International Population Assistance and
Family Planning Programs: Issues for
Congress
Luisa Blanchfield
Specialist in International Relations
July 8, 2010
Congressional Research Service
7-5700
www.crs.gov
RL33250
CRS Report for Congress
P
repared for Members and Committees of Congress
International Population Assistance and Family Planning Programs: Issues for Congress
Summary
Since 1965, the U.S. government has supported international population planning based on
principles of volunteerism and informed choice that gives participants access to information on
all methods of birth control. This policy has generated contentious debate for over three decades,
resulting in frequent clarification and modification of U.S. international family planning
programs. Given the divisive nature of this debate, U.S. funding of these programs will likely
remain a point of contention during the second session of the 111th Congress.
In 1984, controversy arose over U.S. population aid policy when the Ronald Reagan
Administration introduced restrictions that became known as the “Mexico City policy.” The
Mexico City policy denied U.S. funds to foreign non-governmental organizations (NGOs) that
performed or promoted abortion as a method of family planning—even if the activities were
undertaken with non-U.S. funds. Presidents Reagan and George H. W. Bush also banned grants to
the U.N. Population Fund (UNFPA) due to evidence of coercive family planning practices in
China, citing violations of the “Kemp-Kasten” amendment, which bans U.S. assistance to
organizations that, as determined by the President, support or participate in the management of
coercive family planning programs.
President Bill Clinton resumed UNFPA funding and reversed the Mexico City policy in 1993. In
2001, however, President George W. Bush re-applied the Mexico City restrictions. The Bush
Administration also suspended U.S. contributions to UNFPA from FY2002 through FY2008
following a State Department investigation of family planning programs in China. On January 23,
2009, President Obama issued a presidential memorandum revoking the Mexico City policy. The
President also stated that the United States would resume U.S. contributions to UNFPA.
For FY2011, the Obama Administration requested a total of $715.74 million for bilateral and
multilateral international family planning and reproductive health activities. This included $50
million for U.S. voluntary contributions to UNFPA.
In December 2009, President Obama signed the Consolidated Appropriations Act, 2010 (P.L. 111-
117). Division F of that bill, the Department of State, Foreign Operations, and Related Programs
Appropriations Act, 2010, directs that not less than $648.457 million should be made available
for international family planning and reproductive health activities. Of this amount, $55 million
shall be made available for UNFPA under the International Organizations and Programs (IO&P)
account.
This report will be updated as events warrant.
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International Population Assistance and Family Planning Programs: Issues for Congress
Contents
U.S. Population Assistance Issues: Setting the Context ............................................................... 1
The Population Statistics Debate ........................................................................................... 1
Evolution of U.S. Policy (1974 to 1994)................................................................................ 2
Trends in Population Research .............................................................................................. 2
Financing Population Assistance Programs............................................................................ 3
Overview of the U.S. Family Planning Debate ............................................................................ 3
The Mexico City Policy .............................................................................................................. 5
Mexico City Policy Removed by the Bill Clinton Administration (1993) ............................... 5
The George W. Bush Administration Restores the Mexico City Policy (2001)........................ 5
Bush Administration Mexico City Policy Guidelines ....................................................... 6
Obama Administration Revokes the Mexico City Policy (2009) ............................................ 7
Restrictions on U.N. Population Fund (UNFPA) Funding: The “Kemp-Kasten
Amendment”............................................................................................................................ 7
George W. Bush Administration Determinations Under Kemp-Kasten ................................... 8
State Department Team Assesses UNFPA Program in China ............................................ 9
Bush Administration Response to the New UNFPA China Program ................................. 9
Opposition to the Bush Administration Determination ................................................... 10
Obama Administration Determinations Under Kemp-Kasten ............................................... 10
Family Planning Conditions in China .................................................................................. 10
U.S. Funding Levels.................................................................................................................. 13
Overview ............................................................................................................................ 13
FY2011 Administration Request.......................................................................................... 14
FY2010 Administration Request and Appropriations ........................................................... 14
Tables
Table 1. U.S. Population Assistance, FY1995-FY2010 .............................................................. 13
Contacts
Author Contact Information ...................................................................................................... 15
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International Population Assistance and Family Planning Programs: Issues for Congress
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 (IPPF), 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. With passage of the Foreign Assistance Act of 1961, Congress first authorized
research on international family planning and population issues and, in 1965, the U.S. Agency for
International Development (USAID) launched a series of population and reproductive health
programs. In 1968, Congress specifically funded family planning aid activities and USAID began
to purchase contraceptives for distribution through its programs in the developing world.
