Trump Administration Dramatically Expands the Global Gag Rule
PAI condemns President Trump’s alarming decision to impose new restrictions on U.S. foreign aid by dramatically expanding the Global Gag Rule —a policy that endangers the health and lives of people, especially women and girls, around the world. As one of his first acts in office, the President reinstated the Global Gag Rule and changed the policy to apply to all global health funding. The policy is already unpopular with most Americans, and the newly announced expansion will be even more disruptive and deadly, adding restrictions to new funding streams, new entities, and on new issues.
“The dramatically expanded Global Gag Rule undermines decades of progress on global health, gender equality, and human rights, and cuts millions of people off from essential health care,” said Nabeeha Kazi Hutchins, President & CEO of global reproductive health non-profit, PAI. “This GGR restricts what countries and organizations can do with their own non-U.S. resources that support the health, safety and wellbeing of their own communities. The GGR is unpopular with a majority of Americans and the expanded scope furthers harm and injustice, placing the Trump Administration out of step with efforts to advance global health and stability.”
Under the dramatic expansion, all organizations accepting any form of U.S. non-military foreign aid, including U.S.-based partners, the United Nations, other multilateral entities, and even other national governments will be barred from promoting what the Administration describes as “gender ideology,” supporting “discriminatory equity ideology,” or engaging in activities it deems “unlawful diversity, equity, and inclusion”.
The United States has long been a leader in providing foreign aid, but this policy change is yet another way of dismantling that legacy and undermining global norms and human rights. Last fall, the administration rescinded nearly $8 billion in foreign aid which was destined for disease prevention, famine control, and disaster relief, including approximately $500 million for global family planning and reproductive health. To add insult to injury, the administration has threatened to burn nearly $10 million in already paid-for birth control destined for low-income countries. The enormous expansion of an already deadly policy will exacerbate existing inequalities and undo decades of global progress towards sustainable development.
PAI will continue to push Congress, funders, and courts to hold the Trump administration accountable. PAI will continually update our Global Gag Rule website to mobilize reproductive rights advocates around the world to document the consequences of the policy. We will also work alongside our 77 partners in 35 countries to document the policy’s impacts, capture affected communities’ stories, and amplify these on-the-ground voices and data showing the human cost of these restrictions. PAI will continue to deliver on its mission to keep the American people and the international community informed and updated.
PAI today announced that it has been awarded a $2 million grant from the William and Flora Hewlett Foundation in support of PAI’s Reproductive Health Advocacy Partnership (RHAP). Under the grant, PAI will build on eight years of partnership with civil society organizations in Malawi and Zambia to expand access to family planning and reproductive health services.
“We are so thankful to the Hewlett Foundation for their ongoing, trusted partnership and for recognizing that, in the face of political, social, and economic challenges, civil society is the backbone of progress and resilience,” said Nabeeha Kazi Hutchins, President and CEO of PAI. “This year, PAI marks 60 years of advancing the health, rights, and potential of women and young people worldwide. The consequential support of the Hewlett Foundation strengthens the ability of PAI and our partners to amplify evidence for policy change, build grassroots movements, drive accountability, and ensure that our voices shape a future where every woman, girl, and young person has the power and the means to thrive.”
Hewlett’s support for Malawi and Zambia recognizes urgent action to tackle the unacceptably high rate of preventable maternal deaths and unintended pregnancies among Malawian and Zambian youth, where nearly 50% and 40% of all pregnancies respectively are among adolescents. Through RHAP, local partners build coordinated advocacy strategies; hold political leadership accountable; address barriers such as contraceptive stock-outs and misinformation; and increase domestic financing for reproductive health.
“The Hewlett Foundation is proud to continue our long-standing partnership with PAI, especially as they mark 60 years of advancing global health, human rights, and gender equality,” said Janet Holt, Program Officer in Gender Equity and Governance at the Hewlett Foundation. “We remain deeply committed to supporting sexual and reproductive health, rights, and justice. Together with PAI and local organizations in Malawi and Zambia, we are elevating the leadership of civil society organizations that are driving urgent change. This renewed commitment reflects our shared belief that when local advocates—and the organizations that stand with them—have the resources, tools, and support they need, they can drive meaningful change that protects the lives and well-being of women and girls and helps build thriving families and communities where reproductive health and rights are fully realized.”
PAI gratefully acknowledges all funders and supporters of the Reproductive Health Advocacy Partnership, most notably, the Hewlett Foundation, which has supported this initiative since 2016. We also proudly recognize and thank our coalition partners for their collaboration and leadership in advancing sexual and reproductive health and rights in Malawi and Zambia: Banja La Mtsogolo, Centre for Reproductive Health and Education, Copper Rose, Marie Stopes Zambia, and Pakachere Institute of Health and Development Communication.
