Population Assistance and Family Planning Programs: Issues for Congress
Order Code IB96026
CRS Issue Brief for Congress
Received through the CRS Web
Population Assistance and
Family Planning Programs:
Issues for Congress
Updated November 10, 2005
Larry Nowels
Foreign Affairs, Defense, and Trade Division
Congressional Research Service ˜ The Library of Congress
CONTENTS
SUMMARY
MOST RECENT DEVELOPMENTS
BACKGROUND AND ANALYSIS
Introduction to U.S. Population Assistance Issues: Setting the Context
Current Scope of USAID Family Planning Programs
Policy and Funding Issues in U.S. Family Planning Debates
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 Operations Appropriations, FY2006
Science, State, Justice, and Commerce Appropriations, FY2006
Emergency Supplemental Appropriations for FY2005
Foreign Affairs Authorization Act, FY2006/2007
LEGISLATION
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Population Assistance and Family Planning Programs:
Issues for Congress
SUMMARY
Since 1965, United States policy has
For FY2005, Congress earmarked in
supported international population planning
Division D of P.L. 108-447 (Consolidated
based on principles of volunteerism and
Appropriations Act) $441 million for bilateral
informed choice that gives participants access
family planning programs and $34 million for
to information on all methods of birth control.
UNFPA.
This policy, however, has generated conten-
tious debate for over two decades, resulting in
On September 17, 2005, the State De-
frequent clarification and modification of U.S.
partment announced that UNFPA would not
international family planning programs.
receive the FY2005 U.S. contribution because
the organization was in violation of the Kemp-
In 1984, controversy arose over U.S.
Kasten restrictions. This is the fourth consec-
population aid policy when the Reagan
utive year that UNFPA has been declared
Administration introduced restrictions, which
ineligible for U.S. support, resulting in a loss
became known as known as the Mexico City
of $127 million in appropriated funds.
policy. (Opponents of the policy also refer to
it as the “Global Gag Rule.”) The “Mexico
In his FY2006 Foreign Operations budget
City policy” denied U.S. funds to foreign non-
request, the President proposed $425 million
governmental organizations (NGOs) that
for family planning programs, including $25
perform or promote abortion as a method of
million for UNFPA should the organization be
family planning, regardless of whether the
eligible under the Kemp-Kasten provision.
money came from the U.S. government.
H.R. 3057), as passed by the House,
Presidents Reagan and Bush also banned
recommended $432 million for bilateral fam-
grants to the U.N. Population Fund (UNFPA)
ily planning programs and $34 million for
because of its program in China, where coer-
UNFPA, and retained the Kemp-Kasten re-
cive practices have been used.
strictions. The Senate companion bill prov-
ided $450 million for bilateral activities, $35
President Clinton resumed UNFPA
million for UNFPA, included a modified
funding and repealed the Mexico City policy.
Kemp-Kasten provision, and altered the Mex-
President George W. Bush, however, re-ap-
ico City policy. The final conference text of
plied the Mexico City restrictions. Following
H.R. 3057 adopted the House-passed funding
a State Department investigation of family
levels and dropped Senate-added changes to
planning programs in China, the Administra-
Kemp-Kasten and the Mexico City policy.
tion suspended U.S. contributions to UNFPA
on July 22, 2002, citing violations of the
In related legislation, on S. 600, an omni-
“Kemp-Kasten” amendment. This provision
bus State Department/Foreign Aid authoriza-
bans U.S. assistance to organizations that
tion measure, the Senate adopted an amend-
support or participate in the management of
ment by Senator Boxer that would effectively
coercive family planning programs.
overturn the Mexico City policy. The bill has
not received a final vote in the Senate.
Congressional Research Service ˜ The Library of Congress
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MOST RECENT DEVELOPMENTS
On November 4, 2005, the House agreed to the conference report on H.R. 3057, the
FY2006 Foreign Operations appropriations. As adopted, the bill includes $432 million for
bilateral population assistance activities and $34 million as a U.S. contribution to the U.N.
Population Fund (UNFPA), levels proposed by the House. The Administration had
requested $425 million for total bilateral and UNFPA funding, while the Senate
recommended $450 million for bilateral programs and a $35 million UNFPA contribution.
Conferees further deleted text approved by the Senate that would have modified restrictions
(“Kemp-Kasten” conditions) on funding for UNFPA and effectively overturned the so-called
Mexico City policy related to abortion. The White House said the President would veto H.R.
3057 if the final bill included the Senate-proposed policy changes.
On September 17, 2005, the State Department announced that the United States, for the
fourth consecutive year, would withhold its voluntary contribution to UNFPA because the
organization did not comply with the Kemp-Kasten restrictions. This provision, enacted
annually in Foreign Operations appropriation bills, bans U.S. support for organizations
involved in the management of a coercive family planning program. UNFPA maintains
activities in China where there is strong evidence of coercive practices. The State
Department said that it would consider future funding for UNFPA if the organization altered
its programs in China or if China terminated its practice of coercive abortion.
On July 20, the House approved (223-205) an amendment to H.R. 2601 (Foreign
Relations Authorization Act, FY2006-2007) altering committee-reported language that
created 12 centers for the treatment and prevention of obstetric fistula in developing nations.
The amendment, proposed by Representative Smith (NJ), deleted a requirement that each
center expand contraceptive services for high-risk women, inserting instead a requirement
that these centers broaden “abstinence education, postponement of marriage and child-
bearing until after teenage years, and activities to expand access to family planning services”
for women in a high-risk category.
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. 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
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(USAID) launched 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. The attention and funding given to
international family planning programs are credited with helping to bring a decrease in
population growth among developing countries from about a 1.7% per year average, 1980-
2002, to a projected annual average of 1.2%, 2002-2015. Fertility rates have fallen in these
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 in 2005).
Nevertheless, while global population growth has slowed, it reached 6 billion in 1999, 6.5
billion in 2005, and is expected to rise to 9.3 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; in 2005 the level had grown to 81%, and these countries now account for 99% of
world-wide population growth. (Population Reference Bureau, Frequently Asked Questions
about the PRB World Population Data Sheet. 2005.)
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 added 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. 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, 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, some participants
reversed their positions. 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
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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 U.S. provisions announced 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.
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.
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.
(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. A
U.N. report dated December 9, 2003 — “World Population 2300” — projects as a “medium
scenario” that world population will peak in 2075 at 9.2 billion and then, as fertility in all
countries reach below replacement levels, decline over the next 100 years to 8.3 billion. 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 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.
