International Family Planning and Reproductive Health

International family planning and reproductive health and programs funded by the U.S. Agency for International Development (USAID) population program and UNFPA (United Nations Population Fund) provide health care choices that assist women in realizing their universal human rights. The right to health, including reproductive health care, and the right to decide freely and responsibly the number and spacing of one’s children, are well established under international law. However, U.S. support for desperately-needed programs in low and middle income countries to ensure these rights has been inconsistent, insufficient and mired with burdensome restrictions. Since 1995, Congress has significantly reduced funds for international family planning, and increased restrictions on these crucial reproductive health programs.

Reproductive Rights Are Human Rights

International human rights treaties affirm that reproductive rights, including the right to health, the right to family planning, the right to reproductive self-determination, and the principle of non-discrimination, are human rights. Lack of access to reproductive health services and information constitutes a violation of these basic human rights principles. The rights to family planning and health were first articulated in the Universal Declaration of Human Rights, and were refined in subsequent human rights treaties adopted by the international community:

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• The International Covenant on Civil and Political Rights, ratified by the U.S. in 1992, states that men and women of marriageable age have the right to marry and found a family.
  

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• The first human rights treaty to require nations to recognize a right to health and to take steps to achieve the realization of that right for the benefit of families was the International Covenant on Economic, Social and Cultural Rights.
  

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• Women’s rights to health and family planning services and information, in particular, are addressed in the Convention on the Elimination of all Forms of Discrimination Against Women.
  

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• The Convention on the Rights of the Child reiterates the right to maternal health and identifies it as a right intrinsically related to the right to health for children.

During the 1990s, a series of international conferences recognized reproductive rights, including the right to family planning information and services, as critical both for advancing women’s human rights and for promoting development. Building on principles articulated at earlier conferences — dating back to 1968 — the international community, including the U.S., made commitments of political will and resources to realizing and securing these rights. At the 1994 International Conference on Population and Development (ICPD) in Cairo and the 1995 Fourth World Conference on Women in Beijing, and their five-year reviews, the international community and the U.S. unequivocally endorsed reproductive rights as human rights.

Human Rights and U.S. Foreign Policy

The promotion of human rights is an important aspect of U.S. foreign policy, including foreign assistance. Although Congress and the President have broad discretion to determine whether to provide foreign assistance and to whom, this discretion must be consistent with the Foreign Assistance Act (FAA), which provides that the United States:

shall, in accordance with its international obligations as set forth in the Charter of the United Nations and in keeping with the constitutional heritage and traditions of the United States, promote and encourage increased respect for human rights and fundamental freedoms throughout the world. . . . Accordingly, a principal goal of the foreign policy of the United States shall be to promote the increased observance of internationally recognized human rights by all countries.¹

The United States’ continued insufficient funding levels and restrictions on family planning contravene a “principal goal of the foreign policy of the United States.” In addition, these policies severely curtail the ability of low-income nations to ensure their citizens’ rights to health, family planning, and reproductive self-determination. By inhibiting the ability of these nations to protect human rights, the U.S. directly contradicts the spirit of the FAA, which seeks to promote development, as well as increased observance of internationally recognized human rights by other nations.

U.S. Financial Commitments to Reproductive Rights

Recognizing “the interrelationship between . . . population growth, and . . . development and overall improvement in living standards in developing countries,” the U.S. began its family planning assistance program over 30 years ago. In a bipartisan effort, Congress expanded the FAA to authorize the President to provide assistance for voluntary family planning and health programs. The U.S. family planning program has contributed significantly to increasing the use of modern contraceptive methods from under 10 percent in the 1960s to 50 percent today, helping to reduce high-risk pregnancies and abortions and saving the lives of hundreds of thousands of women.

During international conferences such as 1994’s ICPD, the U.S recognized the critical role that international assistance plays in achieving important goals regarding population and development. The ICPD estimated that approximately $17 billion would be required in the year 2000 to meet the need for international family planning and reproductive health services, including $5.7 billion from donor countries. However, donor contributions have stagnated at around $2 billion per year, significantly below the amount needed to provide sufficient resources to low-income countries. Donor countries, including the U.S., also committed to official development assistance at a level of 0.7 percent of gross national product, with part of that going toward family planning.

Unfulfilled Commitments

Because of its size and wealth, the U.S. remains one of the largest bilateral donors to international family planning programs, however, the U.S. ranks last out of 22 major donors in its contribution relative to gross national product (GNP). In fiscal year 1999, the U.S. provided a mere 0.1 percent of its GNP for official development assistance, a figure that has actually declined in recent years despite the international pledges to meet higher goals, falling far short of the 0.7 percent of GNP endorsed by the international community.

Appropriations for USAID family planning assistance plummeted from $541.6 million in fiscal year (FY) 1995 to $356 million in FY 1996. Research organizations conservatively estimated that this 35% reduction in funding resulted in 4 million unplanned pregnancies, 1.6 million abortions, 8,000 maternal deaths, and 134,000 infant deaths due to increased high-risk births. Although the funding level rose to $446.5 million in FY 2003, the Bush Administration’s reduced request of $425 for FY 2004 show a lack of commitment to family planning programs.

The U.S. has also been a leader in funding the United Nations Population Fund (UNFPA) which works in over 140 countries to provide crucially needed funding for reproductive health services. Tragically, in 2002, President Bush eliminated funding for UNFPA due to pressure from extreme anti-choice legislators who claimed that the program was involved with coercive abortion in China. The president cut UNFPA funding despite the fact that a team appointed by the White House to investigate the allegations found no evidence to support them and recommended that the United States continue to fund UNFPA. The president’s decision also flew in the face of a bi-partisan agreement to raise the U.S. funding level for UNFPA to $34 million just weeks before. The $34 million from the United States would have allowed the agency to prevent 2 million unwanted pregnancies and more than 77,000 infant and child deaths, according to UNFPA estimates ². Many Members of Congress from both parties have protested the president’s decision and are currently working on an agreement to fully fund UNFPA.

Funding levels for USAID Family Planning, 1995-2003

FY 1995 $541.6 million
FY 1996 $356 million
FY 1997 $385 million
FY 1998 $385 million
FY 1999 $385 million
FY 2000 $372.5 million
FY 2001 $425 million
FY 2002 $446.5 million
FY 2003 $446.5 million
President Bush’s request for FY 2004 $425 million

Conclusion

Cuts and restrictions on funding will continue to cause a significant increase in unplanned pregnancies, abortions, maternal and infant deaths, and transmissions of HIV and other sexually transmissible infections. The United States’ inadequate provision of foreign aid for family planning, and the existing restrictions on such aid, undermine the leadership role of the U.S.

We urge Congress to revitalize U.S. leadership in international reproductive rights through an increase in funding – without undemocratic restrictions – for family planning and reproductive health assistance.

1 Foreign Assistance Act, U.S. Code, 22, secs. 2304(a)(1) (1994).
2 United Nations Population Fund Press Release, July 22, 2002. See www.unfpa.org/news/news.cfm