Foreign Aid for Abortion

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Foreign Aid for Abortion

Author(s): Donald P. WarwickSource: The Hastings Center Report, Vol. 10, No. 2 (Apr., 1980), pp. 30-37Published by: The Hastings CenterStable URL: http://www.jstor.org/stable/3561278 .

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--POLITICS, ETHICS & PRACTICE

F o r e i g n A i d f o r Abortion

by DONALDP. WARWICK

1A id for abortion s the most sensitive subjectin theentirefieldof nonmilitaryoreignassistance.No topic willmakea foreignaid officialblanchmorequickly,andnonewill be greetedwithgreaterwariness n disclosing nforma-tion. The question s so emotionallycharged hatvirtuallynothinghas been writtenabout it. Data on internationalabortionactivitiesare typicallynot reportedat all, arere-served for classifieddocumentsof restricted irculation,or

are buried undersuch generic names and euphemismsas

"surgicalmethodsof familyplanning"or "menstrualegu-

lation." As a consequence t has not been easy to gatherdata for thisarticle,whichis the firstattempt o surveythefield. Officials nvolvedwithforeignaid for abortionwere

generally willing to discuss their work, but were vagueabout details and wary of public attention.However, by

combining nformationrominterviewswith scatteredrag-ments of existing dataone can begin to constructa com-

posite pictureof the international bortion cene.'

The CurrentScene:An Overview

Beforeconsideringhe activitiesof specificagencies,it is

worthnoting

the broad eaturesof the terrainn whichtheyoperate.It is an environmentmarkedby complexity,ambi-

guity, human misery, political tension, and bureaucratic

trepidations.First,apart romany outsideintervention,nducedabor-

tionis a commonpractice n the developingcountries.Not

only is abortionfrequent,but it is a prominentcause of

death and illness among women of childbearingage. InLatinAmerican ountries llegalabortions ftenaccount ora third of maternaldeaths;women whose abortionshave

been mishandled ill half or more of the country'shospitalbeds. And unlikethe situation n the UnitedStates, where

contraceptions generallyavailableto those who want it,

many of the poor women who resortto this methodareunawareof ordo nothavereadyaccessto moder meansof

birth control. While the statisticscited are often used to

argue orlegalizedabortion, heyhavealso beena sourceof

concernto those categoricallyopposed to abortion.They

DONALDP. WARWICKs an Institute Fellow at the HarvardInstitute or InternationalDevelopment.Thisarticle is adaptedfrom a presentationat the National Conferenceon Abortion,

University of Notre Dame, October1979, and will appear in

J.T. Burtchaell, ed., AbortionParley (Mission, Kansas: An-drews and McMeel, 1980).

haveled some Catholicbishopsto soften theiropposition o

contraception,whichthey saw as the lesser of two evils forwomen faced with unwanted children. Whatever one'smoralviews on abortion, he figurespointto a human rag-edy that cannotbe ignored.

Second, foreignaidfor abortion s but a smallproportionof the total aid for populationactivities.Despiteoccasionalrumors hat abortions a mainstayof populationassistance,foreignaid for thispurposeaddsup to less than a quarter fone percentof the totalspentforpopulation.On the supplysideforeigndonorshave beenpreventedby law orinhibited

by politicsfrom

pouringvast amounts nto this controver-

sial area. On the demand ide, despitethe widespreadprac-tice of abortionby individualwomen, it remains llegal in

manycountriesand a pointof moralandpoliticaldebate nthe domesticpolitics of these countries.Hence even if thetotal volume of fundsavailable or abortionwere increasedtenfold, the money would not be quicklyor easily spent.

Third, with the exception of United Nations agencies,mostorganizationsupplying undsfor abortions perateona clandestineandusuallyillegalbasis. As one expertcom-

mented,"Not even yourbest friendswill tell you whattheyaredoingoverseas."In some countries, ncluding he Phil-

ippines,aid for abortion s bothagainst helaw, andagainst

thecountry'sofficialpopulationpolicies. Thisis not to denythat there are many ambiguitiesaboutwhat, precisely, is

"legal," or that officials who speak publicly againstabor-tion may give tacit support o clandestine oreignaid sup-porting t. The gap between rhetoricand realityis greaterherethan n most spheresof development, or understanda-ble reasons.Nevertheless,severelegal and culturalrestric-tions on abortion reatea climate n whichprivateagenciesprovidingabortionservices may behave more like intelli-

gence operatives han bearersof foreignaid.

Fourth, he mostcommontypeof foreignaid involves the

techniqueknown as uterineaspiration.Thisgoes undervar-ious code

phrases, especially"menstrual

egulation"and

"menstrual nduction." The essential feature is that thewombis efficientlyemptiedwithout orcefuldilationof thecervix.2 The InternationalProjects Assistance Service

(IPAS) manufactures he requiredequipment,and almostall the organizations ctive overseasdistributekits for this

purpose. In many countriesdoctors, nurses, paramedics,and midwivesarebeing providedwith such kits and trainedin their use.

