(February 2001) For more than 30 years, the United States has supported family planning programs overseas. According to the U.S. Agency for International Development, these programs have provided contraceptive information and related health services to more than 100 million couples in less developed countries and have contributed to a more than 40 percent decline in the average family size in 28 countries since 1965. Despite their success, the programs have been the subject of considerable debate over the years, most notably because abortion opponents believe that family planning programs promote abortion. Since the 1970s, U.S. law has explicitly prohibited the use of foreign assistance funds to pay for abortion services.

International family planning activities are in the news again because of recent laws and policies that place restrictions on the groups that receive funding for these activities. Congress and the Bush administration have established separate but similar provisions that prevent nongovernmental organizations overseas from receiving U.S. government funds if they, even when using their own funds, provide abortion services or advocate for changes in abortion laws.

The Global ‘Gag Rule’

In the 2000 budget, the U.S. Congress enacted the so-called “global gag-rule” amendment, which denies U.S. funding to private organizations overseas if they use other, non-U.S. government funds to provide abortion services (except in cases of rape, incest, or where an abortion is needed to save a woman’s life) or if they lobby for changes in abortion laws in their country. In order to receive U.S. family planning assistance, non-U.S. groups must agree in writing to these restrictions. President Clinton had waived the restrictions on as much as $15 million (4 percent) of the $385 million appropriated for the entire program. When the waiver was exercised, equivalent funds were transferred to USAID’s child survival program.

Upon taking office, President George W. Bush reinstated the “Mexico City Policy” restrictions, so-called because the U.S. government first announced them at the 1984 United Nations International Conference on Population held in Mexico. The policy states that foreign, nongovernmental organizations receiving U.S. government funds may not use their own funds to: “(i) obtain or distribute equipment for inducing abortions as a method of family planning; (ii) pay special fees or incentives to women for abortions; procure and pay for abortion services for women; (iii) offer information, education, training, or communication programs that promote abortion as a method of family planning; (iv) support biomedical research regarding abortions or involuntary sterilization as a means of family planning; (v) or lobby for abortion.” (These restrictions do not limit organizations from providing post-abortion care, which includes treating injuries or illnesses caused by legal or illegal abortions.)

Representatives of groups affected by the ruling argue that the restrictions ultimately undermine the objective of preventing unwanted pregnancies and improving the health of women and children. When faced with an unwanted pregnancy, some women resort to abortions, whether or not they are legal or safe. According to the World Health Organization, unsafe, illegal abortions result in an estimated 75,000 deaths — and 30 times that number in debilitating maternal injuries — every year.

Maurice Middleberg, director of CARE’s health and population programs, says the net effect of decisions like the global gag rule has been to reduce both the magnitude of funding and the number of family planning providers overseas. In a Jan. 26, 2001, interview with The Washington Post, he noted: “This has to have only bad consequences for the health of the women and children that we serve, and for the abortion rate.”

Supporters of the gag rule, however, applaud the re-imposition of the policy. Douglas Johnson, legislative director for the National Right to Life Committee, contends that “the ruling ends an eight-year crusade by the Clinton-Gore Administration to promote the killing of unborn children in developing countries.”

The U.S. Is the Largest Donor of Family Planning Assistance

Since the 1950s, many countries in the less developed world adopted family planning policies and programs that aimed to slow population growth and improve the health of women and families. These programs have encouraged couples to have smaller families and have provided access to contraceptive information and services. In 1952, India was the first country to initiate a national population policy and family planning program. The International Planned Parenthood Federation (IPPF), the largest private-sector organization dedicated to family planning, was founded the same year.

In the 1960s, the United States became (and remains) the largest single bilateral donor of international family planning assistance. Other industrialized countries such as Sweden also launched large-scale foreign aid programs to support family planning efforts. In 1969, the United Nations created the United Nations Population Fund (UNFPA) to promote family planning programs.

By the early 1980s, family planning programs had become increasingly common around the world. Many governments were convinced of the need to invest in family planning because of a growing body of research showing high rates of population growth, high rates of infant and maternal death, and a widespread desire by women to limit childbearing.

Shifts in Policy Intensify the Debates

During the 1980s, criticism of family planning programs began to surface in the United States. Anti-abortion activists, concerned that family planning programs would directly or indirectly promote abortions, opposed U.S. support for international family planning programs. At the 1984 World Population Conference in Mexico City, the Reagan administration announced the Mexico City Policy. The announcement surprised conference organizers and other governments who strongly supported family planning efforts. The policy remained in place until President Clinton ended it in 1993. In 1994, at the UN International Conference on Population and Development, government negotiations focused on incorporating the concepts of reproductive health and rights as the underpinnings of population and family planning programs. Among the nearly 180 countries attending the conference, the Vatican and a small number of Catholic and Muslim countries objected to how reproductive health and reproductive rights were defined. A major sticking point was whether abortion could be interpreted as a component of reproductive health to which women would have a universal right.

The international consensus on abortion, reached at the 1994 Cairo conference, was that “in no case should abortion be promoted as a method of family planning.” The consensus document recognized the different legal statuses of abortion in different countries. Where abortions are legal, governments agreed that health systems should ensure they are safe. In all countries, even where abortion is illegal, governments agreed that women should receive care for the complications resulting from unsafe abortions. For language on the Cairo consensus, see chapters VII and VIII of the ICPD Programme of Action: Chapter VII, Chapter VIII.

The Clinton administration supported that consensus, as well as the broader conference objectives of promoting individual health, rights, and informed choice, and also increased U.S. support for family planning assistance. In 1995, however, after the Republicans won a new majority in Congress, the balance of power shifted toward those who favored restrictions on international family planning activities. In their 1996 budget, Congress cut foreign aid programs and cut family planning assistance by 35 percent.

The debate regarding the global gag rule continues. On Feb. 15, Sens. Barbara Boxer, D-Calif.; Olympia Snowe, R-Maine; and Lincoln Chafee, R-R.I., introduced a bipartisan measure to nullify the Mexico City ruling. The bill, known as the “Global Democracy Promotion Act of 2001,” would prevent the U.S. from imposing restrictions on organizations eligible for U.S. aid solely on the basis of the health or medical services that they provide. Rep. Nita Lowey, D-N.Y., introduced an identical bill in the U.S. House of Representatives on Feb. 27. If adopted, the measures would overturn Bush’s executive order.

The European Commission has also announced plans to compensate agencies that will be hurt by the legislation. Eveline Herfkens, the Dutch minister for development cooperation, said she was “absolutely appalled” by the U.S. action.

Portions of this article were adapted from a March 2001 PRB Population Bulletin by Lori Ashford that discusses how population policies have evolved worldwide since the early 1990s.

Liz Creel is a population specialist and Lori Ashford is a senior policy analyst at the Population Reference Bureau.

For More Information

See “Restoration of the Mexico City Policy Concerning Family Planning” on the USAID website: www.usaid.gov/bush_pro_new.html.