Current Scope of USAID Family Planning Programs
Throughout this debate — 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 60 countries that include counseling and
services, training of health workers, contraceptive supplies and distribution, financial
management, public education and marketing, and biomedical and contraceptive research and
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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 and transmission.
Policy and Funding Issues in
U.S. Family Planning Debates
In addition to differences of opinion over how population growth affects economic
development in developing countries, family 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. 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 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 non-governmental organizations.
Two issues in particular which were initiated in 1984 — the Mexico City policy involving
funding for foreign non-governmental organizations (NGOs), and restrictions on funding for
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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, by Larry Nowels.) 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 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.
Mexico City Policy Removed. 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 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 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.”
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, the President could waive the
certification requirement for up to $15 million in grants to groups that would otherwise be
ineligible. President Clinton exercised the waiver and further instructed USAID to
implement Section 599D in a way that would minimize the impact on U.S. funded family
planning programs. Nine organizations refused to certify, including two of the largest
recipients of USAID population aid grants — IPPF and the World Health Organization
(WHO). These nine non-certifying organizations received 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, revoked the Clinton Administration memorandum and restored in full the terms of the
Mexico City restrictions. As was the case during the 1980s and early 1990s, foreign NGOs
and international organizations, as a condition for receipt of U.S. funds, would need to certify
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that they would 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. 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; that 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.”
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 are unsure of the full implications
of the restrictions and do not want to risk losing eligibility for USAID funding. 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 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.
Bush Administration 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. The
implementing regulations contain several exceptions, including the following:
! 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 is able to continue support, either directly or through a grantee, to foreign
governments, even in cases where the government includes abortion in its family 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.
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The President 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 apply to USAID activities. This directive affects most directly 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.
Related Mexico City Policy Issues. The Bush Administration policy to shield
foreign assistance from supporting organizations performing or promoting abortions has also
shaped other U.S. policy positions at multilateral fora. In October 2004, international family
planning activists sought to commemorate the 10 year anniversary of the Cairo International
Conference on Population and Development (ICPD) with a statement endorsing the 1994
recommendations. Although more than 250 global leaders, including 85 current and 22
former heads of state and government from Europe, Asia, and Africa, signed the document,
President Bush chose not to add his signature. According to State Department officials,
while the United States supports the goals and objectives of the Cairo conference, the U.S.
could not join others in signing the “world leaders” statement because it included the concept
of “sexual rights.” This term, these officials said, does not have a consensus definition and
was not part of the ICPD platform. Critics, however, note that a year later at the 1995
Beijing women’s conference, “sexual rights” was included in the adopted action plan and
supported by United States.
The matter of abortion arose at a March 2005 conference to reaffirm the platform
approved at the 1995 Fourth World Conference on Women in Beijing. U.S. senior
representative to the conference, Ellen Sauerbrey, said the U.S. delegation supported the
conference’s final declaration only after several issues were clarified. Earlier in the
conference, U.S. representatives had expressed concern that a phrase in the Beijing goals
supporting a women’s access to reproductive health might be interpreted to mean access to
abortion. At one point, the U.S. proposed amending the conference’s document by stating
that the declaration did not guarantee the right to abortion.
Funding for UNFPA. (For more detailed information regarding UNFPA, see CRS
Report RL32703, The U.N. Population Fund: Background and the U.S. Funding Debate, by
Larry Nowels.) 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.
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.
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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.
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. 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. 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 amount UNFPA spent in 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 continued in counties where UNFPA concentrated its programs. (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 of 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, a State Department investigative team visited China in May 2002 and reported a
series of findings and recommendations. Among them, 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. (See
[http://www.state.gov/g/prm/rls/rpt/2002/12122.htm] for report’s full text.)
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
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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 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 opposed it for a number of reasons, including
the loss of $34 million, an amount that represented about 9% of UNFPA income in 2001.
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, preventing
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 that operate in China and
to which the U.S. contributes — for example, UNICEF, WHO, and the U.N. Development
Program. Since the July 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.
In its most recent determination of September 17, 2005, the State Department said 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, USAID notified Congress that the reprogrammed
set-aside UNFPA would be made available to expand family planning and reproductive
health programs in 14 countries. The most significant increases come in programs for
Georgia, Madagascar, Romania, Russia, Rwanda, and Ukraine.
The September 17 announcement followed a June 22 UNFPA Executive Board meeting
to consider UNFPA’s new five-year, $27 million program for China, where 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 spokesman, 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. His statement noted that U.S. 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.
Also related to the July 2002 decision regarding UNFPA, on August 6, 2003, the State
Department decided that it would fund a $1 million HIV/AIDS program supporting African
and Asian refugees only if the implementing NGO group — Reproductive Health for
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Refugees Consortium — did not include Marie Stopes International among its members.
Marie Stopes International is a British-based reproductive health organization that at the time
was 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.
In another related decision, the Administration notified the Global Health Council in
April 2004 that the U.S. government would not provide funding for the Council’s 31st annual
meeting in June 2004 because UNFPA would be a participant. Reportedly, U.S. officials
told representatives of international organizations and NGOs that UNICEF, WHO, and other
organizations that continued involvement in joint programs with UNFPA might jeopardize
their funding support from the United States. (Christopher Marquis, “U.S. is Accused of
Trying to Isolate U.N. Population Unit,” New York Times, June 21, 2004.)
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.)
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. Chinese
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.
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 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 their 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
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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’s Human Rights Report for
2004 (dated February 2005), however, found that enforcement of the law varied by location.
While the law says that officials should not violate citizens’ rights, it does not define those
rights or the penalties for violating them.
The broad question concerning the degree of coercive family planning practices in
China remains a controversial matter. The State Department’s human rights report
concluded that “Central Government policy formally prohibits the use of physical coercion
to compel persons to submit to abortion or sterilization. Because it is illegal, the use of
physical coercion was difficult to document. A few cases were reported during the year
[2004]... However, the Government does not consider social compensation fees and other
administrative punishments to be coercive.” 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.” (State Department Assessment Team Report, May 29, 2002.)
Recent attention has focused on a report 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 to have
an abortion. Local activists are pursuing a class-action lawsuit against the government,
although the group’s leader, Chen Guangcheng, was placed under house arrest after filing the
case. In mid-September, China’s National Population and Family Planning Commission
acknowledged that illegal coercive practices had occurred, and that responsible officials had
been dismissed and that some had been detained. (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, p. A1.; and “China Terse About Action on
Abuses of One-Child Policy,” Washington Post, September 20, 2005, p. A17.)
