Order Code IB96026
CRS Issue Brief for Congress
Received through the CRS Web
Population Assistance and Family Planning
Programs: Issues for Congress
Updated October 14, 2003
Larry Nowels
Foreign Affairs, Defense, and Trade Division
Congressional Research Service ˜ The Library of Congress

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CONTENTS
SUMMARY
MOST RECENT DEVELOPMENTS
BACKGROUND AND ANALYSIS
Introduction to U.S. Population Assistance Issues:
Setting the Context
Abortion and Coercion
The “Mexico City” Policy
Funding for UNFPA
Family Planning Conditions in China
Funding Levels
Current International Family Planning Issues and Legislation
Foreign Relations Authorization, FY2004-2005
Foreign Operations Appropriations, FY2004
LEGISLATION

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Population Assistance and Family Planning Programs:
Issues for Congress
SUMMARY
Since 1965, United States policy has
in violation of the “Kemp-Kasten” amend-
supported international population planning
ment because of its activities in China. This
based on principles of voluntarism and
provision bans U.S. assistance to organiza-
informed choice that gives participants access
tions that support or participate in the manage-
to information on all methods of birth control.
ment of coercive family planning programs.
This policy, however, has generated conten-
The decision resulted in the withholding of
tious debate for over two decades, resulting in
$34 million in funding for each of FY2002
frequent clarification and modification of U.S.
and FY2003.
international family planning programs.
H.J.Res. 2, the Consolidated Appropria-
In 1984, U.S. population aid policy
tion for FY2003, passed Congress in February
became especially controversial when the
2003, providing $446.5 million for bilateral
Reagan Administration introduced
restric-
population aid and $34 million to UNFPA.
tions, which became known as known as the
The UNFPA contribution, however, has been
“Mexico City policy.”
Critics viewed the
re-directed to USAID bilateral family plan-
policy as a major and unwise departure from
ning programs.
U.S. population efforts of the previous 20
years. The “Mexico City policy” denied U.S.
For FY2004 the Administration seeks
funds to foreign non-governmental organiza-
$425 million in bilateral family planning
tions (NGOs) that perform or promote abor-
funds and sets asides $25 million in a reserve
tion as a method of family planning, regard-
account for UNFPA if the organization be-
less of whether the money came from the
comes eligible for U.S. support.
U.S. government. Presidents Reagan and
Bush also banned grants to the U.N. Popu-
The House has deleted a provision in
lation Fund (UNFPA) because of its program
H.R. 1950 that would have authorized $50
in China, where coercion has been used.
million for UNFPA in FY2004 and FY2005,
and revised current law in a way that may
President Clinton repealed the Mexico
have made it more difficult to deny U.S.
City policy and resumed UNFPA funding. On
contributions to UNFPA. In a companion
January 22, 2001, President Bush restored in
measure (S. 925), the Senate adopted a Boxer
full the terms of the Mexico City restrictions
amendment that would effectively overturn
that were in effect on January 19, 1993.
the Bush Administration’s Mexico City pol-
Foreign NGOs and international organiza-
icy.
tions, as a condition for receipt of U.S. funds,
now must certify that they do not perform or
In FY2004 appropriation bills, the House
actively promote abortions as a method of
(H.R. 2800) includes $425 million for family
family planning in other countries.
planning aid while the Senate (S. 1426) pro-
vides $445 million. S. 1426 further overturns
More recently, Secretary of State Powell
the Mexico City policy.
announced on July 22, 2002, that UNFPA was
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˜ The Library of Congress

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MOST RECENT DEVELOPMENTS
On August 29, 2003, President Bush directed the Secretary of State to extend the
provisions of the “Mexico City policy” to programs managed by the State Department.
Previously, the policy, which requires foreign non-governmental organizations receiving U.S.
population assistance to certify that they will not perform or promote abortions as a method
of family planning during the period of the U.S. grant, had applied only to USAID programs.
The directive will most likely affect refugee programs managed by the State Department, but
will not apply to international HIV/AIDS funds authorized in P.L. 108-25.
On a related issue, on August 27, the State Department confirmed that it had decided
not to fund a $1 million HIV/AIDS program for African and Asian refugees if the NGO
consortium managing the project included Marie Stopes International, a British-based
reproductive health organization. Marie Stopes International is a major implementing
partner of the U.N. Population Fund (UNFPA) in China. In July 2002 the Department
determined that UNFPA was involved in China’s coercive family planning program, and
therefore ineligible for U.S. support. As a matter of policy, the State Department made the
same decision regarding Marie Stopes International. The consortium refused U.S. funding
without the inclusion of Marie Stopes International.
On July 15, the House voted 216-211 to delete a UNFPA provision added by the
International Relations Committee to the FY2004/2005 State Department Authorization bill
(H.R. 1950). Previously, the House panel had added an amendment by Congressman
Crowley (23-22) authorizing a $50 million U.S. contribution for each of the two years to
UNFPA. The Crowley amendment, which would have required the President to find that
UNFPA “directly” supports or participates in coercive or involuntary activities, would appear
to have made it more difficult to deny funding to UNFPA than under existing law. During
debate on a companion bill to H.R. 1950, the Senate approved on July 9 an amendment to
S. 925, offered by Senator Boxer, that would effectively overturn the President’s “Mexico
City policy.” (The Senate failed to table the amendment 43-53.) The White House says that
the President will veto any legislation that includes a provision like the Boxer amendment.
