U.S.

GLOBAL HEALTH POLICY

FA CT S H E E T
The U.S. Government and International Family Planning & Reproductive Health May 2010

Reproductive Health (RH): The state of complete physical, mental and social been on the rise, it is still below 50% globally and worse in Africa and
well-being in all matters relating to the reproductive system and to its functions South-East Asia (see Figure 1). Similarly, adolescent fertility rates have
and processes, including family planning and sexual health.1,2 declined slowly and are particularly high in Africa, which also has the
highest rate of unmet need for FP services. Each year, approximately
Family Planning (FP): The ability of families or persons to anticipate and 70,000 women die from complications associated with unsafe abortion.
attain their desired number of children and plan the spacing and timing of
births.3 Reasons for the lack of access to FP/RH services include low awareness
of the risks of sexual activity, such as pregnancy and HIV; cost; gender
Overview inequality; and laws in some countries that require women and girls to
Access to family planning and reproductive health (FP/RH) services be of a certain age or have third party authorization, typically from their
is critical to the health of women and children worldwide. The U.S. husband.13 The 2007 addition to MDG 5 (which aims to improve maternal
government first provided international family planning assistance in health) of a specific target to achieve universal access to reproductive
the mid-1960s and has since been a leading donor to FP/RH. Still, the health was a recognition by governments and world leaders of the need
U.S. role has changed and shifted over time, sometimes due to political to address these challenges.12 Of all 8 MDGs, however, countries have
debates and differing views between Congress and the Administration, made the least progress toward MDG 5.
as well as with the international community. Historically, these debates
have concerned both the amount of U.S. funding provided to international Figure 1: FP/RH Indicators by Region14
FP/RH as well as its use, particularly related to abortion. The latter is Antenatal
Unmet Need Contraceptive Adolescent
governed by several legislative and policy restrictions, including a legal Care
for FP Prevalence Birth Rate
WHO Region Coverage15
ban on the direct use of U.S. funding overseas for abortion as a method (%) (%) (per 1,000)
(%)
of family planning, which has been in place since 1973, as well as more 2000-2007 2000-2008 2000-2007
2000-2009
stringent restrictions in some years (i.e., the “Mexico City Policy”).4 Global 10.8 62.3 47 48
The Obama Administration has stated its strong support for FP/RH, as Africa 24.3 23.7 118 44
part of the overall U.S. global health portfolio. The U.S. Global Health Americas 9.4 70.6 61 NA
Initiative (GHI), a $63 billion six-year (FY09-FY14) initiative announced South-East Asia 12.8 57.5 55 43
in May 2009 calls for a more comprehensive global health agenda and Europe NA 68.4 23 NA
women- and girl-centered approach. The GHI includes the specific E. Mediterranean 18.6 42.8 35 45
FP/RH target to “prevent 54 million unintended pregnancies by FY Western Pacific 3.4 82.7 11 NA
2014.”5
FP/RH Services: FP/RH encompasses a wide range of services that
The Obama Administration has also reversed prior restrictions on the
have been shown to be effective in decreasing the risk of unintended
use of funding for family planning assistance by rescinding the Mexico
pregnancies, maternal and child mortality, and other complications,
City Policy6 and restoring funding to the United Nations Population Fund
including birth spacing; contraception; sexuality education, information
(UNFPA).4,6 U.S. support for achieving universal access to reproductive
and counseling; post-abortion care; screening/testing for HIV and
health as specified in the Millennium Development Goals (MDG) and the
other sexually transmitted diseases (STDs); repair of obstetric fistula;
1994 Cairo International Conference on Population and Development’s
antenatal and postnatal care; genital human papillomavirus (HPV)
(ICPD) Programme of Action has been reaffirmed.7
vaccine to prevent cervical cancer and genital warts; and research into
Current Global Snapshot new methods such as microbicides.16,17,18,19,20
Improving access to FP/RH services globally can help prevent maternal The U.S. Government Response
deaths and reduce unintended pregnancies. Each year, an estimated
342,000 to half a million women die from complications during pregnancy History
and childbirth, almost all in developing countries.8,9 It is also estimated • Congress first authorized research on international family planning
that approximately one third of maternal deaths could be avoided and population issues in the Foreign Assistance Act of 1961.4
annually if women who did not wish to become pregnant had access to • In 1965, USAID launched its first FP program, and in 1968, began
and used effective contraception.10 purchasing contraceptives to distribute in developing countries.
Worldwide, however, more than 200 million women have an unmet need The U.S. is one of the largest purchasers and distributors of
for contraceptives (e.g., they do not wish to get pregnant and are using contraceptives.21,22
no contraceptive method).11 Access to family planning methods varies • In the 1980s, U.S. programs expanded to address maternal, newborn,
significantly by region.11 Contributing factors to maternal deaths and and child health (MNCH). Beginning in the 1990s, USAID began to
unintended pregnancy include: lack of access to antenatal care, which recognize the need for male involvement in FP/RH and focus on the
increases the risk of complications during pregnancy and childbirth; high needs of young people.21
adolescent birth rates, since adolescents (ages 15-19) are more likely
to die or face complications during pregnancy and childbirth; unsafe Structure & Programs
abortions, those performed by individuals without the necessary skills • The GHI has placed a new emphasis on FP/RH and an expectation
or in an unsanitary environment, often lead to complications and death; that these programs will be scaled up over the next several years.
and unmet need for FP services.12,13 While antenatal coverage has USAID has long served as the lead U.S. agency for FP/RH activities;

