|Congressional Research Service Reports
Redistributed as a Service of the NLE*
Population Assistance and Family Planning Programs: Issues for
Foreign Affairs, Defense,
and Trade Division
February 21, 2001
Since 1965, United States policy has supported
international population planning based on principles of voluntarism and
informed choice that gives participants access to information on all methods of
birth control. This policy, however, has generated contentious debate for over
two decades, resulting in frequent clarification and modification of U.S.
international family planning programs.
In the mid-1980s, U.S. population aid policy became
especially controversial when the Reagan Administration introduced restrictions.
At the Second U.N. International Conference on Population, U.S. officials
announced a revised U.S. policy rejecting the existence of a global population
"crisis," characterizing population growth as a "neutral phenomenon," and
advocating sound policies and the development of free-market economies as "the
natural mechanism" for slowing population growth. Critics viewed this policy as
a major and unwise departure from U.S. population efforts of the previous 20
The "Mexico City policy" further denied U.S. funds to
foreign non-governmental organizations (NGOs) that perform or promote abortion
as a method of family planning, regardless of whether the source of money was
the U.S. Presidents Reagan and Bush also banned grants to the U.N. Population
Fund (UNFPA) because of its program in China, where coercion has been used.
During the Bush Administration, a slight majority in Congress favored funding
UNFPA and overturning the Mexico City policy but failed to alter policy because
of presidential vetoes or the threat of a veto.
President Clinton repealed Mexico City policy
restrictions and resumed UNFPA funding. Since 1995, debates have been
contentious regarding efforts to cut funding, codify the Mexico City policy, and
block UNFPA funds if it continued work in China.
In FY2000, Congress capped international family
planning funds at $385 million and earmarked $25 million for UNFPA (P.L.
106-113). Congress further attached abortion-related restrictions similar to
past Mexico City policy amendments that were opposed by the Clinton
Administration. The White House reluctantly accepted the restrictions as a
compromise for congressional agreement to authorize U.S. arrearage payments to
the U.N., but instructed USAID to implement the FY2000 abortion restrictions in
a way that would have minimal impact on family planning programs.
For FY2001, Congress increased population aid to $425
million, a level however, well below the President's $542 million request.
Congress further (P.L.
106-428) denied the obligation of any family planing funds until February
15, 2001, giving the new incoming President the opportunity to decide whether to
On Jan. 22, 2001, President Bush issued a memorandum
revoking the Clinton Administration population aid policy position and restoring
in full the terms of the Mexico City restrictions that were in effect on Jan.
19, 1993. In the future, foreign NGOs and international organizations, as a
condition for receipt of U.S. funds, will need to agree not to perform or
actively promote abortions as a method of family planning in other countries.
MOST RECENT DEVELOPMENTS
On January 22, 2001, two days after taking
office, President George W. Bush issued a Memorandum to the USAID Administrator
rescinding the 1993 memorandum from President Clinton and directing the
Administrator to "reinstate in full all of the requirements of the Mexico City
Policy in effect on January 19, 1993." A separate statement from the President's
press secretary stated that President Bush was "committed to maintaining the
$425 million funding level" for population assistance "because he knows that one
of the best ways to prevent abortion is by providing quality voluntary family
planning services." On February 15, 2001, USAID released specific policy and
contract guidelines to implement the President's directive. Under the terms of
the Foreign Operations Appropriations Act, FY2001 (P.L.
106-429), USAID could not obligate any FY2001 population assistance funds
until February 15. Accordingly, all FY2001 appropriations will be guided by the
new policy directives.
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
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 in
developing countries from about 2.4% per year in the 1960s to about 1.8% in the
1990s. Fertility rates have fallen in the developing world from 6.2 children per
woman in 1950 to just below 3 in 1998. Nevertheless, while global population
growth has slowed, it reached 6 billion in 1999 and is expected to rise to 8.9
billion by 2050, with most all of the growth occurring in developing nations. In
1960, 70% of the world's population lived in developing countries; today the
level is 80%, and these countries now account for 95% of world-wide population
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 population 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, opponents of aggressive
population planning programs hold that there is little or no correlation between
rapid population growth and a country's economic development. Some argue that
increased numbers of people provide increased productive capacity; therefore,
they say, high population growth rates actually can contribute to a country's
ability to increase its standard of living. At the very least, proponents of
this view say, current economies of scale and global trading patterns have too
many empirical variables and uncertainties to establish a direct correlation
between population growth and economic development.
As this population debate evolved, many countries,
including the United States, have changed their views. In the 1974 international
population conference, the United States and other donor countries asserted that
high fertility rates were an impediment to economic development -- an assertion
that was then rejected by developing countries. In keeping with this view, the
Carter Administration in 1977 proposed language in domestic legislation, later
enacted in Section 104(d) of the Foreign Assistance Act (FAA) of 1961, which
sought to link population growth and traditional development assistance programs
on the grounds that a high population growth rate could have a serious negative
effect on other development objectives.
A decade later, at the second conference in Mexico
City in 1984, a reversal of positions occurred. Developing countries had become
convinced of the urgent need to control population growth, while U.S. officials
asserted that population growth was not necessarily a negative force in economic
development, but was instead a "neutral phenomenon." At Mexico City, Reagan
Administration officials emphasized the need for developing countries to adopt
sound economic policies that stressed open markets and an active private sector.
