Blurred vision?

World Vision, with revenue last year of $241 million and operations in 92 countries, describes itself for supporters as "the largest privately funded, faith-based relief and development organization in the United States." Last year it spent $66 million on children overseas through its trademark child sponsorship program. Moving ads in magazines reveal wrenching photos of homeless street children around the world, prompting private contributions last year of $180 million. A typical ad tells potential contributors, "Your gifts of $22 a month will help provide a needy child with improved health, nutrition, and educational opportunities." It's no surprise that World Vision, during its 45 years of service, has helped rescue many children from hunger and disease. What is surprising are the add-ons. Contributors are told that their dollars help children receive medicine, food, and schooling-and they do. But the community development projects that grow up around sponsored children include controversial family planning programs. Last year World Vision received $55 million from the U.S. Agency for International Development (USAID) to help with those extra-curricular activities. An internal survey conducted by World Vision staff last year showed many of its overseas health projects are closely allied to population-control programs. World Vision International's board of directors is meeting this week in California to decide whether to approve a new family planning policy, or to adhere to its current policy, which (says World Vision's director of public relations, Dean Owen) is guided by a document from 1995, "Health and Healing." That document states, "World Vision will supplement governmental and other NGO [non-governmental organization] efforts in making modern family planning methods available to the couples.... These include copper IUDs, pills, and condoms." Copper IUDs are controversial because they succeed to the degree that they produce a toxic environment in the womb. Most pro-life groups regard them as abortifacient because they act against a fertilized egg. Medical experts also question their use in the developing world because of problematic side effects. The 1995 statement also leaves the door open for "morning-after" contraceptives and RU-486 (the abortion pill) by stating that the organization "will not undertake testing of any new methods on humans if they are not approved by the FDA or its equivalent in the country where World Vision has programs" (emphasis added). Christian advocacy groups, including Focus on the Family, have been critical of the policy statement, but World Vision International President Dean Hirsch and World Vision United States President Richard Stearns took exception to a story in World that linked the relief agency to "part of the population-control groupthink" (Sept. 19, 1998). In a joint letter, the officers said a statement "that World Vision has distributed controversial 'post-conception' contraceptive devices such as Norplant and IUDs" in its health clinics "is simply untrue, and it implies that World Vision is not solidly pro-life." The leaders were emphatic: "World Vision will not recommend these methods to clients nor refer clients to any clinics where they may be encouraged or performed." They said World Vision "will not provide funding or support to any such organizations or clinics." But a survey last year of World Vision's health care employees raises questions about organization practice. Milton Amayun, a physician who headed World Vision's health programs in Asia and coordinated the survey, said it was meant to gather "candid, up-to-date, and accurate information on World Vision field practices that relate to family planning, reproductive health, and child spacing." What the survey showed: "All responding NOs [national offices] are engaged in some type of family planning-related activity, either as a straightforward family planning or reproductive health project or buried within child survival, maternal health, or women's health activities." Asked to list, in order of frequency, family planning methods available in World Vision projects, field workers cited:

Two field offices mentioned "menstrual regulation," a procedure widely believed to cause abortion, as a family planning method they support. Field workers also said they were aware that some agencies with which they collaborate in family planning programs perform abortions and "provide incentives for surgical methods of sterilization." These agencies included government ministries of health, Marie Stopes International, the UN Family Planning Association, and International Planned Parenthood affiliates like Profamil. The survey report summarizes, "It is clear that there is significant and widespread family planning/reproductive health activity in many World Vision national offices.... The issue of family planning is [so] very much a mainstream developmental activity in developing countries that it does not raise any controversy in National Offices as it does in the United States." That conclusion overlooks the views of some World Vision employees in developing countries. The policy is particularly upsetting to Roman Catholics such as Jon Merrill, a World Vision food aid manager in Angola from 1997 to 1998. Mr. Merrill complained to his colleagues, including Dr. Amayun, after he learned last year that World Vision floated a funding proposal with USAID in Angola; the proposal included a family planning component. Mr. Merrill said he was told other World Vision family planning programs included all forms of contraceptives-IUDs, birth-control pills, spermicides, injections, and Norplant. Mr. Merrill told WORLD he was disturbed that a similar program proposal was submitted in Angola without, he said, consultation with any Catholic church leaders there, given that Catholics make up more than 60 percent of Angola's population. World Vision Angola director Steve Goudswaard declined to comment on whether Catholics or other church leaders were contacted in connection with the proposal. Mr. Merrill said he received some sympathetic responses to a protest letter he circulated among World Vision officers, but not much agreement from health workers in the field: "World Vision folks are definitely not scoundrels, but they are increasingly part of the nexus of 'professional' development organizations, and in that culture the kind of Catholic concerns I have raised are foreign." USAID turned down the World Vision proposal, in part because its programs were cut short due to Angola's intensifying civil war. Another reason, according to USAID spokesperson Rekah Chalifani: The proposal "concentrated too much on personnel and with attending higher costs, with too little on program activities of substance." The cutback in USAID's Angola programs led to Mr. Merrill's job termination. At an exit interview with World Vision human resource personnel in Washington, D.C., late last year, he was asked to make a statement about his family planning views for an employment file. Mr. Merrill told WORLD he objected to the request but reluctantly provided it. "I did not understand why the family planning issue needed to be raised again, why my opinion needed to be raised. I am not seeking a job in the health field. I don't see how it could help. In many instances it probably would hurt," he said. (World Vision acknowledged its request for a statement from Mr. Merrill. But World Vision human resources personnel in Seattle and Washington, D.C., would not provide an explanation.) The hybrid nature of non-governmental organizations like World Vision-they receive federal funding but no direct oversight from Congress-means they can bypass traditional forms of public scrutiny. World Vision belongs to the Evangelical Council for Financial Accountability, which certifies that the organization files proper financial disclosures for a non-profit organization and makes those available to the public. Additionally, World Vision has been audited by the National Charities Information Bureau, a New York-based "better business bureau" covering private-sector relief work. Spokesman Daniel Langan told WORLD the organization "meets all of our standards." Those standards primarily pertain to structural factors like governance, maintaining an independent board of directors, and what NCIB calls "truth in fundraising." Charities should spend at least 66 cents out of every dollar for programs, with no more than the remainder going to fundraising and overhead (World Vision reports 67 percent going to programs). InterAction, a Washington, D.C.-based umbrella group of relief agencies, also requires its members, including World Vision, to meet truth-in-fundraising standards. Last year InterAction announced new rules for child sponsorship programs-including stricter accounting procedures and closer monitoring of the projects themselves. But none of these peer review mechanisms deal with program content, and, specifically, whether contraceptive distribution and family planning campaigns should be disclosed by a Christian agency. World Vision vice president Bryant Myers said its own family planning survey prompted an internal policy review because U.S. officials found it "sufficiently disturbing that it landed us into a policy reexamination process. It showed a policy not imbedded in performance." The new policy World Vision management is proposing to the organization's board of directors this week will not specifically mention IUDs, according to Mr. Myers. He says the statement reads that World Vision "does not support any form of contraceptives that are proven to be abortifacient in their normal operation." It also states that henceforth "all forms of birth control are subject to constant ethical, medical, and developmental analysis to ensure that only the most appropriate measures are promoted." If board members adopt the new policy, regional heads of World Vision worldwide will be asked to examine their family planning policies against it, Mr. Myers said, to "determine where our practices have gotten fairly wide of the mark." The new policy may draw limits around World Vision's own contraceptive distribution, but pro-lifers have questions about the interaction of World Vision with agencies that promote abortion, and about the definition of what is "appropriate" in the promotion and use of contraceptives.