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| I. Letter from PAI
PAI 2016 ANNUAL REPORT
We will win.
Just three days after taking office, the Trump-Pence administration imposed an expanded Global Gag Rule, ushering in a new era of attacks on women’s rights.
Trump’s Global Gag Rule is just one of many recklessly enacted, expansive and damaging policies that ignore the facts, deny the evidence and infringe upon basic freedoms—including women’s reproductive rights. Yet, in the face of these challenges, we have also seen something incredible: a rising tide of opposition with courageous acts of resistance and outspoken advocates refusing to let these attacks continue.
This is a global movement for women.
A movement that has existed for decades, but is now stronger, more diverse and resolute in its defense of women’s rights.
PAI is part of this movement.
We marched with hundreds of thousands in the unprecedented Women’s March on Washington. We watch as communities big and small mobilize on every continent in daily acts of bravery and humanity. We witness protests at the White House, blocks from PAI’s offices, and hear the repeated refrains: Stand up. Fight back. Resist.
At PAI, that is exactly what we are doing: standing up, fighting back and resisting.
For decades, PAI has shown up, standing for and with women and girls to ensure they have access to the reproductive health care they need. And now, we are leading the call to resist President Trump’s attacks on global reproductive rights—on global human rights.
In the past year, we partnered with nearly 200 organizations in the United States and around the world to advocate for better policies and critical funding for reproductive health. Our international partners are some of the strongest champions for women’s reproductive rights in their respective countries, and we are proud to call them our colleagues and to support their work as they prepare for the fights we face now and in the future.
We have laid the groundwork for continued resistance. Our prescient and bold leadership has prepared us for this moment.
In short, we are ready.
We are ready to keep fighting and to keep standing up for women’s reproductive rights. We do this work together as part of a vocal and committed global movement. Together, we are stronger. Together, we will not stop. Because together:
We are ready. We will win.
President & CEO
This is Our Fight.
Small victories. Huge gains. PAI shows up to win. Even in the face of the biggest challenges, we have achieved incredible successes and championed policies to expand reproductive rights for women across the globe. And right now, we are confronting some of our greatest challenges yet.
Under the Trump-Pence administration, women’s rights are under attack.
We are ready.
Reproductive health and family planning services in communities around the world are facing damaging restrictions and drastic funding cuts thanks to policies put forth by the Trump-Pence administration and a consolidated conservative Congress. Trump’s expanded Global Gag Rule, combined with extensive cuts in U.S. foreign assistance funding, will cause extreme harm to women and girls in the global South. Not only will access to abortion information and services be restricted, so too will access to basic reproductive health services and supplies—like contraceptives—that reduce unplanned pregnancies and save women’s lives. In some cases, health clinics will be forced to shut their doors completely, cutting off what is often the only source of healthcare for entire communities.
The Trump-Pence administration’s attempts to roll back women’s reproductive freedoms are far-reaching and unprecedented. What we’ve seen is only the beginning. These attacks will surely continue for the entirety of the Trump-Pence administration. But PAI is ready.
We are part of a global movement of reproductive rights champions that is standing up in opposition to attacks on women and girls everywhere. Everything we have done in our more-than-50-year history has prepared us for this moment.
How we win.
At PAI, we believe that all women and girls, no matter where they live, should have access to high-quality, effective and affordable family planning and reproductive health services.
PAI challenges the U.S. government to advance global reproductive rights and we support our partners overseas to do the same, whether with local elected officials in the Philippines, national members of Parliament in Zambia or community-based religious leaders in Benin.
What PAI does in the U.S. is exactly what we support our partners to do in their own countries: lead the fight for better policies and critical funding for international reproductive health.
PAI’s complementary efforts at home and abroad are effective because of their strong foundation—a sound evidence base produced by PAI’s expert research and analysis.
We know that real facts and data provide the best base of support for any policy solution. PAI provides expert research and analysis to help advocates and champions better understand reproductive health policies and their implications. Our reports, publications and newsletters help make the case for defending reproductive rights worldwide.
This two-pronged approach—leading the fight for better policies and critical funding, and producing expert research and analysis—supports the global movement to protect and advance women’s reproductive rights.
It is how PAI wins.
Better Policies and Critical Funding for Reproductive Health.