Again nearly a decade later, the Clinton
Administration changed the U.S. position on population planning programs by
lifting restrictive provisions adopted at the Mexico City Conference. At the
1994 Cairo Conference, Clinton Administration emphasized U.S. support for
assuring family planning and reproductive health services, improving the status
of women, and providing access to safe abortion. Eight years later, nearly to
the day, President Bush revoked the Clinton Administration position on family
planning issues and abortion, reimposing in full the Mexico City restrictions in
force during the 1980s and early 1990s.
Throughout this debate, which at times has been the
most contentious foreign aid policy issue considered by Congress, the
cornerstone of U.S. policy has remained to be a commitment to international
family planning programs based on principles of voluntarism and informed choice
that give participants access to information on all major methods of birth
More recently, groups supporting strategies to limit
rapid population growth are supporting 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.
In addition to differences of opinion over how
population growth affects economic development in developing countries,
population planning assistance has become an issue of substantial controversy
among U.S. policymakers for two other reasons: the use of federal funds to
perform or promote abortions abroad and how to deal with evidence of coercion in
some foreign national family planning programs, especially in China; and setting
the appropriate, effective, and affordable funding levels for family planning
Abortion and Coercion
The bitterest controversies in U.S. population
planning assistance have erupted over abortion -- in particular, the degree to
which abortions and coercive population programs occur in other countries'
family planning programs, the extent to which U.S. funds should be granted to or
withheld from such countries and organizations that administer these programs,
and the effect that withholding U.S. funds will have on global population growth
and family planning services in developing nations. These issues essentially
stem from the contentious domestic debate over U.S. abortion policy that has
continued since the Supreme Court's 1973 Roe v. Wade decision holding
that the Constitution protects a woman's decision whether to terminate her
pregnancy. Abortion opponents have introduced in every Congress since 1973
constitutional amendments or legislation that would prohibit abortions, but none
have been enacted. As an alternative, abortion critics have successfully
persuaded Congress to attach numerous provisions to annual appropriation
measures banning the use of federal funds for performing abortions.
Most of this debate has focused on domestic spending
bills, especially restrictions on abortions under the Medicaid program in the
Labor/Health and Human Services appropriation legislation. Nevertheless, the
controversy spilled over into U.S. foreign aid policy almost immediately when
Congress approved in late 1973 an amendment to the Foreign Assistance Act of
1961 (Section 104(f)) prohibiting the use of foreign development assistance to
pay for the performance of abortions or involuntary sterilizations, to motivate
or coerce any person to practice abortions, or to coerce or provide persons with
any financial incentive to undergo sterilizations. Since 1981, Congress has
enacted nearly identical restrictions in annual Foreign Operations appropriation
For the past 25 years, both congressional actions and
administrative directives have restricted U.S. population assistance in various
ways, including those set out in the Foreign Assistance Act of 1961, and more
recent executive regulations and appropriation riders prohibiting
indirect support for coercive family planning (specifically in
China) and abortion activities related to the work of international and foreign
nongovernmental organizations. Two issues in particular which were initiated in
1984 -- the "Mexico City" policy involving funding for
non-governmental-organizations (NGOs), and restrictions on funding for the U.N.
Population Fund (UNFPA) because of its activities in China -- have remained
controversial and continue as prominent features in the population assistance
The "Mexico City" Policy.
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 organizations
(but not governments) that were involved in voluntary abortion activities, even
if such activities were undertaken with non-U.S. funds. U.S. officials presented
the revised policy at the 2nd U.N. International Conference on Population in
Mexico City in 1984. Thereafter, it become known as the "Mexico City" policy.
USAID announced in late 1984 that it would not provide funds for the
International Planned Parenthood Federation/London (IPPF) in FY1985 because the
IPPF/London, which had operations in 132 countries, refused to renounce
abortion-related activities it carried out with non-U.S. funds. On January 13,
1987, Planned Parenthood Federation of America (PPFA) filed a lawsuit against
USAID challenging the "Mexico City" policy. In 1990, the U.S. District Court and
Court of Appeals ruled against PPFA, and in 1991, the Supreme Court refused to
review the lower court's decision. The President's discretionary foreign policy
powers to establish different standards for NGOs and foreign governments were
During the Bush Administration, efforts were made in
Congress to overturn the Mexico City policy and rely on existing congressional
restrictions in the Foreign Assistance Act of 1961 banning direct U.S. funding
of abortions and coerced sterilizations. Likewise, the conference reports on the
FY1992-93 foreign aid authorization bill (H.R. 2508 --
H.Rept. 102-225) and on the FY1993 foreign aid appropriations bill (H.Rept.
102-1011) included language to reverse the Mexico City policy. Ultimately, both
provisions were removed from these bills under threat of a presidential veto.
In its first days in office, the Clinton
Administration changed U.S. family planning assistance policies, covering not
only the Mexico City restrictions but also funding for UNFPA population
assistance in general. In a January 22, 1993 memo to USAID, President Clinton
lifted restrictions imposed by the Reagan and Bush Administrations on USAID
grants to family planning NGOs -- in effect repealing the Mexico City policy.
The memo noted that the policy had extended beyond restrictions in the FAA and
was not mandated by law. In his remarks, President Clinton explained that this
step "will reverse a policy that has seriously undermined much needed efforts to
promote safe and effective family planning programs abroad, and will allow us to
once again provide leadership in helping to stabilize world population."