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 has been “encouraging movement” in China’s approach
to population policy and the reduction of coercive practices. He 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. This he regarded as a positive step towards ending discrimination in China against
girls and women. 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 that would allow the Bush
Administration to resume UNFPA funding.
As noted above, 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
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(2006-2010), $27 million UNFPA program in China. A State Department 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 out of plan 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.
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. Until FY1996, Congress
generally supported higher funding levels for population aid than proposed by the President,
especially during the Reagan and Bush Administrations. Appropriations peaked in FY1995
at $577 million. During the balance of the Clinton Administration, however, Congress cut
and placed restrictions on bilateral funding. Amounts fell to $356 million in FY1996, but
grew steadily since to reach $441 million in FY2005.
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. A more recent analysis suggests a more promising trend, noting that donor
nations contributed $2.3 billion in 2002, the largest amount ever. It cautioned, however, that
donor allocations still fall far below the targets set at Cairo. (Population Action
International, Progress and Promises: Trends in International Assistance for Reproductive
Health and Population, 2004.)
Table 1. Population Assistance, FY1994-2006
(appropriations of millions of $s)
1994 1995 1996 1997 1998 1999
2000
2001
2002b
2003b
2004b
2005b
2006
Bilateral
485.1
541.6
356.0
385.0
385.0
385.0
372.5a 425.0
480.5
446.5
432.0
475.0
432.0
Aid
UNFPA
40.0
35.0
22.8
25.0
20.0
0.0
21.5a
21.5a
0.0
0.0
0.0
0.0 34.0
Total
525.1
576.6
378.8
410.0
405.0
385.0
394.0 446.5
480.5
446.5
432.0
475.0
466.0
Source: USAID/Office of Population and CRS calculations.
a. The bilateral FY2000 aid level reflects a transfer of $12.5 million from population assistance to child survival activities.
UNFPA amounts for FY2000 and FY2001 reflect a $3.5 million deduction due to legislative restrictions.
b. In each of FY2002-FY2005, the Administration determined that UNFPA was ineligible for U.S. funding because of
programs in China, and withheld appropriated funds. The withheld funds were reallocated for USAID bilateral family
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planning, vulnerable children, and counter-trafficking in persons programs. The total for FY2002 includes both the
regular $446.5 million appropriation, plus the $34 million withheld from UNFPA and transferred to family planning
activities. Totals for FY2003 and FY2004 represent the amount earmarked for bilateral family planning programs,
but do not include $25 million and $34 million, respectively, of redirected UNFPA funds which were transferred to
support vulnerable children and trafficking in persons programs. The FY2005 amount includes $441 million
earmarked for bilateral family planning programs, plus $34 million that was redirected from UNFPA contributions.
Current International Family Planning
Issues and Legislation
Foreign Operations Appropriations, FY2006
The President’s FY2006 Foreign Operations request for bilateral family planning
assistance totaled $425 million, a reduction of $16 million, or 3.6%, from the FY2005
enacted level. But unlike recent years, the budget proposal did not set aside a “reserve” for
UNFPA if the organization is determined to be eligible for U.S. support under the terms of
the Kemp-Kasten conditions. During the first four years of the Bush Administration, funding
for UNFPA had been included in the International Organizations and Programs account of
the Foreign Operations spending measure. For FY2006, however, USAID officials said that
should UNFPA comply with the Kemp-Kasten restrictions, a $25 million contribution would
be drawn from the $425 million family planning request proposed under the Child Survival
and Health account. Since unused UNFPA funds in the past have been transferred to the
Child Survival and Health account for family planning and related women’s programs, the
net effect of the $425 million FY2006 request and the account reconfiguration was a
reduction of $50 million, or 10.5% less for population aid and related reproductive health
assistance.
As passed by the House, the FY2006 Foreign Operations bill (H.R. 3057) provided
$432 million for bilateral family planning aid and an additional $34 million for UNFPA. The
combined total of $466 million compared with the Administration’s request of $425 million.
The House recommendation, however, continued all existing restrictions on such funds,
including the Kemp-Kasten provision that resulted in no funds for UNFPA since FY2001.
In the event that UNFPA was found to be ineligible for U.S. support in FY2006, the House
measure required that the funds be used by USAID for bilateral family planning programs.
In the Senate, the State, Foreign Operations spending measure (also H.R. 3057; S.Rept.
109-96; passed on July 20), provided somewhat higher funding levels than the House —
$450 million for USAID bilateral programs and a $35 million UNFPA contribution. UNFPA
funds had to be kept in a separate account by the organization, could not be spent in China,
and could not be used to fund abortions. If the Administration found UNFPA ineligible for
U.S. support, the Senate measure directed that funds drawn from the International
Organizations and Programs account ($20 million) would be transferred to USAID for
additional bilateral family planning activities. Under the terms of a floor amendment by
Senators Leahy, Clinton, and others, UNFPA funds would be available for six specific
activities:
! safe child birth and emergency obstetric care;
! obstetric fistula treatment and care;
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! contraceptive supplies for preventing pregnancies and sexually transmitted
diseases, including AIDS;
! restoration of maternal health care in locations hit by natural disasters;
! elimination of female genital mutilation; and
! access by unaccompanied women and other vulnerable individuals to vital
services.
H.R. 3057, as passed the Senate, further included modified Kemp-Kasten language that
appeared to narrow the terms under which UNFPA could be declared ineligible for U.S.
funding. The Senate language stated that an organization could not receive funds if it
“directly” supported coercive abortion or involuntary sterilization. The term “directly” is not
part of the Kemp-Kasten restriction. The Senate measure further stated that an organization
could not be found in violation of this condition only because the government of a country
in which the organization operates conducted coercive practices. This would have
represented a new exception to past applications of the Kemp-Kasten language.
The Senate bill also added a provision similar to what the Senate had passed earlier
during debate on S. 600 (see below) that would effectively overturn the President’s Mexico
City policy restrictions. The text in H.R. 3057, as passed by the Senate, stated 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 did 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 provision further provided that non-U.S. government funds used by
foreign NGOs for advocacy and lobbying activities would 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 have lifted current prohibitions that apply to overseas NGOs.
