International Population Assistance and Family Planning Programs: Issues for Congress

Prepared for Members and Committees of Congress

Since 1965, the U.S. government has supported international population planning based on
principles of volunteerism and informed choice that gives participants access to information on
all methods of birth control. This policy has generated contentious debate for over two decades,
resulting in frequent clarification and modification of U.S. international family planning
programs. Given the divisive nature of this debate, U.S. funding of these programs will likely th
remain a point of contention during the 111 Congress.
In 1984, controversy arose over U.S. population aid policy when the Reagan Administration
introduced restrictions that became known as the “Mexico City policy.” The Mexico City policy
denies U.S. funds to foreign non-governmental organizations (NGOs) that perform or promote
abortion as a method of family planning—even if the activities are undertaken with non-U.S.
funds. Presidents Reagan and George H.W. Bush also banned grants to the U.N. Population Fund
(UNFPA) due to evidence of coercive family planning practices in China, citing violations of the
“Kemp-Kasten” amendment, which bans U.S. assistance to organizations that support or
participate in the management of coercive family planning programs.
President Clinton resumed UNFPA funding and reversed the Mexico City policy in 1993.
President George W. Bush, however, re-applied the Mexico City restrictions. Following a State
Department investigation of family planning programs in China, the Bush Administration also
suspended U.S. contributions to UNFPA in 2002. The suspension of U.S. contributions to UNFPA
has continued through FY2008.
On December 26, 2007, the President signed into law H.R. 2764, the Consolidated Appropriations
Act, 2008 (P.L. 110-161), which states that not less than $461 million shall be made available for
family planning and reproductive health. The Act also designates $40 million for UNFPA if it is
determined eligible under the Kemp-Kasten amendment. On June 26, 2008, the Administration
announced that UNFPA was ineligible for FY2008 funding under Kemp-Kasten.
The Administration’s FY2009 request for bilateral family planning and reproductive health
activities totals $327.53 million. The Administration also requested $25 million for UNFPA
funding if the organization is deemed eligible under the Kemp-Kasten amendment. The UNFPA
funds would be appropriated under the Child Survival and Health Programs account.
This report will be updated as events warrant.

U.S. Population Assistance Issues: Setting the Context.................................................................1
The Population Statistics Debate...............................................................................................1
Evolution of U.S. Policy (1974-1994)......................................................................................2
Trends in Population Research..................................................................................................2
Financing Population Assistance Programs..............................................................................3
Policy Issues in the U.S. Family Planning Debate..........................................................................3
Abortion and Coercion..............................................................................................................4
The Mexico City Policy............................................................................................................5
Mexico City Policy Removed by the Clinton Administration............................................5
The George W. Bush Administration Restores the Mexico City Policy.............................5
Past Efforts to Legislate the Mexico City Policy................................................................7
Restrictions on U.N. Population Fund (UNFPA) Funding: The “Kemp-Kasten
A mendment” .......................................................................................................................... 7
The George W. Bush Administration and UNFPA..............................................................8
Family Planning Conditions in China...............................................................................10
Other Related State Department Determinations..............................................................12
U.S. Funding Levels......................................................................................................................13
Overvi ew ....................................................................................................................... .......... 13
FY2008 and FY2009 Appropriations and Administration Requests.......................................14
FY2009 Administration Request.......................................................................................14
FY2008 Foreign Operations Appropriations and Administration Request.......................14
Table 1. U.S. Population Assistance, FY1994-2008......................................................................13
Author Contact Information..........................................................................................................15

Population assistance became a global issue in the late 1950s and early 1960s after several private
foundations, among them the International Planned Parenthood Federation (IPPF), began
providing money to developing countries to control high population growth rates. In 1966, when
global population growth rates were reaching an historic annual high of 2.1%, the United Nations
began to include population technical assistance in its international development aid programs.
Population assistance grew rapidly over the next half-dozen years, with the United States, other
developed countries, and international organizations such as the World Bank, all beginning to
contribute funds. With passage of the Foreign Assistance Act of 1961, Congress first authorized
research on international family planning and population issues and, in 1965, the U.S. Agency for
International Development (USAID) launched a series of population and reproductive health
programs. In 1968, Congress specifically funded family planning aid activities and USAID began
to purchase contraceptives for distribution through its programs in the developing world.
The first International Population Conference was held in 1974, followed by the second in 1
Mexico City in 1984, and the third in Cairo in 1994. The attention and funding given to
international family planning programs are credited with helping to decrease population growth in
developing countries from about a 1.7% per year average between 1980 and 2002, to a projected
annual average of 1.2% between 2002 and 2015. Fertility rates have fallen in developing nations
from 4.1 children per woman in 1980 to 3.0 in 2005 (if China is excluded from this calculation,
however, the decline in fertility rates is less dramatic at 3.5 children in 2005). Nevertheless, while
global population growth has slowed, the world’s population reached 6 billion in 1999, 6.5 billion
in 2005, and is expected to rise to 9.3 billion by 2050, with most of the growth occurring in
developing nations. In 1960, 70% of the world’s population lived in developing countries, and in

2005 the level had grown to 81%. These countries now account for 99% of world-wide 2

population growth.
Population statistics alone are only part of a larger story. For the past thirty years and more,
countries have heatedly debated what the statistics mean. Proponents of active family planning
programs have held that high fertility rates and rapid population growth are serious impediments
to a country’s development. According to this school of thought, people are consumers, and no
poor country can increase its standard of living and raise its per capita income while wrestling
with the problems of trying to feed and care for a rapidly expanding population. Thus, poor and
developing countries should invest in family planning programs as part of their economic
development process.

