Preparing Biscuits Made of Dirt in Impoverished Haiti

In 1994, delegates from 179 nations met in Cairo to redefine the international policy regarding population growth. During this convention, the participating countries adopted a 20-year plan which emphasized the rights and aspirations of those countries to regulate population growth in order to achieve demographic and development targets. The result of the meeting, which would eventually become known as the Cairo Consensus, was the “first international document to recognize the interconnections between reproductive health, a sustainable environment, and economic development.”

These interconnections highlighted the necessity of increased family planning initiatives, which can prolong lives, improve health (especially for children), reduce the need for abortions, promote economic growth, expand life choices for women, decrease the spread of HIV/AIDS, and constrain the consumption of natural resources and the many environmental problems associated with the usage of such resources.

Family planning regarding when to have children, through the use of social and technical interventions and assistance, has come to be crucial in the agenda of the Cairo Consensus. In fact, it “encompasses any issue that relates to the health or disease of the reproductive system… linking family planning with maternity services, HIV/AIDS and STD information and services. These also could involve striving eliminate female genital mutilation/cutting, and supporting post-abortion care.”

The five main objectives of the Cairo Consensus were: 1) universal access to reproductive healthcare, 2) providing universal primary education and closing the gender gap in education, 3) reducing maternal mortality by 75 percent, 4) reducing infant mortality, and 5) increasing life expectancy. At the time of the convention, the United States was regarded as a leader on global reproductive health issues and committed itself financially and substantively to support the implementation of the goals through USAID and UNFPA (United Nations Population Fund). However, with five years remaining until the deadline for reform and aid, the U.S. along with other donor nations have provided less than 50 percent of the financial contributions they pledged at the time of the Cairo Consensus.

Global Family Planning Today

According to Joy Phumaphi, Vice President for Human Development at the World Bank, “The global economic downturn has taken a wrecking ball to growth and development in poor countries worldwide, and has become a development emergency for women because invariably they’re the first to suffer when economic crises strike.”

While the Official Global Development Aid for Health reported an increase in overall health-related aid for developing countries from $2.9 billion in 1995 to $14.1 billion in 2007, the figure for population and reproductive health differs only slightly from the $901 million in 1995 to the $1.9 billion amount in 2007. Due to the still wavering support of a number of the donor governments and their unfulfilled commitments to accelerate funding at specified levels, the family planning programs suffer from poor funding. The loss of these valuable funds invariably leads to soaring fertility rates and failed programs. Meanwhile, it has been proven that investment in women’s health advances the well being of communities and yet, the world continues to witness more than 500,000 women die each year because of preventable and treatable pregnancy and childbirth complications.

Phumaphi summarizes the problem by stating that “poor women endure a disproportionate burden of poor sexual and reproductive health because they run into financial and social barriers in obtaining access to basic but vital programs.” These disadvantages may eventually be thwarted by an adherence to the family planning initiative laid out in the Cairo Consensus, as well as by the Millennium Development Goals. A focus on family planning directly affects Millennium Development Goals three through six, which, respectively, seek to achieve gender equality, improve maternal health, reduce child mortality, and combat HIV/AIDS. However, all countries must be profoundly committed in order for such outcomes to be achieved.

While there are overarching justifications for increased funding, as well as emphasis on family planning worldwide, there are case-specific reasons why Haiti requires further international attention. Those involved with the economic development of Haiti must cast a critical eye on the country’s family planning situation in conjunction with the island’s ongoing struggle with poverty and stalled development, by demanding recognition and assistance for the reproductive and demographic health of Haitians.

Haiti in Crisis

With an estimated 9.1 million people, Haiti’s maternal health and family planning statistics are staggering. Of the 261,000 documented births per year, only 26 percent are aided by skilled health personnel, and only 85 percent of the women have visited a prenatal care center. Only 32 percent of married women ages of 15-49 use any form of contraception, whereas 25 percent of married women in this age range turn to more modern methods of birth control. Contraceptive use among sexually active single women ages 15-19 and 20-24 fares only slightly better with respective totals of 33 and 28 percent. Overall, only 46 percent of Haitian women from both urban and rural populations are satisfied with their available planning options.