The conference agreement on H.R. 3057, adopted by the House on November 4,
dropped Senate-passed language modifying the Mexico City and Kemp-Kasten restrictions,
leaving current policy in place. On funding questions, conferees approved House-passed
amounts, providing $432 million for bilateral family planning programs, plus an additional
$34 million for UNFPA if the organization is eligible under the terms of Kemp-Kasten. If
found ineligible, the conference agreement stated that UNFPA funds would become available
for bilateral family planning activities. Conferees did not include the Leahy/Clinton
amendment setting out specific activities for which UNFPA contributions could support.
Science, State, Justice, and Commerce Appropriations, FY2006
Although the SSJC appropriation measure does not contain funds for international
family planning programs or UNFPA contributions, State Department offices that oversee
broad U.S. population policy and manage U.S. voluntary contributions to international
organizations, including UNFPA, are funded in the SSJC bill. During House debate on the
FY2006 SSJC spending measure (H.R. 2862), Representatives Maloney, Shays, Crowley,
and Israel proposed an amendment that would block the State Department from using funds
provided in H.R. 2862 to enforce any provision of law that restricts or prohibits funding for
UNFPA. The affect of the amendment would be to bar the enforcement of the Kemp-Kasten
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restriction that is part of the Foreign Operations appropriation measure. The House defeated
the Maloney amendment, however, on June 16 by a vote of 192-233.
Emergency Supplemental Appropriations for FY2005
During debate on H.R. 1268, an $81.9 billion request for supplemental spending mainly
for military operations in Iraq and Afghanistan, the House adopted by voice vote an
amendment offered by Representative Maloney that increased funding for humanitarian
assistance to tsunami victims by $3 million. Although not directly stated in the text of the
amendment, supporters of the amendment said it was their intent to provide $3 million for
a UNFPA related to organization’s work in tsunami-affected countries. Other Members
noted, however, that the text of the amendment did not direct the Administration to use the
$3 million as a UNFPA contribution, but only to supplement the Tsunami Recovery and
Reconstruction Fund. For this reason, the amendment was not opposed by some lawmakers
that do not support U.S. contributions for UNFPA. The enacted measure (P.L. 108-13)
reduced tsunami relief aid by $3 million below the House-passed level and did not direct the
Administration to provide any funds to UNFPA.
Foreign Affairs Authorization Act, FY2006/2007
On April 5, the Senate adopted (52-46) an amendment by Senator Boxer to S. 600 that
would appear to effectively reject the Mexico City policy. See above under the Senate-
reported version of H.R. 3057 for discussion of the terms of the amendment. The Senate
suspended consideration of S. 600 and has not brought the bill back for further debate.
In the House, the companion bill, H.R. 2601, includes a provision creating 12 centers
for the treatment and prevention of obstetric fistula in developing nations. Obstetric fistula,
which affects an estimated two million women mainly in Africa, occurs primarily from a
prolonged labor that results in a hole or rupture in tissues between the vagina and bladder
(and at times the rectum). Women with this condition are stigmatized and often shunned by
their family and community. It is especially common in girls aged 15-19 whose bodies are
not fully developed for child birth and in girls and women suffering from malnutrition.
This provision, as reported by the House International Relations Committee, specified
that to the maximum extent possible, each center would perform certain services, including
surgical repair and post-surgery support, educational activities to prevent incidents of fistula,
and expanded access to contraceptive services for the prevention of pregnancies among
women that were at high risk for a prolonged or obstructed child birth. During floor debate,
Representative Smith (N.J.) proposed an amendment that deleted the requirement for each
center to expand contraceptive services for high-risk women, and added a new activity
requiring centers to broaden “abstinence education, postponement of marriage and child-
bearing until after teenage years, and activities to expand access to family planning services”
for women in a high-risk category. Prevention activities, as revised in the amendment, would
be provided at the discretion of the centers.
In support of his amendment, Congressman Smith argued that the changes would allow
faith-based hospitals to perform the required activities, something that would not have
occurred under the committee-reported language because of opposition of faith-based
facilities to providing contraceptive services. He further stated that the amendment’s
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reference to “family planning services” would include contraception. Opponents of the
amendment, however, charged that the revised text “gutted” the prevention aspect of the
obstetric fistula centers by making these activities discretionary rather than mandatory in the
original text. They contend that the most effective method to reduce the incidents of
obstetric fistula is to ensure that young girls and high-risk women do not get pregnant. The
House adopted the Smith amendment on a 223-205 vote.
LEGISLATION
H.R. 1011 (Maloney)
Women, Children, and Infant Tsunami Victim Relief Act of 2005. Authorizes $3
million be made available to UNFPA to assist tsunami victims. Introduced on March 1,
2005, and referred to the House Committee on International Relations.
H.R. 2811 (Maloney)
Repairing Young Women’s Lives Around the World Act. Authorizes,
“notwithstanding” any provision of law, $34 million in FY2006 and each subsequent fiscal
year as a U.S. contribution to UNFPA only for prevention and repair of obstetric fistula.
Introduced on June 8, 2005; referred to the House International Relations Committee.
H.R. 2601 (Smith)
Foreign Relations Authorization Act, Fiscal Years 2006 and 2007. Includes a provision
establishing 12 centers for the treatment of obstetric fistula at sites in developing countries.
Introduced on May 24, 2005; reported by the House International Relations Committee on
July 13 (H.Rept. 109-168); passed by the House on July 20 (351-78).
crsphpgw
H.R. 3057 (Kolbe)
Foreign Operations Appropriations, 2006. Introduced and reported by the House
Appropriations Committee on June 24, 2005 (H.Rept. 109-152); passed the House on June
28 (393-32). Reported by the Senate Appropriations Committee June 30 (S.Rept. 109-96);
passed the Senate on July 20. Conference report filed on November 2 (H.Rept. 109-265);
passed the House November 4 (358-39).
H.R. 4188 (McCollum)
Focus on Family Health Worldwide Act of 2005. Authorizes a series of activities aimed
at improving voluntary family planning programs in developing countries, and to increase
funding authorizations from $600 million in FY2007 to $1 billion by FY2011. Introduced
on November 1, 2005, and referred to the House International Relations Committee.
S. 600 (Lugar)
Foreign Affairs Authorization Act, FY2006/2007. Authorizes State Department and
foreign aid programs for FY2006/2007. Reported by the Senate Foreign Relations
Committee March 10, 2005 (S.Rept. 109-35). On April 5, the Senate approved (52-46) an
amendment by Senator Boxer that effectively overturns the President’s Mexico City policy
relating to abortion and international family planning.