Better policies and critical funding are key to ensuring women’s access to comprehensive reproductive health services. That’s why PAI’s leadership for policy change is one of the most effective strategies for securing women’s reproductive rights.
Fighting for better policies.
In the U.S., we have spent decades advocating for more progressive international reproductive and sexual health policies. We have strengthened support for global reproductive rights on Capitol Hill by working with champions like Senator Jeanne Shaheen (D-NH) and Representative Nita Lowey (D-NY). Last year, we helped pave the way for the introduction of the Global Health, Empowerment and Rights (HER) Act in both chambers of Congress. Introduced by Senator Shaheen and Representative Lowey in early 2017, the Global HER Act would repeal the Global Gag Rule once and for all and show the Trump-Pence administration that we will not tolerate attacks on women’s reproductive rights.
Our policy efforts in the U.S. are made stronger by the work of our advocacy partners overseas. From Colombia to India, we empower our partners to lead the fight for reproductive rights in their own countries.
In 2016, we were proud to support the work of STOP-SIDA, PAI’s partner in Mauritania. With a grant from PAI, STOP-SIDA successfully advocated for the passage of Mauritania’s first-ever national reproductive health law. Approved by the Mauritanian Parliament in January 2017, it states that the right to reproductive health is universally guaranteed throughout the course of citizens' lives.
National policy successes like STOP-SIDA’s complement advancements we have seen in local communities. For the past two years, we have worked with religious institutions and leaders in sub-Saharan Africa to support family planning in their communities and congregations. One of our partners in Kenya, the Kenya Muslim Youth Development Organization, published a groundbreaking Muslim guide to family planning last year that is already being used by community health workers, in local clinics and in one major hospital in predominantly Muslim communities.
Use your voice
"For me, PAI is more than just a partner. I always encourage people to be open to learning. So they really add value a lot, and we cannot work alone. PAI is part of the global family...they also keep lifting us up, and continue lifting us up with other partners with whom we can work."
Fadhili Msuri, CEO, Kenya Muslim Youth Development Organization
Mobilizing critical funding.
Without adequate funding, health clinics around the world are unable to provide even the most basic reproductive health services and supplies, like contraceptives.
The Trump-Pence administration has proposed a 30 percent cut across all foreign assistance programs for fiscal year 2018 and has already zeroed out funding for UNFPA, putting women’s health and lives in jeopardy. But our longstanding experience advocating on Capitol Hill has prepared us for these challenges and we will persist in calling on policymakers to stand against President Trump and protect U.S. funding for women’s reproductive rights.
Our partners overseas also work tirelessly to mobilize critical financial resources for reproductive health in their own countries.
Partners like Impact Health Organization in South Sudan who, with a $24,000 seven-month grant from PAI, secured the first-ever family planning budget line in Imotong State on the southwestern border of the country.
Trump’s Global Gag Rule Dramatically Expands Harmful Health Impacts
After millions of women around the world rallied on January 21st in opposition to anti-woman policies, yesterday, President Trump wasted no time in imposing the Global Gag Rule via memorandum. Trump’s Global Gag Rule dramatically expands the scope of the policy to all “global health assistance furnished by all department or agencies”—not just family planning assistance.
The presidential memorandum signed by President Trump entitled “Presidential Memorandum Regarding the Mexico City Policy” mandates four actions:
- Revokes President Obama’s 2009 memorandum rescinding the Global Gag Rule (GGR) in force during the Bush administration (2001-2008);
- Reinstates the Bush presidential memorandum of January 22, 2001 reimposing the GGR, including the Standard Provision that U.S. and foreign NGOs were required to include and certify in their grants and cooperative agreements;
- Directs the Secretary of State, in coordination with the Secretary of Health and Human Services, “to implement a plan to extend the requirements of the reinstated Memorandum to global health assistance furnished by all departments and agencies”; and
- Directs the Secretary of State to implement the so-called Kemp-Kasten restriction on coercive abortion and involuntary sterilization.
