U.S. Global Family Planning and Reproductive Health Programs: Funding Trends and Issues for Congress

U.S. Global Family Planning and Reproductive Health Programs: Funding Trends and Issues for Congress

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Updated October 4, 2021
U.S. Global Family Planning and Reproductive Health
Programs: Funding Trends and Issues for Congress
The United States is the largest global donor of
agreements with nongovernmental organizations. The
international family planning and reproductive health
agency’s technical and administrative staff oversee and
(FP/RH) assistance, supporting programs in 40 countries. In
monitor the work of implementing partners. (For more
recent years, Congress has appropriated approximately
information on USAID FP/RH programs, see CRS Report
$575 million annually in funds for bilateral FP/RH
R46215, U.S. Bilateral International Family Planning and
assistance. Key issues for the 117th Congress include debate
Reproductive Health Programs: Background and Selected
over the merits of U.S. support for these activities, funding
Issues, by Sara M. Tharakan.)
levels, statutory limitations of FP/RH assistance, and
The President’s budget request for FY2022 includes $550
emerging global challenges that may affect access to FP/RH
million for bilateral FP/RH programs. This amount is 132%
services.
higher than the Administration’s FY2021 request, and 4.4%
Background
lower than FY2021-enacted amounts (see Figure 1).
Some U.S. international family planning activities
Figure 1. FP/RH Bilateral Aid Funding,
originated prior to 1965. Following enactment of the
FY2015-FY2022
Foreign Assistance Act of 1961 (FAA), Congress
Requested vs. Enacted Amounts (millions)
authorized research on family planning issues, among other
topics. Beginning in 1965, the U.S. Agency for
International Development (USAID) started contraceptive
distribution programs. These programs evolved over time to
also address reproductive health issues, including female
genital mutilation/cutting (FGM/C) and obstetric fistula
prevention and care. U.S. global FP/RH programs are
authorized in Section 104 of the FAA, as amended (22
U.S.C. 2151b).
USAID administers the majority of FP/RH funding, which
Congress appropriates primarily through the Global Health
Programs (GHP) account in annual State, Foreign
Operations, and Related Programs (SFOPS) appropriations.

