CRS Claims Regarding Healthy Choices Program Contradicted by FOIA Documents

On March 3, 2015, Human Life International, Population Research Institute and the Lepanto Institute conducted a press conference revealing Catholic Relief Services’ (CRS) part in the implementation of contraception-promoting programs in Kenya.  One such program is called Healthy Choices II (HC II).  Here are the facts regarding HC II:

1. In April of 2014, documents published by the government agency known as PEPFAR indicated that CRS implemented HC II in Kenya.
2. CRS’s sub-partners indicated that CRS implemented HC II, one of which stated on its website that this included condom promotion.
3. An on-the-ground investigator in Kenya confirmed that CRS implemented HC II.  Through interviews and by obtaining a physical copy of the HC II facilitator’s manual being used by CRS’s sub-partners, the investigator confirmed that HC II promoted abortifacient contraception and consistent condom use.
4. After alerting CRS to the concerns regarding the original PEPFAR document, CRS claimed to have met with PEPFAR, PEPFAR admitted a “mistake,” and “corrected” the document.
5. PEPFAR has deleted from the original document all references to HC II previously stated as having been implemented by CRS.

During the press conference, CRS published a response to the report, claiming to have “carefully reviewed the facts” in just a matter of a few hours.  CRS’s response to the PRI-Lepanto report regarding Healthy Choices II says “CRS’ implementing partners used two out of the four sections (those two which were appropriate and in accordance with Church and CRS doctrine) and did not use the other sections, as they were deemed inappropriate.” According to documents CRS sent to PEPFAR, bearing CRS’s logo, this is not the case. Documents obtained through the Freedom of Information Act reveal:

• From March 2011 to November 2013, CRS trained facilitators and exposed tens of thousands of kids to the Healthy Choices II curriculum without any indication that Healthy Choices II was being modified for any reason.
• During this same time-period, CRS readily states that Healthy Choices I was modified due to its promotion of condom use, but no such indication is ever made regarding Healthy Choices II.  (the modification of Healthy Choices I was confirmed by the PRI investigator in Kenya, and noted in the PRI-Lepanto report)
• A CRS-written grant proposal to PEPFAR, submitted April of 2012, indicates the intention to implement Healthy Choices II, and illustrates a working knowledge of the facilitator’s manual, describing in detail the 8 modules of the program, including the elements on “safe sex.”  This proposal contradicts CRS’s current claim of implementing only 2 of HC II’s modules.
• In November of 2013, after numerous CRS-written reports indicated that CRS facilitated Healthy Choices II to tens of thousands of kids, CRS stated in its year 5 annual report that it was “made aware” that Healthy Choices II promoted contraception and moved away from it in year 5. CRS’s claim that it only became aware of this in 2013, when it clearly had copies of the facilitator’s manuals as late as April of 2012, stretches credibility beyond its breaking point.

What follows are the details found in the FOIA documents regarding CRS’s implementation of Healthy Choices II. All page numbers refer to the page identified in the FOIA documents.

A March 1, 2011 presentation at a CDC/SAIDIA meeting anticipated that Healthy Choices would be open to SAIDIA just as soon as it had been assessed and authorized by Kenya’s National AIDS & STI Control Programme (NASCOP). (page 125 of the FOIA documents) NOTE: No indication of any moral issues with Healthy Choices II.

A December 2011 presentation CRS submitted to PEPFAR indicated that CRS had trained 92 facilitators in Healthy Choices I and II. (page 69 of the FOIA docs) NOTE: No indication of any moral issues with Healthy Choices II.

The CRS-SAIDIA Annual Report Sept. 2010-2011, which is for year three of the project, shows that CRS-SAIDIA provided all manuals to all partners, including Healthy Choices II. It also shows that CRS-SAIDIA trained 92 facilitators in Healthy Choices II, and that 1,664 children were exposed to Healthy Choices II as of the printing of the report. Of specific note regarding the image to the left … as CRS indicated several trainings in Healthy Choices II, including two SAIDIA staff as trainers of trainers (TOT), the facilitators would have become immediately aware of the contraception-promoting nature of Healthy Choices II.  (pages 140-155 of the FOIA docs) NOTE: No indication of any moral issues with Healthy Choices II.

The CRS-SAIDIA Annual Report Sept. 2011-Sept. 2012 (Year 4), shows that even though Healthy Choices II is being implemented with Healthy Choices I, there are ONLY concerns with Healthy Choices I, and no mention of concerns with Healthy Choices II. The report is very specific about this, saying:

“One CRS Staff has been actively involved in the NASCOP [Healthy Choices I] and FMP technical working group (TWG) throughout the reporting period. The TWG was formed to review [Healthy Choices I] Curriculum which many stakeholders felt was not addressing core values of [Healthy Choices I] which is to promote abstinence. The TWG is expected to come up with a revised curriculum which partners are expected to start using in year five.”