CRS-16
CRS Issue Brief for Congress
Received through the CRS Web
Population Assistance and
Family Planning Programs:
Issues for Congress
Updated November 10, 2005
Larry Nowels
Foreign Affairs, Defense, and Trade Division
Congressional Research Service ˜ The Library of Congress
CONTENTS
SUMMARY
MOST RECENT DEVELOPMENTS
BACKGROUND AND ANALYSIS
Introduction to U.S. Population Assistance Issues: Setting the Context
Current Scope of USAID Family Planning Programs
Policy and Funding Issues in U.S. Family Planning Debates
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 Operations Appropriations, FY2006
Science, State, Justice, and Commerce Appropriations, FY2006
Emergency Supplemental Appropriations for FY2005
Foreign Affairs Authorization Act, FY2006/2007
LEGISLATION
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Population Assistance and Family Planning Programs:
Issues for Congress
SUMMARY
Since 1965, United States policy has
For FY2005, Congress earmarked in
supported international population planning
Division D of P.L. 108-447 (Consolidated
based on principles of volunteerism and
Appropriations Act) $441 million for bilateral
informed choice that gives participants access
family planning programs and $34 million for
to information on all methods of birth control.
UNFPA.
This policy, however, has generated conten-
tious debate for over two decades, resulting in
On September 17, 2005, the State De-
frequent clarification and modification of U.S.
partment announced that UNFPA would not
international family planning programs.
receive the FY2005 U.S. contribution because
the organization was in violation of the Kemp-
In 1984, controversy arose over U.S.
Kasten restrictions. This is the fourth consec-
population aid policy when the Reagan
utive year that UNFPA has been declared
Administration introduced restrictions, which
ineligible for U.S. support, resulting in a loss
became known as known as the Mexico City
of $127 million in appropriated funds.
policy. (Opponents of the policy also refer to
it as the “Global Gag Rule.”) The “Mexico
In his FY2006 Foreign Operations budget
City policy” denied U.S. funds to foreign non-
request, the President proposed $425 million
governmental organizations (NGOs) that
for family planning programs, including $25
perform or promote abortion as a method of
million for UNFPA should the organization be
family planning, regardless of whether the
eligible under the Kemp-Kasten provision.
money came from the U.S. government.
H.R. 3057), as passed by the House,
Presidents Reagan and Bush also banned
recommended $432 million for bilateral fam-
grants to the U.N. Population Fund (UNFPA)
ily planning programs and $34 million for
because of its program in China, where coer-
UNFPA, and retained the Kemp-Kasten re-
cive practices have been used.
strictions. The Senate companion bill prov-
ided $450 million for bilateral activities, $35
President Clinton resumed UNFPA
million for UNFPA, included a modified
funding and repealed the Mexico City policy.
Kemp-Kasten provision, and altered the Mex-
President George W. Bush, however, re-ap-
ico City policy. The final conference text of
plied the Mexico City restrictions. Following
H.R. 3057 adopted the House-passed funding
a State Department investigation of family
levels and dropped Senate-added changes to
planning programs in China, the Administra-
Kemp-Kasten and the Mexico City policy.
tion suspended U.S. contributions to UNFPA
on July 22, 2002, citing violations of the
In related legislation, on S. 600, an omni-
“Kemp-Kasten” amendment. This provision
bus State Department/Foreign Aid authoriza-
bans U.S. assistance to organizations that
tion measure, the Senate adopted an amend-
support or participate in the management of
ment by Senator Boxer that would effectively
coercive family planning programs.
overturn the Mexico City policy. The bill has
not received a final vote in the Senate.
Congressional Research Service ˜ The Library of Congress
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MOST RECENT DEVELOPMENTS
On November 4, 2005, the House agreed to the conference report on H.R. 3057, the
FY2006 Foreign Operations appropriations. As adopted, the bill includes $432 million for
bilateral population assistance activities and $34 million as a U.S. contribution to the U.N.
Population Fund (UNFPA), levels proposed by the House. The Administration had
requested $425 million for total bilateral and UNFPA funding, while the Senate
recommended $450 million for bilateral programs and a $35 million UNFPA contribution.
Conferees further deleted text approved by the Senate that would have modified restrictions
(“Kemp-Kasten” conditions) on funding for UNFPA and effectively overturned the so-called
Mexico City policy related to abortion. The White House said the President would veto H.R.
3057 if the final bill included the Senate-proposed policy changes.
On September 17, 2005, the State Department announced that the United States, for the
fourth consecutive year, would withhold its voluntary contribution to UNFPA because the
organization did not comply with the Kemp-Kasten restrictions. This provision, enacted
annually in Foreign Operations appropriation bills, bans U.S. support for organizations
involved in the management of a coercive family planning program. UNFPA maintains
activities in China where there is strong evidence of coercive practices. The State
Department said that it would consider future funding for UNFPA if the organization altered
its programs in China or if China terminated its practice of coercive abortion.
On July 20, the House approved (223-205) an amendment to H.R. 2601 (Foreign
Relations Authorization Act, FY2006-2007) altering committee-reported language that
created 12 centers for the treatment and prevention of obstetric fistula in developing nations.
The amendment, proposed by Representative Smith (NJ), deleted a requirement that each
center expand contraceptive services for high-risk women, inserting instead a requirement
that these centers broaden “abstinence education, postponement of marriage and child-
bearing until after teenage years, and activities to expand access to family planning services”
for women in a high-risk category.
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. 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
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(USAID) launched 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. The attention and funding given to
international family planning programs are credited with helping to bring a decrease in
population growth among developing countries from about a 1.7% per year average, 1980-
2002, to a projected annual average of 1.2%, 2002-2015. Fertility rates have fallen in these
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 in 2005).
Nevertheless, while global population growth has slowed, it reached 6 billion in 1999, 6.5
billion in 2005, and is expected to rise to 9.3 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; in 2005 the level had grown to 81%, and these countries now account for 99% of
world-wide population growth. (Population Reference Bureau, Frequently Asked Questions
about the PRB World Population Data Sheet. 2005.)
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 added 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. 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, 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, some participants
reversed their positions. 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
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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 U.S. provisions announced 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.
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.
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.
(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. A
U.N. report dated December 9, 2003 — “World Population 2300” — projects as a “medium
scenario” that world population will peak in 2075 at 9.2 billion and then, as fertility in all
countries reach below replacement levels, decline over the next 100 years to 8.3 billion. 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 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.
