307. Memorandum From the Executive Secretary of the Department of State (Tarnoff) to the President’s Assistant for National Security Affairs (Brzezinski)1


  • Implications of Worldwide Population Growth for United States Security and Overseas Interests: Evaluation of Population Program Performance

In response to your memorandum of May 17, 1977,2 and in furtherance of this Administration’s continuing efforts to improve the effectiveness of our foreign aid programs, the attached format evaluating the performance of population programs on a country-by-country basis has been developed by the Department of State, in consultation with the Agency for International Development and the Department of the Treasury, and approved by the NSC Ad Hoc Group on Population Policy.

This effort attempts to assess the effectiveness of our population assistance activities in the context of the programs of recipient governments. It attempts to estimate the prevalence of contraceptive use as a measure of the effect of a country’s overall population program in reducing birth rates, and to estimate the dollar cost per contraceptive user as an indication of the cost-effectiveness of the program. As the attached discussion of the format emphasizes, however, any serious attempt to evaluate the effectiveness of population programs must take into account the influence of other socio-economic determinants of birth rates. For this reason, the performance evaluation format calls for data on a wide range of socio-economic variables potentially affecting fertility, and incorporates this data in the final section of the format in which the overall effectiveness of the program is analyzed. Additional work must be done to improve our understanding of the relative contributions of family planning services and these other determinants of fertility reduction; as this work progresses the evaluation format will be refined by the Ad Hoc Group to increase the usefulness of these criteria and to develop new and better measures of program effectiveness.

[Page 1018]

The information provided by this evaluation effort will be used in deciding how to allocate funds for our population assistance and will be included in the required annual reports of the Ad Hoc Group. Priority attention will be given to the key countries established as priorities for U.S. assistance by NSDM–314.3

Peter Tarnoff


Paper Prepared in the Department of State4

Description of Format for Evaluation of Population Program Performance

The attached format for the evaluation, on a country-by-country basis, of programs to reduce population growth5 has been developed by the Department of State in consultation with the Agency for International Development and the Department of the Treasury. The evaluation will be used: (1) to assess the commitment and progress of countries in controlling population growth and the effectiveness of existing population programs; (2) to assist and support decisions about future funding levels and the direction and priorities of our assistance programs.

The format calls for information and analysis in the following categories:

—basic demographic data over five-year periods or other useful intervals; especially 1965–1975;

—social, economic, and political factors affecting population programs;

—nature and extent of population programs;

—financial inputs, prevalence of contraceptive use, and cost per contraceptive user; and

—critique evaluating the overall effectiveness of the programs.

Using data from a number of sources, including AID, the United Nations system, the World Bank, the Bureau of the Census, the Popula[Page 1019]tion Council, and the International Planned Parenthood Federation, the performance evaluation effort attempts to:

—assess the impact and cost effectiveness of population programs, both national efforts and external assistance, and

—assess the effect of economic, social, and political factors which may have an influence on fertility and which provide a context for population programs.

This will involve the development of data on past, present, and projected resources dedicated to efforts to reduce population growth at country, regional, and global levels from all sources. These data will be used to examine the efforts not only of AID but also of donors receiving AID support, including the United Nations Fund for Population Activities, other external donors, and recipient governments’ own national programs. The data collected and evaluations made will be measured against specific global priorities and objectives which have been established.

I. Demographic Data

Section I summarizes the demographic situation in the host country over five-year periods (1965–1975). Most demographic data are not definitive and the range and trends are indicated. Specifics are reflected in Appendix A6 along with the source of the information.

II. Program Setting

Section II discusses the general setting in which the national program functions, including the socio-economic phenomena that may relate to the fertility reduction process and the various political, religious, cultural, legal, administrative, managerial, and other constraints that impede progress in developing a self-sustaining population program. Information for this section is summarized from data contained in the Development Assistance Program (DAP), AID program documents, Sector Reviews, Area Handbooks, Project Evaluation Summary, the World Bank, and the UNFPA.

III. The Population Program

Section III describes the stage of population policy development, the degree of commitment to the policy, and the establishment of demographic goals.

The national program is summarized—its administration, the rationale under which it operates, and the participation of other Govern[Page 1020]ment ministries and organizations such as education, agriculture, and health in population control activities.

Subsections cover the role of AID, donors receiving AID support (including the UNFPA), other donors, and the host government in the national program (including the percentage of the national budget designated for family planning activities).

IV. Financial Inputs, Impact, and Cost-Effectiveness

Section IV consists of three subsections:

A. Annual per capita funding from 1965–70, and subsequent years through 1976, by the category of donors and the host government. Total funding, per capita, and the percentage of financial input by each to the overall national program are summarized. Details are reflected in Appendix B.7

It is recognized that measuring resource allocations to family planning (FP) programs by the host government is difficult, because resources come from both direct and indirect allocation of funds and in the form of infrastructure support. National budgets do not reflect actual expenditures for FP in many cases. In addition, the quantity of resources expended on FP activities does not always reflect the quality of the services. Changes in the pattern of a host government’s resource allocations can be attributed to a number of factors which will differ between countries, such as demographic factors, availability of domestic financial resources and external donor support, level of development of the health and social service infrastructure, existence of government policy, and the perceived necessity by the government for direct FP activity.