Subsequently, House and Senate Foreign Operations Appropriations bills (H.R. 2800
and S. 1426) have taken different positions on international family planning issues for
FY2004. The House measure, approved on July 23, provides $425 million, as requested, for
bilateral population programs, and $25 million for UNFPA, subject to conditions similar to
those that have blocked U.S. contributions the past two years. The Senate bill, as reported,
appropriates $445 million for bilateral programs, and adds language similar to the Boxer
amendment in S. 925 that would effectively reverse the President’s “Mexico City” abortion-
related restrictions. S. 1426 further provides $35 million for UNFPA, subject to current
restrictions.
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BACKGROUND AND ANALYSIS
Introduction to U.S. Population Assistance Issues:
Setting the Context
Population assistance became a global issue in the late 1950s and early 1960s after
several private foundations, among them the International Planned Parenthood Federation,
began providing money to developing countries to control high population growth rates. In
1966, when global population growth rates were reaching an historic annual high of 2.1%,
the United Nations began to include population technical assistance in its international
development aid programs. Population assistance grew rapidly over the next half-dozen
years, with the United States, other developed countries, and international organizations such
as the World Bank, all beginning to contribute funds.
The first International Population Conference was held in 1974, followed by the second
in Mexico City in 1984, and the third in Cairo in 1994. The attention and funding given to
international family planning programs are credited with helping to bring a decrease in
population growth among low and middle income countries from about a 1.7% per year
average, 1980-2000, to a projected annual average of 1.2%, 2000-2015. Fertility rates have
fallen in these nations from 4.1 children per woman in 1980 to 2.8 in 2000. Nevertheless,
while global population growth has slowed, it reached 6 billion in 1999 and is expected to
rise to 8.9 billion by 2050, with most all of the growth occurring in developing nations. In
1960, 70% of the world’s population lived in developing countries; today the level is 80%,
and these countries now account for 95% of world-wide population growth.
But population statistics alone are only part of a larger story. For the past thirty years
and more, countries have heatedly debated what the statistics mean.
Proponents of
aggressive family planning programs have held that high fertility rates and rapid population
growth are serious impediments to a country’s development. According to this school of
thought, people are consumers: no poor country can increase its standard of living and raise
its per capita income while wrestling with the problems of trying to feed and care for a
rapidly expanding population. Thus, poor and developing countries should invest in family
planning programs as part of their economic development process.
On the opposing side, critics of aggressive population planning programs hold that there
is little or no correlation between rapid population growth and a country’s economic
development. Some argue that increased numbers of people provide increased productive
capacity; therefore, they say, high population growth rates actually can contribute to a
country’s ability to increase its standard of living. At the very least, proponents of this view
say, current economies of scale and global trading patterns have too many empirical variables
and uncertainties to establish a direct correlation between population growth and economic
development.
As this population debate evolved, many countries, including the United States,
changed their views. In the 1974 international population conference, the United States and
other donor countries asserted that high fertility rates were an impediment to economic
development — an assertion that was then rejected by developing countries. In keeping with
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this view, the Carter Administration in 1977 proposed legislative language, later enacted in
Sec. 104(d) of the Foreign Assistance Act of 1961, which sought to link population growth
and traditional development assistance programs on the grounds that a high population
growth rate could have a serious negative effect on other development objectives.
A decade later, at the second conference in Mexico City in 1984, a reversal of positions
occurred. Developing countries had become convinced of the urgent need to control
population growth, while U.S. officials asserted that population growth was not necessarily
a negative force in economic development, but was instead a “neutral phenomenon.” At
Mexico City, Reagan Administration officials emphasized the need for developing countries
to adopt sound economic policies that stressed open markets and an active private sector.
Again nearly a decade later, the Clinton Administration changed the U.S. position on
family planning programs by lifting restrictive provisions adopted at the Mexico City
Conference. At the 1994 Cairo Conference, U.S. officials emphasized support for family
planning and reproductive health services, improving the status of women, and providing
access to safe abortion. Eight years later, President Bush revoked the Clinton Administration
position on family planning issues and abortion, reimposing in full the Mexico City
restrictions in force during the 1980s and early 1990s. Throughout this debate, which at
times has been the most contentious foreign aid policy issue considered by Congress, the
cornerstone of U.S. policy has remained to be a commitment to international family planning
programs based on principles of voluntarism and informed choice that give participants
access to information on all major methods of birth control.
Since the 1994 Cairo conference, groups supporting strategies to limit rapid population
growth have supported a broader agenda of initiatives that include the promotion of gender
equality, increasing adolescent education on sexuality and reproductive health, and ensuring
the universal right of health care, including reproductive health. Although endorsed at the
July 1999 U.N. meeting of 179 nations to assess progress of the Cairo population conference
recommendations, the issues of child education and government responsibilities for ensuring
access to safe abortions in countries where the practice is legal were particularly
controversial. Some governments opposed the broadening of the Cairo mandate and some,
including Argentina, Nicaragua, and the Vatican, filed reservations to the recommendations
reached by consensus.
Most recently, new research suggests that there has been a significant decline in
birthrates in several of the largest developing nations, including India, Brazil, and Egypt.
(See, for example, “Population Estimates Fall as Poor Women Assert Control,” New York
Times, March 10, 2002, p. 3.)
Some demographers conclude that global population
projections for this century may need to be reduced by as much as one billion people.
Although there are differences of opinion as to why fertility rates are falling — and whether
the trend is universal throughout the developing world — a few demographers argue that the
change has less to do with government family planning policies and foreign aid and more to
do with expanded women’s rights in these countries. Women are choosing to have fewer
children, they argue. Others also cite the fact that with improved health conditions and
lowered infant mortality rates, parents are deciding to have fewer babies because they are
more confident that their children will survive.
