The global contraceptives market was estimated to be $22 billion in 2016  and projected to rise to $37 billion by 2025.¹ To promote contraceptive use, especially among youth, manufacturers and other familyplanning advocates commemorate World Contraceptive Day on September 26. Arguably, however, contraceptive profits would not have risen nearly so high without the decades-long efforts of the United Nations to drastically rein in population growth by  a variety of interventions to prevent conception or to intervene when it has already taken place.

In 1969, the United Nations created the United Nations Fund for Population Activities (later renamed the United Nations Population Fund) to address a broad range of population matters, from assistance with population censuses to various aspects of maternal care. However, with the Sixties’ newly developed contraceptive pills and other birth suppression devices creating a synergistic population control wave, UNFPA soon became a major protagonist in family planning. For years now it has employed the slogan: “Every child a wanted child,” without explicitly spelling out what one should do in the event of an unanticipated pregnancy.

The “birth of birth control” dates back to the early 1960s, when the “pill” was medically approved as a contraceptive. Now “liberated” women could have sex at will without fear of pregnancy. Due to contraceptive failure, the need for the safety net of legalized abortion soon became apparent. Not surprisingly, therefore, abortion was legalized not only in the United States but in other major countries by the 1970s.

In combination with other factors (including abortion), the contraceptive pill and other forms of pregnancy prevention contributed to a gradual decrease in fertility rates throughout most of the developed world. In the United States, fertility dropped during the 1960s and early 1970s to a level just at or above the population replacement level of 2.1 children per woman.² It then remained roughly constant until 2007, when fertility resumed its steady decline. In 2017, the American fertility rate was 1.76 (while the average fertility rate for the 28-member European Union was 1.57 and Japan’s fertility rate reached 1.41).

Today the only parts of the world showing high fertility rates are sub-Saharan Africa plus Afghanistan. Of the 224 countries, territories, and areas of the world for which there are estimated data, 105 are at or above the 2.1 level. The highest fertility rates are recorded by Niger (6.49), Angola (6.16), and Mali (6.01); at the bottom are Taiwan (1.13), Macau (0.95), and Singapore (0.83).³ Diagnosing high fertility rates as a chief impediment to health and prosperity, UNFPA moved to ensure sufficient stocks of “high quality” contraceptive products and actively encourage their use among an estimated 225 million women.⁴ Thus, UNFPA became a partner in the “Reproductive Health Supplies Coalition.” But first a word about “reproductive.”

Introducing the Sustainable Development Goals

The word “reproductive” enjoys significant status in the documents produced at the United Nations. UNFPA, WHO (World Health Organization), and assorted activists promote “sexual and reproductive health and services and reproductive rights” at every turn. They are especially persistent about including this language in the “outcome documents” produced at annual meetings of the Commission on the Status of Women, the Commission for Social Development, the Commission on Population and Development, and the High Level Political Forum on Sustainable Development. Activists then use these and other documents to persuade countries to fill “the unmet need for family planning” and ensure “safe and legal abortion”—ostensibly to reduce poverty, save women’s lives, and promote their empowerment.

Their biggest victory came in 2015 with the adoption by the United Nations General Assembly of the Sustainable Development Goals,⁵ which consisted of 17 goals, 169 targets, and 231 indicators with the ultimate aim of eradicating poverty by 2030. In Goal 3, relating to global health, activists succeeded in including the following language in Target 3.7: “By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.” In addition, under Goal 5, dealing with gender equality and the empowerment of women, Target 5.⁶ states: “Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.”

The Reproductive Health Supplies Coalition

UNFPA’s influence on population control extends beyond its individual activities. It is also a partner in the Reproductive Health Supplies Coalition⁶ founded in 2004. As of June 2018, this Brussels-based coalition consisted of 458 member organizations from dozens of countries (up from 203 in 2012), including 115 from the United States. Its primary purpose is expressed as follows:

The Coalition is a global partnership of public, private, and non-governmental organizations dedicated to ensuring that everyone in low- and middle-income countries can access and use affordable, high-quality supplies for their better reproductive health. It brings together agencies and groups with critical roles in providing contraceptives and other reproductive health supplies. These include multilateral and bilateral organizations, private foundations, governments, civil society, and private sector representatives.⁷

Non-governmental members include advocacy organizations, funders, manufacturers of pharmaceutical products and medical devices, various non-profits, and assorted academic institutes.