The Henry J. Kaiser Family Foundation

Headquarters: 2400 Sand Hill Road Menlo Park, CA 94025 650.854.9400 Fax: 650.854.4800
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW Washington, DC 20005 202.347.5270 Fax: 202.347.5274 www.kff.org
The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating
the best possible analysis and information on health issues.
 other agencies involved include the Centers for Disease Control and
Prevention (CDC) (research, surveillance, technical assistance, and
a designated WHO Collaborating Center for Reproductive Health),23
the National Institutes of Health (NIH) (research), and the Peace
Corps (volunteer activities).
• The U.S. government’s stated FP/RH objective is to expand
sustainable access to quality voluntary FP/RH services and
information to: enhance efforts to reduce high-risk pregnancies; allow
sufficient time between pregnancies; provide information, counseling,
and access to condoms to prevent HIV transmission; reduce the
number of abortions; support women’s rights; and stabilize population
growth.19,24 Increased emphasis on linking HIV and FP/RH through
the President’s Emergency Plan for AIDS Relief (PEPFAR) is one
Kasten amendment which prohibits funding any program, as
determined by the President, that supports coercive abortion or
involuntary sterilization.32 In March 2009, President Obama announced
that the U.S. would restore UNFPA funding; $50 million was provided
in FY 2009 and $55 million in FY 2010.6,33,34
• Voluntarism/informed choice: These principles are specified in
legislative language and program guidance.35
Figure 3: U.S. Government Funding for Global Family Planning/
Reproductive Health, FY 2004-FY 2011*30
In Millions
Global Health & Child Survival (GHCS), USAID
$125.7

component.25 Other Accounts $123.5

• USAID operates FP/RH programs in 52 countries, including 24 $90.0

“priority countries,” most of which are in Africa.26,27 Countries are $50.9 $51.1 $36.3 $54.1 $75.5

selected based on high rates of unmet need for FP, prevalence of

high-risk births, low contraceptive use, and significant population $590.0
pressures on land and water resources.28 Although FP/RH and MNCH $525 0
$525.0
$455.0
$418.3 $411.5
are linked, Congress directs funding to and USAID operates these $398.1 $396.8 $391.1
programs separately.
Figure 2: U.S. Government Funded FP/RH Interventions16,17
• Linking family planning with maternity • Training of health workers FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011
2011*
$449.0m $447.9m $454.6m $465.5m $466.6m $545.0m $648.5m $715.7m
services • Counseling and services such as birth
*FY 2011 is the President’s Budget Request to Congress
• HIV/AIDS & STD information and spacing
services • Contraceptive supplies and their Looking Ahead
• Sexuality & reproductive health distribution
education
The Administration has placed increasing emphasis on the importance
• Financial management
of FP/RH within the U.S. global health portfolio as part of the GHI. There
• Eliminating female genital mutilation • Public education and marketing is also growing global attention to the need to augment FP/RH services
• Post-abortion care • Biomedical and contraceptive research worldwide and increase coverage and access. Still, despite widespread
• Prevention and repair of obstetric fistula and development recognition of the importance of FP/RH, it will likely continue to be at
• Multilateral contributions to UNFPA the center of policy debate and discussion, particularly regarding U.S.
funding and policy, within the Congress and Administration, as well as
U.S. Government Funding regarding the broader U.S. role in fostering progress toward the MDGs
• Most U.S. funding for FP/RH is specified by Congress in annual and other global efforts to promote access to FP/RH.
appropriations bills and part of the “Global Health and Child Survival” __________________________
(GHCS) account at USAID; all GHCS funding for FP/RH is counted as
1
WHO. Reproductive Health; http://www.who.int/topics/reproductive_health/en/.
2
International Conference on Population and Development (ICPD), Programme of Action, Cairo 1994, http://
part of the GHI. Additional funding is provided through other accounts www.un.org/ecosocdev/geninfo/populatin/icpd.htm#intro.
(although it is not currently counted as part of the GHI). 3

4
WHO. Family Planning: http://www.who.int/topics/family_planning/en/.
CRS. International Population Assistance and Family Planning Programs: Issues for Congress; January 2010.
• U.S. funding for international FP began in the 1960s. Over time, it has 5