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In addition to differences of opinion over how population growth affects economic
development in developing countries, population planning assistance has become an issue
of substantial controversy among U.S. policymakers for two other reasons: the use of federal
funds to perform or promote abortions abroad and how to deal with evidence of coercion in
some foreign national family planning programs, especially in China; and setting the
appropriate, effective, and affordable funding levels for family planning assistance.
Abortion and Coercion
The bitterest controversies in U.S. population planning assistance have erupted over
abortion — in particular, the degree to which abortions and coercive population programs
occur in other countries’ family planning programs, the extent to which U.S. funds should
be granted to or withheld from such countries and organizations that administer these
programs, and the effect that withholding U.S. funds will have on global population growth
and family planning services in developing nations. These issues essentially stem from the
contentious domestic debate over U.S. abortion policy that has continued since the Supreme
Court’s 1973 Roe v. Wade decision holding that the Constitution protects a woman’s decision
whether to terminate her pregnancy. Abortion opponents have introduced in every Congress
since 1973 constitutional amendments or legislation that would prohibit abortions, but none
have been enacted. As an alternative, abortion critics have successfully persuaded Congress
to attach numerous provisions to annual appropriation measures banning the use of federal
funds for performing abortions.
Most of this debate has focused on domestic spending bills, especially restrictions on
abortions under the Medicaid program in the Labor/Health and Human Services
appropriation legislation. Nevertheless, the controversy spilled over into U.S. foreign aid
policy almost immediately when Congress approved in late 1973 an amendment to the
Foreign Assistance Act of 1961 (Section 104(f)) prohibiting the use of foreign development
assistance to pay for the performance of abortions or involuntary sterilizations, to motivate
or coerce any person to practice abortions, or to coerce or provide persons with any financial
incentive to undergo sterilizations. Since 1981, Congress has enacted nearly identical
restrictions in annual Foreign Operations appropriation bills.
For the past 25 years, both congressional actions and administrative directives have
restricted U.S. population assistance in various ways, including those set out in the Foreign
Assistance Act of 1961, and more recent executive regulations and appropriation riders
prohibiting indirect support for coercive family planning (specifically in China) and abortion
activities related to the work of international and foreign nongovernmental organizations.
Two issues in particular which were initiated in 1984 — the “Mexico City” policy involving
funding for non-governmental organizations (NGOs), and restrictions on funding for the
U.N. Population Fund (UNFPA) because of its activities in China — have remained
controversial and continue as prominent features in the population assistance debate.
The “Mexico City” Policy. (For more detailed discussion of the original “Mexico
City” policy, its implementation, and impact, see CRS Report RL30830, International
Family Planning: The “Mexico City” Policy.) With direct funding of abortions and
involuntary sterilizations banned by Congress since the 1970s, the Reagan Administration
in 1984 announced that it would further restrict U.S. population aid by terminating U.S.
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Agency for International Development (USAID) support for any organizations (but not
national governments) that were involved in voluntary abortion activities, even if such
activities were undertaken with non-U.S. funds. U.S. officials presented the revised policy
at the 2nd U.N. International Conference on Population in Mexico City in 1984. Thereafter,
it become known as the “Mexico City” policy. USAID announced in late 1984 that it would
not provide funds for the International Planned Parenthood Federation/London (IPPF) in
FY1985 because the IPPF/London, which had operations in 132 countries, refused to
renounce abortion-related activities it carried out with non-U.S. funds. On January 13, 1987,
Planned Parenthood Federation of America (PPFA) filed a lawsuit against USAID
challenging the “Mexico City” policy. In 1990, the U.S. District Court and Court of Appeals
ruled against PPFA, and in 1991, the Supreme Court refused to review the lower court’s
decision. The President’s discretionary foreign policy powers to establish different standards
for foreign NGOs and institutions were thereby upheld.
During the Bush Administration, efforts were made in Congress to overturn the Mexico
City policy and rely on existing congressional restrictions in the Foreign Assistance Act of
1961 banning direct U.S. funding of abortions and coerced sterilizations. Provisions adopted
by the House and/or Senate that would have reversed the policy, however, were removed
from legislation under threat of a presidential veto.
Mexico City Policy Removed. In its first days in office, the Clinton Administration
changed U.S. family planning assistance policies, covering not only the Mexico City
restrictions but also funding for UNFPA. In a January 22, 1993 memo to USAID, President
Clinton lifted restrictions imposed by the Reagan and Bush Administrations on USAID
grants to family planning NGOs — in effect repealing the Mexico City policy. The memo
noted that the policy had extended beyond restrictions in the FAAct and was not mandated
by law. In his remarks, President Clinton explained that this step “will reverse a policy that
has seriously undermined much needed efforts to promote safe and effective family planning
programs abroad, and will allow us to once again provide leadership in helping to stabilize
world population.”
Efforts to Legislate the Mexico City Policy. Beginning in 1993, abortion
opponents in Congress attempted to legislate modified terms of the Mexico City policy.
Under the threat of a Presidential veto and resistence from the Senate, Mexico City
restrictions had not been enacted into law until passage in November 1999 of the
Consolidated Appropriations Act for FY2000 (P.L. 106-113). The White House accepted
the family planning conditions in exchange for congressional support of the payment of
nearly $1 billion owed by the United States to the United Nations. The restrictions expired
at the end of FY2000.
Under the terms of Section 599D of P.L. 106-113, private foreign non-governmental
and multilateral organizations had to certify that they neither performed abortions nor lobbied
to change abortion laws in foreign countries in order to receive USAID population aid grants
in FY2000. Section 599D allowed the President to waive the certification requirement for
up to $15 million in grants to groups that would otherwise be ineligible, but with the penalty
of a $12.5 million transfer out of the $385 million population aid appropriation to child
health programs.