Renewed attention to Haiti is crucial. According to a USAID report on Haiti, “links between population trends, poverty, and degraded natural resources are the central feature of Haiti’s vulnerability to tropical storms,” indicating a need for increased family planning due to the country’s dire economic and climatological conditions. As proven by the 2008 statistics in the report, the proclaimed request for family planning services is exceeding their availability in the country. In a 2009 query, 56.9 percent of married women did not want more children and 39.6 percent of women have expressed a need for family planning.

While there is nothing inherently wrong with a large population, problems arise when it surpasses what the economy and environment can support. Haiti’s unmet family planning need is due, in part, to the large portion of the population that does not have access to health care. The limited number of health centers and district hospitals are primarily found in more urban areas. This leaves the majority of the agrarian society to rely on permanent or semi-permanent sterilization methods as a fundamental family planning strategy, rather than short-term options such as birth control pills or condoms, thereby inadvertently persuading Haitians to avoid any method of contraception. Some may argue that cultural values in many of these impoverished areas are conducive to high birthrates. Women are undeniably expected and pressured to have children with their husbands. However, poverty cannot be assuaged until women are able to choose and control how many children to have and when.

Population growth is most severe among Haiti’s poor. 80 percent of the population lives below the poverty line and 54 percent of these live in abject poverty, and women from this lowest socioeconomic cohort have twice as many children than they would have chosen to have voluntarily. Furthermore, women from this group are unlikely to achieve sufficient levels of educational development to break the chains of poverty, thus cementing cyclical generations of poverty. The crushing weight of poverty forces primarily female-headed families to create habitations in the most climatological disaster-prone areas, such as on river banks and deforested lands, because they are the cheapest plots of terrain to be found. In a 1999 statement, former United Nations Secretary General Kofi Annan noted that, “growing numbers of poor people live in harm’s way on flood plains, in earthquake-prone zones and on unstable hillsides.”

“All of these conversations are really one conversation”

Despite this dreary outlook for Haiti’s future, there is some distant hope for social and structural progress. As the United Nations’ Special Envoy to Haiti, former U.S. President Bill Clinton stated in a recent press conference at the UN Headquarters in New York that “Haiti, not withstanding the total devastation wreaked by the four storms last year, has the best chance to escape the darker aspects of its history in the 35 years that I have been going there.” Latin News reports that Clinton’s overall goal is to create long term and sustainable economic and social development for Haiti. Clinton now hopes to encourage private sector investment and support for the Haitian government’s action plan “Haiti: A New Paradigm” that aims to create 100,000-150,000 jobs in the next two years. The United States will oversee the use of $121 million in development assistance to be approved by the World Bank over four years. Despite these promising developments, aid measures from the World Bank and international donors fail to clearly address the issue of family planning, and instead will only attempt to rectify the failed outcomes of overpopulation.

The $324 million pledged from international donors is solely for emergency and long term assistance. The aid provided by the World Bank is aimed at promoting growth and local development, investing in human capital (particularly education), and reducing vulnerability to natural disasters. However, most international donors, especially the U.S., consider foreign aid provided to developing countries as fruitless, with large amounts of funding have resulting in little progress, such as the case in Haiti. What the international community must realize is that little progress will be seen in promoting sustainable economic and social development until reproductive health and population growth are addressed. Given the typical overwhelming family size, the ability of Haitians to financially support themselves is not likely to occur anytime in the near future. Development in Haiti will be stalled if donors do not mandate that a portion of the long term assistance aid be given to improving family planning options.

In the end, the U.S. and other wealthy donor nations must acknowledge and be prepared to formulate better development goals for poverty-stricken nations that focus on family planning and sustained population growth. Not only is more assistance required, since only about one percent of the U.S. budget is currently put towards foreign aid, there also needs to be a consensus that some aid should be directed at the grassroots level (such as family planning) before being applied to grander development projects down the road.

Charlotte Griggs is a research associate with the Council on Hemipsheric Analysis, from where this article was adapted.