Zero Sum Game—Trump Budget Request Proposes Zeroing Out Family Planning Funds and Continues to Starve Global Health Programs

Zero Sum Game—Trump Budget Request Proposes Zeroing Out Family Planning Funds and Continues to Starve Global Health Programs

On April 3rd, the White House released its “skinny” budget for fiscal year (FY) 2027, proposing a massive $16.2 billion in cuts to the diplomatic and foreign assistance activities of the U.S. government, while making note that the administration does not believe U.S. foreign assistance funding should support “unfettered access to birth control.” The proposed cuts to the State Department and other international affairs agencies and programs reduce funding by nearly a one-third from the FY 2026 enacted level. Although a figure of “0” does not appear next to an international family planning and reproductive health (FP/RH) line-item in any of the budget documents released so far, it is a virtual certainty that the Trump administration will not request any bilateral or multilateral funding for these programs for the second year in a row.

The proposal represents a dramatic abandonment of a U.S. financial commitment to international FP/RH funding that has remained stable across administrations of presidents of both parties and through budget and political pressures for more than 16 consecutive fiscal years, including last year, when the overall international affairs budget absorbed a 16 percent cut.

The president’s budget request has become a statement of an administration’s spending priorities that Congress routinely ignores. As the old saying among appropriators goes, the president proposes, and Congress disposes. The routine dismissal of appropriations directives during the second Trump term by the Office of Management and Budget’s dictatorial director, Russell Vought, is calling that adage into question. But as a statement of policy, the administration’s zero-dollar request is sending a blunt message—women’s reproductive health and rights are of zero importance to them. Overall, the proposed funding cut for global health programs is a whopping $4.3 billion—a 46 percent reduction from current levels.

Zeroing out funding for FP/RH in the FY 2027 budget is just the latest episode in a series of actions by the Trump administration that have dismantled U.S. investment in global reproductive health. The administration has persuaded the Republican Congress to rescind $500 million in FY 2025 funding for bilateral FP/RH programs; moved to destroy an estimated $10 million in taxpayer-funded contraceptive supplies; defunded UNFPA, the UN’s sexual and reproductive health agency serving more than 150 countries; and both reinstated and dramatically expanded the Global Gag Rule (GGR). The newest expansion of the GGR goes beyond abortion services. It now targets what the administration terms “gender ideology” and “discriminatory equity ideology” activities, which will significantly worsen the policy’s already well-documented negative impacts on health care programs that help the most vulnerable women and girls around the world survive and thrive.

Proposing to zero out all international FP/RH funding is not unprecedented for Donald Trump. He attempted the same in 2017, in his first budget request, before Congress rejected that zeroing out later in the FY 2018 appropriations process. But unlike the request for the second year in his first term, when his budget proposed an allocation of $302 million, the Trump administration is not even pretending to acknowledge that Congress just appropriated $607.5 million for bilateral and multilateral FP/RH programs for the current fiscal year.

For purposes of comparison, the following table contains the FY 2025 enacted and post-rescission levels, the FY 2026 request (the first of Trump’s second term), the recently enacted FY 2026 spending bill, and the just-confirmed FY 2027 Trump budget request for international FP/RH programs.

The main budget volume reveals a continuing near-obsessive animus toward family planning and contraception among Trump political appointees. Fully half of the global health programs section of the short Department of State chapter is weirdly fixated on sexual and reproductive health and rights (SRHR) issues, stating in its entirety:

“The Budget would ensure no funding supports abortion, unfettered access to birth control, and also eliminates funding for circumcision and Lesbian, Gay, Bisexual, Transgender, and Queer services to better focus funds on life-saving assistance. The United States should not pay for the world’s birth control and therapy. Examples of eliminated activities include:

• In the last administration, PEPFAR funded health workers who performed over 21 abortions in Mozambique;
• Promoting reproductive health education and access to birth control and other harmful programs couched under ‘family planning’ in Ghana;
• A supply chain ‘control tower’ to provide a ‘holistic commercial of [sic] the shelf solution’ on [sic] the Office of Population and Reproductive Health (PRH); and
• Promoting health equity and providing condoms and contraception in Kenya.”

Let’s dissect some of the allegations. A quick perusal of the annual State Department and foreign operations appropriations bill will quickly dispel the notion that overseas family planning programs are “unfettered” being more regulated than any other global health sector and the subject of extensive statutory requirements regarding performance or promotion of abortion, biomedical research on abortion, lobbying on abortion, and protection of voluntarism and informed consent, among other restrictions.

The bulleted examples of work the Trump administration will not support call out mainstream family planning programs in Ghana and Kenya that have existed for decades, with strong support from their governments and are widely utilized by their citizens, and are akin to the type of birth control education and services that are routinely available and used by American women. The unintentional violation of the Helms amendment in Mozambique that was identified, reported, and rectified—the way a compliance system is supposed to work—continues to be used as a crude cudgel by family planning opponents to beat up on SRHR programs. (The supply chain “control tower” referenced is a component of a health commodity procurement mechanism that was never fully activated.)

