Cents and Sensibility: U.S. International Family Planning Assistance from 1965 to the Present

A HISTORY OF U.S. INTERNATIONAL FAMILY PLANNING ASSISTANCE

The Early Years

In 1965, the U.S. Agency for International Development (USAID) launched its first population and family planning program and provided a total of approximately $10.5 million by 1967. By 1969, USAID had established an Office of Population (now the Office of Population and Reproductive Health) to provide technical leadership and coordination in developing and implementing population and family planning programs.

Annual U.S. investments in bilateral and multilateral family planning and reproductive health (FP/RH) programs grew steadily in the early years, breaking the $100 million mark in fiscal year (FY) 1974 and the $200 million milestone in FY 1981. These totals included U.S. government contributions to the United Nations Fund for Population Activities (UNFPA—now the UN Population Fund), beginning at its founding in 1969. Influential Americans, inside and outside government, such as PAI’s founder General Draper, were instrumental in UNFPA’s establishment, and the U.S. contribution represented as much as 40 percent of UNFPA’s budget in the early years.

Funding continued to rise in the early 1980s despite attempts by family planning opponents in the Reagan administration to zero out all funding. FP/RH funding exceeded $300 million for the first time in FY 1985.

Opposition Intensifies

Beginning in 1985, congressional critics used UNFPA’s presence in China, where the country’s one-child policy was resulting in widespread human rights abuses, as pretext for cutting UNFPA off from U.S. financial support. For the remainder of the Reagan administration and throughout the presidency of George H.W. Bush, no U.S. contribution was provided to UNFPA. Fortunately, bipartisan family planning champions in Congress did their best to preserve bilateral FP/RH funding and restore a UNFPA contribution. However, overall funding dipped before recovering slightly at the end of President Bush’s term.

With the election of President Clinton in 1993, U.S. funding broke $400 million for the first time and contribution to UNFPA was restored. Congress approved nearly $580 million for FY 1995. To this day, FY 1995 remains the high-water mark for U.S. FP/RH funding when measured in constant dollars.

Unfortunately, Republican family planning opponents in Congress, in the majority after the 1994 mid-term election, sought to enact legislation re-imposing the Global Gag Rule, which President Clinton had rescinded when he came into office. Most of these bills were vetoed by the president. In retaliation, foreign aid bills attacked FP/RH funding through cuts, delays, and metering, resulting in a steady decline in funding for the remainder of President Clinton’s time in office, eventually dipping to less than $400 million.

Shortly after George W. Bush was inaugurated in 2001, the Bush administration wasted no time reinstating the Global Gag Rule, slashing FP/RH funding and withholding the entire U.S. contribution to UNFPA. Bilateral funding recovered somewhat, hovering in the mid-$400 million range. This was due in large part to family planning champions in Congress who mitigated the damage caused by these harmful policies by appropriating larger amounts of funding and by rejecting declining presidential budget requests each year.

Holding the Line

When President Obama took office in 2008 with Democratic majorities in Congress, FP/RH appropriations shot up dramatically in the succeeding two fiscal years, jumping to $545 million, including $40 million for UNFPA, in FY 2009 and to $648.5 million in FY 2010.

But the vagaries of the electoral process visited renewed attacks on FP/RH funding with the election of a Republican House majority in 2010, which again sought to leverage funding cuts to legislatively impose the Global Gag Rule and cut off funding for UNFPA. Over the next seven fiscal years, foreign aid appropriations bills emanating from the House proposed cutting bilateral funding to the FY 2008 level of $461 million, prohibiting a UNFPA contribution, and reinstating the Global Gag Rule. And each year, key champions on the Senate and House Appropriations Committees beat back those challenges and successfully preserved the status quo on funding in the low-$600 million range and resisting policy changes.

Unprecedented Attacks

The election of President Trump in 2016 along with Republican majorities in both houses of Congress has brought unprecedented attacks on FP/RH funding. The Trump-Pence administration wasted no time imposing the Global Gag Rule, introducing a vastly expanded policy just three days after taking office on January 23rd. Trump’s Global Gag Rule applies to all foreign NGOs receiving any U.S. global health assistance, forcing them to choose between receiving U.S. funding and providing comprehensive sexual and reproductive health care.

In addition to burdening organizations receiving FP/RH assistance, for the first time, providers implementing programs for maternal and child health, nutrition, HIV/AIDS (including PEPFAR), malaria, tuberculosis, infectious diseases, neglected tropical diseases, and water sanitation and hygiene will now be subject to oppressive Global Gag Rule restrictions. This impacts nearly $9 billion in global health assistance for programs at USAID, the Department of State, and the Department of Defense, 15 times the amount of funding when the Global Gag Rule was just applied to FP/RH programs.

Two months following this announcement, on March 30th, the Trump-Pence administration issued an official determination cutting off the entire U.S. contribution to UNFPA under the terms of the so-called Kemp-Kasten amendment, the same legislative authority utilized since 1985 by UNFPA opponents to cut-off the contribution during the Reagan and both Bush administrations.

Not wasting any time in also attacking bilateral FP/RH funding, the Trump-Pence administration proposed zeroing out all funding in its FY 2018 budget request in May of 2017, a first for any President since the inception of the USAID program in 1965. The subsequent FY 2019 budget request of $302 million was literally better by half, but still representing a 50 percent cut from the prior year enacted level.

Rejecting administration efforts to slash and burn FP/RH funding, congressional champions on the Senate and House appropriations committees successfully secured FP/RH funding from all accounts at $607.5 million (and blocked the attachment of anti-family planning policy “riders.”) in negotiations after both the FY 2017 and FY 2018 omnibus spending bills.

Woefully Inadequate

It is essential to remember, however, that even though FP/RH funding remains above $600 million today, it remains woefully inadequate, particularly if calculated according to inflation-adjusted dollars. The high-water mark for FP/RH funding in FY 1995 would require an expenditure of $975 million in today’s dollars to have the same purchasing power.

Looking at it from a needs-based perspective, if the United States, the recognized world leader in the provision of FP/RH financial and technical assistance, were to provide its appropriate share of the total financial resources necessary to address the unmet need for contraception of 214 million women in the developing world, this sum would total $1.66 billion annually, a near tripling of the current level. While the prospects for funding to reach the U.S. “fair share” of the amount needed are daunting, PAI, along with the community of family planning advocates, will continue to fight for more robust funding by documenting the need, providing the justification, and demonstrating the cost-effectiveness of increased U.S investments.