The first International Population Conference was held in 1974, followed by the second in
Mexico City in 1984, and the third in Cairo in 1994.1 The attention and funding given to
international family planning programs are credited with helping to decrease population growth in
developing countries from about a 1.7% per year average between 1980 and 2002, to a projected
annual average of 1.2% between 2002 and 2015. Fertility rates have fallen in developing nations
from 4.1 children per woman in 1980 to 3.0 in 2005 (if China is excluded from this calculation,
however, the decline in fertility rates is less dramatic at 3.5 children in 2005). Nevertheless, while
global population growth has slowed, the world’s population reached 6 billion in 1999, 6.5 billion
in 2005, and is expected to rise to 9.3 billion by 2050, with most of the growth occurring in
developing nations. In 1960, 70% of the world’s population lived in developing countries, and in
2005 the level had grown to 81%. These countries now account for 99% of worldwide population
growth.2
The Population Statistics Debate
Population statistics alone are only part of a larger story. For the past 30 years and more, countries
have heatedly debated what the statistics mean. Proponents of active 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, and 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.
1 The conferences were coordinated by the United Nations. More information is available at http://www.un.org/esa/
devagenda/population.html.
2 Population Reference Bureau (PRB), Frequently Asked Questions About the PRB World Population Data Sheet,
(2005). Also see PRB, 2007 World Population Data Sheet, available at http://www.prb.org/Publications/Datasheets/
2007/2007WorldPopulationDataSheet.aspx.
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On the opposing side, critics of active 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 added productive capacity; therefore, they say, high
population growth rates actually can contribute to a country’s ability to increase its standard of
living. Proponents of this view argue that, at the very least, 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.
Evolution of U.S. Policy (1974 to 1994)
As the population debate evolved, many countries, including the United States, changed their
views. At the 1974 international population conference, the United States and other donor
countries asserted that high fertility rates were an impediment to economic development—a point
that was then rejected by developing countries. In keeping with this view, in 1977 the Carter
Administration proposed legislative language, later enacted in Sec. 104(d) of the Foreign
Assistance Act of 1961, as amended, that sought to link population growth and traditional
development assistance programs on the grounds that a high population growth rate could have a
negative effect on other development objectives.
A decade later, at the second International Conference on Population in Mexico City in 1984,
some participants reversed their positions. Many developing countries had become convinced of
the urgent need to manage 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.
Nearly a decade later, the Clinton Administration changed the U.S. position on family planning
programs by lifting restrictive U.S. provisions announced at the Mexico City Conference. At the
1994 International Conference on Population and Development in Cairo, U.S. officials
emphasized support for family planning and reproductive health services, improving the status of
women, and providing safe access to abortion.
Trends in Population Research
Since the 1994 Cairo conference, groups supporting strategies to limit rapid population growth
have supported a broader agenda of initiatives that includes 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.
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More 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.3 Some demographers
conclude that global population projections for this century may need to be reduced by as much
as 1 billion people. A U.N. report dated December 9, 2003—World Population 2003—projects as
a “medium scenario” that world population will peak in 2075 at 9.2 billion and then, as fertility
rates in all countries reach below replacement levels, decline over the next 100 years to 8.3
billion. The report projects that if fertility rates return to replacement levels, world population
would begin to rise, reaching 9 billion by 2300; otherwise, the number of people would remain at
around 8.3 billion.
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 contend 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.
Financing Population Assistance Programs
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. It also noted that donor
allocations still fall far below the targets set at Cairo.4 A more recent analysis suggests a different
trend, noting that donor nations contributed $2.3 billion in 2002, the largest amount ever.
Similarly, UNFPA announced in 2008 that the number of donors to its program had increased
from 166 in 2004 to 182 in 2007. The amount promised from donors reached a record of $457.1
million in 2007.5
Overview of the U.S. Family Planning Debate
Throughout the debate on family planning—at times the most contentious foreign aid issue
considered by Congress—the cornerstone of U.S. policy has remained a commitment to
international family planning programs based on principles of volunteerism and informed choice
that give participants access to information on all major methods of birth control. At present,
USAID maintains family planning projects in more than 50 developing countries that include
counseling and services, training of health workers, contraceptive supplies and distribution,
financial management, public education and marketing, and biomedical and contraceptive
3 See, for example, “Population Estimates Fall as Poor Women Assert Control,” New York Times, March 10, 2002.
4 Population Action International, Progress and Promises: Trends in International Assistance for Reproductive Health
and Population, 2004.