1 The conferences were coordinated by the United Nations. More information is available at
2 Population Reference Bureau (PRB), Frequently Asked Questions About the PRB World Population Data Sheet,
(2005). Also see PRB, 2007 World Population Data Sheet, available at

On the opposing side, critics of active population planning programs hold that there is little or no
correlation between rapid population growth and a country’s economic development. Some argue
that increased numbers of people provide added productive capacity; therefore, they say, high
population growth rates actually can contribute to a country’s ability to increase its standard of
living. Proponents of this view argue that, at the very least, current economies of scale and global
trading patterns have too many empirical variables and uncertainties to establish a direct
correlation between population growth and economic development.
As the population debate evolved, many countries, including the United States, changed their
views. At the 1974 international population conference, the United States and other donor
countries asserted that high fertility rates were an impediment to economic development—a point
that was then rejected by developing countries. In keeping with this view, in 1977 the Carter
Administration proposed legislative language, later enacted in Sec. 104(d) of the Foreign
Assistance Act of 1961, that sought to link population growth and traditional development
assistance programs on the grounds that a high population growth rate could have a negative
effect on other development objectives.
A decade later, at the second International Conference on Population in Mexico City in 1984,
some participants reversed their positions. Many developing countries had become convinced of
the urgent need to manage population growth, while U.S. officials asserted that population growth
was not necessarily a negative force in economic development, but was instead a “neutral
phenomenon.” At Mexico City, Reagan Administration officials emphasized the need for
developing countries to adopt sound economic policies that stressed open markets and an active
private sector.
Nearly a decade later, the Clinton Administration changed the U.S. position on family planning
programs by lifting restrictive U.S. provisions announced at the Mexico City Conference. At the
1994 International Conference on Population and Development in Cairo, U.S. officials
emphasized support for family planning and reproductive health services, improving the status of
women, and providing safe access to abortion.
Since the 1994 Cairo conference, groups supporting strategies to limit rapid population growth
have supported a broader agenda of initiatives that include the promotion of gender equality,
increasing adolescent education on sexuality and reproductive health, and ensuring the universal
right of health care, including reproductive health. Although endorsed at the July 1999 U.N.
meeting of 179 nations to assess progress of the Cairo population conference recommendations,
the issues of child education and government responsibilities for ensuring access to safe abortions
in countries where the practice is legal were particularly controversial. Some governments
opposed the broadening of the Cairo mandate and some, including Argentina, Nicaragua, and the
Vatican, filed reservations to the recommendations reached by consensus.

More recently, new research suggests that there has been a significant decline in birthrates in 3
several of the largest developing nations, including India, Brazil, and Egypt. Some demographers
conclude that global population projections for this century may need to be reduced by as much
as one billion people. A U.N. report dated December 9, 2003—”World Population 2300”—
projects as a “medium scenario” that world population will peak in 2075 at 9.2 billion and then,
as fertility rates in all countries reach below replacement levels, decline over the next 100 years to
8.3 billion. The report projects that if fertility rates return to replacement levels, world population
would begin to rise, reaching 9 billion by 2300; otherwise, the number of people would remain at
around 8.3 billion.
Although there are differences of opinion as to why fertility rates are falling—and whether the
trend is universal throughout the developing world—a few demographers argue that the change
has less to do with government family planning policies and foreign aid, and more to do with
expanded women’s rights in these countries. Women are choosing to have fewer children, they
argue. Others also contend that with improved health conditions and lowered infant mortality
rates, parents are deciding to have fewer babies because they are more confident that their
children will survive.
Financing family planning and basic reproductive health care programs in developing countries
became a major issue at the 1994 Cairo population conference. Participating nations agreed that
foreign aid donors would provide one-third, or $5.7 billion, of the annual costs of such services
that were estimated to grow to about $17 billion in 2000. A July 1999 conference assessing
implementation of the 1994 Cairo strategy, however, found that industrialized countries had fallen
far short of the financing goal, providing only about $1.9 billion per year. It also noted that donor 4
allocations still fall far below the targets set at Cairo. A more recent analysis suggests a different
trend, noting that donor nations contributed $2.3 billion in 2002, the largest amount ever.
Similarly, UNFPA announced in 2008 that the number of donors to its program had increased
from 166 in 2004 to 182 in 2007. The amount promised from donors reached a record of $457.1 5
million in 2007.