Any conclusions on host government resource support are in most cases tentative, and cross-country comparisons, while necessary, should be made only with extreme caution. It is hoped that AID will be able to improve on the uniformity and reliability of the data in the future.

B. The impact of the program is measured in part by prevalence of use—the percentage of married women of reproductive age (MWRA) or couples using a reliable method of contraception; the percentage of MWRA/couples with reasonable knowledge of a reliable method of contraception; and the percentage of MWRA/couples with reasonable access to contraceptive services.

Data on the above indicators were compiled by a number of the AID Missions last December for the AID Worldwide Population Of[Page 1021]ficers Conference. This performance criteria effort relies on the ability of the USAIDs to continue to collect these data on an annual basis.

Conceptually, the best measure of accomplishment of a FP program would be the difference between the reduction in fertility produced by the program and what theoretically would have been achieved in the given socio-economic conditions without any FP program. Even attempting to estimate this difference would require a much better understanding than we now have of the relationship between fertility reduction in a particular country and family planning services and other socio-economic factors.

In the absence of such multivariate analyses of the determinants of birth rates, one measure of fertility reduction is provided by the increase in the use of contraceptives obtained from public and private programs throughout the country. Based on field experience in selected countries, a rough approximation of the relationship between the crude birth rate and use of reliable methods of contraception (i.e., excluding abstinence, coitus interruptus, and rhythm) is that a two percent increase in the percentage of couples using contraception is associated with a decrease of one birth per thousand population, and that a contraceptive user rate of 60 to 70 percent is associated with a replacement level birth rate of 20 per thousand.

In measuring rates of contraceptive use, there is considerable variation among developing country FP programs in the quality and reliability of FP service statistics. Many systems generally collect only data on new acceptors, from which current use rates must be estimated through the application of method continuation rates to new acceptor data or through analysis of contraceptive distribution over time.

An increasing number of the developing countries are beginning to use prevalence of use as a measure of program impact, and AID has initiated programs to assist them with this activity. Estimates of contraceptive use and births averted can be improved by better data and more sophisticated techniques of analysis.

The responsibility would rest with AID in cooperation with the Office of the Coordinator of Population Affairs, State Department, to establish guidelines for the missions to estimate prevalence of use, and to continue efforts to develop new and better estimates of program impact.

One measure of cost-effectiveness can be obtained by dividing annual financial inputs from all sources by the number of users. These cost-per-user statistics (in dollars) are calculated for the last year in which data are available and as averages of the latest three, five, and ten-year periods.

A crucial aspect of the analysis of cost-effectiveness is the explanation of variations in cost-per-user rates. These rates tend to be much [Page 1022] higher in those countries where social, economic and cultural factors encourage population growth. For example, in Bangladesh, where rural societies are male-dominated, village systems are weak, adequate numbers of administrators are lacking, and rural health and educational systems are sadly deficient, costs per user are almost certain to be higher than in a country such as Thailand, where basic social, economic and cultural factors are more favorable. Hence, any performance evaluation system must take these essential factors into consideration in judging cost-effectiveness.

V. Critique

The purpose of this Section is to evaluate the overall effectiveness of a country’s population program, bearing in mind the socio-economic factors affecting the program, the leadership commitment to the program, the encouragement, especially through person-to-person contacts, of smaller families and the supply and delivery of family planning services. To the extent possible, quantitative estimates are made of the effect of these factors in reducing fertility. The critique also contains recommendations for program action and emphasis.

In order to make this overall assessment of program effectiveness, additional data must be obtained, through such means as better vital registration systems, sample surveys, and research projects. There is also the need, especially in key countries, for more sophisticated multivariate studies to quantify, as far as possible, the impact of socio-economic variables on population growth and identify more accurately the degree to which a nation’s family planning program is responsible for lowering fertility rates.

Global Policy and Program Analysis

These individual country analyses are aggregated into an overall examination of the global effort to reduce population growth. This global summary includes an evaluation of the efforts of recipient nations, the U.S., other donor countries, and multilateral and private organizations. Total funding for population programs on a regional and global basis is measured against special priorities and objectives which have been established and, where possible, progress toward specific targets is estimated.

The performance evaluations, as improved by new data and analysis, are applied on a regional and global basis to guide decision-makers with respect to the performance of US-funded bilateral, multilateral, and private population assistance. The global summary will include a projection of demographic factors and estimated impacts of alternative funding and program strategies.

  1. Source: National Archives, RG 59, Office of the Deputy Secretary—Records of Warren Christopher, 1977–1980, Lot 81D113, Box 8, Memos/Letters FM WC to Agencies. No classification marking. Christopher sent a copy to Gilligan under a January 31 covering memorandum, commenting that he hoped “that this effort proves helpful in making future planning and budgeting decisions about our foreign aid programs and that State and AID can continue to work together in monitoring and improving the effectiveness of our aid programs in population and in other areas.” (Ibid.)
  2. See Document 282.
  3. See footnote 3, Document 280.
  4. No classification marking. No drafting information appears on the paper.
  5. Attached but not printed is the undated “Family Planning Performance Evaluation (Format).”
  6. Attached but not printed is the undated “Selected Demographic and Social Indicators” table.
  7. Attached but not printed is the undated “Annual and per capita funding per year (in thousands of dollars)” table.