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One day after signing the legislation, the President exercised his waiver authority
(November 30, 1999), thereby reducing FY2000 population aid funds to $372.5 million. He
further instructed USAID to implement Section 599D in a way that would minimize the
impact on U.S. funded family planning programs. In USAID-issued certification forms,
organizations had to state that they would not engage in three types of activities with either
USAID or non-USAID funds from the date they signed an agreement to receive FY2000
USAID population funds through September 30, 2001:
! perform abortions in a foreign country, except where the life of the mother
would be endangered, or in cases of forcible rape or incest;
! violate the laws of a foreign country concerning the circumstances under
which abortion is permitted, regulated, or restricted; or
! attempt to alter the laws or governmental policies concerning circumstances
under which abortion is permitted, regulated, or restricted.
If an organization declined to certify or did not return the certification form, it was ineligible
to receive FY2000 USAID population funds unless it was granted a waiver under the $15
million exemption cap. In total, nine organizations refused to certify, including two of the
largest recipients of USAID population aid grants — IPPF and the World Health
Organization (WHO). (During the Reagan and Bush Administrations, IPPF was one of the
few family planning organizations that declined to sign “Mexico City” policy conditions and
received no USAID funding during that period.) These nine non-certifying organizations
were awarded about $8.4 million in FY2000 grants, of which IPPF accounted for $5 million
and WHO roughly $2.5 million.
Bush Administration Restores the Mexico City Policy. President George W.
Bush, as one of his first official actions in office, issued a memorandum revoking the Clinton
Administration memorandum and restoring in full the terms of the Mexico City restrictions
that were in effect on January 19, 1993. As was the case during the 1980s and early 1990s,
in the future foreign NGOs and international organizations, as a condition for receipt of U.S.
federal funds, must certify that they will not perform or actively promote abortions as a
method of family planning in other countries. President Bush noted in his order that
American taxpayer funds should be not used to pay for abortions or advocate or actively
promote abortion. Other supporters of the certification requirement argued that even though
permanent law bans USAID funds from being used to perform or promote abortions, money
is fungible; that organizations receiving American-taxpayer funding can simply use USAID
resources for legal activities while diverting money raised from other sources to perform
abortions or lobby to change abortion laws and regulations. The certification process, they
contended, stops the fungibility “loophole.”
Critics charge, however, that the policy is a violation of free speech and the rights of
women to choose. They contend that the policy undermines maternal health care services
offered in developing nations and may actually contribute to the rise in the number of
abortions performed, some that are unsafe and illegal. They further believe that family
planning organizations cut back on services because they will be unsure of the full
implications of the restrictions and do not want to risk losing eligibility for USAID funding.
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Opponents also believe the conditions undermine relations between the U.S. government and
foreign NGOs and multilateral groups, creating a situation in which the United States
challenges their sovereignty on how to spend their own money and imposing a so-called
“gag” order on their ability to promote changes to abortion laws and regulations in
developing nations. The latter, these critics note, would be unconstitutional if applied to
American groups working in the United States.
New Mexico City Policy Guidelines. USAID released on February 15, 2001,
specific contract clauses necessary to implement the President’s directive. The guidelines
state that U.S. NGOs receiving USAID grants cannot furnish assistance to foreign NGOs
which perform or actively promote abortion as a method of family planning in USAID-
recipient countries, or that furnish assistance to other foreign NGOs that conduct such
activities. When USAID provides assistance directly to a foreign NGO, the organization
must certify that it does not now or will not during the term of the grant perform or actively
promote abortion as a method of family planning in USAID-recipient countries or provide
financial support to other foreign NGOs that carry out such activities. Abortion is defined
as a “method of family planning when it is for the purpose of spacing births,” including (but
not limited to) abortions performed for the physical or mental health of the mother. To
perform abortions is defined as the operation of a “facility where abortions are performed as
a method of family planning.” (USAID memorandum to all contracting officers and
negotiators, titled Voluntary Population Activities — Restoration of the Mexico City Policy,
dated February 15, 2001.)
Promoting abortion is defined as an organization committing resources “in a substantial
or continuing effort to increase the availability or use of abortion as a method of family
planning.” Examples of what constitutes the promotion of abortion include: operating a
family planning counseling service that includes information regarding the benefits and
availability of abortion; providing advice that abortion is an available option or encouraging
women to consider abortion; lobbying a foreign government to legalize or to continue the
legality of abortion as a method of family planning; and conducting a public information
campaign in a USAID-recipient country regarding the benefits and/or availability of abortion
as a method of family planning.
The regulations also contain exceptions:
! abortions may be performed if the life of the mother would be endangered
if the fetus were carried to term or abortions performed following rape or
incest; health care facilities may treat injuries or illnesses caused by legal or
illegal abortions (post-abortion care).
! “passive” responses by family planning counselors to questions about
abortion from pregnant women who have already decided to have a legal
abortion is not considered an act of promoting abortion; referrals for
abortion as a result of rape, incest, or where the mother’s life would be
endangered, or for post-abortion care are permitted.
USAID will further be able to continue support, either directly or through a grantee, to
foreign governments, even in cases where the government includes abortion in its family
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planning program. Money provided to such governments, however, must be placed in a
segregated account and none of the funds may be drawn to finance abortion activities.
Most recently, the President issued a memorandum on August 29, 2003, for the
Secretary of State, directing him to apply Mexico City policy conditions on State Department
programs in the same way they apply to USAID activities. This new directive will most
likely apply most directly to State Department-managed refugee programs, large portions of
which are implemented by international organizations and NGOs.
