50 Years of U.S. International Family Planning Assistance

In 2015, the U.S. government commemorates the 50th anniversary of its involvement in providing population, family planning, and reproductive health assistance. It is no coincidence that PAI was founded in 1965, the same year that the United States began nascent funding to programs to enable women and couples to determine the number and spacing of their children by providing the information and services to do so.

In his second State of the Union Address in January of 1965, President Lyndon Johnson uttered these words: “I will seek new ways to use our knowledge to help deal with the explosion in world population and the growing scarcity in world resources.” Although his statement was rooted in concern about overpopulation and natural resource scarcity, the president’s statement gave new and deliberate priority to family planning as an issue worthy of the U.S. government’s attention and action and bolstered internal advocates within the U.S. Agency for International Development, the State Department, and the former Department of Health, Education, and Welfare.

Among the leading external activists encouraging President Johnson to have the United States lead the world community in addressing population issues after the 1964 election were prominent individuals like William H. Draper, Jr. and Cass Canfield, two of the founders of PAI.

In the wake of LBJ’s address, USAID launched its first population and family planning program in 1965 and provided a total of about $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. In reading USAID’s 50th anniversary history of the agency’s global health program, it is striking to see all of the strategies developed by the population and family planning program that have been applied to solving other public health problems in more cost-effective and impactful ways.

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 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 with its founding in 1969. Influential Americans, inside and outside government, such as 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.

Despite an attempt by family planning opponents inside the Reagan administration to zero out all funding in FY 1983, funding continued to rise in the early 1980s, exceeding $300 million in FY 1985. However, funding was withheld from UNFPA beginning in 1985 as 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 administrations of Presidents Reagan and George H.W. Bush, the U.S. contribution to UNFPA was withheld. Fortunately, bipartisan family planning champions in Congress did their best to preserve bilateral FP/RH funding and restore a UNFPA contribution, but overall funding dipped before recovering slightly at the end of President Bush’s term.

With the arrival of President Clinton, U.S. funding broke $400 million for the first time and a contribution to UNFPA was restored, and for the first two years of his presidency, grew rapidly. Congress approved nearly $580 million for FY 1995 in August 1994 just before the landmark International Conference on Population and Development in Cairo and the November election that year in which Republicans gained control of both houses of Congress for the first time in 40 years. FY 1995 remains the high-water mark for U.S. FP/RH funding to this day when measured in constant dollars.

In their attempt to reinstate the Global Gag Rule that President Clinton had rescinded when he came into office in January 1993, Republican family planning opponents in Congress, now in the majority, sought to enact amendments reimposing the policy which the President threatened—and in some years did—veto. In retaliation, foreign aid bills attacked FP/RH funding by cutting, delaying, 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.

After George W. Bush was inaugurated and reinstated the Global Gag Rule and withheld the entire U.S. contribution to UNFPA, bilateral funding recovered somewhat, hovering in the mid-$400 million range, due in large part, to family planning champions in Congress who sought to mitigate the damage caused by these harmful policies by appropriating larger amounts of funding and by rejecting declining presidential budget requests each year.

With the election of President Obama and the return of Democratic majorities in Congress as a result of the 2008 election, 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.

For the last six fiscal years, House appropriations bills have proposed cutting bilateral funding to $461 million, prohibiting a UNFPA contribution, and reinstating the Global Gag Rule. And each year, key champions in the Senate and House beat back those challenges.

But the vagaries of the electoral process visited renewed attacks on the FP/RH funding with the election of a Republican House majority in 2010, which again sought to leverage funding cuts to legislatively impose the GGR and cut off funding for UNFPA. For the last six fiscal years, foreign aid appropriations bills emanating from the House have proposed cutting bilateral funding to the FY 2008 level of $461 million, prohibiting a UNFPA contribution, and reinstating the GGR. And each year, key champions on the Senate and House Appropriations Committee beat back those challenges and successfully preserve the status quo on funding in the low-$600 million range and resisting policy changes. In the FY 2016 omnibus spending bill enacted at the end of last week, for example, total funding is set at $607.5 million, including $32.5 million for UNFPA, and no new policy “riders”—either positive or negative—are attached.

It is essential to remember, however, that even though FP/RH funding remains above $600 million today, it remains woefully inadequate, particularly if you look at it in inflation-adjusted dollars. The high-water mark for FP/RH funding in 1995 would require an expenditure of $898 million in today’s dollars to have the same purchasing power.

It is essential to remember, however, that even though funding remains above $600 million today, it remains woefully inadequate. The high-water mark for funding in 1995 would require an expenditure of $898 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 225 million women in the developing world, this sum would total $1.2 billion annually, including $65 million for a voluntary contribution to UNFPA—roughly a doubling of the current level. The prospects for increasing funding to reach the U.S. “fair share” of the amount needed are daunting, but you can be assured family planning advocates will continue fight for more robust funding by documenting the need, providing the justification, and demonstrating the cost-effectiveness of increased U.S investments.

In many respects, the world in 2015 is vastly different than that which existed in 1965. The rationale and justification for providing family planning and contraception has shifted from an emphasis on overpopulation to a priority on sexual and reproductive health. But the necessity of providing women and couples around the world the services and information to prevent unintended pregnancies and space births remains no less vital. These issues are as critical as ever, 50 years hence.