In addition to UNFPA, some of the more prominent members include the International Planned Parenthood Federation (which is headquartered in London), International Planned Parenthood/Western Hemisphere Region (headquartered in New York City), the Bill and Melinda Gates Foundation, Catholics for Choice, CARE USA, David and Lucile Packard Foundation, Engender Health, Evofem Biosciences, Family Care International, Female Health Institute, Friends of UNFPA, Guttmacher Institute, International Partnerships for Microbicides, International Consortium for Emergency Contraception, International Youth Alliance for Family Planning, Ipas, Jhpiego (an affiliate of Johns Hopkins University), MacArthur Foundation, John Templeton Foundation, Medicines360, Merck Sharp & Dohme, Male Contraception Initiative, PATH, Pathfinder International, Population Reference Bureau, Population Services International, USAID, United Nations Foundation (founded by Ted Turner), William and Flora Hewlett Foundation, Women Deliver, World Health Partners, the World Bank, and the World Health Organization.

Every few years the Coalition makes estimates for the perceived need and cost of family planning supplies—which are oddly referred to as “commodities”—for 135 low- and middle-income countries (as determined by the World Bank) in what they term the Commodity Gap Analysis. In their 2018 report they estimated that contraceptive spending in the prior year totaled $2.55 billion, of which $2.1 billion was funded by the private sector and $463 million by governments. To satisfy perceived future demand, the Coalition estimated that by 2020 there will be 493 million users of various contraceptive forms, requiring

$8.45 billion over the three-year period.⁸

“UNFPA Supplies”

The Coalition helps provide “UNFPA Supplies”—the distribution arm of UNFPA—with a market to purchase the “commodities” it needs. For pharmaceutical firms and other manufacturers of birth control devices, what bigger client could there be than the billion-dollar UNFPA with a global reach?

Bolstering the perceived demand for contraceptive commodities is the spurious concept of an “unmet need for modern methods of family planning” that presumably exists among women in the poorest countries. In somewhat loosely constructed surveys, women are asked elementary questions regarding having and spacing children. The context of “unmet need” is derived from those responses. With strong UNFPA promotion, over time “unmet need” has turned into “unmet demand,” as illustrated in one UNFPA publication: “UNFPA Supplies works in 46 low income countries with high maternal death rates, low contraceptive use and growing unmet demand for family planning.” (I have bolded “demand.”)⁹ Even the Secretary-General recently referred to progress made in meeting “demand” for “modern” contraception: “Globally, among women of reproductive age who are married or in a union, the proportion whose demand for family planning is satisfied by using modern contraceptive methods increased from 74.9 per cent in 2000 to 77.4 per cent in 2018. Progress has been more significant in the least developed countries, where this proportion increased from 39.4 per cent in 2000 to 58.5 percent in 2018.”¹⁰

UNFPA has turned itself into a global purveyor of contraceptives under the banner “UNFPA Supplies.”¹¹ Working mostly in sub-Saharan Africa, UNFPA takes the contraceptive products it purchases (sterilization and implants, intrauterine devices, injectables, pills, male condoms, and “other”) and distributes them for free, billing itself as “The World’s Largest Provider of Donated Con traceptives.”¹²

Several years ago, the Coalition’s website listed a more comprehensive set of “commodities,” presumably part of the “other” category. These included anatomical models (reproductive and sexual health education), manual vacuum aspirators and accessories, emergency reproductive health kits, sampling and inspection services, and condom testing services.¹³ (Note that this list included abortion instruments in addition to contraceptive devices.) However, the web page with this expanded list is no longer available. Besides “commodities,” UNFPA purchases various other goods and services to carry out its work, including vehicles (ambulances and mobile clinics), IT equipment, and conference organizing services.

Under “emergency reproductive health kits” are 13 categories of items for use in disaster and humanitarian crisis situations: administration/training supplies, condoms, clean delivery kits, post-rape treatment, oral and injectable contraception, treatment of sexually transmitted infections, clinical delivery assistance, intrauterine devices, management of miscarriage and complications of abortion, suture of cervical and vaginal tears, vacuum extraction delivery, referral level kit for reproductive health, and a blood transfusion kit.¹⁴ Currently, UNFPA is operating with these kits in the refugee camps of the Rohingya people who were expelled from Myanmar and fled to neighboring Bangladesh.¹⁵

Where does UNFPA get its funding? Primarily from government development agencies of developed countries and from wealthy foundations. The former include USAID and its counterparts in Denmark, Norway, United Kingdom, France, Germany, and others. It should be noted that government contributions for reproductive supplies count as foreign aid.

