Health Care

The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies

STATUTORY Helms Amendment (1973)
Prohibits the use of foreign assistance to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion. Note: meaning of “motivate” clarified by Leahy Amendment (1994); see below. Abortion All foreign assistance authorized under the Foreign Assistance Act of 1961(FAA); all funds under State-Foreign Operations Appropriations (State-Foreign Ops.)

Yes, in effect.
Permanent law, amendment to the FAA.

Also included in annual State-Foreign Ops.

Involuntary Sterilization Amendment (1978)
Prohibits the use of funds to pay for involuntary sterilizations as a method of family planning or to coerce or provide a financial incentive to anyone to undergo sterilization. Voluntarism/
Informed Choice & Consent; Incentives; Involuntary Sterilization All foreign assistance authorized by the FAA of 1961; all foreign assistance funds under State-Foreign Ops.

Yes, in effect.
Permanent law, amendment to the FAA.

Also included in annual State-Foreign Ops.

Peace Corps Provision (1978)
Prohibits Peace Corps funding from paying for an abortion for a Peace Corps volunteer or trainee; beginning in FY 2015, allows for payment in cases where the life of the woman is endangered by pregnancy or in cases of rape or incest. Abortion All Peace Corps funding Yes, in effect.
Included under the “Peace Corps” heading of the State-Foreign Ops. Biden Amendment (1981)
States that funds may not be used for biomedical research related to methods of or the performance of abortion or involuntary sterilization as a means of family planning. Abortion; Involuntary Sterilization All foreign assistance authorized by the FAA of 1961; all foreign assistance funds under State-Foreign Ops.

Yes, in effect.
Permanent law, amendment to the FAA.

Also included in annual State-Foreign Ops.

