USAID Policy Determination 3 on Voluntary Sterilization in United States

USAID Policy Determination 3 on Voluntary Sterilization and Family Planning-Related Provisions

This section provides a general background of usaid policy determination 3 on voluntary sterilization in the framework of the abortion and family planning-related provisions in U.S. foreign assistance and, in special, in relation to Executive Branch Policies and Restrictions.Policy Determination 3 (PD-3) on voluntary sterilization (VS) was issued by USAID in September 1982 with the purpose of ensuring that voluntary sterilization services funded by the U.S. government protect the needs and rights of individuals [50]. According to USAID, such protections are necessary given the special nature of voluntary sterilization as a highly personal and permanent surgical procedure [51]. USAID Policy Determination 3 outlines a number of requirements for USAID voluntary sterilization services, including the following:

Informed consent—USAID assistance to voluntary sterilization service programs is contingent on satisfactory determination that such services, performed in whole or in part with USAID funds, are performed only after the acceptor of the procedure has voluntarily presented himself or herself at the treatment facility and given his or her informed consent.
Ready access to other methods—Where voluntary sterilization services are available, other means of family planning should also be readily available at a common location, thus allowing the acceptor to have a choice of family planning methods.
No incentive payments—USAID funds cannot be used to pay potential acceptors of sterilization to induce their acceptance of voluntary sterilization. In addition, the fee or cost structure applied to voluntary sterilization and other contraceptives shall be established in such a way that no financial incentive is created for sterilization over another method [52].

More Details about USAID Policy Determination 3 on Voluntary Sterilization

PD-3 also provides guidance on payments to voluntary sterilization service acceptors, providers, and referral agents. Certain types of payment are not considered incentives provided they are “reasonable.” Determination of a reasonable payment must be based on a country and program specific basis using knowledge of social and economic circumstances. Specifically:

VS acceptors may generally receive recompense for legitimate extra expenses related to voluntary sterilization (such as transportation, food, medicines, and lost wages during a recovery period);

VS service providers may receive per-case payment and compensation for related items (such as anesthesia, personal costs, transportation, and pre- and post-operative care); and

VS service referral agents may receive per-case payment for extra-expenses incurred in informing or referring voluntary sterilization clients [53].

PD-3 applies to family planning assistance from any account where USAID funds are used for whole or partial direct support of the performance of voluntary sterilization activities. It applies to U.S. NGOs, foreign NGOs, public international organizations, and governments.

Note: Based on the Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Law and Policy Report.

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Notes and References

50 Section V, “Annex” of Population Assistance—USAID Policy Paper, USAID Bureau for Program and Policy Coordination, September 1982. Also see Policy Determination 3 and Addendum: USAID Policy Guidelines on Voluntary Sterilization.51 USAID states that voluntary sterilization services include activities that are primarily intended to provide voluntary male and female sterilizations to persons requesting this type of contraceptive procedure. In the context of USAID Policy Determination 3, they may also include voluntary sterilization training programs.

52 Drawn from Policy Determination 3 and Addendum: USAID Policy Guidelines on Voluntary Sterilization. Other requirements are (1) quality of voluntary sterilization services: medical personnel who operate on sterilization patients must be well-trained and qualified in accordance with local medical standards, and equipment will be the best available; (2) sterilization and health services: voluntary sterilization programs shall be conducted as an integral part of the total health care services of the recipient country and shall be performed with respect to the overall health and well-being of the prospective acceptors; and (3) country policies: USAID should take appropriate precautions through consultations with host country officials to minimize the prospect of misunderstandings concerning potential voluntary sterilization activities.

53 Ibid.