Click here to learn more about RHAP.
About PAI
For 60 years, PAI has championed policies that enable women and youth to exercise their sexual and reproductive health and rights and eliminate barriers to the life-saving supplies and services they need. We achieve change by strengthening civil society partners’ advocacy capacity and advancing policy, legal, and funding solutions that make sexual and reproductive health care accessible, sustainable and undeniable.
PAI today announced that it has been awarded a $2,800,000 grant by the Gates Foundation to support the “Accelerating Policy Action to Make Family Planning Possible” project. This award will ensure that family planning remains a global health priority, sustain advocacy momentum, and address systemic challenges that limit access to family planning services.
Under the grant, PAI will build on its 60 years of experience engaging in critical advocacy, investing in global partnerships, and funding changemakers to advance universal access to sexual and reproductive health and rights.
“PAI deeply appreciates the Gates Foundation’s commitment to family planning and support for the work of civil society partners as we focus on the systems that keep family planning accessible—domestic budgets, supply chains, and policies that ensure family planning is consistently available where women seek it,” said Nabeeha Kazi Hutchins, President and CEO of PAI. “Women with an intention to use modern contraception need reliable access to quality methods and accurate information, without the misinformation or service gaps that too often interrupt their choices.”
The foundation’s long-standing commitment to helping women and girls in low- and middle-income countries make informed family planning decisions and access the contraception they need continues to guide the global reproductive health community. Over the past two decades, their investments have reduced maternal mortality, advanced gender equity, supported economic growth, and accelerated progress toward the Sustainable Development Goals.
With this support, PAI will leverage new and underused pathways to equip civil society organizations with the resources, data, coordination, and access needed to respond to funding shifts, elevate emerging opportunities, and influence policy at all levels—ultimately securing sustainable financing for contraceptive supplies.
“This partnership with the Gates Foundation leverages PAI’s global network of more than 1,000 civil society organizations and coalitions, and six decades of family planning advocacy and convening experience to broaden who is at the table,” said Mustafa Kudrati, PAI’s Senior Vice President of Strategy and Growth. “By engaging our existing networks and new sectors—finance, education, agriculture, nutrition, and beyond—we expand the tent and align ambitions. When more stakeholders see themselves in this work, our collective voice grows, and so does our ability to ensure that women who intend to use modern contraception can count on systems that truly work for them.”
About PAI:
For 60 years, PAI has championed policies that enable women and youth to exercise their sexual and reproductive health and rights and eliminate barriers to the life-saving supplies and services they need. We achieve change by strengthening civil society partners’ advocacy capacity and advancing policy, legal, and funding solutions that make sexual and reproductive health care accessible, sustainable, and undeniable.
PAI Named as ‘Action for Women’s Health Awardee’ to Fight for Reproductive Health and Rights
PAI receives the largest grant amount possible from Action for Women’s Health, a $250 million global open call funded by Pivotal to improve women’s health around the world
WASHINGTON, D.C. (November 12, 2025) – PAI, a U.S.-based NGO with 60 years of leadership in global sexual and reproductive health and rights, today announced that it is a grant recipient of Action for Women’s Health. This $250 million global open call is managed by Lever for Change and funded by Pivotal. Founded by Melinda French Gates, Pivotal works to advance social progress and expand women’s power and influence in the U.S. and around the world.
Every day, almost 800 women die from preventable causes related to pregnancy and childbirth and most of these deaths occur in low- and middle-income countries. In addition, it is women and girls who experience the most severe reproductive health consequences from humanitarian crises, climate emergencies, and policy and health financing rollbacks. At such a pivotal moment for reproductive rights, this grant enables PAI to keep driving forward—to protect bodily autonomy, end preventable maternal deaths, close the gap for the 270 million women worldwide who cannot access lifesaving family planning and reproductive healthcare, and champion reproductive freedom across the globe.
“This generous grant from Action for Women’s Health comes at a sobering and urgent time for our movement,” said Nabeeha Kazi Hutchins, President & CEO of PAI. “It is a bold affirmation that reproductive freedom matters for just, equitable, and safe societies. We are deeply grateful for this support of PAI and our mission—and for the clear recognition that women’s health is not up for negotiation. This grant enables PAI to protect hard-won gains in family planning and maternal health, mobilize bold policy and financing reforms, and accelerate action so that women have the power, resources, and freedoms to make decisions about their bodies and their futures. It also helps build momentum across our movement—bringing in new champions, fueling collective action, and catalyzing the investment needed to advance reproductive freedom everywhere.”