Throughout the debate on family planning—at times the most contentious foreign aid issue
considered by Congress—the cornerstone of U.S. policy has remained a commitment to
international family planning programs based on principles of volunteerism and informed choice
that give participants access to information on all major methods of birth control. At present,
USAID maintains family planning projects in more than 50 developing countries that include
counseling and services, training of health workers, contraceptive supplies and distribution,
financial management, public education and marketing, and biomedical and contraceptive

3 See, for example, “Population Estimates Fall as Poor Women Assert Control,New York Times, March 10, 2002.
4 Population Action International, Progress and Promises: Trends in International Assistance for Reproductive Health
and Population, 2004.
5 UNFPA 2007 Annual Report, U.N. Population Fund, 2008, available at

research and development. USAID applies a broad reproductive health approach to its family
planning programs, increasingly integrating it with other interventions regarding maternal and 6
child health, the enhancement of the status of women, and HIV prevention.
In addition to differences of opinion over how population growth affects economic development
in developing countries, family planning assistance has become a source of substantial
controversy among U.S. policymakers on two other issues: (1) the use of federal funds to perform
or promote abortions abroad and how to deal with evidence of coercion in some foreign national
family planning programs, especially in China, and (2) setting appropriate and effective funding
levels for family planning assistance.
Arguably, the most bitter controversies in U.S. family planning policy have erupted over
abortion—in particular, the degree to which abortions and coercive programs occur in other
countries’ family planning programs, the extent to which U.S. funds should be granted to or
withheld from such countries and organizations that administer these programs, and the effect that
withholding U.S. funds might have on global population growth and family planning services in
developing nations. These issues essentially stem from the contentious domestic debate over U.S.
abortion policy that has continued since the Supreme Court’s 1973 Roe v. Wade decision holding
that the Constitution protects a woman’s decision whether to terminate her pregnancy. In every
Congress since 1973, abortion opponents have introduced constitutional amendments or
legislation that would prohibit abortions. As an alternative, abortion critics have also persuaded
Congress to attach numerous provisions to annual appropriation measures banning the use of
federal funds for performing abortions.
Much of this debate has focused on domestic spending bills, especially restrictions on abortions
under the Medicaid program in the Labor/Health and Human Services appropriation legislation.
Nevertheless, the controversy spilled over into U.S. foreign aid policy almost immediately when
Congress approved an amendment to the Foreign Assistance Act of 1961 in late 1973 (Section
104(f)). The act prohibits the use of foreign development assistance to (1) pay for the
performance of abortions or involuntary sterilizations, (2) to motivate or coerce any person to
practice abortions, or (3) to coerce or provide persons with any financial incentive to undergo
sterilizations. Since 1981, Congress has enacted nearly identical restrictions in annual Foreign
Operations appropriation bills.
For the past 25 years, both congressional actions and administration directives have restricted
U.S. population assistance in various ways, including those set out in the Foreign Assistance Act
of 1961, and more recent executive regulations and appropriation provisions prohibiting indirect
support for coercive family planning (specifically in China) and abortion activities related to the
work of international and foreign NGOs. Two issues in particular which were initiated in 1984—
the Mexico City policy involving funding for foreign non-governmental organizations, and
restrictions on funding for the U.N. Population Fund (UNFPA) because of its activities in
China—have remained controversial and continue as prominent features in the population
assistance debate.

6 For further information on USAID family planning and reproductive health programs, see

In 1984, the Reagan Administration announced that it would further restrict U.S. population aid
by terminating USAID support for any foreign organizations (but not national governments) that
were involved in voluntary abortion activities, even if such activities were undertaken with non-nd
U.S. funds. U.S. officials presented the revised policy at the 2 U.N. International Conference on
Population in Mexico City in 1984. Thereafter, it become known as the “Mexico City policy.”
During the George H.W. Bush Administration, efforts were made in Congress to overturn the
Mexico City policy and rely on existing congressional restrictions in the Foreign Assistance Act
of 1961 banning direct U.S. funding of abortions and coerced sterilizations. Provisions adopted
by the House and/or Senate that would have reversed the policy, however, were removed from
legislation under threat of a presidential veto.
Critics charge that the Mexico City policy is a violation of free speech and the rights of women to
choose. They contend that the policy undermines maternal health care services offered in
developing nations and may actually contribute to the rise in the number of abortions performed,
including some that are unsafe and illegal. They further emphasize that family planning
organizations may cut back on services because they are unsure of the full implications of the
restrictions and do not want to risk losing eligibility for USAID funding. Opponents also believe
that the conditions of the Mexico City policy undermine relations between the U.S. government
and foreign NGOs and multilateral groups, creating a situation in which the United States
challenges their right to determine how to spend their own money and imposes a so-called gag
order on their ability to promote changes to abortion laws and regulations in developing nations.
The latter, these critics note, would be unconstitutional if applied to American groups working in
the United States.
President Clinton, in a January 22, 1993 memo to USAID, lifted restrictions imposed by the
Reagan and Bush Administrations on grants to family planning NGOs—in effect ending the
Mexico City policy. The memo noted that the policy had extended beyond restrictions in the
Foreign Assistance Act and was not mandated by law. In his remarks, President Clinton explained
that this step would “reverse a policy that has seriously undermined much needed efforts to
promote safe and effective family planning programs abroad, and will allow us to once again 8
provide leadership in helping to stabilize world population.”
On January 22, 2001, President George W. Bush revoked the Clinton Administration
memorandum and restored in full the terms of the Mexico City restrictions. In making the
announcement, however, the White House Press Secretary stated that the “President is committed
to maintaining the $425 million funding level provided in the FY2001 appropriation because he

7 For a more detailed discussion of the original Mexico City policy, its implementation, and impact, see archived CRS
Report RL30830, International Family Planning: The "Mexico City" Policy, by Larry Nowels.
8 President Bill Clinton, “Remarks on Signing Memorandums on Medical Research and Reproductive Health and an
Exchange With Reporters,” January 22, 1993.

