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The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies « » The Henry J. Kaiser Family Foundation

The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies

This fact sheet summarizes the major statutory requirements and policies pertaining to U.S. global family planning/reproductive health (FP/RH) efforts over time and identifies those currently in effect. These laws and policies collectively serve to direct how U.S. funds are spent, to where and which organizations funds are provided, and generally shape the implementation and define the scope of U.S. global FP/RH activities. It includes U.S. laws and annual requirements enacted by Congress through appropriations bills (statutory provisions) as well as executive branch policies and guidance specific to FP/RH (policy provisions). Each category lists provisions in chronological order.

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TABLE 1: STATUTORY REQUIREMENTS AND POLICIES FOR U.S. GLOBAL FP/RH EFFORTS (as of FY 2014)1
Provision (Year First Instituted) Issue(s) Applies to Status
STATUTORY 
Helms Amendment (1973)
Prohibits the use of foreign assistance to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion. Note: meaning of “motivate” clarified by Leahy Amendment (1994); see below.
Abortion All foreign assistance authorized under the Foreign Assistance Act of 1961(FAA); all funds under State-Foreign Operations Appropriations (State-Foreign Ops.) Yes, in effect.
Permanent law, amendment to the FAA.
Also included in annual State-Foreign Ops.
Involuntary Sterilization Amendment (1978)
Prohibits the use of funds to pay for involuntary sterilizations as a method of family planning or to coerce or provide a financial incentive to anyone to undergo sterilization.
Voluntarism/
Informed Choice & Consent; Incentives; Invol. Sterilization
All foreign assistance authorized by the FAA of 1961; all foreign assistance funds under State-Foreign Ops. Yes, in effect.
Permanent law, amendment to the FAA.
Also included in annual State-Foreign Ops.
Peace Corps Provision (1978)
Prohibits Peace Corps funding from paying for an abortion for a Peace Corps member or personnel.2
Abortion All Peace Corps funding Yes, in effect.
Included under the “Peace Corps” heading of the State-Foreign Ops.
Biden Amendment (1981)
States that funds may not be used for biomedical research related to methods of or the performance of abortion or involuntary sterilization as a means of family planning.
Abortion; Invol. Sterilization All foreign assistance authorized by the FAA of 1961; all foreign assistance funds under State-Foreign Ops. Yes, in effect.
Permanent law, amendment to the FAA.
Also included in annual State-Foreign Ops.
Siljander Amendment (1981)
Prohibits the use of funds to lobby for or against abortion. When initially introduced, the amendment prohibited only lobbying for abortion, but in subsequent years Congress modified the language to include lobbying against abortion as well.
Abortion All funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops.
DeConcini Amendment (1985)
Requires that U.S. funds be provided to organizations that offer, either directly or through referral to, information about access to a broad range of family planning methods and services. See Livingston-Obey Amendment (1986) below.
Voluntarism/
Informed Choice
All FP funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops.
Kemp-Kasten Amendment (1985)
Prohibits funding any organization or program, as determined by the President, that supports or participates in the management of a program of coercive abortion or involuntary sterilization.
UNFPA Funding; Abortion; Voluntarism/
Informed Choice & Consent; Invol. Sterilization
All funds under State-Foreign Ops. as well as unobligated balances from prior appropriations acts Yes, in effect, but most recently, the President determined UNFPA was not in violation of Kemp-Kasten.
Included in annual State-Foreign Ops.3
Involuntary Sterilization and Abortion Provision (1985)
Specifies that U.S. foreign assistance funding could be withheld from a country or organization if the president certifies that the use of such funds would violate key provisions of the FAA of 1961 related to abortion or involuntary sterilization (namely the Helms, Biden, and Involuntary Sterilization Amendments).
Voluntarism/
Informed Choice & Consent; Incentives; Abortion; Invol. Sterilization
All foreign assistance funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops.
Livingston-Obey Amendment (1986)
Prohibits discrimination by the U.S. government against organizations that offer only “natural family planning” for religious or conscientious reasons when the U.S. government is awarding related grants. All such applicants must comply with the requirements of the DeConcini Amendment (1985).
Voluntarism/
Informed Choice
All FP funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops.
Leahy Amendment (1994)
Clarifies Helms Amendment (1973) language that uses the term “motivate” by stating that “motivate” shall not be construed to prohibit, where legal, the provision of information  or counseling about all pregnancy options.
Abortion; Voluntarism/
Informed Choice
All authorizing and appropriating legislation related to the State Dept., foreign operations, and related programs Yes, in effect.
Included in annual State-Foreign Ops.
Timing of Release of UNFPA Contribution Funds (1994)
Not more than half of funding designated for the U.S. contribution to UNFPA is to be released before a particular date (varies by fiscal year).
UNFPA Funding Funds made available to UNFPA No, not in effect.
Sometimes included in annual State-Foreign Ops.
Conditions on Availability of UNFPA Funds (UNFPA Segregated U.S. Contribution Account; UNFPA Does Not Fund Abortions; Prohibition on the Use of U.S. Funds in China by UNFPA) (1994)
States that funds may not be made available to UNFPA unless:

  • UNFPA keeps the U.S. contribution to the agency in a separate account, not to be commingled with other funds, and
  • UNFPA does not fund abortions (note: language used beginning in FY 2000).

It also prohibits UNFPA from using any funds from the U.S. contribution in their programming in China.

UNFPA Funding; Abortion Funds made available to UNFPA Yes, in effect.
Included in annual State-Foreign Ops.
UNFPA Dollar-for-Dollar Withholding of Amount UNFPA Plans to Spend in China During Fiscal Year (1994)
Reduces the U.S. contribution to UNFPA by one dollar for every dollar that UNFPA spends on its programming in China.
UNFPA Funding Funds made available to UNFPA Yes, in effect.
Typically included in annual State-Foreign Ops.
Tiahrt Amendment (1998)
Prohibits the use of targets/quotas and financial incentives4 in family planning projects and requires projects to provide comprehensible information on family planning methods. Protects people who choose not to use family planning from being denied rights or benefits and requires experimental family planning methods be provided only in the context of a scientific study. Intended to “promote voluntarism and prevent coercion in family planning programs,” it specifically prohibits three types of targets: total number of births, number of family planning acceptors, and acceptors of a particular method of family planning.5
Voluntarism/
Informed Choice & Consent; Incentives and Disincentives
All FP funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops.
Reallocation of Funds Not Made Available to UNFPA (2004)
Provides for funds not made available to UNFPA to be reallocated to USAID’s family planning, reproductive health, and maternal health activities/services (and, in some years, assistance to vulnerable children and victims of trafficking in persons).6
UNFPA Funding Funds appropriated for UNFPA Yes, in effect.
Typically included in annual State-Foreign Ops.
Medically Accurate Information on Condoms (2005)
Ensures that information provided by U.S.-supported programs about the use of condoms is medically accurate information and includes the public health benefits and failure rates of such use.
Condoms All funds under State-Foreign Ops. Yes, in effect.
Typically included in annual State-Foreign Ops.
POLICY
USAID Policy Paper on Population Assistance (1982)
Outlines the longstanding USAID guidelines surrounding its fundamental programmatic principles of voluntarism and informed choice and consent.7
Voluntarism/
Informed Choice & Consent
All FP/RH assistance provided by USAID Yes, in effect.
Policy Determination 3 (PD-3) and Addendum: USAID Policy Guidelines on Voluntary Sterilization (1982)
Describes guidelines for informed consent and voluntarism specifically for voluntary sterilization services, including provisions to ensure ready access to other contraceptive methods and prohibiting incentive payments that might induce a person to select voluntary sterilization over another method.
Voluntarism/
Informed Choice & Consent; Voluntary Sterilization
All FP/RH assistance provided by USAID Yes, in effect.
Mexico City Policy (“Global Gag Rule”, 1984)8
As a condition for receiving U.S. family planning assistance (though once extended more broadly—see “Applies to”), requires foreign NGOs to certify that they would not perform or promote abortion as a method of family planning using funds from any source.
Abortion 1984- 2003: when in effect, was applied to FP assistance at USAID only. In 2003, expanded to include all FP assistance at USAID and the State Dept., exempting multilateral organizations and HIV/AIDS funding under PEPFAR.9 In 2009, rescinded again. No, not in effect.
Not currently in force through Executive action or legislation.10
USAID Post-Abortion Care Policy (2001)
Clarifies that post-abortion care – the treatment of injuries or illnesses caused by legal or illegal abortion – is permitted under the Helms Amendment and that any restrictions under the Mexico City Policy, when in force, do not limit organizations from treating injuries or illnesses caused by legal or illegal abortions (i.e., providing post-abortion care). Notes USAID does not finance manual vacuum aspiration equipment purchase/distribution for any purpose.
Post-Abortion Care All FP/RH assistance provided by USAID Yes, in effect.
Guidance on the Definition and Use of the Global Health Programs Account: Section on Allowable Uses of Funds for Family Planning/Reproductive Health (2013)11
Outlines allowable uses of funds for FP/RH by providing a description of activities allowed and examples of activities not allowed, addressing not only FP/RH activities but also FP/RH system strengthening activities and family planning activities’ integration with other global health and multisectoral activities.
FP/RH Activities; FP/RH System Strengthening Activities; Integrated FP Activities All FP/RH assistance provided by USAID Yes, in effect.
Updated periodically.
PEPFAR FY 2014 Country Operational Plan Guidance: Section 4.2 Family Planning (2013)
Provides guidance to the field about how PEPFAR programs may support or be linked with U.S. government FP/RH programs to facilitate comprehensive programming that increases access to HIV and FP/RH services. States that in efforts to provide comprehensive care for HIV and AIDS, PEPFAR funds should be targeted to the HIV/AIDS portion of integrated or linked FP/HIV activities.
HIV/AIDS Program Linkages with FP/RH Activities “Wraparound” PEPFAR activities related to FP/RH Yes, in effect.
Updated annually.
NOTES: PEPFAR= U.S. President’s Emergency Plan for AIDS Relief; UNFPA= United Nations Population Fund; USAID= U.S. Agency for International Development.