Fifth,abortionn thedevelopingcountries an be a profit-makingproposition.Especially n urbanareasand wherea

countryhas tastedthe fruits of development,as in Taiwan

HastingsCenterReport,April1980

- l

30





thesemethods,which is conductedby collaboratorsn sev-eralcountries,does involveabortion,butunder hetermsofthe Helms Amendment t is permissible o long as there isno activepromotion rprovisionof services.AID also sup-portstrainingprogramsn which medicaldoctorsaregiveninstruction n abortionmethods under the conditions out-

lined earlier.Coupled with the political controversies surrounding

abortion, he Helms Amendmenthas affectedAID and its

fundingrecipients n many ways. Mostimportant,heover-all level of monitoring ndcontrol n this field has increasedat least fivefold. Sensitive to the political dangersat stakefor themselves and the agency, administrators,awyers,contractofficers,andauditorsn AID andelsewhere n the

governmentkeepa close watchon anyactivitieseven closeto abortion.WithinAID, officials must be exceptionallycarefulof what heydo inthe first nstanceand then clearall

proposals hroughmultiple evels of approvals.Needless to

say, this process dampensthe enthusiasmof those mostcommitted o providingabortion ervices.Organizationse-

ceiving AID funds, most notablythe International lannedParenthoodFederationIPPF)andthe Pathfinder und,arealso under strong pressure to maintain detailed records

showingthatAID fundshave not been used for abortion.Where there s doubt,the burdenof proofis on the receiv-

ing organization.Thisis a classicalcase of thepoliticalcon-text of administrationconstraining public officials tominimize controversy.Recipient organizationshave alsobeen forced to changetheir entirereporting ystemandaddtheir own auditors o deal with the demandsandquestionsof monitors romthe government.

The only two major agencies thatdo operateopenly inthisfield, thoughwithoutpublicityandon a smallscale, arethe WorldBank andthe United NationsFundfor Popula-tion Activities (UNFPA). The UNFPA's policy is to re-

spond to countryrequestsfor assistance for all kinds of

populationprograms,provided hatthey are within the or-

ganization'smandate and do not violate UN policies onhumanrights.The UNFPAplacesno restrictions n meth-ods of fertilitycontrol,andis willing to entertain equestsfor abortionassistance.To dateit has providedsuch assis-tanceto India, Thailand,and Tunisia. It also contributesothe Special Programof the World Health Organization,which

includesresearch n methodsof abortion,andto uni-versityresearchprograms nvestigatingabortionmethods.In 1979 UNFPA assistance for all activities in abortioncame to less than one-quarter f one percentof its total

budget. The WorldBank operatesundersimilarpolicies,andspendsaneven smallerproportion f its fundson abor-tion. While both organizations eceive substantialundingfrom the United States for a wide varietyof aid projects,theirpositionis that the monies providedmust come withno spendingrestrictions.They will thus resistany attemptby contributorso imposea curb on abortionexpenditures.

Major philanthropicorganizations,including the Ford

andRockefellerFoundations,havealwaysshiedawayfrom

funding abortionprojects. While Ford has long been afrontrunnern support or populationactivities, and for atime was the largestsingle contributoro the field, it has

consistently urneddown projects nvolving abortion erv-ices. The RockefellerFoundationhas been similarlyin-

clined. Despite some urgingfrom AID and otheragenciesto fill the gap createdby the Helms Amendment,estab-lished foundationsapparentlydecided to avoid abortion

projects.Two reasons were cited by personsfamiliarwiththese organizations.The first is thatassociationwith abor-tion couldtouch off controversieshatwould mpairwork nless volatile areas of higher priority.The secondis thatthe

illegal natureof abortion n many countriesand the com-monuse of clandestineechniques o promoteabortion erv-ices would cause considerable squeamishness amongprofessionalstaff members at the foundations. Criticsac-cuse these organizationsof excessive caution springing

froma desire to protect heir magein the "establishment,"while moresympathetic bserverscommend hemforcom-mon sense and adherence o the law and to their basic in-stitutional alues. Whatever he case, the largefoundationshave given little more thanmoralsupport o international

programs or abortion ervices.The PopulationCouncil of New York falls somewhere

between the foundationswhichhelp to keep it in existenceand more activist agencies. Perhapsthe single most re-

spectedprofessionalorganizationn population tudies,theCouncil has had a notableimpacton populationpolicies,programs,andresearch n manynations.In legal constitu-

tion, internalorganization,staff composition,and institu-

tional demeanor t is much like a large foundation. Theword "professionalism"was citedby manystaff membersas a keynoteof the Council'sbehavior,whilethe desirefor

cooperativerelationshipswith governmentshas generallyled to an "above board"approachn technical assistance.One mightthusexpectthat t wouldhave some of the same

antipathieso abortionprojectsas the Ford andRockefellerFoundations,with which it is in close contact.At the sametime the Council has undertaken dvisoryassignments nthe developingcountries, ncludingprojectscarriedout in

very delicatepoliticalenvironments. t also did not shrinkfrom controversywhen it developed and promotedthe

Lippes oop,and whenit becamea frankadvocateof volun-

tary family planning programs.But from its inceptionin1952until 1976 its activities on abortionwere confined toresearchand writing. Duringhis presidencythe late Ber-nardBerelson had serious ethical and prudential eserva-tions aboutforeignaid for abortion,andhis boardseemedto sharethose misgivings.

