "... World Relief will neither promote IUDs as part of its health programs nor fund or promote the provision of IUDs by partner agencies." The policy also requires referrals to be warned of the dangers and potential abortifacient effect of IUDs. World Relief president Clive Calver told WORLD his agency is "against any post-conception method of contraception and against federal funds being used for that purpose." World Relief also has a long-standing policy opposing abortion (see sidebar).
Mr. Pitts's proposal could be put to the test this week, when the foreign operations budget is finalized in committee before consideration in the full House. Mr. Pitts says he believes it will "win big" in a House vote once successfully through the committee.
If the funding switch is successful, it would be another end-run for pro-life legislators around pro-abortion forces in the Clinton administration and the non-profit community. House Republicans were successful in capping expenditures under the population-control program at $385 million last year; Mr. Pitts's $100 million reassignment would reduce the figure to $285 million. They also passed a measure to "meter" the program, forcing USAID to issue funds in monthly allotments rather than lotto-sized grants.
Stronger links between pro-life leaders and Christian relief organizations will do more to move the aid agencies' campaign against population programs from token to total. World Vision's new president, Richard Stearns (the former CEO of Lenox Corp. and a long-time contributor to both World Vision and Focus on the Family), plans to meet with Focus president James Dobson in October, shortly after his installation, to discuss those very issues.