For decades, PAI has worked alongside partners in more than 35 countries to ensure reproductive health care is accessible where women and youth live, work, and learn. Putting power directly in women’s hands strengthens their education, economic opportunities, and ability to achieve their aspirations.
This grant announcement comes on the heels of PAI’s recently launched Freedom Starts with Her campaign: a global call to defend reproductive rights everywhere and equip advocates in the United States with the tools and resources they need to fight for women and girls around the world. Together with a network of more than 1,400 civil society partners worldwide, PAI is driving local and global action toward a future where every pregnancy is wanted, every birth is safe, and every person can exercise their reproductive freedom with dignity and choice.
More information is available at: https://leverforchange.org/open-calls/action-for-womens-health.
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About PAI: PAI is a global leader in advancing sexual and reproductive health and rights, working to ensure that women, youth, and at-risk communities can make informed decisions about their bodies and futures. For 60 years, PAI has partnered with grassroots organizations, advocates, and policymakers in the United States and across more than 35 countries to expand access to family planning, maternal health care, and reproductive health services. To learn more, visit www.pai.org.
For 60 years, PAI has been at the forefront of holding the U.S. government accountable to its commitments to global health and reproductive rights. We have worked tirelessly with champions in Congress, U.S. agencies, and advocates around the world to ensure that U.S. leadership translates into real access to family planning and reproductive health services. That advocacy has enabled hundreds of millions of women to obtain contraceptives — from pills and IUDs to injectables — that safeguard their health, rights, and futures.
To witness those gains now at risk of going up in literal flames, and threatened by policies grounded in misinformation rather than evidence, underscores why PAI is deeply engaged: our mandate has always been to demand that the U.S. government and global institutions prioritize, support, and advance reproductive health, not undermine it.
We are closely tracking the conflicting information we continue to receive from multiple sources regarding the U.S. government’s potential incineration of contraceptive supplies. We remain deeply disappointed by the lack of transparency from the U.S. government, which has consistently created confusion among civil society and the general public. We hear one thing from one source and another from a different source.
Regardless, the decision to incinerate contraceptives remains appalling. These are lifesaving supplies that women and families urgently need and want. The U.S., with its long history of leadership in global health, should uphold that legacy, not destroy it. The contradictory information coming out of the administration only reinforces the urgent need for honesty and accountability in how these decisions are made.
PAI’s ability to hold the Trump administration accountable and defend reproductive freedom depends on the support of those who share our commitment. We are grateful for your continued partnership in sustaining this advocacy, and PAI will provide ongoing updates on critical developments, ensuring our community remains well-informed and equipped to raise its voice alongside us.
PAI is pleased to announce the election of Mr. Gilbert Deans to its board of directors. The board’s combined expertise and support in strategic planning, fiduciary oversight, and governance strengthens PAI’s ability to achieve its mission, vision, and goals.
“We are thrilled to have Gilbert join PAI’s board of directors and welcome his exceptional expertise and commitment to health equity, gender equality, and human rights,” said Neeraja Bhavaraju, PAI board chair. “His leadership comes at a pivotal time for our sector, as we accelerate efforts toward our mission of sexual and reproductive rights for all people.”
Mr. Deans is an accomplished financial leader with extensive experience in senior financial management roles across various organizations. He currently serves as Chief Financial Officer at NAFSA, the largest association serving international educators worldwide, where he oversees a $16 million annual operating budget and maintains an investment portfolio of $10 to $12 million.
“I’ve always believed that sound financial leadership can be a catalyst for real change,” Deans said. “I’m honored to join PAI’s board and support an organization that’s doing vital, global work to advance reproductive rights and equity. I look forward to contributing in a way that reflects my commitment to justice, partnership, and sustainable impact.”
Previously, Mr. Deans held significant positions including vice president at Hamid Foundation Inc., chief operating officer and deputy chief financial and administrative officer at Color Of Change, and director of finance and operations at Let’s Get Ready.
As PAI advances its mission to ensure universal access to sexual and reproductive health and rights, the guidance and governance of its Board of Directors are essential. PAI’s board supports the organization’s strategic vision, fiduciary oversight, and leadership that anchor impact and help position PAI as a trusted advocate, partner, and catalyst for change.