In 1976 thepresidencypassedto GeorgeZeidenstein,andin a report o the boardthatJune,Zeidensteinmadethreerecommendationselated o abortion:1) that the Council's

purposeshould be, inter alia, to "stimulate,encourage,promote,conduct,support . . abortion;" 2) that its Bio-




MedicalCenterengage in "mission-orientedesearch"onabortionechnology;and(3) that heorganization ddabor-tion to the "rangeof services" it provides.4This recom-mended change drew a strong dissent from trusteeJohnNoonan, Jr., who resigned n protest.Despitethis shift in

policy, over the past threeyearsthe PopulationCouncil's

involvementwithabortionhasbeenminimal,andnotstrik-ingly differentfrom the period before 1976. ChristopherTietze continues to conductstatisticalresearchon variousfacets of abortionandthere are some smallresearchefforts

overseas,but on the whole the PopulationCouncilremainsmorelike the Ford Foundationhanmoreactivistagencies.The reasonsareprobably hesameas in the foundations-afear thatcontroversy verabortionwill cripple heorganiza-tionin otherareas,problemsof professional elf-imageforstaffmembers,anddifficulty n actingwithoutbreaking helaws of othercountries.

The InternationalPlanned ParenthoodFederation ofLondon(IPPF)has been the most outspokenadvocate of

legal abortion ervicesin the developingcountries,thoughnot the most ardentpromoterof such services. TheIPPFisthe centraloffice for several dozen semi-autonomous ri-vate nationalfamily planning associations. As a central

body it receives fundsfrom international onors,includingAID, andpasses money andsupplies alongto the local as-sociations.It also tries to setpoliciesand standards pplica-ble to all associations, ncludingpolicies on abortion.TheIPPF's statedposition is that abortion should be legallyavailable o those who desire it and that local associations,when possible, should assist in providing the necessaryservices. But while it has considerable everage from its

fundingposition,theIPPFmust also respect he constraintsandpreferencesof its local affiliates.Inpractice hecentraloffice can recommend,lobby, and cajole, but it cannotforce a memberassociation o takeactionon abortion.

Despiteits frequentpronouncementsn the need for safeandlegal abortion ervicesand ts lobbyingefforts n manycountries, heIPPFspendsonly aboutone-thirdof one per-cent of its total funds on abortion.As of 1978it hadcarriedout specific projects n ten countriesas well as variousre-

gionalandglobalefforts, mostlyin training.In the Philippines,whereabortion s bothillegal and ex-

plicitly againstofficialpopulation olicy, theIPPFprovided200 "menstrual

regulation"kits for demonstration

pur-poses. IPPF also conducteda local seminarthat set off

sharpcontroversy.Beginning n 1974theIPPFaffiliate, he

FamilyPlanningOrganizationf thePhilippinesFPOP)or-

ganizeda seriesof meetingsunder he title of "SymposiaonAdvancesin Fertility."5The topics includedmedicaland

legal aspects of abortion,proceduresand techniquesof

abortion,andthedangersandattendant ealthrisks of abor-tion. The firstmeetingtouchedoff a stormof protest rom

religiousand civic leaders, and led the government o re-

affirm ts officialopposition o abortion.Nevertheless,theFPOP continued ts symposia,whichwereclearlyaimedat

legitimizingdiscussionof abortion n the Philippinesandwhich were madepossibleby fundingfromIPPF.

Furthercontroversyarose when the FPOP distributed"menstrual egulation"kits to local doctors.Althoughthegovernmenthad laws specificallyprohibiting he importa-tion of abortivedevices, these kits were brought nto the

countryas "medical nstruments"o obtain"sample issuefor examination."While aware that the vacuumaspiratorshad been importedand were being distributed o privatedoctors, the government'sofficial body in this field, theCommissionon Population,chose not to take action.SincetheFPOPdidnot take a publicstand avoringabortion,andsince it did not use these devices in its own clinics, theCommissionfelt that its regulatorypowers were limited.Otherobserversconcluded hatPOPCOMofficialswere de

facto notopposedto suchundergroundctivitiesso long as

they generatedno publicuproar.These examplesshow the

potentialof the IPPFand its collaborating rganizationsor

circumventing ational aws andpolicies, andalsosuggestthatofficialsresponsiblefor enforcingthose policies may

themselves not be totally opposedto theirviolation.One of IPPF'slargestprojects, totallingabout$62,000,

was in Bangladesh,where 5,000 vacuum aspirationkitswere provided to the local family planning association.These kits have also been suppliedto Korea, Singapore,Hong Kong, Thailand,Vietnam,and India.Althoughmostof theseprojectshave been relativelysmall-usually under$30,000-the IPPFhas notprovideddetails of its activitiesin its published reports,even in its main reportto donor

agencies.6Onereason,apart rom theillegalandcontrover-sial natureof these activities,may be that the federation s

underconstant crutiny romthe U.S. governmento insurethatit is not violatingthe Helms Amendment.