5 UNFPA 2007 Annual Report, U.N. Population Fund, 2008, available at http://www.unfpa.org/publications/detail.cfm?
ID=373&filterListType=.
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research and development. USAID applies a broad reproductive health approach to its family
planning programs, increasingly integrating it with other interventions regarding maternal and
child health, the enhancement of the status of women, and HIV prevention.6
In addition to differences of opinion over how population growth affects economic development
in developing countries, family planning assistance has become a source of substantial
controversy among U.S. policymakers, centering on two key issues: (1) the use of federal funds to
perform or promote abortions abroad and how to deal with evidence of coercion in some national
family planning programs, especially in China, and (2) setting appropriate and effective funding
levels for family planning assistance.
Arguably, the most bitter controversies in U.S. family planning policy have erupted over
abortion—in particular, the degree to which abortions and coercive 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 might 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. In every
Congress since 1973, abortion opponents have introduced constitutional amendments or
legislation that would prohibit abortions. As an alternative, abortion critics have also persuaded
Congress to attach numerous provisions to annual appropriation measures banning the use of
federal funds for performing abortions.
Much 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 an amendment to the Foreign Assistance Act of 1961 in late 1973 (Section
104(f)). The act prohibits the use of foreign development assistance to (1) pay for the
performance of abortions or involuntary sterilizations, (2) motivate or coerce any person to
practice abortions, or (3) 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 several decades, both congressional actions and administration 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 provisions
prohibiting indirect support for coercive family planning (specifically in China) and abortion
activities related to the work of international and foreign NGOs. Two issues in particular which
were initiated in the mid-1980s—the Mexico City policy involving funding for foreign non-
governmental organizations, 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.
6 For further information on USAID family planning and reproductive health programs, see http://www.usaid.gov/
our_work/global_health/pop/index.html.
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The Mexico City Policy
In 1984, the Reagan Administration announced that it would restrict U.S. population aid by
terminating USAID support for any foreign 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.”
During the George H. W. 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.
Critics charge that the Mexico City 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,
including some that are unsafe and illegal. They further emphasize that family planning
organizations may cut back on services because they are unsure of the full implications of the
restrictions and do not want to risk losing eligibility for USAID funding. Opponents also believe
that the conditions of the Mexico City policy undermine relations between the U.S. government
and foreign NGOs and multilateral groups, creating a situation in which the United States
challenges their right to determine how to spend their own money and imposes 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.
Mexico City Policy Removed by the Bill Clinton Administration
(1993)
President Clinton, in a January 22, 1993, memo to USAID, lifted restrictions imposed by the
Reagan and Bush Administrations on grants to family planning NGOs—in effect ending the
Mexico City policy. The memo noted that the policy had extended beyond restrictions in the
Foreign Assistance Act and was not mandated by law. In his remarks, President Clinton explained
that this step would “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.”7
The George W. Bush Administration Restores the Mexico City
Policy (2001)
On January 22, 2001, President George W. Bush revoked the Clinton Administration
memorandum and restored in full the terms of the Mexico City restrictions. In making the
announcement, however, the White House Press Secretary stated that the “President is committed
7 President Bill Clinton, “Remarks on Signing Memorandums on Medical Research and Reproductive Health and an
Exchange With Reporters,” January 22, 1993.
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to maintaining the $425 million funding level provided in the FY2001 appropriation because he
knows that one of the best ways to prevent abortion is by providing quality voluntary family
planning services.”8
As was the case during the 1980s and early 1990s when the Mexico City policy was in place,
foreign NGOs and international organizations, as a condition for receipt of U.S. funds, would
need to certify that they would not perform or actively promote abortions as a method of family
planning in other countries. President Bush, in announcing the policy change, noted that
American taxpayer funds should not be used to pay for abortions or to advocate or actively
promote abortion. Supporters of the certification requirement argue that even though permanent
law bans USAID funds from being used to perform or promote abortions, money is fungible;
organizations receiving American-taxpayer funding can 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 contend, stops the fungibility “loophole.”