knows that one of the best ways to prevent abortion is by providing quality voluntary family 9
planning services.”
As was the case during the 1980s and early 1990s when the Mexico City policy was in place,
foreign NGOs and international organizations, as a condition for receipt of U.S. funds, would
need to certify that they would not perform or actively promote abortions as a method of family
planning in other countries. President Bush, in announcing the policy change, noted that
American taxpayer funds should not be used to pay for abortions or to advocate or actively
promote abortion. Supporters of the certification requirement argue that even though permanent
law bans USAID funds from being used to perform or promote abortions, money is fungible;
organizations receiving American-taxpayer funding can use USAID resources for legal activities
while diverting money raised from other sources to perform abortions or lobby to change abortion
laws and regulations. The certification process, they contend, stops the fungibility “loophole.”
On February 15, 2001, USAID released specific contract clauses necessary to implement the
President’s directive. The guidelines state that U.S. NGOs receiving USAID grants cannot furnish
assistance to foreign NGOs that (1) perform or actively promote abortion as a method of family
planning in USAID-recipient countries, or (2) furnish assistance to other foreign NGOs that
conduct such activities. When USAID provides assistance directly to a foreign NGO, the
organization must certify that it does not now or will not during the term of the grant perform or
actively promote abortion as a method of family planning in USAID-recipient countries or
provide financial support to other foreign NGOs that carry out such activities. The implementing
regulations contain several exceptions, including the following:
• Abortions may be performed if the life of the mother would be endangered if the
fetus were carried to term or following rape or incest; health care facilities may
treat injuries or illnesses caused by legal or illegal abortions (post-abortion care).
• “Passive” responses by family planning counselors to questions about abortion
from pregnant women who have already decided to have a legal abortion are not
considered an act of promoting abortion; referrals for abortion as a result of rape,
incest, or where the mother’s life would be endangered, or for post-abortion care
are permitted.
USAID is able to continue support foreign governments, either directly or through a grantee, even
in cases where the government includes abortion in its family planning program. Money provided
to such governments, however, must be placed in a segregated account and none of the funds may
be drawn to finance abortion activities.
The President issued a memorandum on August 29, 2003, for the Secretary of State, directing that
the Mexico City policy conditions be applied to State Department programs in the same way they
are applied to USAID activities. This directive mostly impacts State Department-managed
refugee programs, large portions of which are implemented by international organizations and
NGOs. The President’s memorandum, however, stated that the policy would not apply to
multilateral organizations that are associations of governments, presumably referring to the U.N.
High Commissioner for Refugees, among others. The President further stated that the Mexico

9 The White House. Office of the Secretary. Restoration of the Mexico City Policy, January 22, 2001.

City policy would not apply to foreign aid funds authorized under P.L. 108-25, the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.
Beginning in 1993, abortion opponents in Congress attempted to legislate modified terms of the
Mexico City policy. Under threat of a Presidential veto and resistance from the Senate, Mexico
City restrictions had not been enacted into law until the November 1999 passage of the
Consolidated Appropriations Act for FY2000 (P.L. 106-113). The White House accepted the
family planning conditions in exchange for congressional support of the payment of nearly $1
billion owed by the United States to the United Nations. The restrictions expired at the end of
Under terms of Section 599D of P.L. 106-113, the President could waive the certification
requirement for up to $15 million in grants to groups that would otherwise be ineligible. President
Clinton exercised the waiver and further instructed USAID to implement Section 599D in a way
that would minimize the impact on U.S. funded family planning programs. Nine organizations
refused to certify under the terms of P.L. 106-113, including two of the largest recipients of
USAID population aid grants—IPPF and the World Health Organization (WHO). These nine non-
certifying organizations received about $8.4 million in FY2000 grants, of which IPPF accounted
for $5 million and WHO roughly $2.5 million. These conditions, enacted in an appropriation act,
expired at the end of FY2000.

At the 1984 Mexico City Conference, the Reagan Administration instituted a new policy relating 11
to UNFPA. The Administration required that the organization provide “concrete assurances that
[it] is not engaged in, or does not provide funding for, abortion or coercive family planning
programs.” It was particularly concerned with UNFPA’s activities in China, where there is
evidence of coercive family planning practices.
Subsequently, Congress legislated a more restrictive UNFPA policy—aimed at coercive Chinese
family planning programs and UNFPA’s continuing operations in the country—by enacting the
“Kemp-Kasten amendment” in the FY1985 Supplemental Appropriations Act (P.L. 99-88). This
language prohibited the use of appropriated funds for any organization or program, as determined
by the President, found to be supporting or participating “in the management” of a program of
coercive abortion or involuntary sterilization. Following enactment of P.L. 99-88, USAID
announced that $10 million of $46 million that had been directed for UNFPA during FY1985
would be redirected to other programs, and later said that the United States would not contribute
to UNFPA at all in 1986. Most of the $25 million that was originally allocated for UNFPA was