Anotheractivistagency, andone thathas beenmorewill-

ing to "go public"with its activities, s thePathfinder undof Boston.Pathfinderwas founded n 1929by Dr. ClarenceGambleto find new ways of promotingbirthcontrol. Itscharacteristics ave been innovation,small size and quickaction. In recent years innovationhas meant activities in

abortion,particularlyhepromotion f the uterineaspirator.A Pathfinderlyerissued around1975 states:

Abortion-safe, legal, and available-is important s a backupfor contraceptive ailure, and as a way to bring women into

programsof contraception t themomenttheyare mostsuscep-tible to persuasion.But because of the Helms Amendment othe foreign-aidlaw, no AID money can be spent to promoteabortion. Thereforewe do this importantwork with moneyraisedfromthe privatesector.

Pathfinder s encouragingthe establishmentof abortionas awoman'sright.We arepromoting he early-abortion rocedureknown as "menstrual nduction"-through publications,dis-tributionof instruments,and directgrants.And Pathfinder as

sponsoreda majorconference.7

In recentyears Pathfinderhas engagedin two kinds ofabortionactivities:helpingto establish clinics in countries

TheHastingsCenter 33



whereabortion ervices areillegalbuttoleratedby thegov-ernment;anddistributing acuumaspirationkits to clinicsandprivatepractitionerswho wish to use them. Thusit has

recentlyworkedwith a local doctorto open a privateabor-tion clinic in Colombia,andhassimilaractivitieselsewherein LatinAmerica. When asked about the legality of this

move in Colombia,an individual amiliarwith the projectsaid thatthe clinic was indeedillegal, but thatprosecutionwas unlikely,if only becausethe childrenof publicfigureswereusingits services.A staffmember urther ommented:"Whereabortions culturally cceptablewe don'tthink hatthe law is restrictive n an ethicalsense. We are also con-cernedat thepracticalevel-will it be enforcedornot."Helikewiseraised a crucialpointabout egality:the differencebetween the laws on the books andthe laws as interpretedby the government.In Bangladesh,abortion s still tech-

nically illegal in most cases, but the governmenthas in-structed medical schools that by 1981 the country's420local health centers should offer "menstrual

regulation"services. There is thus a differencebetween the law andexecutiveregulations,with the lattertaking precedence n

Bangladesh.The PathfinderFund, whichreceives over 90 percentof

its fundsfromAID, has been hardhitby theHelmsAmend-ment. The net effect has been to force the organizationochoose betweenproviding amilyplanning ervices withoutabortionor abortionwithoutbroader ervices.If Pathfinderwantsto helpestablisha familyplanningunit withoutabor-

tion,AID will coverall ormost of the costs. Butif abortionis included,AID will provideonly thecontraceptives.As aPathfinder fficialputit, "The Helms Amendmenthas dis-

astrouslyaffected populationprogrammingby destroyingall the linkagesbetweenabortionandcontraceptive ecruit-

ing." Pathfinder asalso been forcedto change ts account-

ing and auditingsystem in orderto convince governmentmonitors hatno federal undsarebeing spentforabortions.

One of the most influentialandyet anomalousorganiza-tionsin this fieldis thePopulationCrisisCommittee,whichhas been a powerful obbyistfor birthcontrol n Washing-ton. This organizationhas been very much "up front"on

the UnitedStatesdomesticscene. With ts boardmadeupofretiredambassadors ndgenerals, prominentbusinessmen,andother notablepublic figures,it wouldseem an unlikelysupporterof illegal abortion activities overseas. And yetthat is precisely what it does outside the United States,thoughneverunder ts own name. A recentUN documenton populationprogramsandprojectscontainsthis descrip-tion of the PopulationCrisisCommittee/Draperund:

PCC/DFworksto generatesupport orreducingworldpopula-tion growthin two basic ways: throughhigh-leveladvocacyathome and abroad to increase government commitment to

strong,effective family planningprogrammes; ndthrough ts

highly selective supportof innovative, cost-effective privatefamilyplanningprojects n developingcountries. . . Througharrangingprivate supportof special projects overseas, PCC

makes possible indigenous activities that can be readily ex-

pandedor replicated.8

While abortion s not specificallymentioned n this de-

scription,closercheckingrevealsthatthis is its major ormof "innovative,cost-effective,private amily planningproj-ects." Abortionactivitiesaccountfor aboutone half of the

Committee's "Special Projects" and about one-fourth of itsinternational budget. The organization works as follows:

PCC has no overseas operations. Instead, it funds or finds

fundingfor selectedhigh-leverageprojects nitiatedby or rec-ommended o PCCby IPPFandotherfamily planning/popula-tion organizations hat have a proventrack recordin overseas

operations.Projectsareundertakenn collaborationwithindig-enous leaders andgroups . . . Projectsselected for supportarethose thatpromiseexceptionalreturn n lowered birthratesperdollarinvested. Typicallysuchprojects nvolve one of the tenmostpopulousThirdWorldcountries; hey demonstrate r ex-tend an approach o delivery of family planningservices thathasprovencost-effectivein loweringbirthrates n similarcon-

ditionselsewhere;theyrequireprivatemoneybecause thegov-ernment s notreadyto accepta new approachuntil it hasbeen

provensuccessful;andthey include a sensibleplanfor expan-sion or replication.9

At present the Population Crisis Committee leans stronglytowardprograms nvolving the participation f local busi-nessmen.Inabortionprogramsheyspeakof a three-leggedstool involving a doctor, who provides the services, the

woman, who receives them, and the businessman, who or-

ganizes them to generate a profit. In practice, PCC looks for

projects in which a small amount of seed money can be

used by local entrepreneursto launch self-funding abortion

activities on a much larger scale. PCC officials offer as an

examplea project n Taiwan n whicha loanfor one clinicultimately led to a total of nineteen, all patterned exactlyafter the first. PCC prefers projects in which abortion serv-

ices are closely linked to contraception so that the experi-ence is not repeated. The following are some of its projects:

Philippines: Menstrual Regulation Training. To train and

equipdoctors to performmenstrual egulationon the islandofMindinao. $34,000 committedfor two years beginning May1978 to InternationalProjectsAssistanceServices.10

Colombia:Bogota PregnancyClinic. To provideinexpensive,humane reatment or incompleteabortionsusingthe new tech-

nology developed for simple first-trimester bortion,to train

doctors throughoutLatinAmericain these abortionclean-uptechniques,and to reduce the incidence of abortion n Colom-bia by using the occasion of botched abortion to involvewomen in appropriateamily planningpractices."

Bangladesh: (1) AbortionTrainingand Supplies. Training ordoctors from governmenthealth centers, mobile camps andhealthdistricts n the use of the latest abortion echniquesand

supplyof non-electricalvacuumaspirators.$8,356 committedfor one year to InternationalProjectsAssistance Services. (2)Abortiontraining. To train new doctors and qualified para-medics in early abortion,menstrualregulationand the treat-ment of incomplete abortions as well as contraceptive




counseling n 6 regionaland 2 Dacca medicalcolleges.$35,000committedoroneyear o thePathfinder und.12

The agenciesmost oftenchosen forprojectexecution arethe PathfinderFund and InternationalProjectAssistanceService (IPAS). PCC officials feel that private abortion

services have a brightfuture in the developingcountries,mainlybecause they are profitableand thus appealto the

entrepreneurialnstinctsof localpeople. They also feel thatthe Helms Amendmentmay have been a blessing in dis-

guise, for it has forcedabortionadvocates to rely less on

largedonorsand thepublicsectorand makeproductive x-

plorations nto abortionas a businessventure.Beyond its

catalyticrole in stimulatingabortionactivities,the PCC isthe Americanpurchasing gentfor theIPPFandsupplies twith vacuum aspirationkits manufactured y the IPAS.

Thoughunobtrusiven its internationalperations, hePCCis undoubtedlyone of the most influentialagencies in thisfield. And besides its own indirect

undingof

abortionandotherprojects,PCC takes an active role in fundraising.The mostagressiveorganizationn this arena s the Inter-

national Projects Assistance Service (IPAS), formerlyknown as the InternationalPregnancyAdvisory Service.This is anorganizationhat is disreputable ndproudof it.Itspolicy is to movein wherevert can topromoteabortion.As aformer taff member aid, "Ourpolicyis that he moreabortions illegal, the more attractivet is because t is nec-

essary. If it is legal otherorganizations an handleit." At

presentIPAS worksin three areas:(1) providing oans forthe establishmentof abortionclinics; (2) manufacturingvacuum aspirationequipmentfor sale to other organiza-

tions, such as Pathfinder ndtheIPPF;and(3) directabor-tion services. Theirstrategyon this last front is to identifydoctorswho are nterestedn abortion,whether t is legal ornot, andthenhelp themto initiatenew services. They arenow supporting linics in some twentycountries, ncludingMexico, Brazil and Indonesia,where abortion s illegal.Theyare alsotrainingmidwives nthePhilippineso use thevacuumaspirator, venthough histechniques specificallybannedby the government.In Bangladesh,Pakistan,Sri

Lanka,Thailand,andMexico, IPASoffers vacuumaspira-tor kitsthrough directmailprogram,andprovides rainingin theiruse. They find themselveshandicappedn raising

funds, mainlybecause their direct action tactics leave

potentialdonors uncomfortableabout supportinga "pa-riah."Foundations uch as Fordand Rockefellerareunwill-

ing to support hem, while AID is unableto do so. Hence

theymustdependon grants romthePCCandotherprivatesourcesas well as on the revenuesgeneratedby their oan

programand manufacturing perations.Although,as theyputit, "ourresponse s always yes," the ExecutiveDirectorclaims that the funds availableare much smaller thantheinterest hey find in expandingabortion ervices.