“I am honored to work with Gilbert Deans as a member of PAI’s board of directors,” said Nabeeha Kazi Hutchins, PAI’s president and CEO. “As we build on six decades of impact and chart our next chapter, his leadership will further strengthen our foundation and support our continued growth. Gilbert’s non-profit financial leadership and dedication to equity will enrich our Board’s collective strengths and help advance PAI’s urgent mission.”
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About PAI
PAI is a leading civil society advocacy organization dedicated to advancing universal access to SRHR across the globe. For nearly 60 years, PAI has served as a credible source of information, a strong ally to in-country partners, and an unrelenting advocate for improved and expanded SRHR at the national, regional, and global levels. PAI works to advance its mission by propelling evidence-informed advocacy strategies in the United States and globally and supporting in-country CSO partners across nearly 40 low- and middle-income countries to advocate for increased access to sexual and reproductive health services and expand SRHR for all.
To learn more, visit www.pai.org and follow us on LinkedIn, Instagram, and X,
PAI warmly welcomes the appointment of Diene Keita as Executive Director of the United Nations Population Fund (UNFPA). Ms. Keita is a seasoned and respected leader in international development, and a trusted partner in advancing gender equality, public health, and human rights around the world.
Throughout her career, Ms. Keita has remained steadfast in her commitment to empowering women and youth, addressing gender-based violence, and championing sexual and reproductive health and rights. Her deep expertise, diplomatic acumen, and relationships with governments and civil society position her to lead UNFPA at this pivotal time.
“Diene Keita understands that reproductive rights are the bedrock of resilient, just and prosperous societies,” said Nabeeha Kazi Hutchins, President and CEO of PAI. “Her institutional knowledge and policy leadership, and vision and courage are what the civil society partners need to advance rights and choices amid rising global threats.”
PAI looks forward to continuing its close partnership with UNFPA under Ms. Keita’s leadership to ensure that every person—no matter who they are or where they live—has access to the sexual and reproductive health information, services and rights they need to realize their full potential.
PAI is deeply alarmed by the U.S. State Department’s continued efforts under the Trump administration to minimize or eliminate reporting on reproductive rights, women’s rights, and LGBTQI rights in its annual Country Reports on Human Rights Practices.
Since the 1970s, these reports have been relied upon by Congress, diplomats, journalists, civil society, and the private sector as objective records shaping U.S. foreign policy and aid. Yet the Trump administration has once again chosen to redefine and omit key issues, denying the lived realities of people facing discrimination, violence, and systemic injustice worldwide.
This abdication of rights by the Trump Administration is not new. In 2018, Trump officials directed State Department staff to scale back reporting on reproductive rights, violence against women, and gender-based discrimination. The Biden administration restored comprehensive reporting, but today the Trump administration is escalating its ideological reframing of human rights.
The 2024 reports strip entire categories once considered standard—gender-based violence, reproductive health and rights, maternal health, access to contraception, and protections for at-risk communities.
“For decades, the State Department’s human rights reports have been a vital record shaping U.S. policy, diplomacy, and aid,” said Rachel Clement, Senior Director of U.S. Government Affairs at PAI. “In the 2024 reports we reviewed, critical sections on reproductive rights, women’s rights, and LGBTQI rights are missing. Omitting these facts denies lived realities and weakens accountability for systemic violence and discrimination. These reports are not meant to serve political expediency—they are meant to serve the truth, and the people whose rights and lives depend on it.”
Previously, the reproductive rights section documented access to family planning, contraception, maternal health care, and services for survivors of sexual violence. Erasing this information obscures global violations and weakens accountability. Policymakers and civil society rely on these reports to press for reform and safeguard rights.
PAI stands with members of Congress advancing the Reproductive Rights Are Human Rights Act (S. 2671, H.R. 4888), which would restore and protect comprehensive reproductive rights in State Department reporting. We urge lawmakers to pass this legislation and reaffirm the United States’ full commitment to human rights.
U.S. human rights reporting must remain comprehensive, consistent, and factual if it is to guide sound policy and uphold global standards. Restoring full reporting is essential to preserving the integrity of U.S. human rights leadership. Anything less weakens accountability, obscures abuses, and undermines U.S. credibility on the world stage.
On July 18, Congress passed the Rescissions Act of 2025, which cuts funding for U.S. foreign assistance, specifically targeting support for family planning and reproductive health and rights. This decision by U.S. lawmakers will have enormous and devastating consequences for women, girls, and families around the world.