10 For more detailed information regarding UNFPA, see CRS Report RL32703, The U.N. Population Fund:
Background and the U.S. Funding Debate, by Luisa Blanchfield.
11 UNFPA is a U.N. specialized agency that “supports countries in using population data for policies and programs to
improve reproductive health, prevent HIV/AIDS, promote gender equality, and make motherhood safer. UNFPA was
the lead U.N. agency for the 1994 International Conference on Population and Development in Cairo. For further
information on UNFPA’s mandate and activities, see

spent for other international family planning activities. Even though this pattern to redirect
UNFPA transfers to other population assistance programs continued, critics of the Kemp-Kasten
amendment and the President’s determination to suspend contributions asserted that UNFPA was
the world’s most effective family planning organization, and that the quality of services provided
in developing nations outside of China suffered due to the unwillingness of the United States to
support them. At the time of suspension, U.S. payments represented nearly one-third of UNFPA’s
annual budget. From 1986 through 1993, no U.S. contributions went to UNFPA.
The Clinton Administration lifted the ban on UNFPA contributions, making available $14.5
million in FY1993 but stipulating that funds could not be used in China. Again, congressional
critics of China’s family planning practices attempted unsuccessfully to attach provisions to
various foreign aid bills banning U.S. contributions unless UNFPA withdrew from China or the
President could certify that China no longer maintained a coercive family planning program.
While the United States continued to support UNFPA during the next eight years (except for
FY1999), Congress attached restrictions in appropriation measures that in most cases reduced the
U.S. contribution by the proportionate share of UNFPA funds spent on China.
For FY2002, Congress provided not more than $34 million for UNFPA. But in mid-January 2002,
the Bush Administration placed a hold on U.S. contributions to UNFPA, pending a review of the
organization’s program in China. The White House said it initiated the review because of new 12
evidence that coercive practices continued in counties where UNFPA concentrated its programs.
From FY2002 to FY2008, the Bush Administration determined that UNFPA was ineligible for 13
U.S. funding under the Kemp-Kasten amendment. Since the 2002 determination, the
Administration has transferred $34 million from each of FY2002, FY2004, and FY2005
appropriations, and $25 million from FY2003 funds that would have otherwise been provided to
UNFPA to support bilateral family planning programs and activities combating human trafficking
and prostitution. Approximately $22.5 million in unused UNFPA funds from FY2006 was
transferred to the International Organizations and Program (IOP) account.
While most observers agree that coercive family planning practices continue in China, differences
remain over the extent, if any, to which UNFPA is involved in involuntary activities and whether
UNFPA should operate at all in a country where such conditions exist. Given conflicting reports,
a State Department investigative team visited China in May 2002 and reported a series of findings
and recommendations. The team found no evidence that UNFPA “has knowingly supported or
participated in the management of a program of coercive abortion or involuntary sterilization” in

12 See House International Relations Committee hearing, Coercive Population Control in China: New Evidence of
Forced Abortion and Forced Sterilization, October 17, 2001, and a Senate Foreign Relations Committee hearing, U.S.
Funding for the U.N. Population Fund: The Effect on Womens Lives, February 27, 2002.
13 For the most recent Administration statements, see “White House: No U.N. Funding for China,The Associated
Press, September 7, 2007, and Press statement by Tom Casey, Deputy Spokesman, “Fiscal Year 2008 Funding for the
United Nations Population Fund (UNFPA), U.S. Department of State, June 27, 2008, available at

China, and recommended the United States release not more than $34 million of previously 14
appropriated funds to UNFPA.
Nevertheless, on July 22, 2002, Secretary of State Powell, to whom the President had delegated
the decision, announced that UNFPA was in violation of Kemp-Kasten and ineligible for U.S.
funding. The State Department’s analysis of the Secretary’s determination found that even though
UNFPA did not “knowingly” support or participate in a coercive practice, that alone would not 15
preclude the application of Kemp-Kasten. Instead, a finding that the recipient of U.S. funds—in
this case UNFPA—simply supports or participates in such a program, whether knowingly or
unknowingly, would trigger the restriction. The assessment team found that the Chinese
government imposed fines and penalties on families (“social compensation fees”) that have
children exceeding the number approved by the government. The Department further noted that
UNFPA had funded computers and data-processing equipment that had helped strengthen the
management of the Chinese State Family Planning Commission. Beyond the legitimate uses of
these and other items financed by UNFPA, such equipment facilitated, in the view of the State
Department, China’s ability to impose social compensation fees or perform coercive abortions.
The State Department analysis concluded that UNFPA’s involvement in China’s family planning
program, “allows the Chinese government to implement more effectively its program of coercive
On September 17, 2005, the State Department stated that the United States had been urging
UNFPA and China to modify the organization’s program in a manner that would permit U.S.
support to resume, but that no key changes had occurred that would allow a resumption of U.S.
funding under the conditions of the Kemp-Kasten provision. Subsequently, on October 18 of that
year, USAID notified Congress that the reprogrammed UNFPA set-aside would be made 16
available to expand family planning and reproductive health programs in 14 other countries.
The September 17 announcement followed a June 22, 2005 UNFPA Executive Board meeting to
consider UNFPA’s new five-year, $27 million program for China. At the meeting, Kelly Ryan,
Deputy Assistant Secretary of State for the Bureau of Population, Refugees and Migration, argued
that UNFPA should end its operations in China because of the coercive nature of China’s family
planning programs. Two days later, State Department spokesperson, Sean McCormick, issued a
statement saying the United States was “disappointed” that UNFPA had decided to continue
financial and technical support to the Chinese birth limitation program. He noted that U.S.
opposition was not aimed at UNFPA but was a “matter of principle,” based on strong American
opposition to “human rights abuses associated with coercive birth limitation regimes.” He
acknowledged that UNFPA does not approve of coercive policies but that the organization’s
continued presence in China offered a “seal of approval” for Chinese policies.

