Craig Lasher's blog

International Women's Health? Who's President Makes The Difference

2008-09-29T08:00:00-04:00

Under the Constitution and our system of government as it has evolved over the more than 200 years of the country's history, the President has been vested with a number of powers and authorities by which he can imprint his stamp on the interactions of the United States with the rest of the world, including through development and humanitarian assistance. As a result, who occupies the White House can greatly affect what policies govern international family planning and reproductive health (FP/RH) programs and how much money is spent on these critical health activities. The President matters.

The fact that the President matters is nowhere more obvious in the policymaking arena, in two ways -- either through promulgation of policy directives himself or in interpreting and enforcing the laws passed by Congress.

In the first instance, it is important to remember that the Mexico City Policy/Global Gag Rule, which prohibits U.S. family planning and reproductive health (FP/RH) assistance from being provided to foreign nongovernmental organizations (NGOs) that provide abortion services or counsel, refer, or lobby on abortion with non-U.S. funds, is solely an executive branch policy. The Global Gag Rule has been a ping pong ball that has bounced back and forth depending on who was in the White House. President George W. Bush announced the reinstatement of these restrictions, which were in effect during the Reagan and Bush administrations in the mid-1980s and early 1990s, on his second day in office, merely by issuing a "presidential memorandum" to the Administrator of the Agency for International Development. President Clinton had rescinded the policy on one of his first days of his term in 1993 by issuing a similar memorandum. The next President could choose either course of action -- leave in place or rescind.

Whether or not the United States will provide a contribution to the United Nations Population Fund (UNFPA) is dependent upon and an example of the second type of leverage that the President can exert on FP/RH policymaking -- the ability to interpret the law. For the last seven years, President Bush has withheld the U.S. contribution to UNFPA by employing an overly broad interpretation of the so-called Kemp-Kasten amendment (first attached to annual appropriations bills in 1985), which prohibits funding to any organization that "supports or participates in the management of a program of coercive abortion or involuntary sterilization," and by pointing to the presence of a UNFPA country program in China, where human rights abuses have occurred, as grounds for denying funding. Conversely, the lawyers in President Clinton's State Department employed a different and more narrow and proper interpretation of the statute to allow U.S. funds to flow to UNFPA during his tenure. Whether or not the next President wants to fund UNFPA will determine how the Kemp-Kasten amendment is interpreted and whether the United States will rejoin the more than 180 nations that now contribute to UNFPA.

(The next President might go even further by expanding the application of the Kemp-Kasten amendment, following through on the threat of the Bush administration to defund other organizations working in China with the same Chinese government institutions which they have judged to be the enforcers of the "one-child" policy.)

The President has wide discretion in the conduct of foreign policy. So unless Congress explicitly prohibits or restricts something, the President enjoys broad latitude in choosing how to implement legislative directives and in establishing policy guidance for the programs the executive branch administers. This separation of powers will enable the next President to choose how to interpret and implement various reproductive health-related provisions contained in the recently-passed reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR). Suc provisions include the anti-prostitution pledge requirement and abstinence funding reporting requirement as well as whether the Office of the Global AIDS Coordinator will explore ways to better integrate FP/RH activities into HIV prevention programs, such as prevention-of-mother-to-child transmission and voluntary counseling and testing.

As the old aphorism goes, "The President proposes, Congress disposes." On the question of funding for FP/RH programs, the President can also exert considerable influence over the amount appropriated through the request level in his annual federal budget proposal, but ultimately Congress has the power of the purse. Nevertheless, a low request from the President such as the 25 and 29 percent cuts to FP/RH proposed by President Bush in the last two fiscal years, taxes the ability of family planning champions (especially the chairs of the House and Senate State-foreign operations appropriations subcommittees) to find additional funding and to balance many important competing priorities within a limited overall budget ceiling within which they have to work.

Bottom line, whether it is policymaking or funding for U.S. involvement in family planning and reproductive health programs around the world, the President matters -- and matters greatly.

Bush Takes Parting Shot at International Family Planning Organizations

2008-06-27T14:41:05-04:00

You've probably heard that the Bush administration is once again withholding funding for the United Nations Population Fund (UNFPA). Because UNFPA provides funding for health services, including voluntary family planning, in China, where the government maintains a "one-child policy," the Bush administration decided Thursday to unjustly withhold U.S. funding to UNFPA, as it has for the last seven years. That's no surprise (it's barely even news-worthy), though it is disappointing. Contrary to the administration's assertions, UNFPA provides alternative and voluntary approaches to China's compulsory family planning program.

But you may have missed the news that might be even bigger. Now the Bush administration has threatened to dramatically expand the interpretation of the Kemp-Kasten amendment, which prohibits U.S. funding to organizations that support coerced abortion or involuntary sterilization. Until now, Kemp-Kasten has only been used to withhold funding from UNFPA. Now there's a threat to cut off funding to other organizations solely because they operate health programs in China. Buried in the statement released by Deputy Secretary of State John Negroponte is the ominous warning:

During the course of our evaluation of UNFPA's work, we learned of other organizations that conduct activities in China. The relevant funding agencies are conducting a comprehensive analysis to determine what appropriate and lawful actions can be taken.