For six decades, Congress has maintained bipartisan support for U.S. foreign assistance for family planning. This investment has been vital to enabling women, girls, and couples to choose whether, how, and when to have children. U.S. funding has led to demonstrable improvements in the quality of contraceptive options available and lowered costs. The decision to claw back already appropriated funds is particularly damaging, considering the proposed cuts to future funding, the decimation of U.S. foreign aid infrastructure provided through the U.S. Agency for International Development, and the firing of thousands of qualified development, diplomatic, and humanitarian experts in Washington, D.C., and around the world.
U.S. international family planning and reproductive health assistance was implemented in a variety of ways: providing birth control pills in active war zones, where pregnancy and childbirth pose significant risks; ensuring access to long-acting contraceptives for survivors of gender-based violence who cannot safely negotiate daily contraceptive use; and other programming to support a couple’s conscious decision to time the births of their children in a way that aligns with their social and economic realities. Each decision is as unique as the individual, underscoring that voluntary family planning provides not just health benefits, but also dignity, autonomy, and hope.
It is with deep disappointment and profound fear for the future of global reproductive health and rights that we watched this rescission package pass—even after members of Congress were warned by the Office of Management and Budget Director, Russell Vought, that it would eliminate $500 million in funding for international family planning assistance.
“This rescission is not just a budget decision—it is a Congressional decision that will directly lead to innumerable deaths globally,” said Nabeeha Kazi Hutchins, President and CEO of PAI. “By changing course on decades of bipartisan U.S. leadership, Congress is abandoning women, girls, and families who rely on these services to survive and thrive. Congress must reassert its constitutional authority over spending the fiscal year 2026 appropriations bill. Here at PAI, we will continue to fight for the restoration of these critical funds and stand with our global partners, who are now left to face impossible choices.”
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About PAI
PAI is a leading civil society advocacy organization dedicated to advancing universal access to SRHR across the globe. For nearly 60 years, PAI has served as a credible source of information, a strong ally to in-country partners, and an unrelenting advocate for improved and expanded SRHR at the national, regional, and global levels. PAI works to advance its mission by propelling evidence-informed advocacy strategies in the United States and globally and supporting in-country CSO partners across nearly 40 low- and middle-income countries to advocate for increased access to sexual and reproductive health services and expand SRHR for all.
To learn more, visit www.pai.org and follow us on Facebook, Twitter, Instagram, and LinkedIn.
PAI extends its deepest gratitude to Dr. Natalia Kanem for her visionary leadership as Executive Director of the United Nations Population Fund (UNFPA). Over the past eight years, Dr. Kanem has been a bold and unwavering champion for sexual and reproductive health and rights, gender equality, and the dignity of all people, particularly those who are too often pushed to the margins of society.
Her tenure was marked by steadfast commitment to advancing rights-based policies and programs, even amid growing political resistance and global crises. From fragile and humanitarian settings to global convenings, Dr. Kanem elevated the voices of women and girls and helped catalyze international action to protect and fulfill their rights.
“Natalia Kanem has led with integrity, heart, and fearless resolve,” said Nabeeha Kazi Hutchins, President and CEO of PAI. “She reminded the world that sexual and reproductive health and rights are essential, not optional. Her legacy is one of courage and meaningful partnership with civil society. We thank Dr. Kanem for her leadership and for standing up for girls and women everywhere. We will carry forward the momentum she has generated.”
As Dr. Kanem concludes her tenure, PAI remains committed to working with UNFPA and the global community to ensure that her legacy endures, and that the vision she advanced becomes reality for every person, in every community.
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About PAI
PAI is a leading civil society advocacy organization dedicated to advancing universal access to SRHR across the globe. For nearly 60 years, PAI has served as a credible source of information, a strong ally to in-country partners, and an unrelenting advocate for improved and expanded SRHR at the national, regional, and global levels. PAI works to advance its mission by propelling evidence-informed advocacy strategies in the United States and globally and supporting in-country CSO partners across nearly 40 low- and middle-income countries to advocate for increased access to sexual and reproductive health services and expand SRHR for all.
To learn more, visit www.pai.org and follow us on Facebook, Twitter, Instagram, and LinkedIn.
Chairman Graham, Ranking Member Schatz, and distinguished Members of the Committee, thank you for the opportunity to submit testimony on the importance of international family planning and reproductive health.
Support for international family planning and reproductive health has historically been a point of bipartisan agreement—anchored in shared values of human dignity, smart investment, and global stability. From the earliest days of the U.S. Foreign Assistance Act in 1961 through to recent decades, lawmakers from both parties have understood that empowering women and couples to make voluntary and informed decisions about their reproductive lives leads to healthier societies and more stable communities. Republican and Democratic administrations alike have supported these programs—not only because they save lives, but because they reflect the best of American leadership and moral responsibility.