 

Endnotes
  1. Congressional Research Service (CRS), International Population Assistance and Family Planning Programs: Issues for Congress, January 2010; CRS, Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Legislation and Policy, January 2014; USAID Global Health eLearning Center, “FP Legislative & Policy Requirements (Updated),” online course, February 2009, authored by Debbie Gueye, Management Systems International (MSI); CRS, The U.N. Population Fund: Background and the U.S. Funding Debate, February 1, 2010; congressional appropriations acts.

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  2. As noted in CRS, Abortion and Family Planning-Related Provisions in U.S. Foreign Assistance Legislation and Policy, January 2014: “ No restrictions exist on funding for the medical evacuation of Peace Corps volunteers who decide to have an abortion. Under existing policy, the Peace Corps covers the cost of evacuation to a location where ‘medically adequate facilities’ for obtaining an abortion are available and where abortions are legally permissible.”

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  3. In some years, includes a rider that requires the Kemp-Kasten determination to be accompanied by evidence and criteria used to make the determination.

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  4. USAID defines a target/quota as “a predetermined figure that a service provider or referral agent is assigned or required to affect or achieve” for the purposes of the Tiahrt Amendment. It states that “the key to interpreting ‘incentives’ is to see whether they are provided in exchange for accepting a method (in the case of a client) or linked to achievement of a predetermined target or quota (in the case of program personnel).” USAID Global Health eLearning Center, “FP Legislative & Policy Requirements (Updated),” online course, February 2009, authored by Debbie Gueye, MSI.

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  5. USAID Global Health eLearning Center, “FP Legislative & Policy Requirements (Updated),” online course, February 2009, authored by Debbie Gueye, MSI.

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  6. Although such reallocation began in practice in FY 2002, it was first authorized by Congress in legislation beginning in FY 2004 with reference to FY 2002 and FY 2003 funds.

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  7. Informed Choice: Effective access to information on family planning choices and to the counseling, services, and supplies needed to help individuals choose to obtain or decline services; to seek, obtain, and follow up on a referral; or simply to consider the matter further. Voluntarism: Decision to use a specific method of family planning or to use any method of family planning is based upon the exercise of free choice and is not obtained by any special inducements or any element of force, fraud, deceit, duress or other forms of coercion or misrepresentation. USAID Global Health eLearning Center, “FP Legislative & Policy Requirements (Updated),” online course, February 2009, authored by Debbie Gueye, MSI.

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  8. This policy was first instituted via presidential memorandum in 1984 by President Reagan. In 1993, it was rescinded by President Clinton, although it was briefly applied legislatively in 1999 (see “Status” column). In 2001, it was reinstated by President Bush, who expanded its applicability in 2003 to include family planning funds at the State Department (see “Applies to” column) with some exemptions. In 2009, it was rescinded by President Obama.

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  9. George W. Bush Administration, “Subject: Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, August 29, 2003, Bush Administration White House Archives, accessed at
    http://georgewbush-whitehouse.archives.gov/news/releases/2003/08/20030829-3.html, and PAI, Global Gag Rule Timeline, July 12, 2011.

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  10. Note that, with one exception, has been applied via Executive action. The exception was in FY 2000, when President Clinton agreed to a one-year legislative codification with a partial waiver of restrictions as part of a broader arrangement to pay the U.S. debt to the United Nations. See P.L. 106-113, Sec. 599D, and PAI, Global Gag Rule Timeline, July 12, 2011.

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  11. USAID, Guidance on the Definition and Use of the Global Health Programs Account: A Mandatory Reference for ADS Chapter 200, July 2013.

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