Otherorganizationsnvolvedin some aspectsof abortionare FamilyPlanningInternationalAssistance, the interna-

tional division of the Planned ParenthoodFederationofAmerica; Population Services International;and Johns

HopkinsUniversity,whichprovidestraining n techniquesof abortion.But the most critical actors are IPPF, Path-finder,the PopulationCrisisCommittee,and IPAS.

Toward New Groundfor EthicalDebate

Foreignaidfor abortion aisesa host of ethicalquestions.Themostbasicis, of course,themoralityof abortiontself.Debateon this issue is not simplewithinthe UnitedStates,but it becomes immensely more complicatedwhen thescene of action involves two or more nations. The root

problem s thatthere s no universallyacceptedethics, noreven a commonlanguage or debatingmoral ssues acrosscountriesandcultures.Thus whenwe ask whatethicalprin-ciples shouldguidethe UN in aid for abortion,we quicklystumbleoverthe questionsof what andwhose moralviews

shouldprevail.Shouldwe opt for a franknationalrelativ-ism, allowing each governmentto announce its moralstandardsand then having the UN respect those judge-ments?This position is appealing n its simplicity,but itclashes withthe conceptof universalhumanrightsalso en-dorsed by the UN. And where governmentshave une-

quivocallystated theiropposition o abortionon religious,moral,orpoliticalgrounds,shouldpro-choiceadvocates ryto claimthat heirconceptionsof individual ights akeprec-edence over nationalsovereignty?These are tough ques-tions that will not be resolved with instantabsolutes or

readyrelativisms.And the debateis not likely to progressvery far without much more systematicwork on a cross-

culturalandcross-national thics. At this time ourpovertyof principles s outdoneonly by the richness of rhetoricalflourishes n the abortiondebate.

Whilethe moralityof abortionwill remain heparamountquestion n evaluating oreignaidfor thatpurpose, t is nottheonly issue atstake. Otherquestionsarise rom theobjec-tives, processes,andcompositionof international ssistancein this field.Theremaywell be situationsn which themoststaunchpro-choice advocate would concede that certainkinds of foreignaid for abortionareunjustified,andwhere

equallyardentpro-life representativesmight grantthat aidfor problemsrelated o abortion s ethicallyacceptable.Tostakeoutsome new

groundor ethicaldebate t will be

help-ful to begin with threeworkingprinciples.The first is that the overarching goal of foreign aid

should be individualandfamily welfare. All assistance othe developingcountriesshould aim to promotesuch uni-

versallysoughtgoodsashealth,education,a decent evel of

living, self-respect,and the abilityto controlsignificantas-

pectsof one's existence.Whilethisprinciplehas been used

by pro-choiceas well as pro-life groupsto supporttheir

respectiveclaims,therearequestions ranscendinghe usualdebates.The broadestmplicationof thewelfareprinciple sthat foreign aid should be used to remove or reduce the

The HastingsCenter 35



conditions eadingpoorwomento seekabortionsn thefirst

place. Basically, these conditions are poverty and igno-rance. A welfare orientationwouldarguestronglyagainstforeignaid for abortion hat does nothingto changethe so-cio-economicconditions eadingto high fertility.A single-minded concernwith the fertilityvariable seems inconsis-

tent with the promotionof individualand family welfare.Thesame criticismwouldapplytopro-lifegroups hatseemmore intent on stopping foreign aid for abortion han on

increasing heamounts penton generaldevelopmentactiv-ities. Indeed, if pro-lifeforces align themselves with anti-UN lobbies to cutoff all American unds to the WorldBankand the UNFPA, as has been threatenedn the past, theywouldjoin theirantagonistsn anobsessionwithfertility othe detrimentof economicjustice.

The welfareprinciple urther uggeststhatforeignaid forabortionwould not bejustified f its sole orprimary imwasto bringdownthe birthrate.It wouldseema flagrant iola-tion of welfare o use the

desperationf women for

popula-tion control while doing nothingto remove the conditions

producing uchdesperation.Specifically,programsprovid-ing only abortion ervices, withno assistance or health or

contraception, would be ethically suspect on welfare

grounds,anddoublyso whenthey yield a profit.The wel-fare criterionmight also arguefor foreign aid to treatin-

complete abortions. Humancompassioncalls for helpingwomenwho incur the risk of death or serious illness from

badlyperformedabortions,even if one disapprovesof thesourcesof thatrisk.Manyphysiciansof pro-life sympathieshave no moralqualmsaboutprovidingmedical servicesinthesecircumstances, lthough heywouldreject hepreven-

tivestepof medicallysupervised bortions. n short,raisingthe questionof welfaremay help to take the debate about

foreignaid to at least a few steps beyondthe polarizationthathas been its hallmark o date.