Siljander Amendment (1981)
Prohibits the use of funds to lobby for or against abortion. When initially introduced, the amendment prohibited only lobbying for abortion, but in subsequent years Congress modified the language to include lobbying against abortion as well. Abortion All funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops. DeConcini Amendment (1985)
Requires that U.S. funds be provided to organizations that offer, either directly or through referral to, information about access to a broad range of family planning methods and services. See Livingston-Obey Amendment (1986) below. Voluntarism/
Informed Choice All FP funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops. Kemp-Kasten Amendment (1985)
Prohibits funding any organization or program, as determined by the President, that supports or participates in the management of a program of coercive abortion or involuntary sterilization. UNFPA Funding; Abortion; Voluntarism/
Informed Choice & Consent; Involuntary Sterilization All funds under State-Foreign Ops. as well as unobligated balances from prior appropriations acts Yes, in effect.
Included in annual State-Foreign Ops. each year; Presidents determined that it applied to UNFPA in FY85-FY92, FY02-FY08, FY17-FY19. Involuntary Sterilization and Abortion Provision (1985)
Specifies that U.S. foreign assistance funding could be withheld from a country or organization if the president certifies that the use of such funds would violate key provisions of the FAA of 1961 related to abortion or involuntary sterilization (namely the Helms, Biden, and Involuntary Sterilization Amendments). Voluntarism/
Informed Choice & Consent; Incentives; Abortion; Involuntary Sterilization All foreign assistance funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops. Livingston-Obey Amendment (1986)
Prohibits discrimination by the U.S. government against organizations that offer only “natural family planning” for religious or conscientious reasons when the U.S. government is awarding related grants. All such applicants must comply with the requirements of the DeConcini Amendment (1985). Voluntarism/
Informed Choice All FP funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops. Leahy Amendment (1994)
Clarifies Helms Amendment (1973) language that uses the term “motivate” by stating that “motivate” shall not be construed to prohibit, where legal, the provision of information  or counseling about all pregnancy options. Abortion; Voluntarism/
Informed Choice All authorizing and appropriating legislation related to the State Dept., foreign operations, and related programs Yes, in effect.
Included in annual State-Foreign Ops. Timing of Release of UNFPA Contribution Funds (1994)
Not more than half of funding designated for the U.S. contribution to UNFPA is to be released before a particular date (varies by fiscal year). UNFPA Funding Funds made available to UNFPA No, not in effect.
Sometimes included in annual State-Foreign Ops. Conditions on Availability of UNFPA Funds (UNFPA Segregated U.S. Contribution Account; UNFPA Does Not Fund Abortions; Prohibition on the Use of U.S. Funds in China by UNFPA) (1994)
States that funds may not be made available to UNFPA unless:·     UNFPA keeps the U.S. contribution to the agency in a separate account, not to be commingled with other funds, and·     UNFPA does not fund abortions (note: language used beginning in FY00).It also prohibits UNFPA from using any funds from the U.S. contribution in their programming in China. UNFPA Funding; Abortion Funds made available to UNFPA Yes, in effect.
Included in annual State-Foreign Ops. UNFPA Dollar-for-Dollar Withholding of Amount UNFPA Plans to Spend in China During Fiscal Year (1994)
Reduces the U.S. contribution to UNFPA by one dollar for every dollar that UNFPA spends on its programming in China. UNFPA Funding Funds made available to UNFPA Yes, in effect.
Typically included in annual State-Foreign Ops. Tiahrt Amendment (1998)
Prohibits the use of targets/quotas and financial incentives in family planning projects and requires projects to provide comprehensible information on family planning methods. Protects people who choose not to use family planning from being denied rights or benefits and requires experimental family planning methods be provided only in the context of a scientific study. Intended to “promote voluntarism and prevent coercion in family planning programs,” it specifically prohibits three types of targets: total number of births, number of family planning acceptors, and acceptors of a particular method of family planning. Voluntarism/
Informed Choice & Consent; Incentives and Disincentives All FP funds under State-Foreign Ops. Yes, in effect.
Included in annual State-Foreign Ops. Reallocation of Funds Not Made Available to UNFPA (2004)
Provides for funds not made available to UNFPA to be reallocated to USAID’s family planning, maternal, and reproductive health activities/services (and, in some years, assistance to vulnerable children and victims of trafficking in persons). UNFPA Funding Funds appropriated for UNFPA Yes, in effect.
Typically included in annual State-Foreign Ops. Medically Accurate Information on Condoms (2005)
Ensures that information provided by U.S.-supported programs about the use of condoms is medically accurate information and includes the public health benefits and failure rates of such use. Condoms All funds under State-Foreign Ops. Yes, in effect.
Typically included in annual State-Foreign Ops. POLICY USAID Policy Paper on Population Assistance (1982)
Outlines the longstanding USAID guidelines surrounding its fundamental programmatic principles of voluntarism and informed choice and consent. Voluntarism/
Informed Choice & Consent All FP/RH assistance provided by USAID Yes, in effect. Policy Determination 3 (PD-3) and Addendum: USAID Policy Guidelines on Voluntary Sterilization (1982)
Describes guidelines for informed consent and voluntarism specifically for voluntary sterilization services, including provisions to ensure ready access to other contraceptive methods and prohibiting incentive payments that might induce a person to select voluntary sterilization over another method. Voluntarism/
Informed Choice & Consent; Voluntary Sterilization All FP/RH assistance provided by USAID Yes, in effect. Mexico City Policy (“Global Gag Rule”, 1984)
As a condition for receiving U.S. family planning assistance and, now, also other global health assistance (see “Applies to”), requires foreign NGOs to certify that they will not perform or promote abortion as a method of family planning using funds from any source.Under the Trump administration, now called “Protecting Life in Global Health Assistance” policy. Abortion 1984- 2003: when in effect, was applied to FP assistance at USAID only. In 2003, expanded to include all FP assistance at USAID and the State Dept., exempting multilateral organizations and HIV/AIDS funding under PEPFAR. 2009-17: Not in effect. 2017-: applied to all global health assistance. Yes, in effect.
Currently in force through Executive action. USAID Post-Abortion Care Policy (2001)
Clarifies that post-abortion care – the treatment of injuries or illnesses caused by legal or illegal abortion – is permitted under the Helms Amendment and that any restrictions under the Mexico City Policy, when in force, do not limit organizations from treating injuries or illnesses caused by legal or illegal abortions (i.e., providing post-abortion care). Notes USAID does not finance manual vacuum aspiration equipment purchase/distribution for any purpose. Post-Abortion Care All FP/RH assistance provided by USAID Yes, in effect. Guidance on the Definition and Use of the Global Health Programs Account: Section on Allowable Uses of Funds for Family Planning/Reproductive Health (2014)
Outlines allowable uses of funds for FP/RH by providing a description of activities allowed and examples of activities not allowed, addressing not only FP/RH activities but also family planning activities’ integration with other global health and multisectoral activities. FP/RH Activities; FP/RH System Strengthening Activities; Integrated FP Activities All FP/RH assistance provided by USAID Yes, in effect.
Updated periodically. PEPFAR FY 2020 Country Operational Plan Guidance
Outlines certain FP/RH activities that may be reported under specific PEPFAR budget categories, such as youth-friendly sexual and RH services that are part of prevention for adolescent girls and young women. Includes explanation of implementation of the Mexico City Policy (now called Protecting Life in Global Health Assistance policy) in PEPFAR programs. HIV/AIDS Program Linkages with FP/RH Activities; Abortion “Wraparound” PEPFAR activities related to FP/RH; Mexico City Policy applied to all global health assistance, including PEPFAR. Yes, in effect.
Updated annually. NOTES: PEPFAR= U.S. President’s Emergency Plan for AIDS Relief; UNFPA= United Nations Population Fund; USAID= U.S. Agency for International Development.

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