population problems is centered in the Agency for International Development. Second only to the work of AID is that of the Department of Health, Education, and Welfare, with its expanding relationship to the World Health Organization. 133 THE DEPARTMENT OF STATE The Department of State is perforce involved in the U.S. effort to cope with the worldwide population explosion. The impact of the expanding population on international relations is a pervasive one. The Department has concluded that its officers serving abroad must have a greater knowledge of population dynamics, and the Foreign Service Institute has introduced material on population and family matters into its courses for junior, middle level, and senior personnel. In addition, the Institute conducts a series of seminars on population for key officers at State and other foreign affairs agencies. The Special Assistant for Population Matters, whose office was established by the Secretary of State in 1966, consults with other agencies which have responsibilities in the population field and also acts as the Department's liaison man with U.S. embassies, particularly in the LDCs. He sees to the exchange of information on developments in population matters. In addition he maintains liaison with private organizations active in population work. In each regional bureau an official is now designated as the Population Officer for that bureau; moreover an official is similarly designated in each of the U.S. embassies, including those in countries where there is no AID mission. THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE The Department of Health, Education, and Welfare is directly concerned with U.S. international population programs, principally in the field of research. Under the Public Health Service's administrative umbrella, the National Institutes of Health, the Health Services and Mental Health Administration, and the Consumer Protection and Environmental Health Services are all conducting research, both in this country and abroad, on aspects of family planning. The Center for Population Research of the National Institute of Child Health and Human Development coordinates the research programs carried on in those countries where the United States owns excess local currencies accumulated under PL 480. A number of such projects are currently going forward. The Center for Population Research is also the focal point for HEW's contract research program in contraceptive development, which was initiated in 1969. This program looks to the development of contraceptive methods that will be effective, safe, reversible, inexpensive, and adapted to the diverse needs of the world's varied population. Research has been concentrated in four areas: corpus luteum function, sperm capacitation, oviduct function and gamete transport, and the biology of the ovum; each has demonstrated particular pro 133 For a discussion of the relationship, see "The Politics of Global Health." an earlier study in the series on Science, Technology, and American Diplomacy. (Op. cit.) mise for the development of new methods to regulate fertility. Investigations are also going forward on the medical effects of contraceptive agents now in use, particularly as to whether there is any connection between the use of oral contraceptives and the incidence of cerebrovascular and other disorders. In 1970 the Center supported nine projects on the medical effects and mechanism of action of steroid contraceptives and IUDs, fields in which research is considered important for family planning the world over. The Center also funds considerable contract research in demography, as well as projects in the social and behavioral sciences. A number of contracts relate specifically to population problems and programs in the developing areas: for example, one study covers urbanization, migration, and fertility in Thailand. The Food and Drug Administration supports research to evaluate the safety of oral contraceptives. The Health Services and Mental Health Administration supports research in mental health and behavioral aspects of fertility, and in the operational aspects of family planning services. It also provides academic training or field observation for foreign physicians and health personnel in family planning. The Social and Rehabilitation Service, another HEW unit, supports research overseas in the operational side of family planning projects, and also provides training opportunities in the social aspects of family planning for paticipants sponsored by the U.N., AID, or other national or international organizations. For example, it cooperated in planning the 1970 International Conference on Social Work Education, Population, and Family Planning, which was sponsored by the Council on Social Work Education and supported by AID. THE UNITED STATES INFORMATION AGENCY In contrast with the role of HEW, that of the United States Information Agency (USIA) is relatively modest. However it is not insignificant. Its principal function is to disseminate information, particularly to foreign opinion leaders, in order to increase awareness and understanding of population growth and family planning. In those LDCs with programs to check expanding populations, the USIA tries to strengthen public interest in and support for these programs, but within the bounds set by the policies of the particular country and the sensitivities of its people. Its information activities relate population problems to housing, education, health, and the ability of the particuÎar country to achieve its own development goals. Materials are prepared in support of U.S. policies and programs, but emphasis is also given to the role of international agencies, especially those connected with the U.N., and even to programs sponsored by agencies in other countries. USIA posts and libraries abroad make available copies of pertinent speeches, articles, and other materials on population and family planning prepared by governments, by international institutions, and by private organizations and individuals. This service is in line with USIA's recognition of the fact that population growth and distribution are matters of worldwide concern. THE PEACE CORPS Since 1966, the Peace Corps has also been involved in family planning progress, though on a limited scale. Some 100 volunteers are working in established national programs or in programs set up through local initiative. This assistance is furnished only to those countries that have asked for it. In some countries Peace Corps assistance is technical, using physicians and highly skilled nurses. In other places generalist volunteers are used in the education and training aspects of the program and in staff referral centers. THE AGENCY FOR INTERNATIONAL DEVELOPMENT AID has the most extensive responsibility in the U.S. effort to help the LDCs check the steady climb in population in the third world and to restore equilibrium to the food/population balance. That responsibility is centered in the Office of Population, under AID's Bureau for Technical Assistance. In addition, there are population officers in AID's regional bureaus in Washington and in its missions abroad. Consideration of space precludes a full discussion of AID activities but what follows may be taken as typical. AID views action to reduce high birth rates as primarily a task in extension education. People need to know, first, the advantages of a lower birth rate, then how to achieve it, and then where to obtain clinical advice and contraceptive supplies. Since the success of population programs depends on mass public support and on millions of individual decisions to practice contraception, programs