Bush Administration Mexico City Policy Guidelines
On February 15, 2001, USAID released specific contract clauses necessary to implement
President Bush’s directive. The guidelines stated that U.S. NGOs receiving USAID grants could
not furnish assistance to foreign NGOs that (1) performed or actively promoted abortion as a
method of family planning in USAID-recipient countries, or (2) furnished assistance to other
foreign NGOs that conducted such activities. When USAID provided assistance directly to a
foreign NGO, the organization had to certify that it did not now or would 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. The implementing regulations contained several exceptions, including the following:
• Abortions could be performed if the life of the mother would be endangered if
the fetus were carried to term or 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 were
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 was able to continue supporting foreign governments, either directly or through a grantee,
even in cases where the government includes abortion in its family planning program. Money
provided to such governments, however, had to be placed in a segregated account and none of the
funds could be drawn to finance abortion activities.
President Bush issued a memorandum on August 29, 2003, for the Secretary of State, directing
that the Mexico City policy conditions be applied to State Department programs in the same way
they applied to USAID activities. This directive mostly impacted State Department-managed
refugee programs, large portions of which were implemented by international organizations and
NGOs. The President’s memorandum, however, stated that the policy would not apply to
8 The White House. Office of the Secretary. Restoration of the Mexico City Policy, January 22, 2001.
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multilateral organizations that were associations of governments, presumably referring to the
U.N. High Commissioner for Refugees, among others. President Bush further stated that the
Mexico City policy would 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.
Obama Administration Revokes the Mexico City Policy (2009)
On January 23, 2009, President Barack Obama issued a presidential memorandum to the
Secretary of State and USAID Administrator revoking the Mexico City policy and Bush
Administration conditions on voluntary population planning provided by the State Department.9
The memorandum stated:
These excessively broad conditions on grants and assistance awards are unwarranted.
Moreover, they have undermined efforts to promote safe and effective voluntary family
planning programs in foreign nations.10
President Obama also directed the Secretary of State and USAID Administrator to waive the
conditions set forth in these policies and to notify current grantees as soon as possible. He further
directed the State Department and USAID to cease imposing such conditions on any future
grants.11
Restrictions on U.N. Population Fund (UNFPA)
Funding: The “Kemp-Kasten Amendment”
At the 1984 Mexico City Conference, the Reagan Administration instituted a new policy relating
to UNFPA.12 The Administration required that the organization provide “concrete assurances that
[it] is not engaged in, or does not provide funding for, abortion or coercive family planning
programs.” It was particularly concerned with UNFPA’s activities in China, where, according to
Administration officials, there was evidence of coercive family planning practices.
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). The
amendment prohibited the use of appropriated funds for any organization or program, as
determined by the President, found to be supporting or participating “in the management” of a
9 Specifically, President Obama’s memorandum revoked President Bush’s January 22, 2001, memorandum for the
USAID Administrator (Restoration of the Mexico City Policy) and the August 29, 2003, memorandum for the
Secretary of State (Assistance for Voluntary Population Planning).
10 Memorandum from President Obama to the Secretary of State and Administrator for USAID, “Mexico City Policy
and Assistance for Voluntary Population Planning,” January 23, 2009, available at http://www.whitehouse.gov/
the_press_office/MexicoCityPolicy-VoluntaryPopulationPlanning/.
11 Ibid.
12 UNFPA is a U.N. specialized agency that “supports countries in using population data for policies and programs” to
improve reproductive health, prevent HIV/AIDS, promote gender equality, and make motherhood safer. UNFPA was
the lead U.N. agency for the 1994 International Conference on Population and Development in Cairo. For more
detailed information regarding UNFPA, see CRS Report RL32703, The U.N. Population Fund: Background and the
U.S. Funding Debate, by Luisa Blanchfield.
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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 directed 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 on 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 the
United States to support them. 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.
The Clinton Administration lifted the ban on UNFPA contributions, making available $14.5
million in FY1993 but stipulating that funds could not be used in China. Congressional critics of
China’s family planning practices attempted unsuccessfully to attach provisions 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. While the United
States continued to support UNFPA during the next eight years (except for FY1999), Congress
attached restrictions in appropriation measures that in most cases reduced the U.S. contribution
by the proportionate share of UNFPA funds spent on China.