UNFPA, as well as other organizations working in China, have sought to play a positive role in helping to reform the Chinese government's program and to end the occurrence of human rights abuses by promoting the replacement of compulsory birth control with good counseling and informed consent, a greater range of contraceptive method choice, and higher quality services. Losing all of their U.S. funding for important programs in countries all over the world would be the reward that organizations get for trying to be part of the solution in China.

Why is it that the Bush administration is again singling out the organizations that are making a difference in the lives of women and their families to make its own political point? As Amy Coen, PAI's President/CEO, has said, "When the issue involves family planning, the White House will always look for new ways to satiate the voracious appetite of its right-wing political constituency." Political posturing should not endanger women's lives.

Opponents of family planning and reproductive health programs argue that the U.S. government -- and U.S. taxpayers -- should have no "complicity" in Chinese government population practices. Few, if any, disagree. In fact, all of the activities of UNFPA and the targeted organizations that work in China are based upon voluntarism and respect for human rights and are supported with funds provided by other donors -- public and private.

Does the administration's argument even withstand scrutiny for consistency and an absence of hypocrisy? The answer is a resounding no. There are a number of examples of other multilateral institutions, U.S. government agencies, and nongovernmental organizations that partner with the Chinese government in the health sector, including those Chinese governmental institutions judged by the State Department to be guilty under the terms of the Kemp-Kasten amendment to have "support[ed] or participate[d] in the management of a program of coercive abortion or involuntary sterilization."

Opponents of contraception inside and outside the Bush administration believe that any financial relationship with the Chinese government somehow indirectly supports coercive practices. The real agenda is clear: funding for international family planning groups is being threatened in pursuit of an ideological agenda that stands transparently in opposition to contraception for poor women around the world and in pursuit of a misguided vendetta against these indispensable organizations.

UNFPA provides international leadership on population issues and is a key source of financial assistance for voluntary family planning and reproductive health programs in poor countries. UNFPA works in more than 150 countries, providing life-saving maternal and child health care, HIV/AIDS prevention services, and emergency care for pregnant women in conflict and disaster situations. Restoring U.S. funding for UNFPA programs is crucial to improving the health and lives of women and their families and to addressing demographic trends and promoting sustainable development -- and should be one of the first actions of the next President.

Restructuring the U.S. Foreign Assistance Program

2006-09-20T09:00:00-04:00

Craig Lasher is a Senior Policy Analyst at Population Action International (PAI).

As a veteran foreign aid advocate, I was keenly interested when Secretary of State Condoleezza Rice announced in January a major restructuring of the U.S. government's foreign assistance program under a new vision of "transformational diplomacy." Its lofty goal was described as "helping to build and sustain democratic, well-governed states that will respond to the needs of their people and conduct themselves responsibly in the international system." As the details of the new strategic framework for foreign aid begin to emerge, however, my cynical concern that short-term national security and democracy promotion objectives favored by the State Department would trump the traditional focus of U.S. foreign assistance on development and poverty reduction appears to be on its way to being confirmed. Such a shift could prove enormously detrimental to long-term development programs, including family planning and reproductive health.

Despite assurance that the U.S. Agency for International Development (USAID) would remain independent, preliminary assessments of the internal bureaucratic wrangling suggest that the State Department is usurping USAID's traditional role in setting foreign aid program priorities and in allocating funding. In the past, USAID's independence has served to at least partly insulate aid decision-making from the transient political and diplomatic crises of the moment. The restructuring process has also proven-so far-to be centralized, Washington-driven, and top-down with limited involvement by mission and embassy staff on the ground with expertise and insight on country needs.

One of the State Department's stated goals of its foreign assistance restructuring plans is to provide maximum flexibility to the executive branch and to eliminate the practice of earmarking funds for programs favored by their congressional champions. A line-item budget from Congress for family planning has been essential to the political survival of the USAID family planning program since its founding over 40 years ago. Threats to the continuing existence of this critical public health program continue today, best evidenced by the $79 million funding cut proposed by the President in his FY 2007 budget request in February.

As anyone who has worked on foreign aid bills for as long as I have knows, the practice of congressional earmarking has evolved over time and exists because of the executive branch's historic resistance-regardless of who is President-to taking direction from Congress on the priorities within U.S. foreign aid budget and the reluctance of Congress to give the President a free hand in dispensing funds overseas.

In June, members of the Senate Appropriations Committee issued what appears to me to be an unmistakable preemptive warning that the State Department's plans to reject funding directives from Congress may face difficulties in winning approval by explicitly earmarking all funding for global health and other development programs by country and program activity in its version of the FY 2007 appropriations bill (H.R. 5522).

Largely sidelined until now, Congress must insist on being involved in the process. It must exercise oversight and leadership in resisting foreign assistance restructuring proposals that may endanger successful foreign aid programs in the pursuit of a notion of greater coherence and coordination. Ultimately, the institutional interests of the two branches of our government will collide when the President sends his FY 2008 budget request to Congress next February-perhaps even sooner. I will bet money on it.