14 See for report’s full text.
15 See for a full text of the determination.
16 The most significant increases were made in programs for Georgia, Madagascar, Romania, Russia, Rwanda, and

Critics of the Administration’s decision opposed it for a number of reasons, including the loss of
$34 million, an amount that represented about 9% of UNFPA income in 2001. They argued that
access to voluntary family planning programs by persons in around 140 countries would be
reduced, undermining the health of women and children, increasing unwanted pregnancies, and
increasing the likelihood of higher numbers of abortions. Still other critics were concerned about
the possible application of the Administration’s interpretation of Kemp-Kasten for other
international organizations operating in China and to which the U.S. contributes—for example,
UNICEF, WHO, and the U.N. Development Program.
As noted, much of this debate has focused on UNFPA’s programs in China, both because of
China’s well-known population growth problem and because of widespread publicity given to
reports of coercion in its family planning programs. China’s population increased from 500
million in 1950 to 1.008 billion according to the 1982 census—an average annual growth rate of
2%, or a doubling of the population every 36 years. (Although the 2% rate is not particularly
large by developing country standards, many consider a lower rate crucial to China’s economic
development prospects given the country’s already huge population size.)
Chinese authorities came to view control of population growth not simply as an important
priority, but as a necessity for the nation’s survival. In an attempt to reach a 1% annual population
growth rate, Chinese authorities, in 1979, instituted a policy of allowing only one child per
couple, providing monetary bonuses and other benefits as incentives to comply. Women with one
living child who became pregnant a second time were said to be subjected to rigorous pressure to
end the pregnancy and undergo sterilization; couples who actually had a second child faced heavy
fines, employment demotions, and other penalties. Chinese leaders have admitted that coerced
abortions and involuntary sterilizations occur, but insist that those involved are acting outside the
law and are punished, particularly through the Administrative Procedure Law enacted in October
1990. Chinese authorities have termed female infanticide an “intolerable crime” that must be
punished by law.
Other press reports suggest that the Chinese State Family Planning Commission (SFPC) has
softened some of its previous harsh tactics to limit population growth. A number of counties have
ended the system of permits for pregnancy and quotas for the number of children that can be born
annually. When it launched in January 1998 a new $20 million, five-year program in China,
UNFPA announced that SFPC officials had agreed to drop birth targets in the 32 counties where
U.N. activities would be focused. And in May 1999, the city of Beijing ended an eight-year policy
that women had to be at least 24 years old to bear a child and lifted the requirement for couples to
obtain a certificate before having a child.
On September 1, 2002, China adopted the Population and Family Planning Law, the country’s
first formal law on this subject. The law, which requires couples who have an unapproved child to
pay a “social compensation fee” and extends preferential treatment to couples who abide by the
birth limits, is intended to standardize the implementation of the Government’s birth limitation
policies. The State Department Country Reports on Human Rights Practices for 2006 (dated
March 2007), however, found that enforcement of the law varied by location.

The broad question concerning the degree of coercive family planning practices in China remains
a controversial matter. The State Department’s most recent human rights report (covering 2006)
concluded that
Chinas birth planning policies retained harshly coercive elements in law and practice. The
laws restrict the rights of families to choose the number of children they have and the period
of time between births. The penalties for violating the laws are strict, leaving some women
little choice but to abort pregnancies ... Those who violated the child limit policy by having
an unapproved child or helping another do so faced disciplinary measures such as job loss or
demotion ... and other administrative punishments, including in some cases the destruction of
property. In the case of families that already had two children, one parent was often 17
pressured to undergo sterilization.
Chinese officials acknowledge past instances of forced abortion and involuntary sterilizations, but
say this is no longer the case and characterize the social compensation fees as not coercive, but a 18
“disincentive” or “necessary form of economic restraint.”
Recent attention has focused on reports documenting a campaign by local family planning
officials around the city of Linyi in Shandong Province to force couples with two children to
undergo sterilizations or to demand women pregnant with a third child have an abortion. Local
activists are pursuing a class-action lawsuit against the government. The group’s leader, Chen
Guangcheng, was placed under house arrest and subsequently sentenced to four years and three 19
months in prison. In mid-September 2005, China’s National Population and Family Planning
Commission acknowledged that illegal coercive practices had occurred, and that responsible 20
officials had been dismissed and that some had been detained.
Following the May 2002 State Department investigation of Chinese policies, senior Department
officials began a series of discussions with China regarding its birth planning law. Arthur Dewey,
Assistant Secretary of State for Population, Refugees, and Migration, told the House International
Relations Committee on December 14, 2004, that in six rounds of talks with Chinese officials,
there had been “encouraging movement” in China’s approach to population policy and the 21
reduction of coercive practices. Nevertheless, Assistant Secretary Dewey said that the social
compensation fee policy set out in China’s national law on Population and Birth Planning is a
“harsh and effective enforcement tool” that is used to force women to have an abortion, and is
therefore regarded as a coercive policy. While negotiations have resulted in some progress, he

