p. 145What is USAID’s family-planning program?

The United States Agency for International Development (USAID) is an independent federal agency that provides economic, developmental, and humanitarian assistance around the world in support of the foreign policy goals of the United States. USAID’s family-planning programs reside within the agency’s Office of Population and Reproductive Health. Since 1965, these programs have supported voluntary family planning, efforts to stabilize population growth, reduction of high-risk pregnancies, child-spacing, reduction of abortion, AIDS education, and distribution of female and male condoms to protect against transmission of infection. The programs have also supported women’s rights and opportunities to participate fully in society.

According to USAID, the agency’s family-planning programs distribute more than 35 percent of all donor-provided contraceptives to the developing world and have helped bring understanding of contraceptive practices to women and men around the world. USAID has pioneered door-to-door distribution of contraceptives, mobile clinic services, and p. 146↵employment-based health care programs in the developing world. The organization has also trained midwives and other traditional birth attendants to provide family-planning services, among other accomplishments.

Since the enactment of the Helms Amendment in 1973, no USAID funds have been used to support abortion as a method of family planning. USAID works to prevent abortion by teaching about family planning, providing materials, and connecting women with family-planning and health services. The organization also works to save the lives of women who have undergone unsafe abortions.

What are the “global gag rule” and the Helms Amendment?

Soon after Roe, Senator Jesse Helms, a Republican from North Carolina, introduced an amendment to the US Foreign Assistance Act, banning all US foreign aid for abortion. The aforementioned Helms Amendment can only be rescinded by an act of Congress; it remains in effect today.

In 1984, during the presidency of Ronald Reagan, the US representative to the International Conference on Population in Mexico City announced that the United States would no longer support nongovernmental organizations (NGOs) that, using their own resources, counsel or advocate abortion or refer individuals to abortion services. The policy also disqualifies foreign NGOs from receiving US family-planning funds if they provide legal abortion services, except in cases of rape, incest, or a pregnancy that is a threat to the woman’s life; or if they lobby to make abortion legal or accessible in their country. This executive branch policy, known as the Mexico City Policy—or, by opponents, as the Global Gag Rule—was in effect until Bill Clinton became president in 1993. While the policy was in force, a five-country study showed that cooperating agencies, in fear of violating its rules, were behaving overcautiously, directly limiting access to reproductive health care and family-planning services, thereby leaving women with p. 147↵fewer options overall. Even after the policy was rescinded in 1993, NGOs had to maintain US money for reproductive health services in segregated accounts, to make certain that none of it would be used for abortions.

When George W. Bush became president in 2001, he reinstated the Mexico City Policy on the twenty-eighth anniversary of Roe v. Wade. President Bush reaffirmed his allegiance to the policy and attempted various extensions of it until he left office, despite a number of Senate votes against these efforts. The policy also faced the opposition of international health professionals, lawyers, policy makers, NGOs, religious organizations, representatives of the United Nations Population Fund, the World Health Organization, and the World Bank because of its demonstrable, deleterious effects on the health of women around the world.

Following the general pattern of Republican opposition/Democratic support, Barack Obama rescinded the Mexico City Policy when he became president in 2009. He issued a statement indicating that USAID and State Department grants should exclude gag rule provisions and that current grants should, too, because the policy “undermined efforts to promote safe and effective voluntary family planning in developing countries.” President Obama called for cooperation among people on “all sides of the issue,” for an end to the politicization of foreign aid for family planning and reproductive health, and for support for programs to reduce unintended pregnancies around the world.

What is the United Nations Population Fund and what relationship does the United States have to this organization?

The recent history of the relationship between the United Nations Population Fund (UNFPA) and the United States government provides another illustration of the enormous impact that reproductive politics within the United States has had on women around the world. UNFPA is the largest p. 148↵internationally funded source of population assistance to developing countries. The organization describes its work as promoting the right of every woman, man, and child to enjoy a life of health and equal opportunity. UNFPA supports policies and programs in about 150 countries that aim to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every woman, young or old, is treated with dignity and respect. For more than forty years, UNFPA has collected voluntary contributions from participating countries and distributed more than $6 billion for use in family-planning, delivery, and other health services.

UNPFA programs target many of the 201 million women around the world who do not have access to effective contraception. Programs also aim to reduce extremely high rates of maternal mortality (536,000 deaths per year, most of which are preventable), to raise rates of prenatal care for the poorest women on earth (about 35 percent of women in poor countries have no contact with health care personnel before delivery), and to slow the spread of HIV/AIDS.

During the Reagan administration, Congress restricted US funding to USFPA because of allegations that the organization sent money to China to fund their involuntary sterilization and forced-abortion programs. (UNPFA has always denied its participation and deplored these practices, and no human rights organization has ever accused UNPFA of these violations in China or other countries.) During subsequent decades, US funding for UNPFA has generally been restored when Democratic presidents are in power and constrained or terminated when Republican presidents are elected and when Republicans control Congress. In 2002, President Bush sent a fact-finding team to China to investigate the connection between UNPFA funds and coercive reproductive practices in that country. The team found no evidence of UNFPA wrongdoing and recommended that the US government fund the organization. Nevertheless, during p. 149↵the administration of George W. Bush, no US funds were contributed to the ­organization. In 2009 after Barack Obama became president, with the support of a Democrat-controlled Congress, the funding program was restarted, although as political changes occur, US support for international family planning and reproductive health remains insecure, uncertain, and highly politicized.

Is there an international body monitoring women’s reproductive health?

The Committee on the Elimination of Discrimination against Women (CEDAW) is the body of independent experts that monitors implementation of the United Nations Convention on the Elimination of All Forms of Discrimination against Women. Countries that are parties to the CEDAW have a duty to ensure maternal health by providing women with appropriate pregnancy services and education about maternity as a “social function.” Countries that have high rates of maternal mortality and morbidity may be in violation of this responsibility to women’s life, health, equality, and nondiscrimination. The CEDAW Committee considers state refusal to provide legitimate reproductive health services—including by criminalization—a form of discrimination against women and recommends that abortion should be available to victims of rape and incest. Further, the CEDAW maintains that a lack of access to contraceptives impedes women’s right to “decide freely and responsibly on the number and spacing of their children”; thus, women across their life span must have information and services regarding contraception as well as sex education.¹