A second principleis thatforeign aid for populationshould respectnationalautonomy.The WorldPopulationPlan of Action, approved n Bucharest n 1974, sets forththefollowingguideline:"Theformulation ndimplementa-tion of populationpolicies is the sovereign right of eachnation. Thisright s to be exercised n accordancewith na-tional objectives and needs and without external inter-ference. . . . The main responsibility for national popula-tionpolicies andprogramsies with nationalauthorities."13Adherence o thisprinciplewouldseem a prima acie obli-

gationfor international onors.According o this normtheUNFPA and the World Bank would be justified, on pro-ceduralgrounds,in supplyingaid for abortion o countries

requesting heir help. By the same token the clandestineactivitiesreviewedearlierwould be unjustified,particularlywhen abortion s not only technically illegal but directlycontravenesa country'sofficialpopulationpolicy.

Threeoverlapping rguments ave been raisedagainstre-

spectfor nationalautonomy.The first s that n manycoun-tries aws aboutabortionhave no moral orce sincetheyare

merelyvestigesof colonialismand are notobserved nprac-tice. One pro-choicephysician compared hem to the anti-

quatedlaws on the books in many states, such as those

governingthe positions of men and women walking to-

gether.A specificcase cited was Bangladesh,wherelawsandexecutiveedicts were patentlycontradictory.This ex-

ample does suggest that there are legitimategroundsfordebate about what really constitutes a country'spolicies.Where the government tself openlyrequestsaid for abor-

tion, donoragencies would obviously not be violatingits

autonomyby providing uch assistance.But wherethegov-ernment s manifestlyandforcefullyon recordas being op-posed to abortion,as in the Philippines,and assures itscritics thatabortion s not beingpracticedwiththe consentof nationalauthorities,covert foreign aid for abortion to

nongovernmentalecipientswould violate autonomy.A second argument s thatforeign aid programsshould

honornot the laws thatare on the books, but the laws ofcultural

preferenceas

expressedn citizen'sbehavior.Thus

whenlargenumbersof womenby theiractionsshow a clear

preference or abortion,donors shouldrespecttheirwishesrather hanoutmoded aws restricting afeabortions.Some-times this arguments premisedon the notion of universalhumanrightsfor women, sometimeson the principlethatculture s a higherlaw thanlegislation.The problemswiththisargument rebothsubstantive ndprocedural.On sub-stantivegroundsone would want to know if all cultural

preferences,includingthe execution of minority groups,cannibalism,and female circumcision,should overridea

country's aws, or if a universalright to life of the fetusshould be cited as a basis for subverting aws permitting

abortion.Fromaproceduraltandpointhe criticaldifficultylies in decidingwho shouldmakedecisionsabout the rela-tive meritsof a country's aws vis-a-vis competingsourcesof legitimacy.It hardlyseemsjustifiable ordonoragenciesto take it upon themselvesto make this judgement,sincetheir own bureaucratic r political interestsare usually atstakein the decision. At the very leastone would want thematter o be adjudicated y some neutralcourtof appeals.

A thirdargument gainstrespect orlawsrestricting bor-tion is that governments hemselvesare often divided onthisquestion.In suchpluralistic ettingssome groupsareinfavorof actionandothersopposed.Under heseconditions,donorrepresentatives ave argued,foreign agencieshave a

rightto work with supportiveofficials, even if abortion s

illegal and against the country'sofficial policy. In otherwords, when opinion is split on abortionpolicy there is

nothingwrongwithdonors akingsidessince therewill alsobe nationalson that side. But here, too, there are ethicaldifficulties.By takingsides, particularlywhen support s

accompaniedby a generous nfusionof foreignmonies, thedonorsare, in fact, infringingon nationalautonomy n a

particularly elicatearea.Foreign nterventionbecomeses-

peciallyquestionablewhen externalfinancing s used as a

bargainingchip in negotiatingwhat is fundamentallya




moralandpolitical questionon the national cene. Second,internationalgenciessupplyingaidforabortionundercon-ditions of secrecy are themselves being hypocriticaland

aiding governmentaldouble-dealing.This approach eems

highly unjustifiedf the government imultaneouslydenies

takingaid for abortionandacceptsfundsfor thatpurpose.

In such circumstances omesticcriticsof abortion,suchasthe RomanCatholichierarchyn the Philippines,arebeingdeliberately eceivedabout hegovernment'sntentionsandthe donor'sactions, andare thusdeprivedof theirrighttocommenton populationactivities.The ethicalproblemsofcovertinterventionare compoundedwhen, as is often thecase, thedonor'saim is to establisha beachheadof serviceswhich will be extremelydifficultto dislodge even whenthey are made public. While such issues arise in otherspheresof foreignassistance,they are of particularignifi-canceherebecauseof thedeepmoralandreligiousvaluesatstakein abortion.

A greatdrawback o violations of nationalautonomy s

thatthey cannotbe turned nto a workableuniversalprinci-ple. One "categorical mperative"mightread:"Whenevera donoragencyconsidersnationalautonomy ubservient oits own conceptionof humanrights or public policy, its

conceptionshouldprevail."According o this criterion or-

eign organizations pposing he U.S. SupremeCourt's1973decision on abortionwould have a moral warrant o useclandestinemeans n supportingheproposedconstitutionalamendment gainstabortion.Hence SaudiArabiaand otherconservative slamiccountrieswouldbejustified n supply-ing the United States Right to Life movementwith, say,$100 million for undercoveractivities in supportof this

amendment.Most of us would find this a horrifyingpros-pect, yet this is very close to what is being done on asmallerscale to promoteabortion n developingcountries.