George W. Bush Administration Determinations Under Kemp-
Kasten
For FY2002, Congress provided not more than $34 million for UNFPA. But in mid-January 2002,
the Bush Administration 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 continued in counties where UNFPA concentrated its programs.13
From FY2002 through FY2008, the Bush Administration determined that UNFPA was ineligible
for U.S. funding under the Kemp-Kasten amendment.14 Since the 2002 determination, the
Administration has transferred $34 million from each of FY2002, FY2004, and FY2005
appropriations, and $25 million from FY2003 funds that would have otherwise been provided to
UNFPA to support bilateral family planning programs and activities combating human trafficking
and prostitution. Approximately $22.5 million in unused UNFPA funds from FY2006 was
transferred to the International Organizations and Program (IOP) account.
13 See House International Relations Committee hearing, Coercive Population Control in China: New Evidence of
Forced Abortion and Forced Sterilization, October 17, 2001, and a Senate Foreign Relations Committee hearing, U.S.
Funding for the U.N. Population Fund: The Effect on Women’s Lives, February 27, 2002.
14 For the most recent Administration statements, see “White House: No U.N. Funding for China,” The Associated
Press, September 7, 2007, and Press statement by Tom Casey, Deputy Spokesman, “Fiscal Year 2008 Funding for the
United Nations Population Fund (UNFPA),” U.S. Department of State, June 27, 2008, available at
http://www.state.gov/r/pa/prs/ps/2008/jun/106348.htm.
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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, if any, to which UNFPA is involved in involuntary activities and whether
UNFPA should operate at all in a country where such conditions exist. Given conflicting reports,
a State Department investigative team visited China in May 2002 and reported a series of findings
and recommendations. The team found no evidence that UNFPA “has knowingly supported or
participated in the management of a program of coercive abortion or involuntary sterilization” in
China, and recommended the United States release not more than $34 million of previously
appropriated funds to UNFPA.15
Nevertheless, on July 22, 2002, Secretary of State Powell, to whom President Bush 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 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.16 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 imposed 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 coercive abortions.
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.”
On September 17, 2005, the State Department stated that the United States had been urging
UNFPA and China to modify the organization’s program in a manner that would permit U.S.
support to resume, but that no key changes had occurred that would allow a resumption of U.S.
funding under the conditions of the Kemp-Kasten provision. Subsequently, on October 18 of that
year, USAID notified Congress that the reprogrammed UNFPA set-aside would be made
available to expand family planning and reproductive health programs in 14 other countries.17
Bush Administration Response to the New UNFPA China Program
The September 17 announcement followed a June 22, 2005, UNFPA Executive Board meeting to
consider UNFPA’s new five-year, $27 million program for China. At the meeting, Kelly Ryan,
Deputy Assistant Secretary of State for the Bureau of Population, Refugees and Migration, argued
that UNFPA should end its operations in China because of the coercive nature of China’s family
planning programs. Two days later, State Department spokesperson Sean McCormick issued a
statement saying the United States was “disappointed” that UNFPA had decided to continue
financial and technical support to the Chinese birth limitation program. He noted that U.S.
15 See http://www.state.gov/g/prm/rls/rpt/2002/12122.htm for report’s full text.
16 See http://www.state.gov/g/prm/rls/other/12128.htm for a full text of the determination.
17 The most significant increases were made in programs for Georgia, Madagascar, Romania, Russia, Rwanda, and
Ukraine.
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opposition was not aimed at UNFPA but was a “matter of principle,” based on strong American
opposition to “human rights abuses associated with coercive birth limitation regimes.” He
acknowledged that UNFPA does not approve of coercive policies but that the organization’s
continued presence in China offered a “seal of approval” for Chinese policies.
Opposition to the Bush Administration Determination
Critics of the Bush Administration’s decision opposed it for a number of reasons. They argued
that access to voluntary family planning programs by persons in around 140 countries would be
reduced, undermining the health of women and children, increasing unwanted pregnancies, and
increasing the likelihood of higher numbers of abortions. Still other critics were concerned about
the possible application of the Administration’s interpretation of Kemp-Kasten for other
international organizations operating in China and to which the U.S. contributes—for example,
UNICEF, WHO, and the U.N. Development Program.
Obama Administration Determinations Under Kemp-Kasten
The Obama Administration has expressed its support for U.S. funding of UNFPA. In March 2009,
a State Department spokesperson confirmed that the U.S. government would contribute $50
million to UNFPA as provided by the Omnibus Appropriations Act, 2009 (P.L. 111-8). This
decision, according to Administration officials, highlights the President’s “strong commitment” to
international family planning, women’s health, and global development.18 In the Congressional
Budget Justification for FY2010, the Administration requested $50 million for UNFPA and
identified voluntary contributions to the organization as a “highest priority,” along with
contributions to the U.N. Development Fund (UNDP) and the U.N. Children’s Fund (UNICEF).19
Family Planning Conditions in China
As noted, much of this debate has focused on UNFPA’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.)