Current Scope of USAID Family Planning Programs
Throughout this debate — 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 60 countries that include counseling and
services, training of health workers, contraceptive supplies and distribution, financial
management, public education and marketing, and biomedical and contraceptive research and
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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 and transmission.
Policy and Funding Issues in
U.S. Family Planning Debates
In addition to differences of opinion over how population growth affects economic
development in developing countries, family 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. 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 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 non-governmental organizations.
Two issues in particular which were initiated in 1984 — the Mexico City policy involving
funding for foreign non-governmental organizations (NGOs), and restrictions on funding for
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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, by Larry Nowels.) 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 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.
Mexico City Policy Removed. 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 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 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.”
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, the President could waive the
certification requirement for up to $15 million in grants to groups that would otherwise be
ineligible. President Clinton exercised the waiver and further instructed USAID to
implement Section 599D in a way that would minimize the impact on U.S. funded family
planning programs. Nine organizations refused to certify, including two of the largest
recipients of USAID population aid grants — IPPF and the World Health Organization
(WHO). These nine non-certifying organizations received 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, revoked the Clinton Administration memorandum and restored in full the terms of the
Mexico City restrictions. As was the case during the 1980s and early 1990s, foreign NGOs
and international organizations, as a condition for receipt of U.S. funds, would need to certify
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that they would 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. 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; that 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.”
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 are unsure of the full implications
of the restrictions and do not want to risk losing eligibility for USAID funding. 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 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.
Bush Administration 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. The
implementing regulations contain several exceptions, including the following:
! 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 is able to continue support, either directly or through a grantee, to foreign
governments, even in cases where the government includes abortion in its family 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.
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The President 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 apply to USAID activities. This directive affects most directly 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.
Related Mexico City Policy Issues. The Bush Administration policy to shield
foreign assistance from supporting organizations performing or promoting abortions has also
shaped other U.S. policy positions at multilateral fora. In October 2004, international family
planning activists sought to commemorate the 10 year anniversary of the Cairo International
Conference on Population and Development (ICPD) with a statement endorsing the 1994
recommendations. Although more than 250 global leaders, including 85 current and 22
former heads of state and government from Europe, Asia, and Africa, signed the document,
President Bush chose not to add his signature. According to State Department officials,
while the United States supports the goals and objectives of the Cairo conference, the U.S.
could not join others in signing the “world leaders” statement because it included the concept
of “sexual rights.” This term, these officials said, does not have a consensus definition and
was not part of the ICPD platform. Critics, however, note that a year later at the 1995
Beijing women’s conference, “sexual rights” was included in the adopted action plan and
supported by United States.
The matter of abortion arose at a March 2005 conference to reaffirm the platform
approved at the 1995 Fourth World Conference on Women in Beijing. U.S. senior
representative to the conference, Ellen Sauerbrey, said the U.S. delegation supported the
conference’s final declaration only after several issues were clarified. Earlier in the
conference, U.S. representatives had expressed concern that a phrase in the Beijing goals
supporting a women’s access to reproductive health might be interpreted to mean access to
abortion. At one point, the U.S. proposed amending the conference’s document by stating
that the declaration did not guarantee the right to abortion.
Funding for UNFPA. (For more detailed information regarding UNFPA, see CRS
Report RL32703, The U.N. Population Fund: Background and the U.S. Funding Debate, by
Larry Nowels.) 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.
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.
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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.
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. 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. 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 amount UNFPA spent in 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 continued in counties where UNFPA concentrated its programs. (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 of 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, a State Department investigative team visited China in May 2002 and reported a
series of findings and recommendations. Among them, 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. (See
[http://www.state.gov/g/prm/rls/rpt/2002/12122.htm] for report’s full text.)
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
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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 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 opposed it for a number of reasons, including
the loss of $34 million, an amount that represented about 9% of UNFPA income in 2001.
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, preventing
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 that operate in China and
to which the U.S. contributes — for example, UNICEF, WHO, and the U.N. Development
Program. Since the July 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.
In its most recent determination of September 17, 2005, the State Department said 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, USAID notified Congress that the reprogrammed
set-aside UNFPA would be made available to expand family planning and reproductive
health programs in 14 countries. The most significant increases come in programs for
Georgia, Madagascar, Romania, Russia, Rwanda, and Ukraine.
The September 17 announcement followed a June 22 UNFPA Executive Board meeting
to consider UNFPA’s new five-year, $27 million program for China, where 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 spokesman, 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. His statement noted that U.S. 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.
Also related to the July 2002 decision regarding UNFPA, on August 6, 2003, the State
Department decided that it would fund a $1 million HIV/AIDS program supporting African
and Asian refugees only if the implementing NGO group — Reproductive Health for
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Refugees Consortium — did not include Marie Stopes International among its members.
Marie Stopes International is a British-based reproductive health organization that at the time
was 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.
In another related decision, the Administration notified the Global Health Council in
April 2004 that the U.S. government would not provide funding for the Council’s 31st annual
meeting in June 2004 because UNFPA would be a participant. Reportedly, U.S. officials
told representatives of international organizations and NGOs that UNICEF, WHO, and other
organizations that continued involvement in joint programs with UNFPA might jeopardize
their funding support from the United States. (Christopher Marquis, “U.S. is Accused of
Trying to Isolate U.N. Population Unit,” New York Times, June 21, 2004.)
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.)
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. Chinese
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.
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 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 their 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
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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’s Human Rights Report for
2004 (dated February 2005), however, found that enforcement of the law varied by location.
While the law says that officials should not violate citizens’ rights, it does not define those
rights or the penalties for violating them.
The broad question concerning the degree of coercive family planning practices in
China remains a controversial matter. The State Department’s human rights report
concluded that “Central Government policy formally prohibits the use of physical coercion
to compel persons to submit to abortion or sterilization. Because it is illegal, the use of
physical coercion was difficult to document. A few cases were reported during the year
[2004]... However, the Government does not consider social compensation fees and other
administrative punishments to be coercive.” 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.” (State Department Assessment Team Report, May 29, 2002.)
Recent attention has focused on a report 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 to have
an abortion. Local activists are pursuing a class-action lawsuit against the government,
although the group’s leader, Chen Guangcheng, was placed under house arrest after filing the
case. In mid-September, China’s National Population and Family Planning Commission
acknowledged that illegal coercive practices had occurred, and that responsible officials had
been dismissed and that some had been detained. (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, p. A1.; and “China Terse About Action on
Abuses of One-Child Policy,” Washington Post, September 20, 2005, p. A17.)