The President’s
memorandum, however, stated that the policy would not apply to multilateral organizations
that are associations of governments, presumably referring to the U.N. High Commissioner
for Refugees, among others. The President further stated that the Mexico City policy would
also not apply to foreign aid funds authorized under P.L. 108-25, the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.
Funding for UNFPA. Also at the 1984 Mexico City Conference, the Reagan
Administration established the requirement that the United Nations Population Fund
(UNFPA) provide “concrete assurances that [it] is not engaged in, or does not provide
funding for, abortion or coercive family planning programs.” Concern was highest over
UNFPA’s activities in China’s coercive family planning practices.
At the time, the
Administration reportedly held up $19 million (of $38 million allocated for UNFPA for
FY1984) until the organization could provide the necessary assurances.
Subsequently, Congress legislated a more restrictive UNFPA policy — aimed at
coercive Chinese family planning programs and UNFPA’s continuing operations in the
country — by enacting the “Kemp-Kasten amendment” in the FY1985 Supplemental
Appropriations Act (P.L. 99-88). This language prohibited the use of appropriated funds for
any organization or program, determined by the President, to be supporting or participating
“in the management” of a program of coercive abortion or involuntary sterilization.
Following enactment of P.L. 99-88, USAID announced that $10 million of $46 million that
had been earmarked for UNFPA during FY1985 would be redirected to other programs, and
later said that the United States would not contribute to UNFPA at all in 1986. Most of the
$25 million that was originally allocated for UNFPA was spent for other international family
planning activities. Even though this pattern to redirect UNFPA transfers to other population
assistance programs continued, critics of the Kemp-Kasten amendment and the President’s
determination to suspend contributions asserted that UNFPA was the world’s most effective
family planning organization and that the quality of services provided in developing nations
outside of China suffered due to the unwillingness of U.S. support.
At the time of
suspension, U.S. payments represented nearly one-third of UNFPA’s annual budget. From
1986 through 1993, no U.S. contributions went to UNFPA.
Like the Mexico City policy, the Clinton Administration moved quickly to lift the ban
of UNFPA contributions, making available $14.5 million in FY1993 but stipulating that none
of the funds could be used in China. Again, congressional critics of Chinese family planning
practices attempted unsuccessfully to attach riders to various foreign aid bills banning U.S.
contributions unless UNFPA withdrew from China or the President could certify that China
no longer maintained a coercive family planning program. Nevertheless, while the United
States continued to support UNFPA during the next five years, Congress attached restrictions
in appropriation measures that in most cases reduced the U.S. contribution by the amount
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UNFPA spent in China. UNFPA ended a 5-year program in China in 1997. But when the
organization negotiated in early 1998 a new multi-year Chinese program, Congress, over the
Administration’s objections, prohibited American support for FY1999. Congress resumed
UNFPA funding in FY2000 and 2001 but under the condition that the $25 million earmark
would be reduced by whatever amount UNFPA’s program cost for China.
Bush Administration freezes FY2002 UNFPA funding. For FY2002, Congress
provided “not more than” $34 million for UNFPA. But in mid-January 2002, the White
House placed a hold on U.S. contributions to UNFPA, pending a review of the organization’s
program in China. The White House said it initiated the review because of new evidence that
coercive practices continue in counties where UNFPA concentrates its programs. (See
House International Relations Committee hearing, Coercive Population Control in China:
New Evidence of Forced Abortion and Forced Sterilization, October 17, 2001, regarding the
charges of coercion made by an investigative team sponsored by the Population Research
Institute. For more testimony of these findings, plus those of UNFPA-commissioned team
that found no evidence of UNFPA-supported coercive family planning practices in China,
see testimony before the Senate Committee on Foreign Relations, February 27, 2002.)
State Department Team Assesses UNFPA Program in China. While most
observers agree that coercive family planning practices continue in China, differences remain
over the extent to which, if any, UNFPA is involved in involuntary activities and whether
UNFPA should operate at all in a country where such conditions exist. Given the conflicting
reports, the State Department sent an investigation team to China for a two-week review of
UNFPA programs on May 13, 2002. The team was led by former Ambassador William
Brown, and included Bonnie Glick, a former State Department official, and Dr. Theodore
Tong, a public health professor at the University of Arizona.
The State Department’s assessment team filed its report with Secretary Powell on May
29, making a series of findings and recommendations. (See [http://www.state.gov
/g/prm/rls/rpt/2002/12122.htm] for report’s full text.) The group found that:
! There is no evidence that UNFPA “has knowingly supported or participated
in the management of a program of coercive abortion or involuntary
sterilization” in China;
! Despite some relaxation of government restrictions in counties where
UNFPA operates, China maintains coercive elements in its population
programs in law and practice; and
! Chinese leaders view “population control as a high priority” and remain
concerned over implications for socioeconomic change.
On the basis of these findings, Ambassador Brown and his colleagues recommended that:
! The United States should release not more than $34 million of previously
appropriated funds to UNFPA;
! Until China ends all forms of coercion in law and practice, no U.S.
government funds should be allocated to population programs in China; and
! Appropriate resources, possibly from the United States, should be allocated
to monitor and evaluate Chinese population control programs.
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Nevertheless, on July 22, 2002, Secretary of State Powell, to whom the President had
delegated the decision, announced that UNFPA was in violation of Kemp-Kasten and
ineligible for U.S. funding. The State Department’s analysis of the Secretary’s determination
(see [http://www.state.gov/g/prm/rls/other/12128.htm] for the full text) found that even
though UNFPA did not “knowingly” support or participate in a coercive practice, that alone
would not preclude the application of Kemp-Kasten. Instead, a finding that the recipient of
U.S. funds — in this case UNFPA — simply supports or participates in such a program,
whether knowingly or unknowingly, would trigger the restriction. The assessment team
found that the Chinese government imposes fines and penalties on families (“social
compensation fees”) that have children exceeding the number approved by the government.