Chinese 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 to comply. 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. Chinese leaders have admitted that coerced
18 Department of State press release, “U.S. Government Support for the United Nations Population Fund (UNFPA),”
March 24, 2009.
19 Congressional Budget Justification, Foreign Operations, FY2010, U.S. Department of State, p. 113, available at
http://www.state.gov/documents/organization/123415.pdf.
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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.
Other 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 a new $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 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 a child.
On September 1, 2002, China adopted the Population and Family Planning Law, the country’s
first formal law on this subject. The law, which requires couples who have an unapproved child to
pay a “social compensation fee” and extends preferential treatment to couples who abide by the
birth limits, is intended to standardize the implementation of the government’s birth limitation
policies. The State Department Country Reports on Human Rights Practices for 2006 (dated
March 2007), however, found that enforcement of the law varied by location.
The broad question concerning the degree of coercive family planning practices in China remains
a controversial matter. The State Department’s most recent human rights report on China
(covering 2008) concluded that
The country’s population control policy relied on education, propaganda, and economic
incentives, as well as on more coercive measures. Those who violated the child limit policy
by having an unapproved child or helping another do so faced disciplinary measures such as
social compensation fees, job loss or demotion, loss of promotion opportunity, expulsion
from the party ... and other administrative punishments, including in some cases the
destruction of private property. In the case of families that already had two children, one
parent was often pressured to undergo sterilization. The penalties sometimes left women
with little practical choice but to undergo abortion or sterilization.20
Chinese officials acknowledge past instances of forced abortion and involuntary sterilizations, but
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.”21
Recent attention has focused on reports documenting a campaign by local family planning
officials around the city of Linyi in Shandong Province to force couples with two children to
undergo sterilizations or to demand women pregnant with a third child have an abortion. Local
activists are pursuing a class-action lawsuit against the government. The group’s leader, Chen
Guangcheng, was placed under house arrest and subsequently sentenced to four years and three
months in prison.22 In mid-September 2005, China’s National Population and Family Planning
20 “Country Reports on Human Rights Practices, 2008—China,” U.S. Department of State, Bureau of Democracy,
Human Rights and Labor, February 25, 2009, available at http://www.state.gov/g/drl/rls/hrrpt/2008/eap/119037.htm.
21 U.S. Department of State, Assessment Team Report, May 29, 2002.
22 For more information, see “Country Reports on Human Rights Practices, 2006—China,” U.S. Department of State,
Bureau of Democracy, Human Rights and Labor, March 6, 2007, available at http://www.state.gov/g/drl/rls/hrrpt/2006/
78771.htm.
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Commission acknowledged that illegal coercive practices had occurred, and that responsible
officials had been dismissed and that some had been detained.23
Following the May 2002 State Department investigation of Chinese policies, senior department
officials began a series of discussions with China regarding its birth planning law. Arthur Dewey,
Assistant Secretary of State for Population, Refugees, and Migration, told the House International
Relations Committee on December 14, 2004, that in six rounds of talks with Chinese officials,
there had been “encouraging movement” in China’s approach to population policy and the
reduction of coercive practices.24 Nevertheless, Assistant Secretary Dewey said that the social
compensation fee policy set out in China’s national law on population and birth planning is a
“harsh and effective enforcement tool” that is used to force women to have an abortion, and is
therefore regarded as a coercive policy. While negotiations have resulted in some progress, he
concluded that China’s policies have not been altered enough to allow the Bush Administration to
resume UNFPA funding.
As noted previously, U.S. officials continued to voice their opposition at a UNFPA Executive
Board meeting on June 22, 2005, where members met to consider a new, five-year (2006-2010),
$27 million UNFPA program in China. A State Department press release on June 24 again
acknowledged that China had made some progress in its approach to population issues, but
argued that Beijing’s birth limitation policy continues to contain several coercive elements,
including the social maintenance fee for unplanned births, and regulations that limit choices by
women other than to undergo an abortion. At the June 22 meeting, China’s deputy U.N.