President Clinton characterized this action as one of the most significant
"environmental" steps the United States could take. On August 26 and 30, 1993,
respectively, USAID provided $2.5 million to the World Health Organization's
Human Reproduction Program (HRP) and $13.2 million to the IPPF.
Beginning in 1993, abortion opponents in Congress
attempted, mainly during debate on Foreign Operations spending bills, 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). As discussed in more detail below under the section,
Congressional Debate in the 106th Congress, 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, although they will apply
to all FY2000 appropriated funds which can be obligated through September 30,
Like his predecessor, President George W. Bush, as
one of his first official actions in office, issued a memorandum revoking the
Clinton Administration memorandum restoring in full the terms of the Mexico City
restrictions that were in effect on Jan. 19, 1993. As was the case during the
1980s and early 1990s, in the future foreign NGOs and international
organizations, as a condition for receipt of U.S. federal funds, must agree not
to perform or actively promote abortions as a method of family planning in other
countries. As President Bush stated in his order, American taxpayer funds should
be not used to pay for abortions or advocate or actively promote abortion.
Critics charge, however, that the policy is a violation of free speech and the
rights of women to choose; and that the policy will undermine 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.
New Mexico City Policy
Guidelines. Following several weeks of inter-agency consultations,
USAID released on February 15, 2001, specific contract clauses necessary to
implement the President's directive. The new guidelines state that U.S. NGOs
receiving USAID grants cannot furnish assistance to foreign NGOs which perform
or actively promote abortion as a method of family planning in USAID-recipient
countries, or that furnish assistance to other foreign NGOs that conduct such
activities. When USAID provides assistance directly to a foreign NGO, the
organization must certify that it does not now or will not during the term of
the grant perform or actively promote abortion as a method of family planning in
USAID-recipient countries or provide financial support to other foreign NGOs
that carry out such activities. Abortion is defined as a "method of family
planning when it is for the purpose of spacing births," including (but not
limited to) abortions performed for the physical or mental health of the mother.
To perform abortions is defined as the operation of a "facility where abortions
are performed as a method of family planning." (USAID memorandum to all
contracting officers and negotiators, titled Voluntary Population Activities
- Restoration of the Mexico City Policy, dated February 15, 2001.)
Promoting abortion is defined as an organization
committing resources "in a substantial or continuing effort to increase the
availability or use of abortion as a method of family planning." Examples of
what constitutes the promotion of abortion include: operating a family planning
counseling service that includes information regarding the benefits and
availability of abortion; providing advice that abortion is an available option
or encouraging women to consider abortion; lobbying a foreign government to
legalize or to continue the legality of abortion as a method of family planning;
and conducting a public information campaign in a USAID-recipient country
regarding the benefits and/or availability of abortion as a method of family
The regulations also contain exceptions to these
- abortions may be performed if the life of the
mother would be endangered if the fetus were carried to term or abortions
performed following rape or incest.
- health care facilities may treat injuries or
illnesses caused by legal or illegal abortions (post-abortion care).
- "passive" responses by family planning counselors
to questions about abortion from pregnant women who have already decided to
have a legal abortion is not considered an act of promoting abortion.
- referrals for abortion as a result of rape,
incest, or where the mother's life would be endangered, or for post-abortion
care are permitted.
USAID will further be able to continue support,
either directly or through a grantee, to foreign governments, even in cases
where the government includes abortion in its family 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.
Funding for UNFPA. Also at
the 1984 Mexico City Conference, the Reagan Administration established the
requirement that the United Nations Population Fund (UNFPA) provide "concrete
assurances that [it] is not engaged in, or does not provide funding for,
abortion or coercive family planning programs." Concern was highest over UNFPA's
activities in China's coercive family planning practices. At the time, the
Administration reportedly held up $19 million (of $38 million allocated for
UNFPA for FY1984) until the organization could provide the necessary assurances.
Subsequently, Congress legislated a more restrictive
UNFPA policy -- aimed at coercive Chinese family planning programs and UNFPA's
continuing operations in the country -- by enacting the "Kemp-Kasten amendment"
in the FY1985 Supplemental Appropriations Act (P.L.
99-88). This language prohibited the use of appropriated funds for any
organization or program, determined by the President, to be supporting or
participating "in the management" of a program of coercive abortion or
involuntary sterilization. Accordingly, on Sept. 25, 1985, USAID announced that
$10 million of $46 million that had been earmarked for UNFPA during FY1985 would
be redirected to other programs. On Aug. 27, 1986, USAID announced that the
United States would not contribute to UNFPA at all in 1986. Most of the $25
million that was originally allocated for UNFPA was spent for other
international family planning activities. Even though this pattern to redirect
UNFPA transfers to other population assistance programs continued, critics of
the Kemp-Kasten amendment and the President's determination to suspend
contributions asserted that UNFPA was the world's most effective family planning
organization and that the quality of services provided in developing nations
outside of China suffered due to the unwillingness of U.S. support. At the time
of suspension, U.S. payments represented nearly one-third of UNFPA's annual
budget. From 1986 through 1993, no U.S. contributions went to UNFPA.
