The Trump-Pence administration released its FY 2019 budget request today. It proposes a 50 percent cut in funding for international family planning and reproductive health (FP/RH) programs. This comes as part of a 30 percent overall cut to the international affairs budget that funds the U.S. government’s diplomatic and development efforts around the world. A funding cut of that magnitude would devastate programs and harm the millions of women and couples that are able to plan the number and spacing of their children through access to modern contraception supported by the U.S. Agency for International Development (USAID). Fortunately, the President’s annual budget request has become merely a statement of an administration’s spending priorities that is regularly ignored by Congress. There is no reason to believe that congressional family planning champions on the appropriations committees will go along with the administration’s plan and that this year will be any different.
The FY 2019 congressional budget justification for the State Department and foreign assistance requests $302 million for FP/RH within the Global Health Programs account administered by USAID (p. 83). No funds whatsoever are requested for the International Organizations and Programs (IO&P) account that is allocated for voluntary contributions to United Nations agencies, including the United Nations Population Fund (UNFPA). Any financial resources in the Economic Support Fund (ESF) that may have been designated for FP/RH activities in a small number of strategically important countries, typically amounting to about $50 million annually in recent years, is not apparent in the budget documents. The $302 million request for international FP/RH programs in FY 2019 compares to a total of $607.5 million appropriated in FY 2017 in all accounts—a cut of $305.5 million or almost exactly a 50 percent reduction.
Family planning advocates would not have been surprised by a reprise of the Trump-Pence administration’s first budget request that proposed zeroing out all funding for international FP/RH programs. A statement in the main budget volume perhaps hints at their rationale for requesting funds this year, by linking the FP/RH funding requested to the implementation of the Trump expansion of the Global Gag Rule (GGR) to all U.S. global health assistance last year: “With the Protecting Life in Global Health Assistance policy now in place, the Budget request includes U.S. investments in family planning and reproductive health, with an emphasis on evidence-based methods, including fertility awareness.” In other words, now that the administration can be assured that no U.S. global health assistance is either directly or indirectly subsidizing foreign organizations engaged in abortion-related activities, it’s okay to ask for some money to be spent for the provision of contraceptive services. But the Trump-Pence administration was still unwilling to recommend a level of funding that even House Republicans have endorsed in their FY 2018 House-passed bill—$461 million, or $159 million more than the FY 2019 request.
What would a 50 percent cut mean in terms of the lives and health of real women and families in the nearly 40 countries in which USAID supports FP/RH programs if it were to be enacted into law by Congress? The Guttmacher Institute estimated the impact of U.S. investments in FP/RH programs in FY 2017, including the effect of funding cuts on health outcomes. Translating a $305.5 million cut into real-life impact, a funding reduction this large would be likely to result in the following:
- 12.65 million fewer women and couples would receive contraceptive services and supplies;
- 3.76 million more unintended pregnancies, including 1.68 million more unplanned births, would occur;
- 1.59 million more abortions would take place (the majority of which are provided in unsafe conditions); and
- 7,637 more maternal deaths would occur.
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.
While the FY 2019 budget request was released today, final resolution of the FY 2018 appropriations process remains pending, nearly six months after the start of the current fiscal year. The sweeping, two-year budget deal approved at the end of last week as part of a fourth continuing resolution (CR) will keep the federal government operating until March 23rd at current funding levels and policy. The agreement negotiated lifts the discretionary spending caps (sequester) in the previous budget agreement that would have resulted in drastic cuts to defense and non-defense spending. The deal provides $63 billion in additional FY 2018 funding for non-defense discretionary programs, including international affairs programs. However, $21 billion, or roughly a third, is earmarked for the opioid epidemic, NIH medical research, veterans programs and other urgent priorities, leaving the remaining two-thirds to be split among a multitude of popular domestic and international affairs programs.
Complicating matters further for international affairs programs is the inclusion in the CR of an $8.8 billion cut to the Overseas Contingency Operations (OCO) account, which made up about one-third of the total international affairs budget of about $60 billion in FY 2017. This OCO cut will put tremendous pressure on the “base” funding portion of the international affairs budget, which includes funding for international FP/RH and the rest of global health assistance.
In the next day or two, the Senate and House Appropriations Committee leadership are expected to divide the approved increases for defense and non-defense programs among the 12 appropriations bills and provide the subcommittees with their so-called 302(b) allocations, the top-line funding level to be divvied up. This will enable the members and staff of the State Department and Foreign Operations Subcommittee to begin negotiating in earnest on the final FY 2018 bill. The House and Senate versions of the State-Foreign Operations bill remain diametrically opposed to each other in their treatment of international FP/RH funding and policy. The House bill proposes only $461 million in funding, a legislative imposition of the expanded GGR, and a prohibition on a UNFPA contribution. The Senate bill includes $622.5 million in funding, a permanent legislative repeal of the GGR, and an earmarked U.S. contribution for UNFPA under most of the current law restrictions.
Family planning advocates remain cautiously optimistic that the final deal on international FP/RH funding and policy will resemble the status quo outcome achieved for the last seven fiscal years—more or less level funding and no new policy “riders,” either positive or negative. However, the pressure on the base funding may result in a funding reduction for FP/RH, but advocates hope only if absolutely required and proportional to other foreign assistance programs—and not a punitive concession for keeping GGR imposition and a UNFPA prohibition out of the final agreement.
In both the endgame negotiations to negotiate the final FY 2018 bill and during the future consideration of the dramatic cut proposed by the Trump-Pence administration for FY 2019, congressional family planning champions will undoubtedly strive to get the whole loaf and will not settle for a few slices and some crumbs.