A thirdguidingprinciple s that oreign aidfor abortionshould not eopardizeforeign aidfor socioeconomicdevel-

opment.The greatbulkof economicassistance oday goesfor activities other than population, includingagricultureand nutrition,education, health, and public works. Mostaidprograms ryto improvehumanwelfareby findingbet-terways of producing ice andwheat,by increasingaccessto schoolingfor the ruralpoor,by experimentingwithlow-cost methodsof deliveringhealthcare, andthrough imilarmeans. To work well in promotingdevelopment, foreign

aid requiresan atmosphereof mutual trust and collabora-tion, not only between the donoragency and the govern-mentbut with othersegmentsof the society as well. The

greatestrisk of covert aid for abortions that t will pollutethis environmentand place all foreign assistance underacloud of controversyand doubt. There are already suspi-cions in some quarters,particularlyn Latin Americaand

Africa, that donorsbootlegas muchbirthcontrolas possi-ble into countries hat do not want it. These suspicionsareabettedby evidence that a decadeago, when family plan-ning programswere coming into their own, donors im-

ported he Lippesloop underthebillingof "Christmasreeornaments" nd othercontraceptives s "fungicides."Thepoint here is that fears abouthidden agendasand surrep-titious activities on abortioncan undercutthe efforts ofagenciesthatoperatecompletelyaboveboard,even in areasseeminglyunconnected o birthcontrol.Andin thepopula-

tion field itself doubts about donor integritycan make agovernment eluctanto openthedoorforassistance o fam-ily planningservices or even research. f anAfricanMinis-ter of Healthfears that a family planningprogramwill betakenoverby abortionadvocatesandlatercause a politicalexplosion, he may be reluctant o move down thatpathatall. No program s an island in foreignaid.

In the end we must ask what constitutesethical foreignaid. Is assistanceto othercountriesprimarilya means tohelp governmentsattaintheirown purpose,or is it an in-strument or subverting hose purposes?The issues raisedhere canfruitfullybe debatedby personswho differon the

moralityof abortionbutwho sharea commoncommitmentto the promotionof nationaldevelopmentandinternationalcooperation. t is a debatethatis badlyneeded.

REFERENCES

'Thisarticle s based on severalinterrelated ources: heauthor'sownresearchon foreignaid agencies;unpublished ountrystudiespreparedfor the Hastings Center'sProjecton CulturalValues and PopulationPolicies by scholars in several of the developingcountries;and recentinterviewsdealing specifically with foreign aid for abortion.Personscontacted ncludedpresentor formerstaff membersof the PopulationCouncil, the Office of Populationof the Agency for InternationalDe-velopment, the PopulationCrisisCommittee,the PathfinderFund, theInternational rojectsAssistanceService, theInternational ertilityRe-searchProgram,and the U.S. Senate.

2H.R. Holtropand R.S. Waife, UterineAspirationTechniques

inFamily Planning (ChestnutHill, Mass.: The PathfinderFund, 1976),p. 1.

3U.S. Departmentof State, Agency for InternationalDevelopment,"A.I.D. Policies Relativeto Abortion-RelatedActivities." Policy De-termination,PD-56, June 10, 1974.

4GeorgeZeidenstein,"FutureDirectionsof thePopulationCouncil."Reportpreparedor the meetingof the Boardof Trusteesof the Popula-tion Council, June8-9, 1976.

5Materialdescribing this incident is contained in M.E. Lopez,A.M.R. Nemenzo, L. Quisumbing-Baybay, ndN. Lopez-Fitzpatrick,Cultural Valuesand PopulationPolicy: Philippines. TheSociologicalStudy(QuezonCity:Instituteof PhilippineCulture,Ateneo de ManilaUniversity, 1978).

6The informationsummarizedhere was obtainedfrom an informalreporton abortionpreparedby IPPF in 1979.

7The PathfinderFund, "Pathways n PopulationPlanning."Promo-

tional flyer issued circa 1975.8United Nations Fund for PopulationActivities, Population Pro-grammesandProjects. Vol. I: Guideto Sourcesof InternationalPopu-lation Assistance (New York: United Nations Fund for PopulationActivities, 1979), p. 297.

91bid.I?UnitedNations Fund for PopulationActivities, Population Pro-

grammesand Projects. Vol. II: Inventoryof Population Projects inDeveloping CountriesAroundthe World1977/78 (New York:UnitedNations Fund for PopulationActivities, 1979), p. 303.

"Ibid., p. 71.2Ibid., p. 31.3United Nations, World PopulationConference,Action Taken at

Bucharest(UnitedNations,New York:Center or EconomicandSocialInformation/OPI or the WorldPopulationConference, 1974), p. 10.

The HastingsCenter 37

Documents

Foreign Aid for Abortion