The Department further noted that UNFPA had funded computers and data-processing
equipment that had helped strengthen the management of the Chinese State Family Planning
Commission. Beyond the legitimate uses of these and other items financed by UNFPA, such
equipment facilitated, in the view of the State Department, China’s ability to impose social
compensation fees or perform abortions on those women coerced to have abortions they
would not otherwise undergo. The State Department analysis concluded that UNFPA’s
involvement in China’s family planning program “allows the Chinese government to
implement more effectively its program of coercive abortion.”
Critics of the Administration’s decision oppose it for a number of reasons, including the
loss of $34 million, an amount that represented about 9% of UNFPA income in 2001. They
argue that access to voluntary family planning programs by persons in around 140 countries
will be reduced, undermining the health of women and children, preventing unwanted
pregnancies, and increasing the likelihood of higher numbers of abortions. The European
Commission announced on July 24, 2002, a $32 million family planning program, launched
in partnership with UNFPA, that would in some degree cover the gap by the loss of U.S.
resources. The EU initiative, however, benefitted just 22 countries participating in its
African, Caribbean and Pacific program. Still other critics are concerned about the possible
application of the Administration’s interpretation of Kemp-Kasten for other international
organizations that operate in China and to which the U.S. contributes — for example,
UNICEF, the World Health Organization, and the U.N. Development Program.
Since the July 2002 determination, the Administration has transferred to USAID $34
million from FY2002 appropriations and $25 million from FY2003 that would have
otherwise been provided to UNFPA in order to fund USAID bilateral family planning
programs for which UNFPA has no involvement. The State Department’s justification of
its September 25, 2003 letter to Congress regarding the FY2003 resources noted that the
“factual circumstances” do not support making a determination that UNFPA no longer
supports or participates in the management of a program of coercive abortion or involuntary
sterilization. Section 572 of the FY2003 Foreign Operations Appropriations required the
President to issue such a statement before restoring U.S. funding to UNFPA.
Also related to the July 2002 decision regarding UNFPA, on August 6, 2003, the State
Department decided that it would provide $1 million from its refugee assistance account for
an HIV/AIDS program supporting African and Asian refugees only if the implementing
group — Reproductive Health for Refugees Consortium — consisting of seven NGOs, did
not include Marie Stopes International. Marie Stopes International is a British-based
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reproductive health organization that is also a major implementing partner of UNFPA in
China. The State Department, while not making a legal determination under the Kemp-
Kasten amendment, felt that an action not to fund Marie Stopes International would be an
“approach most consistent with U.S. policy.” (Details for Funding the Reproductive Health
Consortium (Taken Question), Office of the State Department’s Spokesman, August 27,
2003.) On August 11, however, the Consortium declined to accept the $1 million grant due
to the exclusion of Marie Stopes International.
(See below under the section on Legislation for a discussion of congressional debate on
this and other family planning aid issues in 2003.)
Family Planning Conditions in China. As noted, much of the UNFPA debate has
focused on that organization’s programs in China, both because of China’s well-known
population growth problem and because of widespread publicity given to reports of coercion
in its family planning programs. China’s population increased from 500 million in 1950 to
1.008 billion according to the 1982 census — an average annual growth rate of 2%, or a
doubling of the population every 36 years. (Although the 2% rate is not particularly large
by developing country standards, many consider a lower rate crucial to China’s economic
development prospects given the country’s already huge population size.)
Beijing authorities came to view control of population growth not simply as an
important priority, but as a necessity for the nation’s survival. In an attempt to reach a 1%
annual population growth rate, Chinese authorities in 1979 instituted a policy of allowing
only one child per couple, providing monetary bonuses and other benefits as incentives.
Women with one living child who became pregnant a second time were said to be subjected
to rigorous pressure to end the pregnancy and undergo sterilization; couples who actually had
a second child faced heavy fines, employment demotions, and other penalties. PRC leaders
have admitted that coerced abortions and involuntary sterilizations occur, but insist that those
involved are acting outside the law and are punished, particularly through the Administrative
Procedure Law enacted in October 1990. Chinese authorities have termed female infanticide
an “intolerable crime” that must be punished by law.
After 1983, thought to be the peak year of coercion in Chinese family planning in the
1980s, the PRC relaxed its “one-child” policy in rural areas. The original target for the
PRC’s population in the year 2000 had been 1.2 billion, but that goal was relaxed in 1984
to 1.25 billion, and the Chinese minister of family planning indicated in 1991 that the target
population size for 2000 was now 1.294 billion. (UNFPA reports that China’s population
in 1999 was 1.267 billion, with an annual growth rate of 0.9%.) In addition, the policy has
been loosely applied for Tibetan, Muslim, and other ethnic minorities. China has also
reported regional differences in the so-called “one-child” policy. Economic reforms helped
weaken policy enforcement in more prosperous areas, with rising incomes absorbing fines.
More recent press reports suggest that the Chinese State Family Planning Commission
(SFPC) has softened some of its previous harsh tactics to limit population growth. A number
of counties have ended the system of permits for pregnancy and quotas for the number of
children that can be born annually. When it launched in January 1998 its latest $20 million,
five-year program in China, UNFPA announced that SFPC officials had agreed to drop birth
targets in the 32 counties where U.N. activities would be focused. And in May 1999, the city
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of Beijing ended an eight-year policy that women had to be at least 24 years old to bear a
child and lifted the requirement for couples to obtain a certificate before having their child.
