The AHA has signed on to this letter recommending $1 billion be appropriated for international family planning and reproductive health programs in the 2014 State and Foreign Operations Bill. Read it below or as a PDF here.

INTERNATIONAL FAMILY PLANNING & REPRODUCTIVE HEALTH RECOMMENDATIONS FOR THE FY 2014 STATE-FOREIGN OPERATIONS BILL

31 organizations supportive of international family planning and reproductive health programs recommend the following with regard to funding and policy (see list of endorsers below)

Funding Request:  a total of $1 billion for family planning and reproductive health programs, both bilateral and multilateral, with funding provided from the Global Health Programs account and the Economic Support Fund and from the International Organizations and Programs account in order to provide a $65 million voluntary contribution to the United Nations Population Fund (UNFPA).

Rationale/Background: 

U.S. investments in family planning and reproductive health (FP/RH) programs are cost-effective and deliver real results.  FY 2012 funding of $610 million for international FP/RH programs (of which $35 million is a contribution to the United Nations Population Fund) made it possible to achieve the following:

• 31.6 million women and couples receive contraceptive services and supplies;
• 9.4 million unintended pregnancies, including 4.1 million unplanned births, are averted;
• 4 million induced abortions are averted (3 million of them unsafe);
• 22,000 maternal deaths are averted;
• 2.8 million fewer healthy years of life (DALYs) are lost among women; and
• 96,000 fewer children lose their mothers.[1]

Despite these investments, an estimated 222 million women in developing countries want to delay or avoid pregnancy, but face barriers or lack access to effective family planning.[2]  In 2012, an estimated 291,000 women in developing countries will die from pregnancy-related causes, and unsafe abortion continues to be a major cause of these unacceptably high maternal mortality rates. Addressing the demand for access to reproductive health services, including a full range of effective contraceptive methods, will improve maternal and child health, reduce unintended pregnancies, lower HIV infection rates, promote women’s rights and empowerment, enhance women’s and girl’s education, raise standards of living, and support more sustainable development.

The lack of access to family planning services is also a key driver of the 80 million annual unintended pregnancies worldwide and the resulting yearly net increase in global population of 84 million people.  At the end of 2011, world population reached 7 billion, and the next billion people is expected to be added within 12 years, creating serious challenges to the efforts of the  international community to improve human health and wellbeing, promote economic development, enhance security and stability, and protect the global environment.

In order to meet these 21st century challenges, the United States should be increasing investment in international family planning and reproductive health programs.  In addition, in countries with high HIV prevalence, where most new HIV infections are occurring in women, it is particularly important that reproductive health services be integrated with programs addressing HIV/AIDS, as well as maternal and child health.

Such additional investments would yield tangible benefits.  For every increase of $10 million in U.S. international family planning and reproductive health assistance, the following would result:

• 520,000 more women and couples would receive contraceptive services and supplies;
• 150,000 fewer unintended pregnancies, including 70,000 fewer unplanned births, would occur;
• 70,000 fewer abortions would take place (of which 50,000 would have been unsafe);
• 400 fewer maternal deaths would occur;
• 50,000 more DALYs would be gained; and
• 2,000 fewer children would lose their mothers.

If the United States, the recognized world leader in the provision of FP/RH financial and technical assistance, were to provide its appropriate share of the total financial resources necessary to address the unmet need for contraception, this sum would total $1 billion annually, including $65 million for a voluntary contribution to the United Nations Population Fund (UNFPA).[3]

Unfortunately, U.S. funding commitments have continued to erode.  Since 1995, U.S. financial assistance has declined by more than 30 percent when adjusted for inflation. The number of women of reproductive age in developing countries has grown by more than 340 million during the same time period.  The appropriated level for overseas FP/RH programs has fallen an estimated $50 million or nearly eight percent since FY 2010.

Funding levels:

(in millions of dollars)	FY 2012 enacted	FY 2013 Senate Committee- approved bill	FY 2013 enacted estimated#	FY 2014 President’s request
Global Health Programs account*	523.9	600.0	522.1	534.0
Economic Support Fund	(51.1)	55.5	42.7	63.4*
MENA Incentive Fund	—	—	—	1.0*
TOTAL, bilateral FP/RH	575.0	655.5	564.8	598.4
U.S. contribution to UNFPA (IO&P)	35.0	44.5	33.2	37.0
TOTAL, bilateral & multilateral FP/RH	610.0	700.0	598.0	635.4

#  Estimated FY 2013 enacted level reflects projected additional funding for FP/RH programs provided as a result of the overall increase in funding levels for the Global Health Programs (GHP) account contained in the FY 2013 continuing resolution (H.R. 933)—allocated based on the relative share of FP/RH funding within the GHP account—minus the 5.0 percent cut under sequestration, the rescission of 0.1 percent for accounts in budget function 150 (international affairs), and  a proportionate reduction in Economic Support Funds provided to FP/RH activities as a result of a $325 million transfer to development assistance.

*  FY 2014 request levels for FP/RH activities to be supported by ESF and the MENA Incentive Fund have not been publicly released but have been confirmed by more than one source.

Language to be included in the FY 2014 bill

Delete from final FY 2012 bill (P.L. 112-74)—see strikethrough for subsections for deletion

UNITED NATIONS POPULATION FUND

SEC. 7085. (a) CONTRIBUTION.—Of the funds made available under the heading ‘‘International Organizations and Programs’’ in this Act for fiscal year 2014, $65,000,000 shall be made available for the United Nations Population Fund (UNFPA).