Significantly, in April 2017, the United States decided to defund UNFPA. According to the 2015 UNFPA Annual Report, the United States had contributed approximately $75 million that year. In fiscal year ended September 2016, USAID reported spending $30.7 million on “population and development issues, with an emphasis on reproductive health and gender equality” among various types of allocations made to UNFPA for that period. The spokesperson for United Nations Secretary-General António Guterres issued a statement urging other donors to increase funding to the organization to offset this loss.¹⁶

Conferences for Contraceptives—RHSC, Family Planning 2020, and Women Deliver

Just about every year the Reproductive Health Supplies Coalition has a general membership meeting. The last conference was held in Brussels in March 2018. This three-day confabulation covered a myriad of family planning topics, including many medical innovations. Coalition President John Skibiak, an anthropologist who has written extensively on development and reproductive health matters, offered this overview of their concerns and activities in his address:

I’d like to round out my review of 2017 by looking back on our growing body of work that explores the linkages between supplies and safe abortion. Last year, we saw the completion of four Innovation Fund grants in Asia, sub-Saharan Africa and Latin America. In Kazakhstan, our member Gynuity heightened provider awareness of a multi-level urine pregnancy test to monitor the successful completion of early medical abortion. In Nigeria, Ipas field-tested a mobile health app to help healthcare providers better track medical abortion and manual vacuum aspiration supplies on their premises, thereby reducing the frequency of stockouts. And in six Latin American countries, our partner CLACAI analyzed factors that have either favored or hindered the registration of misoprostol and mifepristone for safe abortion.¹⁷

Also of interest was the 2015 Coalition meeting held in Oslo and hosted by the Norwegian Agency for Development Cooperation (NORAD), which spon- sored an event on “access to safe and legal abortion.” This is but one example that the promoters of family planning are also proponents of abortion—always framed in carefully worded language, always stressing “safe and legal.”

In addition to the Coalition meetings, the contraceptives market received a major boost from the London Summit on Family Planning, a mega-meeting held in July 2012 that designated 69 countries (a subset of the 135 low- and middle-income countries mentioned previously) as targets for contraception.

Spearheaded by the Bill and Melinda Gates Foundation (which as of 2016 listed assets of $41.3 billion), a total of $4.6 billion was pledged for the “unmet need for contraceptives.” Poor countries “committed” to spend $2 billion, while the rich donor countries committed $2.6 billion to make “voluntary family planning” services available by 2020 to 120 million women and girls. Family planning was presented as a “cost saving intervention” beneficial to both families and national governments. Summit participants created yet another United Nations buzz phrase: Family Planning 2020, or FP2020, described as: “. . . global partnership that supports the rights of women and girls to decide, freely, and for themselves, whether, when, and how many children they want to have.”¹⁸

Additional efforts to boost family planning came from the Women Deliver movement. Between 2007 and 2016 they sponsored four major conferences— in London, Washington, Kuala Lumpur, and Copenhagen—to bring together  a diverse group of activists to promote the advancement of women, including through family planning. Attending the meeting were the Gates Foundation, Planned Parenthood, UNFPA and other UN entities, and a great number of NGOs (some 2500 separate organizations) operating in the sexual and reproductive health and rights area.¹⁹

Philanthropists for Contraception

Perhaps the strongest global promoter of family planning is the Bill and Melinda Gates Foundation, which has already donated billions of dollars to the cause. They and others also fund research to develop generic, lower cost versions of contraceptives, especially in lesser developed countries such as China, India and Thailand.

The expansive nature of the Gates’ involvement extends to their Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. They pledged at least $2 billion to the effort, which:

. . . conducts and facilitates cutting-edge research in family planning, reproductive health, and population dynamics and translates science into evidence-informed policies, programs, and practice. The Institute works as an innovator, partner, advocate, and convener to bridge the gap between knowledge and implementation and promote access to universal reproductive health and family planning for all.²⁰