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 has been “encouraging movement” in China’s approach
to population policy and the reduction of coercive practices. He 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. This he regarded as a positive step towards ending discrimination in China against
girls and women. 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 that would allow the Bush
Administration to resume UNFPA funding.
As noted above, 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
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(2006-2010), $27 million UNFPA program in China. A State Department 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 out of plan 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.
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. Until FY1996, Congress
generally supported higher funding levels for population aid than proposed by the President,
especially during the Reagan and Bush Administrations. Appropriations peaked in FY1995
at $577 million. During the balance of the Clinton Administration, however, Congress cut
and placed restrictions on bilateral funding. Amounts fell to $356 million in FY1996, but
grew steadily since to reach $441 million in FY2005.
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. A more recent analysis suggests a more promising trend, noting that donor
nations contributed $2.3 billion in 2002, the largest amount ever. It cautioned, however, that
donor allocations still fall far below the targets set at Cairo. (Population Action
International, Progress and Promises: Trends in International Assistance for Reproductive
Health and Population, 2004.)
Table 1. Population Assistance, FY1994-2006
(appropriations of millions of $s)
1994 1995 1996 1997 1998 1999
2000
2001
2002b
2003b
2004b
2005b
2006
Bilateral
485.1
541.6
356.0
385.0
385.0
385.0
372.5a 425.0
480.5
446.5
432.0
475.0
432.0
Aid
UNFPA
40.0
35.0
22.8
25.0
20.0
0.0
21.5a
21.5a
0.0
0.0
0.0
0.0 34.0
Total
525.1
576.6
378.8
410.0
405.0
385.0
394.0 446.5
480.5
446.5
432.0
475.0
466.0
Source: USAID/Office of Population and CRS calculations.
a. The bilateral FY2000 aid level reflects a transfer of $12.5 million from population assistance to child survival activities.
UNFPA amounts for FY2000 and FY2001 reflect a $3.5 million deduction due to legislative restrictions.
b. In each of FY2002-FY2005, the Administration determined that UNFPA was ineligible for U.S. funding because of
programs in China, and withheld appropriated funds. The withheld funds were reallocated for USAID bilateral family
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planning, vulnerable children, and counter-trafficking in persons programs. The total for FY2002 includes both the
regular $446.5 million appropriation, plus the $34 million withheld from UNFPA and transferred to family planning
activities. Totals for FY2003 and FY2004 represent the amount earmarked for bilateral family planning programs,
but do not include $25 million and $34 million, respectively, of redirected UNFPA funds which were transferred to
support vulnerable children and trafficking in persons programs. The FY2005 amount includes $441 million
earmarked for bilateral family planning programs, plus $34 million that was redirected from UNFPA contributions.
Current International Family Planning
Issues and Legislation
Foreign Operations Appropriations, FY2006
The President’s FY2006 Foreign Operations request for bilateral family planning
assistance totaled $425 million, a reduction of $16 million, or 3.6%, from the FY2005
enacted level. But unlike recent years, the budget proposal did not set aside a “reserve” for
UNFPA if the organization is determined to be eligible for U.S. support under the terms of
the Kemp-Kasten conditions. During the first four years of the Bush Administration, funding
for UNFPA had been included in the International Organizations and Programs account of
the Foreign Operations spending measure. For FY2006, however, USAID officials said that
should UNFPA comply with the Kemp-Kasten restrictions, a $25 million contribution would
be drawn from the $425 million family planning request proposed under the Child Survival
and Health account. Since unused UNFPA funds in the past have been transferred to the
Child Survival and Health account for family planning and related women’s programs, the
net effect of the $425 million FY2006 request and the account reconfiguration was a
reduction of $50 million, or 10.5% less for population aid and related reproductive health
assistance.
As passed by the House, the FY2006 Foreign Operations bill (H.R. 3057) provided
$432 million for bilateral family planning aid and an additional $34 million for UNFPA. The
combined total of $466 million compared with the Administration’s request of $425 million.
The House recommendation, however, continued all existing restrictions on such funds,
including the Kemp-Kasten provision that resulted in no funds for UNFPA since FY2001.
In the event that UNFPA was found to be ineligible for U.S. support in FY2006, the House
measure required that the funds be used by USAID for bilateral family planning programs.
In the Senate, the State, Foreign Operations spending measure (also H.R. 3057; S.Rept.
109-96; passed on July 20), provided somewhat higher funding levels than the House —
$450 million for USAID bilateral programs and a $35 million UNFPA contribution. UNFPA
funds had to be kept in a separate account by the organization, could not be spent in China,
and could not be used to fund abortions. If the Administration found UNFPA ineligible for
U.S. support, the Senate measure directed that funds drawn from the International
Organizations and Programs account ($20 million) would be transferred to USAID for
additional bilateral family planning activities. Under the terms of a floor amendment by
Senators Leahy, Clinton, and others, UNFPA funds would be available for six specific
activities:
! safe child birth and emergency obstetric care;
! obstetric fistula treatment and care;
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! contraceptive supplies for preventing pregnancies and sexually transmitted
diseases, including AIDS;
! restoration of maternal health care in locations hit by natural disasters;
! elimination of female genital mutilation; and
! access by unaccompanied women and other vulnerable individuals to vital
services.
H.R. 3057, as passed the Senate, further included modified Kemp-Kasten language that
appeared to narrow the terms under which UNFPA could be declared ineligible for U.S.
funding. The Senate language stated that an organization could not receive funds if it
“directly” supported coercive abortion or involuntary sterilization. The term “directly” is not
part of the Kemp-Kasten restriction. The Senate measure further stated that an organization
could not be found in violation of this condition only because the government of a country
in which the organization operates conducted coercive practices. This would have
represented a new exception to past applications of the Kemp-Kasten language.
The Senate bill also added a provision similar to what the Senate had passed earlier
during debate on S. 600 (see below) that would effectively overturn the President’s Mexico
City policy restrictions. The text in H.R. 3057, as passed by the Senate, stated 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 did 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 provision further provided that non-U.S. government funds used by
foreign NGOs for advocacy and lobbying activities would 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 have lifted current prohibitions that apply to overseas NGOs.