6
GHI. Implementation of the Global Health Initiative: Consultation Document; February 2010.
White House. Statement of Barack Obama on Rescinding the Mexico City Policy; January 23, 2009.
fluctuated and decreased as a share of the U.S. global health budget. 7
State Department. Remarks on the 15th Anniversary of the International Conference on Population and
After reaching approximately $575 million in FY 1995, it dropped or Development; January 2010: http://www.state.gov/secretary/rm/2010/01/135001.htm.
remained relatively flat for more than a decade, not surpassing this
8
Murray et al. “Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards
Millennium Development Goal 5.” The Lancet. Vol. 375, No. 9726; 2010.
level until FY 2010 when it reached $648.5 million, including $525 9
WHO. Maternal Mortality in 2005; 2007.
10
UN. Fact Sheet, Goal 5: Improve maternal health; September 2008.
million in the GHCS account.29 The FY 2011 budget request includes 11
Guttmacher Institute/UNFPA. Adding It Up: The Costs and Benefits of Investing in Family Planning and
$715.7 million for FP/RH (see Figure 3).30 Despite recent increases, Maternal and Newborn Health; 2009.
designated funding for FP/RH has not kept pace with U.S. global 12

13
UN. The Millennium Development Goals Report 2009; 2009.
WHO. World Health Report 2005 – Making Every Mother and Child Count; 2005.
health funding, declining from 12% in FY 2004 to 6% in FY 2010, and 14
WHO. World Health Statistics 2010; 2010.
is 6% of the FY 2011 request.31 15
At least four visits.
16
USAID. Family Planning Programs - Saving Lives, Protecting the Environment, Advancing U.S. Interests: http://
Legal & Policy Restrictions www.usaid.gov/our_work/global_health/pop/popfaq.html#11.
17
USAID. Fast Facts: Family Planning; December 2009.
There are several legal, policy and programmatic requirements and 18
WHO, Johns Hopkins, and USAID. Family Planning: A Global Handbook for Providers; 2007.
19
USAID. Report to Congress: Global Health and Child Survival Progress Report – FY 2008; 2009.
restrictions concerning U.S. funding for international FP, including: 20
UNESCO. International Technical Guidance on Sexuality Education; December 2009.
USAID. USAID Family Planning Program Timeline: Before 1965 to the Present: http://www.usaid.gov/our_work/
• Abortion: Since 1973, U.S. law, through the Helms Amendment, has
21

global_health/pop/timeline_b.pdf.
prohibited the use of foreign assistance for abortion as a method 22
UNFPA. Donor Support for Contraceptives and Condoms for STI/HIV Prevention (2008); 2009.
of family planning or to motivate or coerce any person to practice 23
CDC. Global Reproductive Health; March 2009: http://www.cdc.gov/reproductivehealth/Global/index.htm.
24
USAID. Strategic Framework for Family Planning: http://www.usaid.gov/our_work/global_health/pop/
abortion.4 framework.html.
25
PEPFAR. Five-Year Strategy; December 2009: http://www.pepfar.gov/strategy/index.htm.
• The Mexico City Policy: First instituted by President Reagan in 1984 26
State Department. Congressional Budget Justification, Foreign Operations; FY 2010 and FY 2011.
through executive order, the Mexico City Policy required foreign NGOs 27
Kaiser Family Foundation personal communication with USAID; April 2, 2010.
28
USAID. Countries: http://www.usaid.gov/our_work/global_health/pop/countries/index.html.
to certify that they would not perform or promote abortion using funds 29
H.R. 3288, 111 Cong., 1st Sess. (2009).
from any source, as a condition for receiving U.S. funding. This policy 30
Kaiser Family Foundation analysis; May 2010.
31
KFF calculation of funding designated for FP/RH through the GHCS account, as part of the GHI, as share of
has been a highly debated issue, rescinded by President Clinton, overall funding the programs now counted as part of the GHI.
reinstated by President Bush, and rescinded again by President 32
CRS. The U.N. Population Fund: Background and the U.S. Funding Debate; February 2010.
Obama in January 2009.4 33
State Department. U.S. Government Support for the United Nations Population Fund (UNFPA); March 2010:
http://www.state.gov/r/pa/prs/ps/2009/03/120841.htm.
• UNFPA: Although the U.S. helped create UNFPA in 1969 and was
34
H.R. 1105, 111 Cong., 1st Sess. (2009).
35
USAID, USAID’s Family Planning Guiding Principles and U.S. Legislative and Policy Requirements: http://www.
a leading contributor for many years, there have been several usaid.gov/our_work/global_health/pop/voluntarism.html.
years in which funding has been withheld due to executive branch
This publication (#8073) is available on the Kaiser Family Foundation’s website at www.kff.org.
determinations that UNFPA’s activities in China violated the Kemp-