FP/RH funding has been subject to several restrictions
Source: State Department Congressional Budget Justifications, 2016-
enacted by Congress since the 1970s, most notably the
2021, and annual SFOPS appropriations.
“Helms Amendment,” which prohibits the use of U.S. funds
Notes: Funding amounts include those requested and enacted in the
to perform abortions or to coerce individuals to practice
GHP and ESF accounts only.
abortions. (For more information, see CRS Report R41360,
The House-passed SFOPS bill (H.R. 4373) for FY2022
Abortion and Family Planning-Related Provisions in U.S.
includes $760 million for bilateral FP/RH programs. On
Foreign Assistance Law and Policy, by Luisa Blanchfield.)
September 30, 2021, the President signed into law the
Bilateral FP/RH Assistance
Extending Government Funding and Delivering Emergency
Assistance Act (P.L. 117-43), which included short-term
The GHP account funds more than 90% of bilateral FP/RH
FY2022 appropriations through December 3, 2021, for the
assistance. Some funding is also provided through other
continuation of federal projects and activities conducted in
accounts, including the Economic Support Fund (ESF),
FY2021.
which funds select countries considered to be politically
and strategically important. For example, Pakistan and
Multilateral FP/RH Assistance
Jordan have received ESF funds for FP/RH activities in
The United States has historically provided multilateral
recent years.
FP/RH assistance through contributions to the U.N.
USAID’s FP/RH programs are administered through the
Population Fund (UNFPA), the primary U.N. entity
Office of Population and Reproductive Health (PRH)
addressing population issues. Since FY1985, the United
within the Global Health Bureau. PRH is responsible for
States has periodically withheld UNFPA funding under the
setting technical and programmatic direction. USAID
“Kemp-Kasten Amendment” in annual SFOPS bills. The
distributes FP/RH commodities (such as contraceptives)
Kemp-Kasten Amendment prohibits funding to any
and related services (such as fistula prevention and efforts
organization or program that, as determined by the
to end FGM/C) primarily through contracts and grant
President, supports or participates in the management of a
program of coercive abortion or involuntary sterilization.
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U.S. Global Family Planning and Reproductive Health Programs: Funding Trends and Issues for Congress
Such a determination has been made regarding UNFPA due
services and into administrative overhead associated with
to concerns that its country program in China supports
ensuring compliance). Some Members have also sought to
coercive abortion. Presidents Reagan, George H.W. Bush,
address potential indirect effects of the MCP on certain
George W. Bush, and Trump found UNFPA ineligible for
groups, such as its perceived disproportionate impact on
funding under the Kemp-Kasten Amendment; Presidents
Lesbian Gay Bisexual Transgender Queer and Intersex
Clinton, Obama, and Biden supported UNFPA funding. In
(LGBTQI) populations, who often receive health care
FY2021, Congress appropriated $32.5 million to UNFPA.
through reproductive health clinics (see GLOBE ACT, H.R.
3800 and S. 1996, introduced in the 117th Congress).
Mexico City Policy (MCP)
The MCP requires foreign nongovernmental organizations
Current and Emerging Policy Issues
(NGOs) receiving USAID family planning assistance to
Some Members may explore the following current and
certify that they will not perform or actively promote
emerging policy issues when considering U.S. FP/RH
abortion as a method of family planning, even if such
funding.
activities are conducted with non-U.S. funds. Since first
Climate Change and Access to FP/RH Services.
applied by the Reagan Administration in 1984, the policy
According to recent studies, climate change has increased
has been rescinded repeatedly (by Presidents Clinton,
some women’s interest in using FP/RH services. For
Obama, and Biden) and reinstated (by Presidents George
example, some women in African countries, where
W. Bush and Trump) through presidential memoranda. In
subsistence farming is the main source of income, note that
January 2017, President Trump expanded the policy to
large family size places more demand on the land for food,
include all U.S. global health assistance and renamed it the
and say they wish to have smaller families to decrease the
Protecting Life in Global Health Assistance (PLGHA),
burdens on their land. Some advocates have called for
representing a departure from previous Administrations. In
climate change mitigation development funds to be used for
January 2021, President Biden rescinded MCP (including
the PLGHA policy), stating that it “undermines [U.S.]
programs increasing access to FP/RH services. Others
assert that the ties between climate change and these family
efforts to advance gender equality while limiting the United
States’ ability to work with local partners around the wo
planning indicators are not confirmed, and that those funds
rld
should focus on other development priorities.
and inhibiting their efforts to confront serious health
challenges.”
COVID-19 and FP/RH Funding. Some Members may
consider secondary public health effects of the Coronavirus
Issues for Congress
Disease 2019 (COVID-19) pandemic, including on
The 117th Congress may consider the following issues.
women’s access to FP/RH services in countries receiving
U.S. global health assistance. The pandemic caused health
FP/RH Funding Levels
systems to scale back sexual and reproductive health
Over the past several decades, Members of Congress have
services to triage COVID-19 patients and avoid further
debated changes to current FP/RH program funding levels.
burdening health systems ’ capacities. The United Nations
Proponents of increased funding say that consistently flat
estimates that in 2020, 12 million women lost access to
funding is equivalent to FP/RH spending cuts, and thus
reproductive health services, leading to 1.4 million
undermines U.S. global development goals on maternal and
unintended pregnancies, as well as 2 million cases of
child health. Advocates note that while the U.S.
female genital mutilation that could otherwise have been
government is currently the largest donor in absolute terms,
averted over the next decade.
it would need to invest $1.5 billion to meet its proportional
share of the burden for foreign assistance for FP/RH
Access to FP/RH Services in Humanitarian and Conflict
funding, and that other donor countries cannot fill the gap.
Settings. Many women who are displaced or living in
Conversely, some opponents question the extent of
conflict zones disproportionately lack access to FP/RH
international demand for FP/RH services and suggest that
services. Researchers note that without access to ongoing
these resources could be better used for other development
care, affected women and girls may suffer from high rates
activities. Further, opponents argue that international FP
of sexually transmitted diseases, unintended pregnancy,
services are controversial in some countries due to religious
premature labor, and maternal mortality. Advocates note
beliefs and societal values related to the use of
that prioritizing these services in U.S. and international
contraceptives and other reproductive health care services.
humanitarian responses and further integrating such
services into routine health care could improve health
Mexico City Policy Debates
outcomes. Congress may consider further oversight of
Since the MCP was first established, some Members have
coordination between those bureaus at USAID and the State
introduced legislation to statutorily mandate or repeal the
Department with programs focused on FP/RH services in
policy, including President Trump’s expansion of the policy
humanitarian and conflict settings. For more information,
(PLGHA). Advocates for the policy argue that it closes
see CRS In Focus IF10568, Overview of the Global
necessary loopholes not covered by other legislative
Humanitarian and Displacement Crisis, by Rhoda
restrictions. Those against MCP assert that, when instated,
Margesson.
the policy has a “chilling effect” on some programs
(through “over implementation” of the policy and self
Sara M. Tharakan, Analyst in Global Health and
-
International Development
censorship by service providers) and reduces the
availability of some FP/RH programming (due to the
IF11013
diversion of resources away from the provision of FP/RH
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U.S. Global Family Planning and Reproductive Health Programs: Funding Trends and Issues for Congress

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