In fact, key policy and funding advances—including the establishment of USAID’s Office of Population, early U.S. leadership at UNFPA, and the forging of public-private partnerships to expand contraceptive access—were often driven by bipartisan coalitions committed to evidence-based policymaking and effective development. This legacy is worth upholding. When we invest in international family planning, we are not just protecting lives—we are preserving a tradition of principled, pragmatic leadership that has long defined the United States’ role on the world stage.
I want to emphasize that family planning and reproductive health are lifesaving activities that must been included in fiscal year 2026 (FY26) appropriations. Not only do these investments save lives, but they also align to the values and priorities of the majority of American people who desire that reproductive freedom be respected.[1] In addition, failing to invest in reproductive health and family planning is a poor use of U.S. taxpayer dollars. For every $1 spent on family planning, between $4 to $8 are gained in returns to health systems and communities.[2], [3]
Specifically, I write to recommend that in FY26 appropriations, you: 1) preserve statutory language and funding for bilateral and multilateral FP/RH; 2) permanently repeal the deadly Mexico City Policy, or Global Gag Rule, that infringes on the rights of individuals and organizations abroad, and; 3) reinstate funding for UNFPA and modify the Kemp-Kasten determination to accurately reflect the status of the agency’s operations and prevent reproductive coercion in all forms.
For sixty years—nearly as long as the U.S. Foreign Assistance Act has been guiding foreign aid[4]—PAI has been motivated by one powerful truth: when women and girls are able to engage in their communities, access quality education and safe economic opportunities, and choose if, when, and how many children to have they can transform whole societies. This belief is reaffirmed through our work with thousands of advocates around the world who work at the local and national level to address the needs in their communities and advance health and human rights in their own countries.
For decades, the United States has led the world in life-saving development and humanitarian aid, saving millions of lives and improving the conditions for countless individuals in low- and middle-income countries. Our foreign aid work is a key reason for the 40% reduction in maternal mortality between 2000-2023[5] and a 39% decrease in new HIV infections from 2010-2023[6]. Our work has also contributed to a stunning 59% decrease in the global mortality rate of children under the age of five.[7]
Without sustained investments, however, the number of women and children who die of preventable causes will increase. In fact, estimates show that proposed cuts to PEPFAR will make nearly three million children orphans,[8] which will have tremendous impacts on the health and stability of communities and nations, as well as those individual children. An estimated 287,000 women die each year from pregnancy and childbirth; that figure will worsen with cuts to U.S. family planning foreign assistance.
While reforms are always possible, the FY26 budget proposal and recent rescissions package do not represent thoughtful improvements, but rather a sweeping rollback of effective, life-affirming programs and a dangerous erosion of American leadership. Congress must reassert its constitutional authority to ensure that appropriated funds for international family planning and reproductive health are fully and swiftly obligated, preserving the impact and integrity of U.S. foreign assistance.
Access to comprehensive reproductive health care—including a full range of contraceptive options and accurate, evidence-based information—is foundational to improving maternal and child health, preventing unintended pregnancies and unsafe abortions, reducing HIV transmission, advancing gender equality, and fostering more stable and resilient communities. These needs are even more acute in the face of escalating humanitarian crises in places like Afghanistan, Gaza, Sudan, Ukraine, and Yemen, where uninterrupted access to sexual and reproductive health services, including care for survivors of gender-based violence, can be lifesaving. Decades of global health and development experience have shown that siloed efforts fail—and that a whole-of-government approach is essential to delivering results and ensuring efficient use of U.S. taxpayer dollars.
The abrupt dismantling of foreign assistance programs has put at risk decades of progress in human capital, goodwill towards the United States, and the rights of millions of women, girls LGBTQ+, and other marginalized communities. The decision by this government, as evidenced by Secretary Rubio’s testimony during a House Appropriations hearing on the FY26 budget that Congressionally appropriated funding with decades of bipartisan support for international family planning and reproductive health is no longer being implemented as Congress intended. In fact, he said: “there is no plan to spend that money. We are not going to be in that business globally. I mean we don’t, we’re not going to do it.”[9]
The U.S. contributed about 40% of funding from all governments in 2023,[10] funding that was distributed to over 30 low- and middle-income countries primarily through the State Department’s Bureau of Population, Refugees, and Migration, and USAID’s Office of Population and Reproductive Health. In 2023 alone, this meant that 17.1 million unintended pregnancies and 5.2 million unsafe abortions were averted, and approximately 34,000 women did not die of preventable maternal deaths.[11]
The stories I hear from current and former PAI partners who have lost funding from the U.S. government are as unique as the individuals who receive care and services as a result of U.S. government funding. For some, this has meant that they will need to shut down, leaving their communities without access to family planning and maternal health services. For others, it means that they can no longer provide health services in rural communities, or to women and girls affected by violence and harm, as they have to scale back and make cuts.