Other American billionaire philanthropists also are involved in the contraceptive arena. One little-known effort involved the Susan Thompson Buffett Foundation, named for Warren Buffett’s first wife. One of the largest family foundations, with $2.6 billion in assets (2016), the Buffett Foundation entered into a multi-year project to develop a cheap, effective and safe IUD. It underwrote research in Colorado, a study in St. Louis, and finally the creation of a non-profit to manufacture the product after securing FDA approval. This very low-profile undertaking was brought to light in 2015 by a diligent financial journalist from Bloomberg BusinessWeek, who reported that “In the past decade the Buffett Foundation has become the most influential supporter of research on IUDs and expanding access to contraception.”²¹

The article also noted that in addition to the IUD development grant, “Much of the [Buffett] foundation’s other grants go to abortion-related work.”²²

Seeking Religious Leaders as Partners

UNFPA and its fellow travelers aim and claim to be “culturally sensitive” in their approach to family planning. They are aware that their “commodities” are naturally spurned, especially in many countries of Africa where children are regarded as “gifts from God.”

To gain converts, they first seek to win over thought leaders, community elders, or religious hierarchy on the benefits of family planning, arguing that having fewer children means more prosperity for families. These leaders in turn can influence the masses—and open up the market.

Through its extensive global network, UNFPA has had some success in acquiring religious partners, primarily through programs carried out in receptive countries. In 2014, for example, UNFPA held a meeting in Indonesia, the country with the largest Muslim population, to develop a training course based on longstanding successful family planning efforts in that country. The pamphlet promoting the course included this revealing statement: “The endorsements of influential Moslem Leaders to new ideas about family planning have facilitated their adoption by the community.”²³ UNFPA’s website offers the following commentary on relations with the “faith-based” world:

The United Nations is considered one of the world’s most secular institutions, with 193 member states representing peoples of different faiths and cultures and professing religious and agnostic beliefs.

Still, faith-based organisations (FBOs) continue to play a vital role in a wide range of issues on the UN’s political, social and economic agenda, including human rights, popu lation, food, health, education, children, peacekeeping, disarmament and refugees.

UNFPA, The United Nations Population Fund, is perhaps the only UN agency that has invested—heavily and systematically since 2002—in setting up a Global Interfaith Net- work of over 500 non-governmental organizations (NGOs) reaching out to disenfranchised communities worldwide.

These NGOs include World Vision, Islamic Relief, Caritas, the World Council of Churches, the Young Women’s Christian Association and CAFOD, the official Catholic aid agency for England and Wales.²⁴

Some of the organizations mentioned do indeed have extensive networks to carry out corporal works of mercy, but UNFPA is more interested in their “extensive networks” of service providers that would enhance distribution of their “commodities.”

Family Planning: A Human Right?

The United Nations has a habit of taking a “rights-based approach” to nearly everything they do, but especially in the procreative prevention area. However, the United Nations Universal Declaration of Human Rights,²⁵ which will commemorate its 70th anniversary in December 2018, makes no mention of reproductive rights or family planning rights. Rather, in Article 3, the Declaration states: “Everyone has the right to life, liberty and security of person.” And in Article 16 (3), the Declaration proclaims that “The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.” These are rights that UNFPA seems no longer to be interested in.

In May 2018, UNFPA issued a little-noted press release entitled: “Fifty years ago, it became official: Family planning is a human right.”²⁶ This press release referenced a UN International Conference on Human Rights held in Iran in 1968; the resulting “Teheran Proclamation” stated that: “Parents have a basic human right to determine freely and responsibly the number and spacing of their children.” However, the 2018 press release omits mention of a prior significant sentence in the Teheran Proclamation: “The protection of the family and of the child remains the concern of the international community.”

Ignoring the earlier reference to the “protection of the family,” the UN press release warned that, after 50 years, family planning is under attack and declared:

Until family planning is a universally available choice, this human right will not be fully recognized. UNFPA and the World Health Organization have recognized nine standards that must be met in every community, for every individual.

The key word here is “every”—which expresses the universal reach of the UN’s family planning claws. As perhaps the most extreme of the nine standards states:

Contraceptive information and services must be available in sufficient quantity, with sufficient variety, to accommodate everyone in need. This is a human rights necessity, just like access to clean drinking water, adequate sanitation and a minimum standard of health care.

In other words, the entire panoply of family planning services must be avail- able to everyone on earth, rich and poor alike, given that such services are as much of a necessity as drinking water!

Rewarding the Outstanding: The United Nations Population Award

Each year the United Nations gives two (occasionally more) population awards, one to an individual and another to an institution, for outstanding contributions made in raising awareness of population matters and their solutions. The award is considered the “most prestigious” in the United Nations system and consists of a citation, a medal, and an undisclosed monetary amount—all granted at an elaborate ceremony at headquarters every June. Awardees are selected by a committee of UN member states.