17Country Reports on Human Rights Practices, 2006—China, U.S. Department of State, Bureau of Democracy,
Human Rights and Labor, March 6, 2007, available at
18 U.S. Department of State, Assessment Team Report, May 29, 2002.
19 For more information, seeCountry Reports on Human Rights Practices, 2006—China, U.S. Department of State,
Bureau of Democracy, Human Rights and Labor, March 6, 2007, available at
Benjamin Kang Lim,Blind China Activist Under House Arrest Since September, Reuters, January 6, 2006; Philip
Pan, “Who Controls the Family? Blind Activist Leads Peasants in Legal Challenge to Abuses of Chinas Population
Growth Policy, Washington Post, August 27, 2005; and “China Terse About Action on Abuses of One-Child Policy,
Washington Post, September 20, 2005.
21 Dewey cited, for example, the elimination of a requirement for married couples to obtain government permission
prior to pregnancy in 25 of Chinas 31 provinces, municipalities, and autonomous regions. He also noted the
government’s launch of a public information project highlighting the status of the girl child. He viewed this as a
positive step towards ending discrimination in China against girls and women.

concluded that China’s policies have not been altered enough to allow the Bush Administration to
resume UNFPA funding.
As noted previously, U.S. officials continued to voice their opposition at a UNFPA executive
board meeting on June 22, 2005, where members met to consider a new, five-year (2006-2010),
$27 million UNFPA program in China. A State Department press release on June 24 again
acknowledged that China had made some progress in its approach to population issues, but
argued that Beijing’s birth limitation policy continues to contain several coercive elements,
including the social maintenance fee for unplanned births, and regulations that limit choices by
women other than to undergo an abortion. At the June 22 meeting, China’s deputy U.N.
ambassador Zhang Yishan argued that due to the size of China’s population, it had to maintain a
strong family planning program, and that without the policies of the last 30 years, China’s
population would have grown by 300 million additional people. He countered that, by law, family
planning workers are not permitted to utilize coercive measures in their work.
The UNFPA Executive Board approved the new five-year program for China on January 30,
2006. Prior to the signing, U.S. Deputy Representative to the United Nations, Ambassador
Alejandro Wolff, expressed disappointment that no substantive changes had been made to the
draft plan that had been reviewed in mid-2005. He argued that UNFPA assistance provided a “de
facto United Nations ‘seal of approval’” to Chinese “abhorrent” practices. He further asserted that
the new Country Program Document for China was incorrect in its claim that China was
committed to implementing the Cairo Population Conference action plan, a program that 22
excluded coercive practices in family planning activities. A group of ten European nations
disagreed, however, issuing a statement saying that China did conform to the program of 1994 23
International Conference on Population and Development.
There have been several other State Department determinations related to the July 2002 decision
regarding UNFPA. On August 6, 2003, for example, the State Department decided that it would
fund a $1 million HIV/AIDS program supporting African and Asian refugees only if the
implementing NGO group—Reproductive Health for Refugees Consortium—did not include
Marie Stopes International among its members. Marie Stopes International is a British-based
reproductive health organization that at the time was a major implementing partner of UNFPA in
China. The State Department, while not making a legal determination under the Kemp-Kasten
amendment, felt that an action not to fund Marie Stopes International would be an “approach
most consistent with U.S. policy.” On August 11, however, the Consortium declined to accept the
$1 million grant due to the exclusion of Marie Stopes International.
In another decision, the Administration notified the Global Health Council in April 2004 that the st
U.S. government would not provide funding for the Council’s 31 annual meeting in June 2004
because UNFPA would be a participant. Reportedly, U.S. officials told representatives of
international organizations and NGOs that UNICEF, WHO, and other organizations that

22 U.S. Mission to the United Nations. Ambassador Wolff: Remarks on Proposed UNFPA Sixth Country Program for
China, January 26, 2006.
23UN Population Fund Endorses 27-million-dollar China Program, Agence France Presse, January 30, 2006.

continued involvement in joint programs with UNFPA might jeopardize their funding support 24
from the United States.

Since 1965, USAID has obligated over $6.6 billion in assistance for international population
planning. In many years, and especially over the past decade, the appropriate level of funding for
population assistance has been controversial, and at times, linked directly with differences
concerning Mexico City restrictions and abortion. Until FY1996, Congress generally supported
higher funding levels for population aid than proposed by the President, especially during the
Reagan and Bush Administrations. Appropriations peaked in FY1995 at $577 million. During the
balance of the Clinton Administration, however, Congress cut and placed restrictions on bilateral
funding. Amounts for bilateral programs fell to $356 million in FY1996, but grew steadily to
$425 million by FY2001 (see Table 1).
When President Bush took office in January 2001, the White House said that it would maintain
the $425 million funding level of the previous Administration. While budgets submitted by
President Bush adhered to the $425 million target through FY2006, in every year Congress
increased funding levels. In some years beginning in FY2002, bilateral family planning levels
have received additional resources when UNFPA-earmarked funds were reprogrammed for
bilateral activities after UNFPA was determined to be ineligible for U.S. support.
Table 1. U.S. Population Assistance, FY1994-2008
(USAID Family Planning/Reproductive Health Budget; millions of $)
1994 1995 1996 1997 1998 1999 2000 2001 2002c 2003c 2004c 2005c 2006c 2007c 2008c
Bilateral 486.9542.0432.0385.0385.0385.0372.0a 425.0 425.0443.6 429.5437.0 435.0435.6457.2d
UNFPA 21.5b 0.00.0 0.00.0
Total 526.9577.0454.8410.0405.0385.0393.5446.5 425.0443.6 429.5437.0 435.0435.6457.2
Source: USAID Bureau of Global Health Strategic Planning and Budgeting Division.
Note: Amounts are adjusted for rescissions in appropriate years.
a. The bilateral FY2000 aid level reflects a transfer of $12.5 million from population assistance to child survival
b. UNFPA amounts for FY2000 and FY2001 reflect a $3.5 million deduction due to legislative restrictions.
c. From FY2002 to FY2008, the Bush Administration determined that UNFPA was ineligible for U.S. funding
because of its programs in China, and withheld appropriated funds. Some of the withheld funds were
reallocated for USAID bilateral family planning, vulnerable children, and counter-trafficking in persons
d. The FY2008 bilateral aid level is an estimate.