By expanding the application of the Global Gag Rule (GGR) to all global health assistance provided across the entire U.S. government, the GGR will apply to assistance provided by USAID, the Department of State, and the Department of Health and Human Services (principally the National Institutes of Health and the Centers for Disease Control and Prevention). Foreign NGOs receiving U.S. government health assistance for family planning, maternal and child health, nutrition, HIV/AIDS (including PEPFAR), infectious diseases, malaria, tuberculosis, and neglected tropical diseases, will now be required to certify that the organization does not provide abortion services, counsel or refer for abortion, or advocate for the liberalization of abortion laws with non-U.S. funds as a condition of receiving assistance from the U.S. government.
U.S. NGOs will continue to remain eligible for global health assistance from the U.S. government—even if the U.S. NGO engages in abortion-related activities, as long as supported with private, non-U.S. funds—but U.S. NGOs will have to enforce the expanded GGR eligibility condition on their foreign NGO partners.
In monetary terms, the expansion of the coverage of Trump’s Global Gag Rule means that more than 16 times the amount of funding may be impacted than if GGR was applied only to bilateral family planning assistance—$575 million for family planning versus a total of at least $9.5 billion for global health assistance, government-wide.
FY 2016 Consolidated Appropriations Act—P.L. 114-113 (in thousands)
*To be determined if GGR restrictions apply
Source: Kaiser Family Foundation, Budget Tracker
Because of the reinstatement of the 2001 standard provision, it would also seem that Trump’s Global Gag Rule should not be applied until a foreign NGO faces a new funding action. According to the accompanying cover memo, “these paragraphs are to be included in the Standard Provision when any existing grant or cooperative agreement for family planning activities is amended to add new funding.”
Based on the fact that the Trump presidential memorandum specifically reinstates the 2001 policy but not a subsequent 2003 Bush memorandum that applied the GGR to State Department “voluntary population planning” activities, the expanded 2017 GGR may theoretically not affect funding for health programs provided in humanitarian settings by the State Department Bureau of Population, Refugees, and Migration and the USAID Office of Foreign Disaster Assistance, funded by humanitarian and disaster assistance accounts.
But the magnitude of the impact on global health programs of the expanded Trump Global Gag Rule is wholly dependent on the implementation of “the plan” to be developed in the coming days by the Secretary of State and HHS Secretary and how the scope of U.S. government “global health assistance” is defined. All U.S. recipients of global health assistance need to begin to assess and attempt to understand the potentially massive implications for their critically-needed health activities in the field and for their valued overseas partners in Africa, Asia, and Latin America.
July 11, 2016
While Supplies Last: Time for Countries to Invest More in Contraceptives
We are marking the midpoint of the FP2020 initiative by reflecting on the current status of funding for contraceptives in sub-Saharan Africa, and what is needed to ensure contraceptive commodity security into the future.
Availability of family planning supplies relies largely on funding from donor countries. However, growth in donor funding could be very volatile into the near future, and is not sustainable into the long term. The United States is preparing for an election year, and therefore is unlikely to increase its funding. The European Union (EU) is in the midst of an immigration crisis, again pointing to flat or declining funding for family planning. As one of the largest donors to family planning, Britain’s exit from the EU has eroded the value of its currency and undermined its legitimacy as a champion for sexual and reproductive health and rights in the EU. UNFPA is currently facing a nearly 40% funding gap of its supplies program. All of these factors come together to signal a looming crisis in donor funding for contraceptives.
July 14, 2016
Towards A Common Framework for Measuring Government Spending on Family Planning
Governments in the global South are in a position to generate significant additional domestic public resources for funding family planning. However, budgets for family planning in many countries still remain far below what is actually required to meet needs. Looming shortfalls in funding for UNFPA, one of the biggest providers of contraceptives globally, and other donor cuts are threatening to undermine tenuous contraceptive security gains that have been achieved. Creative and new approaches to mobilizing government funds for family planning are needed to realize the Sustainable Development Goals (SDGs), which promise to ensure universal access to reproductive and health care services by 2030.
PAI convened CSO budget advocacy experts from Kenya, Malawi, Tanzania, Uganda, and Zambia in South Africa in March, 2016 with the ultimate goal of stimulating sustained domestic resource mobilization for family planning.1 The objectives of the convening were to: (1) develop an understanding of common trends in the availability and quality of data to monitor domestic resources for family planning in the region; and (2) build a framework for measuring government spending across countries. This report shares the outcomes of that meeting, and identifies the next steps.
Expert Research and Analysis.