Budget Appendix and State Department Congressional Budget Justification

On the same day as the “skinny” budget release, the Trump administration issued a technical budget appendix typically used to recommend lengthy and exact statutory changes in current appropriations legislation. This version went much further. The administration has chosen to essentially rewrite the statutory language governing State Department operations and foreign assistance programs in the manner that they would if left to their own devices, excluding some old boilerplate and adding some new provisions.

Among the boilerplate restrictions that the Trump administration has chosen to remove are amendments protecting voluntarism and informed consent (DeConcini, Livingston, Obey, and Tiahrt), requiring counseling and referral on all pregnancy options (Leahy), and providing complete and medically accurate information on the use of condoms.

As in his first budget request, the proposed changes in the appendix include, most notably, codifying the GGR. Last year’s formulation sought merely to codify the restrictions on the eligibility of a foreign nongovernmental organization to receive U.S. global health assistance if it engaged in prohibited abortion-related activities using non-U.S. government funds. Now, with the dramatic expansion of the GGR restrictions to new activities, new recipients, and new funding, the Trump administration is proposing to write the three new rules into a new section in the general provisions of State-foreign operation appropriations bill, deceptively titled collectively as “Promoting Human Flourishing in Foreign Assistance,” that prohibits the provision of a “grant award to a nongovernmental organization or international organization if the Secretary of State determines such award is not in compliance with the rule[s].” The abortion rule stands alone in the section, with the “gender ideology” and the “discriminatory equality ideology” being combined in a separate subsection. Also note the absence of any mention of the rules’ application to foreign governments.

The State Department’s Congressional Budget Justification (CBJ), issued shortly after the release of the budget request and appendix, confirms what we already suspected, explicitly stating: “The Budget eliminates global health activities that do not make Americans safer, such as family planning and reproductive health.” This is a verbatim recitation of the first half of a sentence contained in last year’s CBJ, with neglected tropical diseases and non-emergency nutrition named in the second half of that sentence, now apparently making Americans safe one year later. A detailed statistical appendix with funding tables should be forthcoming, which will presumably provide further confirmation of no funding being requested for FP/RH in FY 2027 and may offer some insight into FY 2025 FP/RH expenditures post-rescission and any plans to spend FY 2026 appropriated funds.

While the Trump administration is requesting a zeroing out of funding for lifesaving FP/RH programs for the second year in a row, PAI and our fellow advocates are pushing the United States to increase funding to $2.11 billion—three-and-a-half times the FY 2026 congressionally-appropriated level of $607.5 million. This amount accounts for the U.S. “fair share” of the global cost of continuing care for 714 million women currently using modern contraception and to meet the current unmet demand for contraception of 78 million women in low- and middle-income countries, based on a cost-analysis by the Guttmacher Institute. In letters to House Appropriations Committee leaders, 144 representatives endorsed the $2.11 billion funding recommendation, as did 33 major national organizations.

What’s Next

SRHR advocates will be urging Congress to reject this fatally flawed and woefully inadequate FY 2027 budget proposal from the president, reassert its constitutional “power of the purse,” and fully fund international FP/RH, reaffirming America’s six-decade commitment to the health, rights, and futures of women and families around the world.

In response to the president’s budget request being sent to Capitol Hill last Friday, Representative Tom Cole (R-OK), Chair of the House Appropriations Committee, stated, “Republican Appropriators will continue to uphold our Article I responsibility—directing taxpayer dollars where they are needed most and ensuring they are spent wisely. We are not waiting—hearings are underway, and markups will move this work forward in the weeks ahead.” Perhaps Republican appropriators are coming around and finding their resolve to assert Congress’s spending prerogatives.

It is now rumored that House committee markup of the FY 2027 National Security, Department of State, and Related Programs (NSRP) subcommittee bill—known in the Senate as the Department of State, Foreign Operations, and Related Programs (SFOPS) bill—may occur as early as the end of this month. As always, Senate appropriators are on a slower timeline.

In his statement, Chair Cole also approvingly pointed out that the “enacted FY 2026 bills contain no poison pills.” And while many advocates for causes like reproductive rights and environmental protection will point out that harmful legacy policy “riders” continue to abound across the 12 subcommittee bills, securing a bipartisan, bicameral agreement not to add any new policy restrictions, such as a legislative codification of the three expanded GGR rules, will be key to successfully moving bills through the FY 2027 appropriations process to a final spending agreement—and for international FP/RH advocates, essential to preserving the status quo on funding and policy for the 17^th fiscal year in a row.

Stay tuned.