Like the Mexico City policy, the Clinton
Administration moved quickly to lift the ban of UNFPA contributions, making
available $14.5 million in FY1993 but stipulating that none of the funds could
be used in China. Again, congressional critics of Chinese family planning
practices attempted unsuccessfully to attach riders to various foreign aid bills
banning U.S. contributions unless UNFPA withdrew from China or the President
could certify that China no longer maintained a coercive family planning
program. Nevertheless, while the United States continued to support UNFPA during
the next five years, Congress attached restrictions in appropriation measures
that in most cases reduced the U.S. contribution by the amount UNFPA spent in
China. UNFPA ended a 5-year program in China in 1997. But when the organization
negotiated in early 1998 a new multi-year Chinese program, Congress, over the
Administration's objections, prohibited American support for FY1999. Congress
resumed UNFPA funding in FY2000 and 2001 but under the condition that the $25
million earmark would be reduced by whatever amount UNFPA's program cost for
China. On February 24, 2000, the State Department announced that it would deduct
$3.5 million - an amount equivalent to UNFPA's planned program in China - from
the U.S. contribution to the international family planning organization.
President George W. Bush has not yet announced a position regarding UNFPA
Family Planning Conditions in
China. As noted, much of the UNFPA debate has focused on that organization's
programs in China, both because of China's well-known population growth problem
and because of widespread publicity given to reports of coercion in its family
planning programs. China's population increased from 500 million in 1950 to
1.008 billion according to the 1982 census -- an average annual growth rate of
2%, or a doubling of the population every 36 years. (Although the 2% rate is not
particularly large by developing country standards, many consider a lower rate
crucial to China's economic development prospects given the country's already
huge population size.)
Given population growth rates, 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 become pregnant a second
time were said to be subjected to rigorous pressure to end the pregnancy and
undergo sterilization; couples who actually had a second child faced heavy
fines, employment demotions, and other penalties. PRC leaders have admitted that
coerced abortions and involuntary sterilizations occur, but insist that those
involved are acting outside the law and are punished, particularly through the
Administrative Procedure Law enacted in October 1990. Chinese authorities have
termed female infanticide an "intolerable crime" that must be punished by law.
After 1983 -- thought to be the peak year of coercion
in Chinese family planning in the 1980s -- the PRC in 1984 relaxed its
"one-child" policy in rural areas. The original target for the PRC's population
in the year 2000 had been 1.2 billion, but that goal was relaxed in 1984 to 1.25
billion, and the Chinese minister of family planning indicated in 1991 that the
target population size for 2000 was now 1.294 billion. (UNFPA reports that
China's population in 1999 is 1.267 billion, with an annual growth rate of
0.9%.) In addition, the policy has been loosely applied for Tibetan, Muslim, and
other ethnic minorities. China has also reported regional differences in the
so-called "one-child" policy. Economic reforms helped weaken policy enforcement
in more prosperous areas, with rising incomes absorbing fines.
More recent press reports suggest that the Chinese
State Family Planning Commission (SFPC) has softened some of its previous harsh
tactics to limit population growth. A number of counties have ended the system
of permits for pregnancy and quotas for the number of children that can be born
annually. When it launched in January 1998 its latest $20 million, five-year
program in China, UNFPA announced that SFPC officials had agreed to drop birth
targets in the 32 counties where U.N. activities would be focused. And in May
1999, the city 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, effective on
October 1, 1999, for couples to obtain a family planning certificate before
having their child.
Nevertheless, the degree of coercive family planning
practices in China remains a cloudy and controversial matter. The State
Department, in its 1999 report on human rights conditions (released February
2000) states that the Chinese government "prohibits the use of force to compel
persons to submit to abortion or sterilization; however, intense pressure to
meet family planning targets set by the government has resulted in documented
instances in which family planning officials have used coercion, including
forced abortion and sterilization, to meet government goals." The State
Department further cautions that, although it is too early for a complete
assessment, it is clear from visits to selected counties where UNFPA/SFPC family
planning and reproductive health activities based solely on voluntary measures
are underway, the record is mixed. Some counties, for example, have not yet
eliminated, or have only begun to eliminate, the birth quota system.
Since 1965, USAID has obligated over $6.6 billion in
assistance for international population planning. In many years, and especially
over the past decade, the appropriate level of funding for population assistance
has been controversial, and at times linked directly with differences concerning
Mexico City restrictions and abortion. During the 1980s and 1990s, Congress and
the executive branch frequently clashed over the amount of foreign aid that
should be allocated to family planning programs. Until FY1996, Congress
generally supported higher funding levels for population aid than proposed by
the President, especially during the Reagan and Bush Administrations. Family
planning assistance appropriations - including both bilateral population aid and
UNFPA contributions - averaged about $280 million annually during the late
1980s, but grew rapidly in the 1990s, peaking in FY1995 at $577 million.
With the change in party control of Congress during
the FY1996 budget cycle, family planning policy and budget issues became, and
have continued to be, the most contentious foreign aid matter considered by
Congress. Population aid appropriation levels fell abruptly to $356 million in
FY1996. But because of the four-month delay in enacting the Foreign Operations
spending measure (largely because of the family planning dispute), coupled with
a new requirement to "meter" population funds - that is, making them available
on a monthly schedule in increments of $23 million over a 15-month period -
USAID had only $151.5 million available for supporting bilateral family planing
programs in FY1996. Most of the FY1996 population aid appropriation was "pushed"
into the next year because of the metering mechanism. Population aid
appropriations grew slightly to $385 million during each of the next four years,
but fell far short of the President's request. Due to restrictions enacted for
FY2000 noted above, $12.5 million of those appropriations were transferred from
population assistance to child health programs. President Clinton proposed a
$541.6 million budget for bilateral population aid in FY2001, a level that would
have returned to the amount provided in FY1995. Congress approved $425 million.