The President’s proposed budget eliminates support for family planning in its entirety and moves away from the prevention and response to HIV to simply responding. This is not only more costly—when you fail to prevent HIV you have more cases of HIV, and the spread of infections around the world and here at home it is more likely—but also denies millions of people the dignity and right to protect themselves.
We have overwhelming evidence that many women and girls are denied their fundamental rights to safety and autonomy—reflected in the alarming rise of gender-based violence and the growing prevalence of child marriage around the world. Too often, women and girls lack the power to decide if, when, or whom to marry, or to make informed choices about their own bodies. Investing in long-term HIV prevention not only lowers future health care costs—it also affirms the dignity and agency of those who are too often denied a say in their own well-being.
I recognize that Congress has many difficult decisions to make about this bill. Therefore, I strongly recommend that FY26 appropriations make a strong investment in international family planning and reproductive health programs, support the role of UNFPA, and permanently repeal harmful and politicized executive actions like the global gag rule. Specifically:
Strategic Recommendations for the US Department of State:
- Fund international family planning and reproductive health programs at no less than $862 million, including $788 million for bilateral family planning and $74 million for the United Nations Population Fund (UNFPA)
- Permanently repeal the Global Gag Rule. For over 40 years, the Global Gag Rule has negatively impacted the health and lives of communities worldwide, particularly women, girls, and at-risk individuals. The harmful policy forces foreign NGOs to choose between providing comprehensive sexual and reproductive health services, information, referrals, and advocacy or remaining eligible to receive U.S. global health funds. A permanent repeal would ensure that foreign nongovernmental organizations are treated fairly and afforded the ability to engage in permissible advocacy and lobbying activities on abortion with non-U.S. funding.
- Update Kemp-Kasten amendment to address all forms of reproductive coercion and delete the requirement for presidential determination, including but not limited to coercive abortion, involuntary sterilization, or forced pregnancy.
Thank you for considering these recommendations. Investments in international family planning and reproductive health improve the lives of people around the world and here at home, while simultaneously supporting economic development and global stability.
Sincerely,
Nabeeha Kazi Hutchins
President and CEO
PAI
[1] Pew Research Center. (2025). Public opinion on abortion. [Fact sheet]. https://www.pewresearch.org/religion/fact-sheet/public-opinion-on-abortion/
[2] Starbird, E., Norton, M., & Marcus, R. (2016). Investing in family planning: Key to achieving the sustainable development goals. Global Health: Science and Practice, 4(2), 191–210. https://doi.org/10.9745/GHSP-D-15-00374.
[3] United Nations Population Fund (2022). Investing in three transformative results: Realizing powerful returns. https://www.unfpa.org/publications/investing-three-transformative-results-realizing-powerful-returns
[4] Foreign Assistance Act of 1961, Pub. L. No. 87-195, 75 Stat. 424 (1961).
[5] World Health Organization. (2025) Trends in maternal mortality estimates 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division.
[6] World Health Organization. (2023). Epidemiological fact sheet: HIV statistics, globally and by WHO region, 2023 [Fact sheet]. https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/j0294-who-hiv-epi-factsheet-v7.pdf
[7] World Health Organization. (2022). Child mortality under 5 years [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/child-mortality-under-5-years
[8] Cluver, Lucie et al. (2025). Protecting Africa’s children from extreme risk: a runway of sustainability for PEPFAR programs.
The Lancet, 405(10490), 1700 – 1712. https://doi.org/10.1016/S0140-6736(25)00401-5
[9] Budget Hearing – Department of State and Related Programs: Hearing before the U.S. House Committee on Appropriations, 119th Cong. (2025). https://appropriations.house.gov/schedule/hearings/budget-hearing-department-state-and-related-programs
[10] Oum, S., Wexler, A., and Kates, J. (2025, May 15). 10 Things to Know about US Funding for Global Health. Kaiser Family Foundation. https://www.kff.org/global-health-policy/issue-brief/10-things-to-know-about-u-s-funding-for-global-health
[11] Sully, E.A., Owolabi, O., and Rosenberg, J.D. (2025, January). Family Planning Impact of the Trump Foreign Assistance Freeze. Guttmacher Institute. https://www.guttmacher.org/2025/01/family-planning-impact-trump-foreign-assistance-freeze
*The text provided on this page and accompanying file have been slightly modified from the written testimony provided to the U.S. Senate Committee on Appropriations Subcommittee on State, Foreign Operations, and Related Programs.
