Congress Giveth and Republicans Taketh Away: House Republicans Propose Family Planning Funding Cut in Foreign Aid Spending Bill

The House Appropriations Committee will consider the State Department-foreign operations appropriations bill for fiscal year (FY) 2024 in full committee markup tomorrow. The subcommittee bill produced by the Republican majority to be marked up proposes to slash international family planning and reproductive health (FP/RH) funding by capping bilateral and multilateral assistance at $461 million — a whopping $146.5 million (24%) cut below the current enacted level of $607.5 million. Were it to be enacted into law, the negative implications of a funding cut of this magnitude for the lives of the people and communities that benefit from U.S. investments are predictable and stark.  

For the last several years, sexual and reproductive health and rights (SRHR) advocates have laid down a marker on how much of an increase in U.S. government investments in FP/RH programs is appropriate and justified and represents the U.S. “fair share” of the annual cost of addressing family planning needs worldwide. PAI has revised its policy brief, entitled Just the Math, explaining the methodology used to calculate the U.S. share of the global investment required. 125 House members — all Democrats — and nearly 90 major national organizations have endorsed the amount calculated, and each have submitted an identical request to congressional appropriators for inclusion of $1.736 billion — a near tripling of the current enacted level for bilateral and multilateral FP/RH programs — in the FY 2024 State Department-foreign operations appropriations bill. 

The $1.736 billion funding recommendation is derived from a July 2020 estimate by the Guttmacher Institute of the $12.6 billion annual global cost of addressing the unmet need for modern contraception of 218 million women in low- and middle-income countries (LMICs) who want to avoid pregnancy but are not using a modern contraceptive method, while continuing to meet the needs of 705 million existing contraceptive users in LMICs. 

This calculation of the appropriate U.S. share of the total global investment required is based on a reasonable burden-sharing rationale for contributions by donor and recipient countries. This can inform policymakers’ priority-setting and decision-making by providing a solid, evidence-based estimate of what the U.S. government should be investing in contraceptive availability and use and can be a call to action if policymakers are willing to prioritize these investments. 

Just as the positive impact of increased U.S. investment in FP/RH programs can be estimated, so can the negative effect of funding cuts. In a recent Guttmacher analysis Just the Numbers, issued in March of this year, the benefits of family planning financing in more than 30 LMICs receiving U.S. FP/RH assistance in FY 2022 were graphically demonstrated. But that which is given, can also be taken away.  

Applying their methodology, the potential impact on reproductive and maternal health outcomes of the proposed Republican cut of $146.5 million below current FY 2023 bilateral and multilateral FP/RH funding levels would be 8.2 million fewer women and couples with contraceptive services, which would result in the following outcomes: 

• 2.7 million additional unintended pregnancies; 
• 1.1 million additional unplanned births; 
• 894,000 additional unsafe abortions; and 
• 4,700 additional maternal deaths. 

But not satisfied with merely hacking away at FP/RH funding, the Republican majority’s subcommittee bill would impose a series of anti- SRHR policy “riders” — both new and old — including: 

• Prohibiting funding for the United Nations Population Fund;  
• Codifying an expanded version of the Global Gag Rule (GGR), applying the GGR to all global health assistance from the U.S. government, including the President’s Emergency Plan for AIDS Relief;  
• Continuing the 1973 Helms amendment restricting the use of U.S. funds to provide “abortion as a method of family planning,” restrictions on abortion coverage for Peace Corps Volunteers and other existing anti-SRHR riders that have been included in past appropriations bills; and  
• Seeking to export the United States’ culture wars by including anti-trans policy provisions, restrictions on funding for diversity, equity and inclusion initiatives and a ban on funding for “drag queen workshops, performances or documentaries.” 

Stay tuned for a report on Wednesday’s markup. It won’t be pretty. But this is just the start of the months-long congressional appropriations process for the fiscal year that begins on October 1, the final resolution of which is unlikely to be reached until the end of the year.