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.
Table 1. Population Assistance,
(appropriations of millions of $s)
Source: AID/Office of Population.
FY2001 = enacted.
a FY2000 levels reflect a transfer of
$12.5 million from population aid and $3.5 million deduction from UNFPA due to
b Because of the FY1996 "metering"
requirement for population aid that delayed the availability of funds, the
actual amount available for obligation in that year was $151.5 million. Since
large amounts appropriated in FY1996 and FY1997 were "metered" into the next
fiscal year, levels available for obligation in FY1997 and FY19998 were $495
million and $554 million, respectively. In years when "metering" was not
required - before FY1996 and since FY1998 - amounts available for obligation
were nearly the same as or identical to the appropriated level shown in Table 1.
Supporters of increasing population aid, many of whom
believe strongly that population growth must be curtailed before meaningful
development can occur, contend that population assistance should be among the
highest priorities of U.S. development strategy. In their view, the United
States should maintain, if not increase, its commitment to family planning
programs overseas. Population growth is seen as having long-term consequences,
affecting diverse U.S. interests in environmental protection, resource
conservation, global economic growth, immigration management, and international
stability. They maintain that attention to family planning assistance now could
obviate future allocations in other development and health-related accounts.
Some proponents of population assistance programs see a particular irony, for
instance, in limiting funds for population stabilization programs while
increasing the budget claims of child survival and infectious disease programs.
Population aid proponents also cite recent studies that suggest that the
prevalence of abortion declines in countries that have wider availability and
use of effective contraceptives. This relationship, they say, further reduces
the risk of unsafe abortions that are the leading cause of maternal deaths in
Opponents of increasing population aid argue that
even without added funding levels, the United States continues to be the largest
bilateral donor in population assistance programs. Some also claim that there is
little or no correlation between rapid population growth and a country's
economic development. At the very least, some opponents say, current economies
of scale and global trading patterns have too many empirical variables and
uncertainties to establish a direct correlation between population growth and
Family Planning Issues and Legislation In the 106th Congress
U.S. population assistance programs and funding
levels have been extraordinarily controversial in Congress since 1995. House and
Senate differences over abortion restrictions and United Nations population
programs have been of such proportion that lawmakers have not been able to agree
to a final, long-term resolution on what degree of abortion restrictions should
govern U.S. international family planning assistance. Instead, House, Senate,
and White House negotiators have eventually reached a series of interim
settlements that have represented temporary solutions to the family planning
controversy. During this period, the House and Senate have differed particularly
over efforts by Representative Chris Smith and others to reinstate "Mexico City"
restrictions on funding for international groups involved in family planning
work that include abortion or efforts to change abortion laws, that restrict
U.S. contributions to UNFPA, and that reduce overall funding for population
Mexico City Restrictions and
Certification Requirements for FY2000
House-Senate Debate. The
controversy over whether to re-instate revised Mexico City abortion restrictions
continued to be a focus of congressional debate on the FY2000 Foreign Operations
Appropriations bill (H.R. 2606).
The House measure, which passed on August 3, did not "meter" or delay the
availability to USAID of international family planning funds, but nevertheless,
retained the $385 million cap on population aid, cutting the President's request
by $15 million. The House further adopted two competing, and apparently
conflicting, amendments affecting U.S. international family planning programs.
On a 228-200 vote, the House approved a modified Mexico City policy amendment by
Representative Smith (NJ) prohibiting U.S. funds to foreign NGOs that perform
abortions or lobby to change abortion laws in foreign countries, regardless of
whether such activities are financed with U.S. funds. The House also adopted
(221-208) a counter amendment by Representative Greenwood permitting U.S. grants
to foreign NGOs as long as they do not use U.S.-provided money to
perform abortions or violate abortion laws in foreign nations, and that they
support programs to reduce the incidence of abortion as a method of family
planning. Because the Smith language was more restrictive concerning foreign NGO
eligibility for receiving USAID grants, it would be the operative text if both
amendments were eventually enacted. Requirements in the Greenwood provision that
NGOs support programs reducing abortions as method of family planning and adhere
to abortion laws in foreign countries, nevertheless, would also apply should
Congress have adopted both positions. Theoretically, however, some foreign NGOs
that would be eligible recipients of USAID grants under the Greenwood amendment
would be barred from receiving U.S. population aid under the Smith restrictions.
Also during floor debate, the House rejected (187-237) amendments by
Representative Pitts that would have banned any child survival funds from being
used for fertility control or child spacing programs (except breast feeding
programs) and by Representative Paul (145-272) eliminating family planning funds
from the bill.
The Senate, in passing its companion measure, S. 1234, on June
30, 1999, voted to increase international family planning assistance without
applying the most controversial abortion-related restrictions. S. 1234
earmarked $425 million within the bilateral development aid account for
population assistance that, combined with anticipated funding from other
bilateral economic aid accounts, would increase total U.S. family planning
funding to about $470 million.