Nevertheless, the degree of coercive family planning practices in China, in the
2001/2002 investigations noted above, remains a cloudy and controversial matter. The State
Department, in its 2002 report on human rights conditions (released March 2003), concluded
that although the Chinese government “formally prohibits the use of physical coercion to
compel persons to submit to abortion or sterilization,...intense pressure to meet birth
limitation targets set by government regulations has resulted in instances in which local birth
planning officials reportedly have used physical coercion to meet government goals.” The
report notes that the SFPC issues nationwide notices prohibiting officials from forcing
women to undergo abortions or sterilization against their will, but that the government does
not regard social compensation fees and other administrative punishments to be coercive.
Chinese officials, while acknowledging past occurrences of forced abortion and involuntary
sterilizations, say this is no longer the case and characterize the social compensation fees as
not coercive, but a “disincentive” or “necessary form of economic restraint.”
(State
Department Assessment Team Report, May 29, 2002.)
Funding Levels
Since 1965, USAID has obligated over $6.6 billion in assistance for international
population planning. In many years, and especially over the past decade, the appropriate level
of funding for population assistance has been controversial, and at times linked directly with
differences concerning Mexico City restrictions and abortion. During the 1980s and 1990s,
Congress and the executive branch frequently clashed over the amount of foreign aid that
should be allocated to family planning programs. Until FY1996, Congress generally
supported higher funding levels for population aid than proposed by the President, especially
during the Reagan and Bush Administrations. Family planning appropriations — including
bilateral population aid and UNFPA contributions — averaged about $280 million annually
during the late 1980s, but grew rapidly in the 1990s, peaking in FY1995 at $577 million.
With the change in party control of Congress for the FY1996 budget cycle, family planning
policy and budget issues became, and have continued to be, the most contentious foreign aid
matter considered by Congress. During the balance of the Clinton Administration, Congress
cut and placed restrictions on bilateral funding. Amounts fell to $356 million in FY1996,
but have grown steadily since to reach $446.5 million in FY2003. The Administration is
requesting $425 million for FY2004.
Financing family planning and basic reproductive health care programs in developing
countries became a major issue at the 1994 Cairo population conference. Participating
nations agreed that foreign aid donors would provide one-third, or $5.7 billion, of the annual
costs of such services that were estimated to grow to about $17 billion in 2000. A July 1999
conference assessing implementation of the 1994 Cairo strategy, however, found that
industrialized countries had fallen far short of the financing goal, providing only about $1.9
billion per year.
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Table 1. Population Assistance, FY1994-2004
(appropriations of millions of $s)
1994 1995
1996a
1997
1998 1999
2000b
2001b
2002
2003
2004d
Population
485.1 541.6
356.0
385.0
385.0 385.0
372.5
425.0
446.5
446.5
425.0
Aid
d
UNFPA
40.0
35.0
22.8
25.0
20.0
0.0
21.5
21.5
0.0c
34.0c
Total
525.1 576.6
378.8
410.0
405.0 385.0
394.0
446.5
480.5c
480.5
450.0d
Source: AID/Office of Population.
a. Because of the FY1996 “metering” requirement for population aid that delayed the availability of funds, the
actual amount available for obligation in that year was $151.5 million. Since large amounts appropriated
in FY1996 and FY1997 were “metered” into the next fiscal year, levels available for obligation in
FY1997 and FY1998 were $495 million and $554 million, respectively. In years when “metering” was
not required — before FY1996 and since FY1998 — amounts available for obligation were nearly the
same as or identical to the appropriated level shown in Table 1.
b. FY2000 levels reflect a transfer of $12.5 million from population aid. FY2000 and FY2001 reflect a $3.5
million deduction from UNFPA due to legislative restrictions.
c. Congress appropriated “not more than” $34 million for UNFPA in FY2002 and directed for FY2003 the
same amount as in FY2002. The State Department, however, determined that UNFPA supported
FY2002 coercive family planning programs in China, thereby making the organization ineligible for U.S.
contributions. FY2002 ($34 million) and FY2003 ($25 million) funds were re-directed to other
population aid programs, keeping the totals both years at $480.5 million. Congressional “holds” placed
on these transfers, however, have kept the funds from being obligated.
d. Request for FY2004. Although there is no specific request for UNFPA in the budget submission, $25 million
is placed in a reserve account that would presumably be available for UNFPA if it is eligible for U.S.
support. Otherwise, the $25 million would most likely be transferred to fund bilateral family planning
programs, bringing the total for the FY2004 request to $450 million.
Supporters of increasing population aid, many of whom believe strongly that population
growth must be curtailed before meaningful development can occur, contend that family
planning should be among the highest priorities of U.S. development strategy. Population
growth, they argue, has long-term consequences, affecting diverse U.S. interests in
environmental protection, resource conservation, global economic growth, immigration
management, and international stability. They maintain that attention to family planning
assistance now could obviate future allocations in other development and health-related
accounts. Some proponents of population assistance programs see a particular irony, for
instance, in limiting funds for population stabilization programs while increasing the budget
claims of child survival and infectious disease programs. Population aid proponents also cite
recent studies that suggest that the prevalence of abortion declines in countries that have
wider availability and use of effective contraceptives. This relationship, they say, further
reduces the risk of unsafe abortions that are the leading cause of maternal deaths in
developing nations.
Opponents of increasing population aid argue that even without added funding levels,
the United States continues to be the largest bilateral donor in population assistance
programs. Some also claim that there is little or no correlation between rapid population
growth and a country’s economic development. At the very least, some opponents say,
current economies of scale and global trading patterns have too many empirical variables and
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uncertainties to establish a direct correlation between population growth and economic
development.
