On April 23, the House Foreign Affairs Subcommittee on Africa and Global Health held a hearing, “U.S. Assistance to Africa: A Call for Foreign Aid Reform.”
Acting Assistant Administrator for Africa at the United States Agency for International Development (USAID) Earl Gast summarized the recent accomplishments of the agency, including an “eight-fold” increase in aid to small and medium businesses especially women-owned businesses under the African Growth and Opportunity Act (P.L. 106-200); increasing girls’ participation in education by 25 percent over the last decade; and decreasing child mortality by 14 percent since 1990. Despite such progress, Mr. Gast noted that USAID faces several challenges, including a dearth of qualified health professionals; poor public infrastructure, such as road and public transportation; and underdeveloped physical health infrastructure.
Mr. Gast told the subcommittee that “nearly half of all Africans are less than 15 years old and, at the current 2.5 percent yearly growth, Africa’s population will double to 1.7 billion by 2050…The expanding population of youth will also have a tremendous impact on the education sector’s ability to respond to their demand for a quality education…It is estimated that Africa will need an additional 25 million new teachers over the next 15 years merely to maintain current class sizes.” He continued, “In addition to mitigating the impact of rapid population growth, the benefits of expanding access to family planning services could help women avoid poorly timed pregnancies that put their health and that of their children at risk. For example in Nigeria, according to a USAID-funded study, meeting the current demand for family planning by women would avert 19,000 maternal deaths, 1 million child deaths, and 1.2 million abortions over 10 years. Not only is USAID the single largest donor to programs to help families extend the time between successive births, it is the strongest advocate with our donor and host country partners for voluntary family planning services.”
Meredeth Turshen, professor at the State University of New Jersey, focused her remarks on the economic plight of women in Africa. While Dr. Turshen noted the successes of “large vertical disease-based initiatives,” such as the President’s Emergency Plan for AIDS Relief (PEPFAR), she said such programs have contributed “to a decline in spending on maternal and child health, which is 22 percent less than it was ten years ago…Maternal mortality rates have risen or stayed the same in 16 of 40 African countries. Skilled personnel attended fewer births in 12 of 31 countries for which comparative data are available…Family planning is the one service that grew in the decade since [the 1994] Cairo [International Conference on Population and Development]. Governments did not meet the 2005 goal of reducing by half the gap between the proportion of individuals using contraceptives and the proportion expressing a desire to space or limit their families.”
“The record is no better in meeting Millennium Development Goals,” she continued. “One in five children (20 percent) die before the age of five. Two-hundred sixty-five thousand women in Sub-Saharan Africa died during pregnancy or childbirth in 2005, approximately one in 22.” Dr. Turshen recommended returning the administration of foreign aid from the Department of the Defense back to USAID and the State Department, reducing the amount spent “on overpriced technical assistance from international consultants …renew[ing] our support of United Nations agencies like UNFPA [United Nations Population Fund] and decreas[ing] the undue influence of religious doctrine on sexual and reproductive health programs,” consolidating health initiatives, and making gender parity in primary and secondary school enrollment a top priority.
Bill O’Keefe, senior director of policy and advocacy at Catholic Relief Services (CRS), said “several significant problems limit the potential of current U.S. foreign assistance to support integral human development,” including a lack of focus on the poorest people and countries, “stove-piping” or allocating resources by single sectors, “which requires groups like CRS to spend an inordinate amount of staff time and effort to patch together sources of funding,” funding mechanisms that are too rigid, and substituting international security measures for international assistance. Mr. O’Keefe urged the subcommittee to increase funding for P.L. 480, Title II, or the Food for Peace program: “CRS uses Title II resources in poor communities around the world…Title II also provides food for maternal/child programs that combine food aid with prenatal and postnatal education and support.”
While discussing PEPFAR’s effectiveness, Mr. O’Keefe urged the “the retention of the ‘conscience clause,’ which will help ensure that Catholic and other faith-based organizations are not discriminated against as HIV and AIDS service providers.” He continued, saying that the ABC [Abstinence, Be Faithful, use a Condom] approach has been effective, but “that data about the effectiveness of abstinence and faithfulness have largely been ignored. However, there is widespread consensus among public health experts that ‘partner reduction’ and the ‘delay of sexual debut’ are critical components of any comprehensive approach to reduce the spread of HIV.” Mr. O’Keefe also touted his agency’s microfinance programs, “where a small group of people pool their resources and can access very small loans of five to 30 dollars…This approach especially benefits women, who increasingly head poor households and are far more likely than men to channel increased income from their business activities into essential benefits for their families.”