PAI Provides Public Witness Testimony for the U.S. Senate Committee on Appropriations

Testimony of Nabeeha Kazi Hutchins
President and CEO of PAI
Prepared for the U.S. Senate Committee on Appropriations Subcommittee on State, Foreign Operations, and Related Programs;
FY 2027 Public Witness Testimony for the Record

June 30, 2026

Chairman Graham, Ranking Member Schatz and distinguished Members of the Committee, thank you for the opportunity to share my testimony on the importance of international family planning and reproductive health (FP/RH) in fiscal year (FY) 2027.

As you consider the budget for FY 2027, I know there will be many asks of a constrained budget, but perhaps none more foundational than a request to reaffirm evidence-based policy commitments. The ability to choose if, when, and how many children to safely have, and to be informed and empowered even in conflict and crises settings has long been a bipartisan priority. Given Secretary Rubio’s recent congressional testimony on the FY27 budget, and his statement that the U.S. will no longer fund overseas FP/RH assistance, strong oversight and urgent accountability are also of critical importance.

As the committee reaffirmed in FY 2026, international FP/RH is a smart fiscal investment. These investments prevent unintended pregnancies, reduce maternal and child mortality, curb the spread of HIV, and support women and girls in exercising their fundamental rights. For every dollar invested, up to eight dollars are saved in downstream health and development costs.^[1],[2] 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 supported. Therefore, we respectfully recommend that the committee: 1) fund international FP/RH programs at no less than $2.11 billion; 2) include statutory language in the bill text to ensure that appropriated funds are fully and faithfully spent for the purposes Congress intended; 3) block implementation of the Global Gag Rule and any attempt at codification; and 4) reinstate funding for UNFPA and modify the Kemp-Kasten determination to accurately reflect reality.

During a House Appropriations hearing on FY27, Secretary Rubio was asked about the status of over $8 million dollars’ worth of birth control purchased with U.S. taxpayer dollars in alignment with congressional appropriations. It has been reported that multiple organizations have offered to pay the U.S. for these supplies, but that the administration intends to either destroy the supplies or store them indefinitely. Secretary Rubio said: “The United States is not going to fund this internationally. It’s as simple as that. That’s what’s happening…The government of the United States is not going to be involved in distributing contraceptives and all these other things around the world.”^[3] This statement directly contradicts appropriations law and ignores a tradition of bipartisan support for international family planning and reproductive health. In fact, for more than six decades, support for international FP/RH has reflected the best of American leadership, rooted in bipartisan commitment, data-driven policy, and a shared belief in human dignity.

Across administrations and political divides, these investments have saved lives, strengthened communities, and advanced global stability. They are among the most effective and evidence-based investments the United States has made abroad, delivering measurable returns for communities while advancing our national interests. In fact, U.S. foreign aid investments in family planning and maternal health have directly enabled a 40% reduction in maternal mortality globally between 2000-2023^[4] and a 39% decrease in new HIV infections from 2010-2023.^[5] Our nation has also contributed to a stunning 59% decrease in the global mortality rate of children under the age of five.^[6] Without sustained U.S. investment, more women will die from preventable causes, more children will be born into fragile conditions, and more communities will face instability. In FY 2024 alone, spending $607.5 million appropriated for FP/RH internationally 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.^[7]

Today, that legacy is at risk. The dismantling of America’s foreign assistance infrastructure, the expanded Global Gag Rule (also known as the  Promoting Human Flourishing in Foreign Assistance Policy), Secretary Rubio’s statement that FP/RH funding won’t be programmed, rescissions of $500 million in FY 2025 funding appropriated by Congress for bilateral FP/RH programs, erasing family planning in the America First Global Health Strategy and subsequent bilateral global health agreements, the aforementioned withholding and imminent destruction of $8 million in taxpayer-funded birth control products, and the lack of transparency from the State Department on their FY 2026 spending plans undermine decades of progress. A failure to include robust funding and oversight for family planning in foreign assistance would weaken global health systems, undermine sustainable development, and abandon the very principles that have long defined U.S. leadership.

Access to comprehensive reproductive health care—including a full range of modern contraceptive options and rigorously validated, data-informed research endorsed by leading global health and medical institutions — 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. Strong congressional support for these life-saving and transformative programs is more important than ever. With that in mind, I would like to encourage you to implement the following strategic recommendations for the U.S. Department of State:

• Fund international FP/RH programs at no less than $2.11 billion, including $1.96 billion in bilateral international FP/RH funding (Global Health Programs account) and $145 million as a voluntary contribution to the United Nations Population Fund (UNFPA) from the International Organizations and Programs (IO&P) account.^[8]
• Ensure that appropriated funds are fully and faithfully spent for the purposes for which Congress intended: In the strongest terms, Congress must ensure that spending on international aid is transparent, evidence-based, and prioritizes impact. Congress has the power to conduct oversight, ensure that required reports on spending are timely and publicly available, and prevent the unlawful destruction of taxpayer-funded commodities.
• Block implementation of the Global Gag Rule and any attempt at codification. The dramatic expansion of this already deadly policy to new issues, new funding, and new entities will have devastating impacts on individuals, communities, and systems. Add statutory language to prohibit the use of any congressionally appropriated funds by the State Department to implement the three rules.
• Update the Kemp-Kasten amendment. Reinstate funding for UNFPA and modify the Kemp-Kasten determination to accurately reflect the status of the agency’s operations and broaden the prohibition to prevent reproductive coercion in all forms, including but not limited to coercive abortion, involuntary sterilization, or forced pregnancy. Remove the requirement for presidential determination.

Thank you for considering these recommendations. Congress must act to preserve and restore these lifesaving investments and reassert its authority to ensure that appropriated funds are spent for the purposes Congress intended.

Sincerely,

Nabeeha Kazi Hutchins
President and CEO
PAI

[1] 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.

[2] 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

[3] Hagan, R. (2026, June 9). Trump administration refuses to distribute up to $10m in contraceptives bought as aid: “It’s as simple as that.” The Independent. https://www.independent.co.uk/news/world/americas/us-politics/trump-contraception-congress-us-aid-rubio-b2992534.html

[4] World Health Organization. (2025) Trends in maternal mortality estimates 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division.

[5] World Health Organization (WHO). (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

[6] 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

[7] Guttmacher (2025). Just the Numbers. https://www.guttmacher.org/2025/02/just-numbers-impact-us-international-family-planning-assistance-2024

[8] PAI. (2026) Just the Math. https://pai.org/resources/just-the-math/