As cleared by a House-Senate conference committee, H.R. 2606
continued current law regarding a $385 million cap on population aid, metered
over a 12-month period but dropped both the Smith and Greenwood amendments
included in the House bill. Nevertheless, keeping an earlier pledge, President
Clinton vetoed H.R. 2606 on
October 18, 1999, because of reductions to his foreign aid budget request.
Following weeks of discussions between congressional leaders and the White
House, negotiators agreed on a compromise package of additional funding for
foreign aid. The House incorporated these changes into a second Foreign
Operations spending bill (H.R. 3196) on
November 5. H.R. 3196
continued the population aid and family planning policy provisions that had been
part of the conference report for H.R. 2606.
As Congress and the White House searched for a final
budget agreement for FY2000, international family planning and population aid
issues became one of the final and most contentious aspects of the negotiations.
When congressional leaders refused to include U.N. arrearage payments without
revised Mexico City language, the White House reluctantly agreed to abortion
restrictions, marking the first time that Mexico City conditions had been
included in legislation signed by the President (enacted in a third Foreign
Operations bill, H.R. 3422,
incorporated into H.R. 3194, the
Consolidated Appropriations Act for FY2000, P.L.
Under the terms of Section 599D of H.R. 3422,
private foreign non-governmental and multilateral organizations must certify
that they neither perform abortions nor lobby to change abortion laws in foreign
countries in order to receive USAID population aid grants in FY2000. Section
599D allowed the President to waive the certification requirement for up to $15
million in grants to groups that would otherwise be ineligible, but with the
penalty of a $12.5 million transfer out of the $385 million population aid
appropriation to child health programs. The restrictions applied only to FY2000
funds, although the money is available for obligation until September 30, 2001.
Implementing the Certification
Requirement and Program Impact. One day after signing the legislation, the
President exercised his waiver authority (November 30, 1999), thereby reducing
FY2000 population aid funds to $372.5 million. He further instructed USAID to
implement Section 599D in a way that would minimize the impact on U.S. funded
family planning programs. In January 2000, USAID issued guidance to its overseas
missions and cooperating agencies on how it would manage the certification
requirement. USAID required all non-U.S. NGOs (whether non-profit or for-profit)
and multilateral organizations that are prime contractors, grantees, and
cooperative agreement recipients to complete a certification form prior to
receiving FY2000 population funds. In addition, all U.S. and non-U.S. prime
awardees were directed to collect certification statements from foreign NGOs and
multilateral organizations that are sub-contractors or grantees below the prime
award level. In the certification form, organizations had to state that they
would not engage in three types of activities with either USAID or non-USAID
funds from the date they signed an agreement to receive FY2000 USAID population
funds through September 30, 2001:
- perform abortions in a foreign country, except
where the life of the mother would be endangered, or in cases of forcible rape
- violate the laws of a foreign country concerning
the circumstances under which abortion is permitted, regulated, or restricted;
- attempt to alter the laws or governmental policies
concerning circumstances under which abortion is permitted, regulated, or
If an organization declined to certify or did not
return the certification form, it was ineligible to receive FY2000 USAID
population funds unless it was granted a waiver under the $15 million exemption
In the first external review of USAID's management of
the new restrictions, the General Accounting Office released a report on October
5, 2000, finding that USAID had complied with FY2000 legislative family planning
conditions regarding abortion activities (GAO Report GAO-01-3, found at http://www.gao.gov/). The GAO, however, also
reported that the International Planned Parenthood Federation (IPPF) had
inadvertently transferred $700,000 in USAID funds to two affiliates the
Federation and USAID had earlier agreed would not be supported with U.S. funds
because the two organizations engaged in abortion-related activities. Although
the error was corrected prior to the GAO audit, Senator Helms, who commissioned
the GAO study, raised concerns over IPPF's initial violation of its agreement
A key issue regarding an evaluation of the impact of
the FY2000 restrictions is whether the $15 million in total grants allowed under
the waiver authority were sufficient to cover all foreign organizations that
declined to certify regarding their involvement in abortion-related activities.
As of late 2000, 448 groups had signed the certification agreement, and USAID
officials expected another 250 groups would certify over the next year. Nine
organizations refused to certify, including two of the largest recipients of
USAID population aid grants - IPPF and the World Health Organization (WHO).
(During the Reagan and Bush Administrations, IPPF was one of the few family
planning organizations that declined to sign "Mexico City" policy conditions and
received no USAID funding during that period.) It is estimated that these nine
non-certifying organizations will be awarded about $8.4 million in FY2000
grants, of which IPPF accounts for $5 million and WHO roughly $2.5 million.
USAID expects that another 10 organizations will refuse to sign the agreement,
but that cumulative awards for non-certifying groups will fall within the $15
Critics of the certification requirement opposed it
on several grounds. From an administrative standpoint, they say it increases
USAID costs to manage family planning programs because of the additional
paperwork and delay implementation of projects. (USAID has contracted with John
Snow, Inc. to track the certification process.) They further believe that family
planning organizations will 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 new conditions will undermine
relations between the U.S. government and foreign NGOs and multilateral groups,
creating a situation in which the United States challenges their sovereignty on
how to spend their own money and 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. 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 simply use USAID resources for legal
activities while diverting money raised from other sources to perform abortions
or lobby to change abortion laws and regulations. The certification process,
they contend, stops the fungibility "loophole."