As world leaders convene in Seville, Spain, for the 4th International Conference on Financing for Development (FfD4), PAI and our partners join global civil society in calling for transformative, inclusive, and accountable financing that centers people, equity, and rights. With over 60 years of leadership advancing sexual and reproductive health and rights (SRHR), PAI is engaging in the Civil Society and Feminist Forums, as well as official proceedings, to push for a financing agenda that removes systemic barriers and enables countries to sustainably fund their development priorities.
“We are in Seville to make it clear: sustainable development will not be achieved without bold investment in sexual and reproductive health and rights—and a financing architecture that no longer forces governments to trade off what is essential to the health and wellbeing of their people in order to meet the demands of the global financial system,” said Nabeeha Kazi Hutchins, PAI President and CEO. “We are standing with partners across the world to ensure that women, girls, and historically excluded communities are not afterthoughts in global financing—they are the starting point.”
On June 24, the United States chose to walk away from deliberations and the approval of the FfD4 outcome document, known as Compromiso de Sevilla (Sevilla Commitment), which will be formally adopted during FfD4. The U.S. cited concerns related to global financial governance, trade and taxation, UN authority, and provisions related to gender. Regardless of the rationale, the result is the same: the U.S. stepped away from a process designed to support those most harmed by current financing inequities—especially women and girls.
In contrast, more than 190 countries remained committed and approved the outcome document. At a moment when international cooperation is urgently needed, the U.S. chose disengagement over collaboration.
While the outcome document includes commitments to debt relief, domestic resource mobilization, gender equality, and climate financing—it leaves many root causes of inequality and exclusion unaddressed. This is a vital moment for national leaders, donors, and civil society to ensure that structural barriers and bold reforms remain front and center beyond Seville.
PAI is also participating in the Feminist Forum and the Civil Society Forum to help shape a shared vision for equitable, inclusive, and accountable financing.
PAI and its partners will continue to advocate for long-term, sustainable financing for SRHR. This includes access to family planning and contraception, maternal, newborn, and child health, adolescent-responsive services, and action to end violence against women and girls. These are among the most cost-effective and transformative investments governments and donors can make.
For example, every $1 invested in family planning yields up to $8 in savings. Investments to end violence against women and girls can return up to $10 for every $1 spent, while such violence costs some countries up to 3.7% of GDP. These interventions reduce poverty, improve health and education outcomes, and help build more resilient and equitable societies.
“If you are financing climate, education, or economic growth but failing to invest in SRHR, you’re limiting your impact,” said Mustafa Kudrati, Senior Vice President for Program Strategy and Growth at PAI. “SRHR is not a silo—it’s the foundation that allows every other investment to succeed.”
To advance this vision, PAI supports a reformed global financing framework that must:
- Enable low- and middle-income countries to escape financing constraints and reinvest in public goods;
- Support stronger domestic resource mobilization for essential services, including SRHR;
- Hold donor governments accountable to their official development assistance commitments—especially for health, gender equality, and the rights of women and girls;
- Prioritize the role of civil society to inform, shape, and monitor investments in health and development.
PAI remains committed to working with governments, financial institutions, and communities to move from promises to progress. Investing in SRHR is investing in dignity, health, resilience, and opportunity—for everyone, everywhere.
During FfD4, Nabeeha Kazi Hutchins will deliver remarks during a parliamentary convening hosted by the European Parliamentary Forum on the first 180 days of the Trump Administration’s impact on global health and development. She will also deliver opening remarks at a high-level event hosted by the United Nations Spotlight Initiative, in partnership with UNFPA, UN Women, IOM, the Spotlight Initiative’s Global Civil Society Reference Group, and the International Olympic Committee, among others.
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About PAI
PAI is a leading civil society advocacy organization dedicated to advancing universal access to SRHR across the globe. For nearly 60 years, PAI has served as a credible source of information, a strong ally to in-country partners, and an unrelenting advocate for improved and expanded SRHR at the national, regional, and global levels. PAI works to advance its mission by propelling evidence-informed advocacy strategies in the United States and globally and supporting in-country CSO partners across nearly 40 low- and middle-income countries to advocate for increased access to sexual and reproductive health services and expand SRHR for all.
To learn more, visit www.pai.org and follow us on Facebook, Twitter, Instagram, and LinkedIn.