of information and education, particularly through mass media of communication, have drawn active AID encouragement. The Agency has supported such programs in India, Pakistan, Korea, Tunisia, Morocco, Kenya, Ghana, and other countries. It has also aided private organizations working in this field, such as the International Planned Parenthood Foundation and the Pathfinder Fund. A project at the East-West Center at the University of Hawaii which would provide a continuing inventory, analysis, and evaluation of information/education/communications support activities, and would train specialists in this field, is considered to be one of the most important population activities of the Agency. AID also makes an effort to interest national youth groups in the population problem. But it sees the principal means for fostering information, education, and communications in the programs undertaken by the developing countries themselves. To assist such programs AID provides financial aid, commodities, training, consultant assistance, and other help. Support of research is another major function of AID in the field of population. It emphasizes applied or "goal directed" research, which will contribute to the success of AID-assisted population programs. Four areas of research are particularly pertinent: (1) descriptive demography; (2) population dynamics; (3) operational research; and (4) the development of new or improved methods of fertility regulation, more suitable to conditions in the LDCs. Some typical projects in these areas are as follows: (1) Establishment of population laboratories at universities in various LDCs which would seek to improve the reliability and predictive value of the data used for population and family planning programs; (2) research into the attitudes and values held by husbands and wives that affect their utilization of available family planning services; (3) actual operation of family planning programs, staffing patterns and training methods for program workers, and best methods for educating or motivating users of the program; and (4) improving the acceptability of some specific method of contraception.134 AID also helps private and government-sponsored programs to provide contraceptives and clinical supplies which will increase their effectiveness. As of June 30, 1970, more than 18 million monthly cycles of oral contraceptives had been purchased with AID financing for use in developing countries. Purchases of oral pills, IUDs, and condoms are made through the General Services Administration. In this way, AID can standardize specifications of quality and safety, and encourage competitive bidding. It buys only those oral contraceptives which are covered by what is known as an approved New Drug Application (NDA), and it requires that the safeguards of the Food and Drug Administration with respect to information requirements for medical personnel and patients as stipulated for the United States be applied to purchases made for consignment to the LDCs. On request, this information will be translated into the local language. (Approximately two-thirds of the oral contraceptives financed by AID through June 1970 were on behalf of private nonprofit programs, while bilateral government-to-government assistance accounted for the rest.) AID also helps to train the manpower to carry out family planning and population programs. Preliminary surveys in 37 countries indicate that over the next ten years manpower requirements for these programs will exceed 50,000 physicians, 150,000 nurses and nurse-midwives, 45,000 health and family life educators, 100,000 health and family planning home visitors, and 20,000 medical social workers.185 There will be an additional need for small numbers of demographers, behavioral scientists, communications specialists, and training specialists. To meet this challenge AID has stepped up development of manpower analysis skills in AID-assisted institutions, looking for a formula applicable to different countries and situations. It has also expanded its support of training in the skills needed in this field. Some of this training takes place overseas, although not necessarily in the specific country of the trainee; other trainees come to the United States. The training consists of special seminars, on-the-job training, academic work, or some combination of two or more of these. Four U.S. universities receive AID institutional support grants for training in this field. They are Johns Hopkins, North Carolina, Michigan, and Hawaii. A grant is also made to the Population Council to support advanced training of a small number of students overseas. Table 7 shows the total number of students receiving family planning and population training in the United States, both long and short term, through special courses funded by AID, as of October 1970. 134 The ideal method is described as one in which a "nontoxic and completely effective substance or method" can be self-administered on a single occasion and ensure the absence of pregnancy at the end of a monthly cycle. 135 U.S. Agency for International Development. "Population Program Assistance," 1970, op. cit., page 24. TABLE 7.-STUDENTS RECEIVING FAMILY PLANNING AND POPULATION TRAINING IN AID-FUNDED COURSES GIVEN IN THE UNITED STATES* National Center for Health Statistics: Measurement of population change 2. East-West Center, Hawaii: Population Studies 109 42 121 163 23 18 Government Affairs Institute for the Study of Human Reproduction, Columbia University: Clinical training. 37 87 450 Grand total. *Source: AID, "Population Program Assistance," 1970, op. cit., p. 27. 1 Participants in University of Chicago, Community and Family Studies Center, summer workshop who get field training at PPA. 2 Includes Vital Statistics, Survey Statistics, and Evaluation of Family Planning Programs. In addition, AID directly or indirectly assists the training of population program personnel in more than 30 countries. For example, in the Philippines some 1900 people underwent training at three separate institutions, while training personnel of the Philippines Health Department were themselves undergoing training in family planning in order to launch a department-wide course. In Chile more than 900 individuals received some form of short-term training. AID Assessment of Program Requirements Nevertheless, the number of people being trained in family planning and allied fields seems likely to fall far short of the requirements projected for the next decade. To train sufficient numbers would appear to require a greater cooperative effort, involving the developing countries, other donor countries, and international agencies, as well as the United States. AID itself, in the evaluation it conducts of its programs and projects, reached the following conclusions at its 1970 Spring Review: 136 First, family planning programs need to stress quality as well as quantity. Initial emphasis on quantitative targets could be self-defeating. Second, greater emphasis should be placed on the private sector, that is, on people who do not utilize clinics and hospitals. Abortion, of considerable importance in reducing fertility in countries where it is legal, also warrants increased attention. Third, younger "lower parity" mothers, mothers with fewer living children, should be reached with newer techniques like the pill. Present programs tend to reach older individuals who have already had several children. Fourth, family planning services should not be held back when more comprehensive health programs are lacking, even though it is extremely beneficial for a family planning system to operate in relation 136 Ibid., page 28. |