Ambassador Zhang Yishan argued that due to the size of China’s population, it had to maintain a
strong family planning program, and that without the policies of the last 30 years, China’s
population would have grown by 300 million additional people. He countered that, by law, family
planning workers are not permitted to utilize coercive measures in their work.
The UNFPA Executive Board approved the new five-year program for China on January 30,
2006. Prior to the signing, U.S. Deputy Representative to the United Nations, Ambassador
Alejandro Wolff, expressed disappointment that no substantive changes had been made to the
draft plan that had been reviewed in mid-2005. He argued that UNFPA assistance provided a “de
facto United Nations ‘seal of approval’” to Chinese “abhorrent” practices. He further asserted that
the new Country Program Document for China was incorrect in its claim that China was
committed to implementing the Cairo Population Conference action plan, a program that
excluded coercive practices in family planning activities.25 A group of 10 European nations
23Benjamin Kang Lim, “Blind China Activist Under House Arrest Since September,” Reuters, January 6, 2006; Philip
Pan, “Who Controls the Family? Blind Activist Leads Peasants in Legal Challenge to Abuses of China’s Population
Growth Policy,” Washington Post, August 27, 2005; and “China Terse About Action on Abuses of One-Child Policy,”
Washington Post, September 20, 2005.
Benjamin Kang Lim, “Blind China Activist Under House Arrest Since September,” Reuters, January 6, 2006; Philip
Pan, “Who Controls the Family? Blind Activist Leads Peasants in Legal Challenge to Abuses of China’s Population
Growth Policy,” Washington Post, August 27, 2005; and “China Terse About Action on Abuses of One-Child Policy,”
Washington Post, September 20, 2005.
24 Dewey cited, for example, the elimination of a requirement for married couples to obtain government permission
prior to pregnancy in 25 of China’s 31 provinces, municipalities, and autonomous regions. He also noted the
government’s launch of a public information project highlighting the status of the girl child. He viewed this as a
positive step towards ending discrimination in China against girls and women.
25 U.S. Mission to the United Nations. Ambassador Wolff: Remarks on Proposed UNFPA Sixth Country Program for
China, January 26, 2006.
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disagreed, however, issuing a statement saying that China did conform to the program of 1994
International Conference on Population and Development.26
U.S. Funding Levels
Overview
Since 1965, USAID has obligated over $6.6 billion in assistance for international population
planning. In many years, and especially over the past two decades, the level of funding for
population assistance has been controversial, and at times, linked directly with differences
concerning Mexico City policy restrictions and abortion. Until FY1996, Congress generally
supported higher funding levels for population aid than proposed by the President, especially
during the Reagan and Bush Administrations. During the balance of the Clinton Administration,
however, Congress cut and placed restrictions on bilateral funding. Amounts for bilateral
programs fell to $385 million in FY1997, but grew steadily to $425 million by FY2001 (see
Table 1).
When President Bush took office in January 2001, the White House said that it would maintain
the $425 million funding level of the previous Administration. While budgets submitted by
President Bush adhered to the $425 million target through FY2006, in every year Congress
increased funding levels. In some years, bilateral family planning levels received additional
resources when UNFPA-earmarked funds were reprogrammed for bilateral activities after UNFPA
was determined to be ineligible for U.S. support under the Kemp-Kasten amendment.
Table 1. U.S. Population Assistance, FY1995-FY2010
(Family planning/reproductive health budget; millions of $)
1995 1996 1997 1998 1999 2000 2001 2002c 2003c 2004c 2005c 2006c 2007c 2008c 2009 2010
Bilateral
Aid
542.0 432.0 385.0 385.0 385.0 372.0a 425.0 425.0 443.6 429.5 437.0 435.0 435.6 457.2 522.4d 593.4
UNFPA
35.0 22.8 25.0 20.0 0.0 21.5b 21.5b
0.0 0.0 0.0 0.0 0.0 0.0 0.0 50.0e 55.0
Total 577.0 454.8 410.0 405.0 385.0 393.5 446.5 425.0 443.6 429.5 437.0 435.0 435.6 457.2 572.4 648.4f
Source: USAID Bureau of Global Health Strategic Planning and Budgeting Division
Note: Amounts are adjusted for rescissions in appropriate years.
a. The bilateral FY2000 aid level reflects a transfer of $12.5 million from population assistance to child survival
activities.
b. UNFPA amounts for FY2000 and FY2001 reflect a $3.5 million deduction due to legislative restrictions.
c. From FY2002 through FY2008, the Bush Administration determined that UNFPA was ineligible for U.S.
funding because of its programs in China, and withheld appropriated funds. Some of the withheld funds
were reallocated for USAID bilateral family planning, vulnerable children, and counter-trafficking in persons
programs.