This is very consistent with what PRI’s investigator found in Kenya. Due to a public outcry over the condom promoting elements of Healthy Choices I, the manual was modified to remove all mention of condoms. However, PRI’s investigator also found that Healthy Choices II was being implemented in full, without any modifications. Furthermore, PRI’s investigator was told by CRS’s sub-partners that they were told by CRS not to take Healthy Choices II to any Catholic school. Given the content of Healthy Choices II, it should be clear why CRS would make this demand. However, as can be seen in this document, CRS does not express any concerns over Healthy Choices II, though it modified Healthy Choices I after a public outcry. This document also indicates that 21,825 children were exposed to Healthy Choices II from Oct. of 2011 to Sept. 2012, without any indication of the program being modified. (pages 166-188 of the FOIA docs)

A CRS presentation year indicator, dated Feb. 6, 2012 (which is year 4) indicates that over 5,000 kids were exposed to Healthy Choices II. (pages 217-218 of the FOIA docs) NOTE: No indication of any problems with Healthy Choices II.

The following slides come from a CRS Dec. 2012, Year 4 review meeting which shows that Healthy Choices I was under review and revision, but there is no such indication for Healthy Choices II. In fact, due to the review process of Healthy Choices I, that program was scaled down and partners shifted focus to Healthy Choices II. This is consistent with what was discovered by PRI’s field investigator, and is reflected in our report. (pages 293-301 of the FOIA docs)

The CRS-written Year 5 grant continuation application, submitted by CRS, April 27, 2012, provides by far the most damning evidence against CRS’s claim that it implemented a modified version of Healthy Choices II. This document shows that CRS knew what was in Healthy Choices II in April of 2012. It identified Healthy Choices as containing 8 modules, giving no indication of using only a portion of them because of the inappropriate content related to contraception and condoms. In fact, it actually identified the portions of the modules related to “safe sex,” with no complaint, no indication of an intent to modify the program, and no indication of concern at all. There is no indication that CRS has any problem with Healthy Choices II, and even indicates that as of March 2012, CRS-SAIDIA had already exposed over 6,000 kids to Healthy Choices II. (pages 333-341 of the FOIA docs).

The very first indication of any concerns regarding Healthy Choices II comes in November of 2013, over two and a half years after CRS first mentioned Healthy Choices II in any of its reports to PEPFAR. CRS’s Quarter 4 Progress Review Meeting shows the very first indication that CRS found ANY issues with Healthy Choices II. On a page titled, “HC II: Challenges and lessons learned,” CRS notes that Healthy Choices II “is heavily based on safer-sex practices” so it “avoided activities and procedures that are based on condoms.” It claims to have avoided activities based on condoms, but no such indication or concern is provided in any of CRS’s former reports, which strongly suggests that CRS had done nothing to modify Healthy Choices II until the end of 2013, which would have been the end of year 4 of the 5 year SAIDIA project. In fact, as will be found in the SAIDIA Annual Report 2012-2013 CRS indicates that it only became aware of the condom and contraception promotion in Healthy Choices II toward the end of Year 4, and that as a result, SAIDIA will “shift away from Healthy Choices II” in year 5. By this point, tens of thousands of kids had already been exposed to HC II, and in fact, the metric CRS reported on the number of kids reached by Healthy Choices II for this period was 19,214. All of this is consistent with what was discovered by PRI’s field investigator. (pages 477-484 of the FOIA docs)

On page 640, taken from CRS-SAIDIA’s Annual Report 2012-2013 (year 5), CRS speaks  about the curriculum review process for Healthy Choices I (which began in FY 2011-2012), and then claims that the problems with Healthy Choices II suddenly came to their attention at some point in year 4 and into year 5. According to CRS’s reporting timeline, this concern wasn’t raised until November of 2013, two and a half years after CRS had already implemented it and introduced it to tens of thousands of kids. Given that CRS had copies of the facilitators manuals in 2012, when it applied for the continuation grant for year 5, and even described the “safer sex” modules of the program in the grant application, it stretches credibility that CRS was unaware of the contraception-promoting elements in Healthy Choices II. Furthermore, given that Healthy Choices I was under review and revisions because of the condom-promoting elements contained in it, one has to ask why no such revision of Healthy Choices II was indicated until November of 2013.

In summary:

• CRS documents indicate the implementation of Healthy Choices II, while Healthy Choices I was undergoing a revision.
• No such revision of Healthy Choices II is indicated until the very end of 2013, two and a half years after CRS started talking about HC II.
• PRI’s investigator in Kenya obtained a copy of the HC II facilitator’s manual being used by CRS’s sub-partners, and it included all of the contraception-promoting elements.
• PRI’s investigator in Kenya interviewed children who participated in the CRS-implemented HC II program, and they identified abortifacient contraception as one of the things they learned about as a “healthy choice.”

As a reminder, it should be mentioned here that CRS told the Lepanto Institute, Human Life International and Population Research Institute that the PEPFAR document that indicated CRS’s implementation of Healthy Choices II had been “corrected.”  This correction deleted all mention of Healthy Choices II from the document.  See the image below:

In short, CRS’s new talking point about only implementing two out of four aspects of the Healthy Choices II curriculum is proved false by its own reporting documents. CRS would have been much better off admitting that it made a mistake and was careless in properly vetting the programs being implemented under its watch, but unfortunately, it decided to do its best to obfuscate the facts.