24 Christopher Marquis,U.S. Is Accused of Trying to Isolate U.N. Population Unit,” New York Times, June 21, 2004.

When President Bush took office in January 2001, the White House said that it would maintain
the $425 million funding level of the previous Administration. While budgets submitted by
President Bush adhered to the $425 million target through FY2006, in every year Congress
increased funding levels. In some years beginning in FY2002, bilateral family planning levels
have received additional resources when UNFPA-earmarked funds were reprogrammed for
bilateral activities after UNFPA was determined to be ineligible for U.S. support.
The Bush Administration’s FY2009 request for bilateral international family planning and
reproductive health activities totals $327.53 million. This includes $301.7 million from the Child
Survival and Health Program account, $17.166 million from Economic Support Funds (ESF),
$7.901 million from FREEDOM Support Act (FSA), and $763,000 for Eastern Europe and Baltic 25
States Assistance (SEED). The Administration also requested $25 million for UNFPA funding if
the organization is deemed eligible under the Kemp-Kasten amendment. The UNFPA funds 26
would be appropriated under the Child Survival and Health Programs account.
On December 26, 2007, the President signed into law H.R. 2764, the Consolidated Appropriations
Act, 2008, (P.L. 110-161),which states that not less than $461 million shall be made available for 27
family planning and reproductive health. The Act also directs that $40 million be made available
to UNFPA if it becomes eligible under the terms of the Kemp-Kasten amendment. UNFPA funds
would be drawn from the Global Health and Child Survival account, with no less than $7 million
derived from the International Organizations and Programs (IOP) account. On June 26, 2008,
however, a State Department official announced that UNFPA is ineligible for FY2008 funding
under the Kemp-Kasten amendment due to evidence that it supports or participates in coercive
abortion and involuntary sterilization practices in China. The official stated, “We are prepared to
consider funding UNFPA in the future if its program in China is ended or restructured in a way
consistent with U.S. law, or if China ends its program of coercive abortion and involuntary 28
sterilization.” This marks the seventh consecutive year that the Bush Administration has not
funded UNFPA under the Kemp-Kasten provision.
P.L. 110-161 includes reporting requirement for UNFPA funding. The Act requires the Secretary
of State to submit a report on UNFPA funding to the appropriate congressional committees no
later than four months after enactment. The report shall indicate the amount of funds that UNFPA
is budgeting for the year in which the report is submitted for a country program in the People’s

25 Congressional Budget Justification, Foreign Operations, Fiscal Year 2009, p. 754-755, available at
26 Appendix, Congressional Budget Justification, Foreign Operations, Fiscal Year 2009, p. 815, available at
27 Consolidated Appropriations Act, 2008, December 26, 2007, P.L. 110-161 [121 Stat. 1844]. See Division J, the
Department of State, Foreign Operations, and Relations Programs Appropriations Act, 2008, Title III and Section 660.
28 Ibid.

Republic of China.29 If the Secretary of State’s report indicates that UNFPA funds will be used for
a program in China, then the funds “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.” The provision also states, “Nothing in this section shall be construed to limit the
authority of the President to deny funds to any organization by reason of the application of
another provision of this Act or any other provision of law.”
P.L. 110-161 also establishes a reporting requirement for Administration decisions made under
the Kemp-Kasten amendment. The Act directs that any determination “must be made no later
than six months after the date of enactment of this Act, and must be accompanied by a
comprehensive analysis as well as the complete evidence and criteria utilized to make the 30
determination.” In past years, for example, the Administration has announced UNFPA eligibility
for U.S. funding in September or October of the appropriate fiscal year. In some cases, it did not
provide justification for its decision. The new provision requires the Administration to announce
its decision by June and to provide comprehensive analysis and evidence to support its position.
The Bush Administration’s FY2008 request for bilateral international family planning and 31
reproductive health activities totaled $324.8 million. This represented a $32.2 million decrease
from the FY2007 Administration request of $357 million, and a $115.2 million decrease from the
enacted 2006 funding level of $440 million. The Administration cited “significant successes that
have been achieved after 40 years of worldwide family planning efforts” as justification for
decreased funding. The Administration also requested $25 million for UNFPA funding if the
organization is deemed eligible under the Kemp-Kasten amendment. The funds would be 32
appropriated under the Child Survival and Health Programs account.
Luisa Blanchfield
Analyst in International Relations, 7-0856

29 Ibid., Section 660.
30 Ibid., Title III.
31 The Administration requests $301.7 million for family planning and reproductive health activities. It also requests
$14.3 million in Economic Support Funds (ESF), $7.1 million for the FREEDOM Support Act (FSA), and $1.7 million
for Eastern Europe and Baltic States Assistance (SEED) for family planning and reproductive health programs.
32 Appendix, Congressional Budget Justification, Foreign Operations, Fiscal Year 2008, p. 752, available at