The culture war is breaking out in American foreign policy. And the main culture warrior is not a ranting televangelist but America's secretary of state.
Prime Minister Stephen Harper of Canada, as host of June's Group of Eight meeting in Ontario, has been preparing an initiative to reduce maternal mortality in poor nations. At first, his government implied that neither contraception nor abortion would be part of the proposal. Under pressure, Harper's foreign affairs minister later clarified that the plan "doesn't deal with abortion" but that "it doesn't exclude contraception."
Last month, during a political controversy in Canada on the issue, Secretary of State Hillary Clinton spoke at a news conference in Quebec. "I've worked in this area for many years," she said. "And if we're talking about maternal health, you cannot have maternal health without reproductive health. And reproductive health includes contraception and family planning and access to legal, safe abortion."
The Toronto Star described this as a "grenade in the lap of her shell-shocked Canadian hosts."
Clinton's search for a fight on this issue is not the recent norm. Increased development assistance to improve global health has been one of the bipartisan achievements of the past decade -- an exception to Washington's general bitterness. Millions are taking AIDS drugs, sleeping under anti-malarial bed nets and getting treatment for tropical diseases because ideology has not been allowed to sabotage goodwill.
But the political alliance on this issue has always been fragile. Traditionally, liberal advocates of global health spending have worked in uneasy alliance with conservatives -- mainly non-libertarian social conservatives -- who hold a moral view of America's role in the world. This is the Bono-Bush coalition that passed and then reauthorized the President's Emergency Plan for AIDS Relief (PEPFAR) -- an initiative that intentionally avoided the issue of abortion to prevent infighting among its wildly diverse supporters.
Clinton's grenade did damage beyond Canada. Liberals need to understand -- however strong their pro-choice convictions -- how offensive many conservatives find the global health argument for abortion. It seems like addressing poverty by doing away with the poor; like fighting disease by getting rid of those with diseases. If the Obama administration and global health advocates place abortion rights at the center of their development agenda, they will not only solidify conservative opposition on child and maternal health but will also undermine Republican support for development spending as a whole.
Conservatives also need to show some flexibility to preserve the development coalition. Often, they interpret any mention of "family planning" as a coded reference to abortion. But contraception is an unavoidable part of public health. Effective AIDS prevention is certainly more than just a bowl of condoms at the clinic door -- but it includes the use of condoms during high-risk sexual activity. Some on the right were unhappy that the Bush administration distributed nearly 2.4 billion condoms during the first five years of PEPFAR. That is a lot of latex. But sound health policy, based on realism about human nature, required it.
Maternal health is also improved by the availability of voluntary contraception. Women in the United States have a lifetime chance of dying from pregnancy-related causes of about one in 4,800. For women in a country such as Niger, it is about one in seven. Some 60 percent of births in sub-Saharan Africa take place without a health worker present. Contraception allows women, if they choose, to avoid high-risk pregnancies early or late in life, to space births at safer intervals and to limit the number of pregnancies they have during their childbearing years. Americans now generally assume these practices are essential to the creation of happy, healthy families. The same is true for many in the developing world.
Most Protestants, even of the more sober varieties, do not view contraception as a moral issue. The Catholic Church strongly dissents -- but most Catholics concede a wide moral difference between the prevention of a pregnancy and the ending of a life. Catholic opposition to family planning in development programs is far more muted than opposition to abortion.
Though it has not pleased everyone, the recent consensus on development spending has been pro-life, or at least neutral on abortion, and pro-contraception -- the position that Harper has taken and that Clinton has attacked. Challenging either of these commitments may scratch an ideological itch, but it is likely to divide a movement, which could impose a cost on the poor and the sick that no one intends.