The conference agreement on H.R. 3057, adopted by the House on November 4,
dropped Senate-passed language modifying the Mexico City and Kemp-Kasten restrictions,
leaving current policy in place. On funding questions, conferees approved House-passed
amounts, providing $432 million for bilateral family planning programs, plus an additional
$34 million for UNFPA if the organization is eligible under the terms of Kemp-Kasten. If
found ineligible, the conference agreement stated that UNFPA funds would become available
for bilateral family planning activities. Conferees did not include the Leahy/Clinton
amendment setting out specific activities for which UNFPA contributions could support.
Science, State, Justice, and Commerce Appropriations, FY2006
Although the SSJC appropriation measure does not contain funds for international
family planning programs or UNFPA contributions, State Department offices that oversee
broad U.S. population policy and manage U.S. voluntary contributions to international
organizations, including UNFPA, are funded in the SSJC bill. During House debate on the
FY2006 SSJC spending measure (H.R. 2862), Representatives Maloney, Shays, Crowley,
and Israel proposed an amendment that would block the State Department from using funds
provided in H.R. 2862 to enforce any provision of law that restricts or prohibits funding for
UNFPA. The affect of the amendment would be to bar the enforcement of the Kemp-Kasten
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restriction that is part of the Foreign Operations appropriation measure. The House defeated
the Maloney amendment, however, on June 16 by a vote of 192-233.
Emergency Supplemental Appropriations for FY2005
During debate on H.R. 1268, an $81.9 billion request for supplemental spending mainly
for military operations in Iraq and Afghanistan, the House adopted by voice vote an
amendment offered by Representative Maloney that increased funding for humanitarian
assistance to tsunami victims by $3 million. Although not directly stated in the text of the
amendment, supporters of the amendment said it was their intent to provide $3 million for
a UNFPA related to organization’s work in tsunami-affected countries. Other Members
noted, however, that the text of the amendment did not direct the Administration to use the
$3 million as a UNFPA contribution, but only to supplement the Tsunami Recovery and
Reconstruction Fund. For this reason, the amendment was not opposed by some lawmakers
that do not support U.S. contributions for UNFPA. The enacted measure (P.L. 108-13)
reduced tsunami relief aid by $3 million below the House-passed level and did not direct the
Administration to provide any funds to UNFPA.
Foreign Affairs Authorization Act, FY2006/2007
On April 5, the Senate adopted (52-46) an amendment by Senator Boxer to S. 600 that
would appear to effectively reject the Mexico City policy. See above under the Senate-
reported version of H.R. 3057 for discussion of the terms of the amendment. The Senate
suspended consideration of S. 600 and has not brought the bill back for further debate.
In the House, the companion bill, H.R. 2601, includes a provision creating 12 centers
for the treatment and prevention of obstetric fistula in developing nations. Obstetric fistula,
which affects an estimated two million women mainly in Africa, occurs primarily from a
prolonged labor that results in a hole or rupture in tissues between the vagina and bladder
(and at times the rectum). Women with this condition are stigmatized and often shunned by
their family and community. It is especially common in girls aged 15-19 whose bodies are
not fully developed for child birth and in girls and women suffering from malnutrition.
This provision, as reported by the House International Relations Committee, specified
that to the maximum extent possible, each center would perform certain services, including
surgical repair and post-surgery support, educational activities to prevent incidents of fistula,
and expanded access to contraceptive services for the prevention of pregnancies among
women that were at high risk for a prolonged or obstructed child birth. During floor debate,
Representative Smith (N.J.) proposed an amendment that deleted the requirement for each
center to expand contraceptive services for high-risk women, and added a new activity
requiring centers to broaden “abstinence education, postponement of marriage and child-
bearing until after teenage years, and activities to expand access to family planning services”
for women in a high-risk category. Prevention activities, as revised in the amendment, would
be provided at the discretion of the centers.
In support of his amendment, Congressman Smith argued that the changes would allow
faith-based hospitals to perform the required activities, something that would not have
occurred under the committee-reported language because of opposition of faith-based
facilities to providing contraceptive services. He further stated that the amendment’s
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reference to “family planning services” would include contraception. Opponents of the
amendment, however, charged that the revised text “gutted” the prevention aspect of the
obstetric fistula centers by making these activities discretionary rather than mandatory in the
original text. They contend that the most effective method to reduce the incidents of
obstetric fistula is to ensure that young girls and high-risk women do not get pregnant. The
House adopted the Smith amendment on a 223-205 vote.
LEGISLATION
H.R. 1011 (Maloney)
Women, Children, and Infant Tsunami Victim Relief Act of 2005. Authorizes $3
million be made available to UNFPA to assist tsunami victims. Introduced on March 1,
2005, and referred to the House Committee on International Relations.
H.R. 2811 (Maloney)
Repairing Young Women’s Lives Around the World Act. Authorizes,
“notwithstanding” any provision of law, $34 million in FY2006 and each subsequent fiscal
year as a U.S. contribution to UNFPA only for prevention and repair of obstetric fistula.
Introduced on June 8, 2005; referred to the House International Relations Committee.
H.R. 2601 (Smith)
Foreign Relations Authorization Act, Fiscal Years 2006 and 2007. Includes a provision
establishing 12 centers for the treatment of obstetric fistula at sites in developing countries.
Introduced on May 24, 2005; reported by the House International Relations Committee on
July 13 (H.Rept. 109-168); passed by the House on July 20 (351-78).
crsphpgw
H.R. 3057 (Kolbe)
Foreign Operations Appropriations, 2006. Introduced and reported by the House
Appropriations Committee on June 24, 2005 (H.Rept. 109-152); passed the House on June
28 (393-32). Reported by the Senate Appropriations Committee June 30 (S.Rept. 109-96);
passed the Senate on July 20. Conference report filed on November 2 (H.Rept. 109-265);
passed the House November 4 (358-39).
H.R. 4188 (McCollum)
Focus on Family Health Worldwide Act of 2005. Authorizes a series of activities aimed
at improving voluntary family planning programs in developing countries, and to increase
funding authorizations from $600 million in FY2007 to $1 billion by FY2011. Introduced
on November 1, 2005, and referred to the House International Relations Committee.
S. 600 (Lugar)
Foreign Affairs Authorization Act, FY2006/2007. Authorizes State Department and
foreign aid programs for FY2006/2007. Reported by the Senate Foreign Relations
Committee March 10, 2005 (S.Rept. 109-35). On April 5, the Senate approved (52-46) an
amendment by Senator Boxer that effectively overturns the President’s Mexico City policy
relating to abortion and international family planning.
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