The first awards were granted in 1983 to Prime Minister Indira Gandhi of India and Qian Xinghong of China for their respective population control policies. China’s one-child policy created significant demand for contraception and abortifacients. In 1985, the International Planned Parenthood Federation received the award.²⁷ Some other members of the Reproductive Health Supplies Coalition have also received this award for participating in the reproductive rights agenda and its population implications.

In 2018, three awardees were nominated: Sir Prince Ramsey, a doctor from Antigua and Barbuda for his response to the HIV/AIDS epidemic in the Caribbean; and two institutions, Save a Child’s Heart of Israel which specializes in cardiac surgery for children in developing countries and the Guttmacher Institute of the United States, an offshoot of Planned Parenthood. Guttmacher was characterized as “a leading research and policy organization that advances sexual and reproductive health and rights in the United States and globally.”²⁸

Fertility Control: A Growth Industry

Almost from its creation in 1969, UNFPA has taken aim at population growth and “uncontrolled” fertility as primary obstacles to global health, prosperity, and the empowerment of women. Along the way, it has collaborated with large numbers of government entities, NGOs, and wealthy philanthropists similarly convinced that the key to addressing many of the world’s problems, particularly poverty and inequality, is pouring money into family planning initiatives. Not content with making contraceptives available to everyone, UNFPA also works to promote and provide abortion. Nearly fifty years after coming into be ing, UNFPA has achieved remarkable success in lowering fertility rates world-wide—and shows no signs of easing on the accelerator.

 

NOTES

1. https://www.transparencymarketresearch.com/pressrelease/contraceptives-market.htm
2. https://fred.stlouisfed.org/series/SPDYNTFRTINUSA
3. Data refer to 2017. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2127rank. html#ja
4. The Lancet/Women Deliver, “Deliver for Good,” 10.
5. https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustain able%20Development%20web.pdf
6. https://www.rhsupplies.org/
7. https://www.rhsupplies.org/uploads/tx_rhscpublications/Commodity_Gap_Analysis-2018.pdf
8. ibid.
9. https://www.unfpa.org/sites/default/files/resource-pdf/FINAL_UNFPA_Backgrounder_web.pdf
10. United Nations Economic and Social Council, “Progress towards the Sustainable Development Goals, Report of the Secretary General, E/2018/64, issued 10 May
11. ibid.
12. ibid.
13. http://www.unfpa.org/public/home/procurement/pid/3229 Originally accessed June 7,2013.
14. https://www.unfpa.org/sites/default/files/resourcepdf/1.%20UNFPA%20QA%20Framework%20 for%20Procurement_0.pdf
15. https://www.irrawaddy.com/news/dhaka-un-coordinate-contraception-campaign-rohingya-camps. html
16. https://www.un.org/press/en/2017/sgsm18483.doc.htm
17. https://www.rhsupplies.org/fileadmin/uploads/rhsc/General_Membership_Meetings/Brussels_2018/ Presentations/Day_2/John_Skibiak_-_State_of_the_Coalition.pdf
18. http://www.familyplanning2020.org/
19. http://womendeliver.org/wp-content/uploads/2016/09/WD2016_ConferenceReport_Final.pdf
20. https://www.gatesinstitute.org/about-us
21. Bloomberg BusinessWeek, The Buffetts’ Biggest Investment: How the billionaire’s family secretly funded a revolution in birth control.” August 3-9, 2015, 46-51.
22. https://www.mercatornet.com/articles/view/how_warren_buffetts_philnthropy_secretly_funded_con– traception/17162
23. UNFPA and BkkbN (Indonesian Family Planning Board), “Training on Developing Strategic Partner- ships with Faith-Based Organizations (FBOs) and Moslem Leaders in Family Planning,” Yogyakarta, 9-14 June
24. https://www.unfpa.org/news/faith-groups-partners-development
25. https://www.ohchr.org/EN/UDHR/Documents/UDHR_Translations/eng.pdf
26. https://www.unfpa.org/news/fifty-years-ago-it-became-official-family-planning-human-right
27. United Nations pamphlet, “Information note on the United Nations Population ”
28. https://www.unfpa.org/press/physician-two-ngos-win-2018-un-population-award