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There has yet to be a decision in United States Congress on what funds for global women’s health, if any, will survive in the current 2018 national budget, a decision that is nearly six months overdue. But Donald Trump and his vice president, Mike Pence, a hard-line social conservative who is playing a larger role in policymaking in the stressed-out White House, have proposed that the budget for 2019 will cut international family planning and reproductive health from its 2017 level by 50 percent.
The requested cuts and others that fall under the State Department’s overall budget are just opening bids in what could be a long, contentious process in Congress this year — an important midterm election year in the US. The national budget year ends on Sept. 30. But in the recent past, as the drawn-out work on the 2018 budget demonstrated, the government has been forced to operate on a series of temporary measures known as continuing resolutions.
One thing is certain: there will be no US funds for the United Nations Population Fund, or UNFPA, because of a decision made in March 2017 by Trump. After that pre-emptive action, a bill was introduced in Congress that would have brought aid to the Population Fund under legislative control and rescinded anti-abortion restrictions on aid. A year later, the bill continues to languish.
Advocates for more US aid to international family planning and reproductive health services are campaigning to renew Congressional action this year. Even Republicans in the House of Representatives have endorsed a call for $461 million in the still-unfinished 2018 budget.
PAI, a leading research and analysis organization in Washington, D.C., provided details on what lies ahead, in response to the the 2019 Trump budget proposals, which were released on Feb. 12.
“In both the endgame negotiations to negotiate the final FY [fiscal year] 2018 bill and during the future consideration of the dramatic cut proposed by the Trump-Pence administration for FY 2019, congressional champions will undoubtedly strive to get the whole loaf and will not settle for a few slices and some crumbs,” PAI said in its report, “Half a Loaf: Trump’s Fiscal Year Budget Request Proposes Slashing International Family Planning Funding in Half.”
The report includes a chart, below, comparing recent years. (Note that the figures for 2017, in an Obama budget, totaled all relevant aid, a sum double what the Trump administration is requesting for 2019.)
On Feb. 12, when the Trump 2019 budget proposals were released, the State Department’s portion totaled $39.3 billion. As usual under Trump, it was heavy on national security, looking for a US economic advantage in global relations and reducing illegal immigration.
Under the subsection on international organizations, the $2.3 billion budget request for the State Department (which includes the US Agency for International Development, or USAID) reiterates what the Trump team has been saying for more than a year, that membership in any global organization must be advantageous to the US and that all such bodies need to do more with less money.
Here is the rationale, in italics, in summary:
Promoting American Leadership Through Balanced Engagement:
International Organizations: Funding $2.3 billion for preserving strategic participation in multilateral fora to achieve outcomes favorable to the U.S. and its allies while reinforcing the expectation that we will continue to work with the international organizations including the UN to reduce costs, improve effectiveness, and more fairly share the funding burden.
The budget request claims leadership in global health programs, proposing $6.7 billion for mostly US-based initiatives on AIDS relief, malaria and family planning and reproductive health assistance under a policy that is euphemistically labeled Protecting Life in Global Health Assistance, or what could be read as: anti-abortion restrictions imposed internationally.
Paradoxically, the budget request also pledges to support women’s empowerment.
Five days before the release of the Trump budget requests, the State Department publicized the findings of a six-month review of the effects of its anti-abortion, antichoice policy, which was thinly disguised by the renaming of the so-called Mexico City policy, known around the world as the global gag rule.
The restrictions under that rule prevent US money from going to foreign, mostly independent, nongovernmental organizations that use their own money to provide abortion, make referrals or counsel women and campaign for safe abortion laws.
The State Department review admitted “with less than six months of policy implementation, it is too early to assess the full range of benefits and challenges of the PLGHA [‘protecting life’] policy for global health assistance . . . and not all existing agreements have received new funding, so the picture on progress and challenges is still developing.”
The reviewers from USAID visited only four field missions as well as numerous offices and focus groups in Washington to “reflect both internal and external feedback.”
However, the State Department also asked for comments from those organizations and institutions dealing with issues of family planning and women’s health globally.
“Thirty-one stakeholder groups, including three foreign governments as well as non-governmental entities, provided written comments,” the review said, adding that “several submitted comments in support of the policy.”
Predictably, a positive response came from the United States Conference of Catholic Bishops, which has been a major force in the anti-abortion lobby in Washington. The review noted that the Catholic bishops “lauded the new policy as one of the most significant policy initiatives on abortion ever taken by the United States in an area of foreign assistance.”
Other responses were mixed, “expressing the need for guidance on aspects of the policy, concerns about the continuity of healthcare services, and a potential chilling effect of the policy on global health services in situations in which the application of the policy is unclear,” the review also noted.
Human Rights Watch looked closely at the review and concluded — as have numerous other NGOs — that six months is hardly enough time to collect substantive detail about the effects on family planning and the health of women and girls worldwide, which the department acknowledges.
Several major global organizations dealing with women’s health, including the International Planned Parenthood Federation and Marie Stopes International, announced in 2017 that they would sacrifice US funding rather than change their policies or certify to Washington that they were not breaking the global gag rule.
“Given the size and influence of US health funds in many countries, the rule affects not only abortion, but the ability of many of the organizations to provide health services such as HIV and cancer screening, family planning, and maternal and child health care,” Human Rights Watch said in its report.
In measuring the damage to the health of girls and women across the world, the Guttmacher Institute published a memo in July 2017 on the threats posed by Trump policies. It was titled “Just the Numbers: The Impact of US International Family Planning Assistance.”
“The United States — through its Agency for International Development — has long been a global leader in enabling women’s access to contraceptive services in the world’s poorest countries,” the memo said. “Empowering women with control over their own fertility yields benefits for them, their children and their families. It means fewer unintended — and often high-risk — pregnancies and fewer abortions, which in developing countries are often performed under unsafe conditions.”
“In FY 2017, a total of $607.5 million was appropriated for US assistance for family planning and reproductive health programs,” the memo continued. “This level of funding makes it possible to achieve the following: 25 million women and couples receive contraceptive services and supplies; 7.4 million unintended pregnancies, including 3.3 million unplanned births, are averted; 3.1 million induced abortions are averted (the majority of which are provided in unsafe conditions); and 15,000 maternal deaths are averted.”
The $607.5 million included an American contribution to the UN Population Fund.
The analysis by PAI noted that these figures, adjusted to the $305.5 million Trump 2019 budget proposal — a 50 percent decline in US funds alone — “would be likely to result in the following: 12.65 million fewer women and couples would receive contraceptive services and supplies; 3.76 million unplanned pregnancies (including 1.68 million births) would occur; 1.59 million more abortions would take place, and 7,637 maternal deaths would occur.”
As PAI noted, “Clearly the Trump-Pence administration’s decision to cut access to contraceptive services and supplies for nearly 13 million women and couples is hypocritical and counterintuitive to their purported goal of reducing the incidence of abortion.”