Facts matter—especially for the women around the world whose health and lives are put at risk by policies that limit their access to comprehensive reproductive health information and services.
Making the case.
In 2016, we released dozens of data-driven publications, like PAI’s highly regarded Washington Memo, that provide timely, in-depth coverage of U.S. government developments for donors, partners and the public. Most importantly, we equipped our champions on Capitol Hill with analysis, messaging and data to bolster their defense of funding for international family planning in the Congressional appropriations and budget process.
PAI also produced research reports and graphic analyses underscoring the urgent need for countries to invest more of their own money in contraceptives. Our compelling infographic While Supplies Last: Time for Countries to Invest More in Contraceptives, presented the facts about the dangers of a UNFPA funding shortfall and the possibility of a contraceptive crisis. This analysis, coupled with our report Towards a Common Framework for Government Spending on Family Planning, made the case for national governments to prioritize funding their own reproductive health programs.
PAI’s longstanding position, that countries must mobilize their own resources to become less reliant on external donor funding, continues to be critical, especially now that funding cuts to UNFPA and other family planning assistance mechanisms are no longer a threat, but a reality. We remain focused on providing data that shows the value and cost-effectiveness of investments to fulfill the global need for family planning, as well as the substantial human impact of cuts to U.S. global health and foreign assistance.
Out in front.
When President Trump imposed his version of the Global Gag Rule, PAI was the first to break the story of the policy’s expansion to all global health assistance funding, not just family planning. Thanks to our early and real-time analysis and documentation, PAI became the primary source for accurate, accessible information. We sounded the alarm for journalists, partners and elected officials in the U.S. and abroad, helping them understand the policy’s far-reaching and damaging effects. PAI’s media presence in the first months of the Trump-Pence administration allowed us to also inform the general public, including our donors and community, about the devastating effects of Trump’s Global Gag Rule.
Use your voice
"We’re telling organizations that they can’t use their own money to advocate for supportive and more liberalized [reproductive health] policies. This is an incredible overreach on the part of the U.S. government."
Jonathan Rucks, PAI Director of Advocacy on Trump's Global Gag Rule, NBC News, January 27, 2017
Together, we will win.
PAI is ready to defend women’s reproductive rights around the world against the unprecedented attacks we are facing. These attacks are sure to continue, but PAI will be there, just as we have been for more than 50 years. And we do not do this work alone.
A global movement for women.
The movement for reproductive rights—for women’s rights, for human rights—is a global one.
We stand shoulder to shoulder with other advocates and citizens ready to fight back against assaults on women’s reproductive freedom. We work in solidarity with activists and organizers around the world to defend women’s basic human rights.
We will continue to urge global leaders and donors to provide the critical funding that is needed to make sure women have life-saving reproductive health services and supplies.
We will monitor and document the Global Gag Rule’s devastating consequences for communities and health systems to bolster our call on Capitol Hill for a permanent, legislative repeal. And we will help health clinics keep their doors open by making sure they have accurate information about what they can and cannot do under the Global Gag Rule’s restrictions.
The movement for reproductive rights—for women’s rights, for human rights—is a global one.
We will continue to stand with our network of local partners in the global South, providing the financial and technical resources they need to remain leaders for policy change in their own countries. We will work to mitigate the impact of funding cuts and harmful U.S. policies by helping local advocates liberalize their own reproductive health laws and policies and increase government investments in family planning.
Use your voice
“PAI is bold and pioneering. It has done, and continues to do, things long before they are fashionable. A gift to PAI will help ensure that we do not lose the hard-fought gains we’ve had in reproductive rights.”
Dr. Pouru Bhiwandi, Board Member, PAI
We will not stop.
Working in the U.S. and with our partners abroad, PAI remains motivated and inspired by the millions of activists, organizers and advocates who stand with us as part of the global movement for women’s reproductive rights.
We work alongside the hundreds of people who have supported PAI for decades and those who have joined our fight for women’s reproductive rights more recently. We are proud to stand with you and will continue to provide the information and tools you need to advance our fight together.
We face enormous challenges, but we know that together we will not be deterred. Our movement is strong and committed, and we will not waver in our defense of women’s reproductive rights.
Not now, not ever.
As part of the global movement for women, we know that together, we will win.
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