Legislation. Certification critics, supporting the Administration position,
introduced several bills that would have had the effect of reversing the
restrictions as they existed, by either:
- making the eligibility requirements for NGOs and
multilateral organizations no more restrictive than those that apply to
foreign governments (H.R. 3634
- subjecting foreign groups (concerning the use of
non-USAID funding for advocacy and lobbying activities) to the same
restrictions imposed on U.S. NGOs and maintaining their eligibility as long as
these groups do not engage in health or medical services in violation of the
laws of the country in which they operate or that would violate U.S. law if
provided here (H.R.
Restrictions on Use of USAID Funds for Abortion. Aside from the controversy
over whether the United States should regulate how foreign family planning
organizations spend their own money, legislation was reported that would add
penalties for groups found to use USAID funds to perform or promote abortions.
Section 205 of S.
2382 would have required the USAID Administrator to certify annually that
any organization about to receive U.S. population aid funds had not violated
abortion, involuntary sterilization, and biomedical research restrictions under
permanent law first enacted in 1973 (Section 104(f) of the Foreign Assistance
Act of 1961). If any organization violated these conditions, the group would be
barred for ten years from receiving any U.S. foreign aid funds authorized under
the Foreign Assistance Act of 1961. Under current policy, USAID, using
discretionary authority, would most likely take remedial action or suspend
grants to any organization it found to be in violation of the abortion-related
restrictions. There is no Agency policy, however, regarding how this might
affect an organization's eligibility for other, non-population foreign aid
grants, nor is there a specified penalty like that imposed by S. 2382. USAID
administrators would make determinations on a case-by-case basis, although it
could be expected that the relationship between the Agency and an offending
organization concerning future grants would be strained. The Clinton
Administration, as well as family planning organizations and pro-choice
proponents, opposed these additional restrictions in S. 2382 on the
grounds that they undermined USAID discretionary authority, imposed excessive
administrative burdens on agency officials, and represented yet another,
although perhaps symbolic, attack on international family planning programs. S. 2382 received
no further action during the 106th Congress.
Appropriations, FY2001, and Abortion Restrictions. S. 2522, the
Foreign Operations appropriations approved by the Senate on June 22, effectively
reversed the abortion-related restrictions applied to FY2000 population funding.
Section 590 of the bill substituted for the FY2000 restrictions language that
restored previous Clinton Administration policy on foreign NGOs and multilateral
organization eligibility for USAID population aid grants. Specifically, the
conditions stipulated that such organizations:
- shall not be subject to requirements regarding how
they use non-U.S. government funds for advocacy or lobbying activities that
are more restrictive than those that apply to U.S. NGOs which receive economic
aid grants; and
- shall not be ineligible for USAID grants solely on
the basis of health or medical services provided with non-U.S. government
funds so long as such services do not violate the laws of the country in which
they are provided or would not violate U.S. federal law if provided in this
It is generally held that under the Constitution,
U.S. NGOs cannot be restricted from using their own funds to advocate policy
positions they support. The first new condition would essentially extend that
protection to foreign NGOs and multilateral organizations. The second condition
would not disqualify an organization from receiving USAID grants for performing
abortions with its own money if abortion or whatever medical service it provided
was legal in the country in which it operated, and that the service would be
legal in the United States if performed here.
H.R. 4811, the
FY2001 appropriations bill, approved the House on July 13 (239-185), maintained
the identical FY2000 enacted abortion-related restrictions: a prohibition on
U.S. grants to private foreign non-governmental and multilateral organizations
that perform abortions or lobby to change abortion laws in foreign countries,
even if they use non-U.S. government resources for these activities. The
President could waive (as he did for FY2000) the application of the restrictions
for up to $15 million in grants to organizations that failed to certify their
non-involvement in abortion activities, an action however, that would result in
the loss of $12.5 million in population assistance. During subcommittee markup,
the Foreign Operations panel rejected (7-8) an amendment by Representative Lowey
to remove the abortion restrictions from the bill. A similar amendment during
full Committee mark-up also failed 26-34. During House debate on the bill,
another amendment was rejected (Greenwood, 206-221) that would have removed the
restrictions. The White House has said that the President would veto an
appropriation bill that included the House restrictions.
As enacted, the Foreign Operations Appropriations (P.L.
106-429) provided $425 million for population aid - roughly mid-way between
House and Senate-passed amounts - but deferred the question of abortion
restrictions until a new President assumed office. None of the $425 million
could be obligated until February 15, 2001.
UNFPA Restrictions and Other
Coercive Family Planning Issues
FY2000 conditions and
funding. Congress debated UNFPA policy several times in 1999 and re-visited
the issue in 2000 as part of the Foreign Operations Appropriations bill. In
1999, the first congressional position came from the House International
Relations Subcommittee on International Operations and Human Rights, which
included in its March 23 markup of H.R. 1211, a
bill authorizing State Department programs for the next two years, restrictions
on further U.S. participation in the UNFPA. The legislation, as approved by the
subcommittee, would have prohibited a $25 million U.S. contribution unless the
President certified that the U.N. group had withdrawn from China or that China
had ended coercive abortion and family planning policies. The full House
International Relations Committee, however, overturned the subcommittee
recommendation on an amendment by Representative Campbell, approved 23-17. H.R. 1211, as
ordered reported on April 25, authorized $25 million for UNFPA in each
FY2000/2001, with several conditions:
- UNFPA must keep U.S. funds separate and not use
them in China;
- the U.S. contribution would be reduced
dollar-for-dollar by the amount UNFPA spends in China, unless the President
certified that the UNFPA's China program emphasized improving the delivery of
voluntary family planning services, was consistent with human rights
principles, operated only in counties where targets and quotas had been
terminated, and worked under the oversight of UNFPA's Executive Board.