(b) AVAILABILITY OF FUNDS.—Funds appropriated by this Act for UNFPA, that are not made available for UNFPA because of the operation of any provision of law, shall be transferred to the ‘‘Global Health Programs’’ account and shall be made available for family planning, maternal, and reproductive health activities, subject to the regular notification procedures of the Committees on Appropriations.

(c) PROHIBITION ON USE OF FUNDS IN CHINA.—None of the funds made available by this Act may be used by UNFPA for a country program in the People’s Republic of China.

(d) CONDITIONS ON AVAILABILITY OF FUNDS.—Funds made available by this Act for UNFPA may not be made available unless—

 (1) UNFPA maintains funds made available by this Act in an account separate from other accounts of UNFPA and does not commingle such funds with other sums; and

(2) UNFPA does not fund abortions.

(e) REPORT TO CONGRESS AND DOLLAR-FOR-DOLLAR WITHHOLDING OF FUNDS.—

(1) Not later than 4 months after the date of enactment of this Act, the Secretary of State shall submit a report to the Committees on Appropriations indicating the amount of funds that the UNFPA is budgeting for the year in which the report is submitted for a country program in the People’s Republic of China.

(2) If a report under paragraph (1) indicates that the UNFPA plans to spend funds for a country program in the People’s Republic of China in the year covered by the report, then the amount of such funds the UNFPA plans to spend in the People’s Republic of China shall be deducted from the funds made available to the UNFPA after March 1 for obligation for the remainder of the fiscal year in which the report is submitted.

ADD THE FOLLOWING NEW SECTION

ASSISTANCE FOR FOREIGN NONGOVERNMENTAL ORGANIZATIONS

SEC. ____. Part I of the Foreign Assistance Act of 1961 (22 U.S.C. 2151 et seq.) is amended by inserting after section 104C, the following new section:

‘‘SEC. 104D. ELIGIBILITY FOR ASSISTANCE.  ‘‘Notwithstanding any other provision of law, regulation, or policy, in determining eligibility for assistance authorized under sections 104, 104A, 104B, and 104C—

‘(1) a foreign nongovernmental organization shall not be ineligible for such assistance solely on the basis of health or medical services, including counseling and referral services, provided by such organization with non-United States Government funds if such services are permitted in the country in which they are being provided and would not violate United States law if provided in the United States; and

‘‘(2) a foreign nongovernmental organization shall not be subject to requirements relating to the use of non-United States Government funds for advocacy and lobbying activities other than those that apply to United States nongovernmental organizations receiving assistance under this part.’’.

ADD THE FOLLOWING NEW PROVISO

 INDEPENDENT AGENCIES

PEACE CORPS

(INCLUDING TRANSFER OF FUNDS)

Provided further, That notwithstanding the previous proviso, section 614 of division C of Public Law 112–74 shall apply to funds appropriated under this heading.

ADD THE FOLLOWING NEW REPORT LANGUAGE

 “The Committee recognizes that, despite great progress in reducing unmet need for contraceptives, an unacceptably high number of women use no modern method or experience contraceptive failure because current methods are difficult to use or have side effects, and there is a need to accelerate research and development of contraceptives and multipurpose prevention technologies that are more effective, affordable, acceptable, and easier to deliver and may also prevent sexually transmitted infections. The Committee calls upon USAID to increase the amount of central funds provided to its Office of Population and Reproductive Health in order to allow for the expansion of efforts in this area, with the expectation that these funds will encourage increased investments by other public and private sources and foster expanded partnerships and cost-sharing among U.S. government offices and agencies, including USAID’s Office of HIV/AIDS and NIH. The Committee directs USAID to develop a strategic plan for such investments and to consult with the Committees on Appropriations not later than 180 days after enactment of this Act on implementation of such plan.”

Rationale/Background

USAID’s contraceptive research and development program has provided strong leadership in developing new methods, especially for use in low-resource countries.  And yet, the contraceptive revolution remains unfinished. One in four women in developing countries in need of contraception are not using a modern method, resulting in some 80 million unintended pregnancies, 30 million unplanned births and 40 million abortions, the majority of which are unsafe. An expanding body of knowledge suggests that improving and expanding use requires more than just increasing access to existing methods. Biomedical research is needed to refine existing contraceptive methods to make them more acceptable, affordable, and accessible, and to develop new methods that fill gaps in the existing method mix, including the development of multipurpose prevention technologies that simultaneously prevent both unintended pregnancy and STIs/HIV.

Organizational endorsers

 

Advocates for Youth	International Center for Research on Women
American Congress of Obstetricians &      Gynecologists	International Women’s Health Coalition Ipas
American Humanist Association	John Snow, Inc. (JSI)
Better World Campaign	Management Sciences for Health
Catholics for Choice	MSI-US
Center for Environment and Population (CEP)	NARAL Pro-Choice America
Center for Health & Gender Equity (CHANGE)	National Council of Jewish Women
Center for Reproductive Rights	Pathfinder International
Center for Women Policy Studies	Plan International USA
EngenderHealth	Planned Parenthood Federation of America
Family Care International	Population Action International
Feminist Majority	Population Connection
FHI 360	Population Institute
Friends of UNFPA	PSI
Guttmacher Institute	Public Health Institute

[1] Guttmacher Institute, Just the Numbers: The Impact of U.S. International Family Planning Assistance, May 2012.  See http://www.guttmacher.org/media/resources/FB-Family-Planning-Assistance.pdf

[2] Susheela Singh and Jacqueline E. Darroch, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012 (New York:  Guttmacher Institute, June 2012), see http://www.guttmacher.org/pubs/AIU-2012-estimates.pdf

[3] Ibid.  Total global expenditures of $8.1 billion are necessary to meet the current unmet need for contraceptives from all funding sources, both donor nations and the developing countries themselves.