Current International Family Planning Issues and
Legislation
Foreign Relations Authorization, FY2004-2005
During debate on an omnibus bill authorizing State Department and public diplomacy
programs, the House International Relations voted 23-22 to authorize $50 million for
UNFPA in FY2004 and FY2005, and to amend existing eligibility requirements that would
appear to have made it more difficult for the President to deny funding to UNFPA. The vote
came on an amendment offered by Congressman Crowley to H.R. 1950, legislation reported
by the Committee on May 8, 2003.
The Crowley amendment would have made the money available only if the President
determined that UNFPA “directly” supports or participates in coercive or involuntary
activities.
This was similar to language recommended in July 2002 by the Senate
Appropriations Committee in the FY2003 Foreign Operations bill, but later dropped. By
adding the word “directly,” many presume that the determination issued in July 2002 by the
Secretary of State that denied transfers to UNFPA would not be sufficient to cut off
contributions authorized in H.R. 1950. In addition, the Crowley amendment defined the
circumstances under which UNFPA would be found ineligible. The provision in H.R. 1950
stated that the President would need to find that UNFPA is “knowingly and intentionally
working with a purpose to continue, advance or expand the practice of coercive abortion or
involuntary sterilization, or playing a primary and essential role in a coercive or involuntary
aspect of a country’s family planning program.” Many believe that the justification for
terminating UNFPA funds for FY2002 would not meet this more specific test. During House
debate on H.R. 1950, however, lawmakers voted 216-211 on July 15 to delete the Crowley
amendment.
The Senate companion measure — S. 925 — does not include any reference to UNFPA.
During floor debate on July 9, however, the Senate adopted an amendment by Senator Boxer
that would effectively reject the President’s Mexico City policy. The Boxer amendment
states that foreign NGOs shall not be ineligible for U.S. funds solely on the basis of health
or medical services they provide (including counseling and referral services) with non-U.S.
government funds. This exemption would apply so long as the services do not violate the
laws of the country in which they are performed and that they would not violate U.S. laws
if provided in the United States. The amendment further provides that non-U.S. government
funds used by foreign NGOs for advocacy and lobbying activities shall be subject to
conditions that also apply to U.S. NGOs. Since it is largely held that American NGOs would
not be subject to these restrictions under the Constitutional protection of free speech, it is
possible that this latter exemption would lift current prohibitions that apply to overseas
NGOs. Senate opponents had tried to table the Boxer amendment, an effort that failed on
a vote of 43-53. The Administration strongly opposes the Boxer amendment and says the
President would veto the bill if it remains in the legislation.
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Foreign Operations Appropriations, FY2004
On July 23, the House approved $425 million for bilateral family planning programs,
as requested. For UNFPA, the House bill (H.R. 2800) provides $25 million, available only
under certain conditions:
! none of the funds can be used in China;
! funds must be maintained in a separate account and not co-mingled;
! UNFPA does not perform abortions;
! UNFPA does not provide any resources for the Chinese State Planned-Birth
Commission or its regional affiliates; and
! U.S. contributions will be reduced by whatever amount, if any, UNFPA
spends in China.
In addition, the provisions of the Kemp-Kasten amendment continue to apply, the terms of
which resulted in a cut-off of U.S. contributions for FY2002 and FY2003. Unless the
Administration alters its interpretation of Kemp-Kasten or determines that conditions in
China have changed, it is unlikely that UNFPA would receive the $25 million earmark in
H.R. 2800.
On July 17, the Senate Appropriations Committee approved its FY2004 Foreign
Operations (S. 1426), including several significant changes regarding international family
planning funding and policy. For bilateral family planning activities, the Senate bill provides
$445 million, $20 million above the President’s request. In Section 691, the bill effectively
reverses the Administration’s Mexico City policy, using nearly the same language as the
Boxer amendment to S. 925. (See above under Foreign Relations Authorization and
discussion of Senate action on S. 925.) Although the White House has not yet issued its
“Statement of Administration Policy” for S. 1426, in its assessment of the House companion
measure, H.R. 2800, the executive said that it would “oppose any legislation that would
infringe upon the President’s ability to enforce current Administration policy regarding
international family planning.” Addition of such a provision to the House bill, the Statement
said, would result in a Presidential veto. For UNFPA, S. 1426 provides $35 million in
FY2004, but makes these funds, together with those appropriated for FY2002 and FY2003,
subject to Kemp-Kasten limitations and current restrictions that applied in FY2003.
LEGISLATION
H.R. 2800 (Kolbe)
Foreign Operations Appropriations, FY2004. Reported by the House Appropriations
Committee July 21 (H.Rept. 108-222); passed the House on July 23 (370-50). Provides $425
million in bilateral family planning programs and $25 million for UNFPA, subject to certain
conditions.
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S. 925 (Lugar)
Foreign Relations Authorization Act, FY2004. Introduced and reported on April 24,
2003 (S.Rept. 108-39). Senate began, but did not complete, consideration of S. 925 on July
9 and 10. On July 9, the Senate adopted a Boxer amendment that would effectively overturn
the President’s Mexico City abortion-related restrictions currently applied to international
family planning assistance (the Senate failed to table the amendment 43-53).
S. 1426 (McConnell)
Foreign Operations Appropriations, FY2004. Reported by the Senate Appropriations
Committee July 17 (S.Rept. 108-106). Provides $445 million in bilateral family planning
programs, and includes language that effectively reverses the President’s “Mexico City”
policy. Also provides $35 million for UNFPA, subject to current restrictions.
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