Most of H.R. 1211,
including the UNFPA provisions, were repeated in H.R. 2415, the
American Embassy Security Act. During debate on H.R. 2415 in
mid-July, the House adopted (221-198) an amendment by Representative Campbell
authorizing a $25 million U.S. contribution to the U.N. Population Fund (UNFPA)
and replacing the conditions agreed to by the House International Relations
Committee. Under the terms of the Campbell amendment, the United States would
reduce the UNFPA transfer by whatever amount, if any, the international family
planning organization spent on a program in China in 2000. The Campbell
amendment replaced text proposed by Representative Smith (N.J.) that would have
prohibited funds for UNFPA unless the organization withdrew from China or the
President certified that China had ended practices of coercive family planning
activities. Congress eventually agreed to the House-passed UNFPA conditions and
a $25 million earmark as part of the Consolidated Appropriations Act for FY2000
106-113). The Foreign Operations Appropriations Act for FY2000, legislation
also incorporated into P.L.
106-113, repeated nearly identical restrictions and funding level for UNFPA.
Pursuant to these legislative requirements, the State
Department notified Congress on February 24, 2000, that UNFPA budgeted $3.5
million for China in FY2000. As a result, the United States deducted an
equivalent amount from its planned $25 million contribution.
Congress also continued for FY2000 a provision first
enacted the previous year in the Foreign Operations appropriations measure
strengthening the "voluntary" principal of U.S. family planning programs.
Prompted by reports of coercive family planning practices in Peru and other
countries, the provision, sponsored by Representative Tiahrt, specifically
defines the principal of voluntarism in population aid programs and
establishes criteria for USAID to apply in managing U.S. family planning
projects overseas. The Tiahrt amendment was included in the enacted Foreign
Operations bill incorporated into P.L.
Legislative action for
FY2001. Congressional actions regarding UNFPA funding and restrictions
generally followed provisions approved by the House and Senate in 1999. In S. 2522, the
Senate earmarked $25 million for UNFPA, under conditions that none of the funds
could be used for programs in China. In H.R. 4811, the
House continued current law, permitting $25 million for UNFPA, an amount that
would be reduced dollar-for-dollar by whatever amount UNFPA spends in China.
Conferees adopted the House position.
Based on reports of continuing coercive family
planning practices in Peru, the House Appropriations Committee proposed a series
of new investigations and reports by USAID and its Inspector General in an
effort to strengthen application of the Tiahrt amendment, not only in Peru, but
in all countries where USAID maintains family planning programs.
Population Aid Funding,
Similar to recent debates over funding for bilateral
population assistance, the Senate proposed to increase the President's $400
million request for FY2000 while the House recommended a continuation of the
$385 million cap that has been in place since FY1997. S. 1234 (Foreign
Operations Appropriations, FY2000) earmarked $425 million for family planning
programs under the development assistance account, an action that would have
resulted in about $470 million for population activities across all
appropriation accounts. P.L.
106-113 included the House amount of $385 million.
Renewing its priority placed on family planning
programs within the U.S. foreign aid budget, the Administration asked Congress
to approve $541.6 million for FY2001, an amount equal to appropriations in
FY1995. Officials said that such a large increase was necessary to restore U.S.
leadership in international family planning programs. They estimated that the
additional $169 million for FY2001 would prevent about 3.5 million unintended
pregnancies. Contending that unintended pregnancies are one of the primary
causes of abortions, they further argued that a U.S. funding commitment of this
size would translate into 1.4 million fewer abortions.
Congressional Action. S. 2522, the
FY2001 Foreign Operations Appropriations bill, earmarked $425 million of
development aid funding for population assistance, an amount that when combined
with resources in other foreign aid accounts, would total about $482 million for
FY2001. Although considerably higher than the $372.5 million FY1999
appropriation, the Senate bill fell well short of Administration efforts to
restore family planning resources to the FY1995 level. The House bill, H.R. 4811,
capped funding for population programs at $385 million. House-Senate conferees
agreed to provide $425 million for FY2001.
Foreign Operations Appropriations, 2001. Appropriates
$425 million for U.S. bilateral population aid programs and $25 million for
contributions to UNFPA. None of the bilateral aid money, however, can be
obligated until February 15, 2001. Introduced and reported by the House
Appropriations Committee on July 10, 2000 (H.Rept.
2522 introduced and reported by the Senate Appropriations Committee on May 9
106-291). Approved by the Senate (95-4) on June 22. Conference report (H.Rept.
106-997) filed on Oct. 24. House and Senate agreed to the conference report
(307-101 and 65-27, respectively) on Oct. 25. President signed H.R. 4811 on
Global Democracy Promotion Act of 2001. Prohibits certain
restrictive eligibility requirements to foreign nongovernmental organizations
with respect to family planning programs. Introduced on Feb. 15, 2001; referred
to the Senate Foreign Relations Committee.
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