26 “UN Population Fund Endorses 27-million-dollar China Program,” Agence France Presse, January 30, 2006.
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d. This figure includes $455 million from the USAID Global Health and Child Survival (GHCS) account ($20
million of which is allocated for UNFPA); $78.284 million from Economic Support Fund (ESF), and $9.117
from the Assistance to Europe, Eurasia, and Central Asia account (AEECA).
e. Of the $50 million designated for UNFPA, $30 million was made available through the State Department
International Organizations and Programs (IO&P) account. The remaining $20 million was made available
through the GHCS account.
f.
This figure is an estimate. Bilateral aid funds include $525 million from the USAID Global Health and Child
Survival account; $58.849 million from ESF; and $9.608 from AEECA. The $55 million allocated to UNFPA
shal be made available through the IO&P account.
In FY2009, total U.S. population assistance was approximately $572.4 million, an increase of
about $115 million over the FY2008 level of $457.2 million. U.S. population assistance levels
will likely peak in FY2010, with USAID estimating that total assistance, including contributions
to UNFPA, will reach $648.4 million. This increase in funding can be attributed in part to
President Obama’s determination that UNFPA is eligible for U.S. funding under the Kemp-Kasten
amendment.27
FY2011 Administration Request
In March 2010, President Obama requested a total of $715.74 million for bilateral and
multilateral family planning and reproductive health assistance. Specifically, the Administration
requested $590 million from the USAID Global Health and Child Survival account (GHCS);
$65.267 million from the Economic Support Fund (ESF); and 10.473 million from the Assistance
to Europe, Eurasia, and Central Asia account (AEECA). It also requested $50 million for UNFPA
to be funded through the International Organizations and Programs (IO&P) account.28
FY2010 Administration Request and Appropriations
The Obama Administration had requested a total of $593.457 million for international family
planning and reproductive health activities in FY2010. This included $475 million from the
USAID GHCS account, $58.849 million from ESF, and $9.608 million from AEECA. The
Administration also requested $50 million for UNFPA funding to be made available under the
IO&P account.29
On December 16, 2009, President Obama signed the Consolidated Appropriations Act, 2010 (P.L.
111-117). Division F of that bill, the Department of State, Foreign Operations, and Related
Programs Appropriations Act, 2010, directs that not less than $648.457 million should be made
available for international family planning and reproductive health activities. Of this amount,
$525 million shall be made available under the USAID GHCS account, and $55 million shall be
made available for UNFPA under the IO&P account. The remaining amounts will be made
available under other accounts, including $58.849 million from ESF, and $9.608 million from
AEECA.
27 Department of State press release, “U.S. Government Support for the United Nations Population Fund (UNFPA),”
March 24, 2009.
28 Congressional Budget Justification, Foreign Operations, FY2011, Volume 2, U.S. Department of State, p. 240.
29 Congressional Budget Justification, Foreign Operations, FY2010, U.S. Department of State, pp. 27, 91, 193.
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Sec. 7078 of P.L. 111-117 outlines funding restrictions for UNFPA. As stated above, it allocates
$55 million for UNFPA to be made available under IO&P. The bill also establishes a number of
conditions for U.S. contributions to UNFPA. Specifically, none of the funds made available may
be used by UNFPA for a country program in China. In addition:
• U.S. contributions to UNFPA must be kept in an account separate from other
accounts at UNFPA and should not commingle with other sums, and
• for UNFPA to receive U.S. funding, it must not fund abortions.30
Author Contact Information
Luisa Blanchfield
Specialist in International Relations
lblanchfield@crs.loc.gov, 7-0856
30 The bill also establishes related reporting requirements for the Secretary of State. Not later than four months after the
enactment of P.L. 111-117, the Secretary is required to submit a report to the Committees on Appropriations indicating
the funds UNFPA is budgeting for a country program in China. If the Secretary’s report indicates that funds will be
spent on such a program, then the amount of such funds shall be deducted from the funds made available to UNFPA for
the remainder of the fiscal year in which the report is submitted. (See Sec. 7078 (e)(1) and (e)(2).)
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