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Once Upon a Time: The History of Republican Support for International Family Planning and Contraception

Washington Memo Craig Lasher, Senior Fellow

This edition of the Washington Memo is a deviation from our usual practice of providing an analysis of current events. Instead, it provides a perspective on the history of the evolution of Republican support of U.S. involvement in international family planning and reproductive health and a governmental role in providing contraceptives, a history long forgotten — or never fully known — by many in and outside of the United States.

The analysis is divided into three sections: the first two focus on the actions of Republican presidents while in office and the third on the decline in Republican support in Congress for international family planning and reproductive health funding and policy.

Republican Presidents on Birth Control: Eisenhower to Trump

Despite the adamant and vocal opposition of the Catholic Church to the use of taxpayer dollars for family planning programs, a consensus had begun to develop in the post-World War II era among the American public and policymakers that the United States and other high-income nations should begin to assist low-income countries with coping with rapid population growth by providing funding for family planning.

Dwight D. Eisenhower

One of the most important catalysts for the initiation of U.S. government involvement in family planning programs was President Eisenhower’s creation of the Draper Committee, formally known as The President’s Committee to Study the United States Military Assistance Program, and the release of its recommendation in 1959. Despite its mandate to consider the proper balance between military and economic development assistance in the nascent U.S. government foreign aid program, the committee — referred to by the name of its chairman William Draper, Jr., an investment banker and retired Army general and later one of PAI’s founders — deviated from its central mission to recommend, “That in order to meet more effectively the problems of economic development, the United States … [should] assist those countries with which it is cooperating in economic aid programs, on request, in the formulation of their plans designed to deal with the problem of rapid population growth…”

President Eisenhower rejected that recommendation of the committee, not because he disagreed that rapid population growth was a significant impediment to economic progress, but rather, the controversial nature of birth control. He did not want to further divide the country on the eve of the 1960 presidential election featuring a Catholic as the Democratic nominee. But after leaving office, Eisenhower and Truman, the two living former presidents in 1964, agreed to serve as co-chairmen of the honorary sponsors council of Planned Parenthood-World Population. In 1968, Eisenhower was quoted: “Once, as President, I thought and said that birth control was not the business of our Federal Government. The facts changed my mind…”

Republicans in Congress during the Kennedy and Johnson administrations

After his election, President John F. Kennedy defied expectations in December 1962 by authorizing U.S. support for a United Nations resolution to provide birth control assistance whenever a country requested. But it was not until the Johnson administration that the decision to fund some modest bilateral family planning projects overseas was made, beginning in 1965. That breakthrough was bolstered by the passage of an amendment to the 1966 foreign aid authorization bill giving USAID specific authority to use foreign currencies as part of the Food for Peace program to provide family planning services and codifying the first statutory definition of a “voluntary family planning program.”

This was the beginning of Congress taking the lead on birth control at home and abroad with active collaboration between a cadre of Republicans and Democrats. Many Republican legislators became active champions over multiple Congresses, including Senators Mark Hatfield (R-OR) and Charles Percy (R-IL), who were later elevated to the chairmanships of the Appropriations and Foreign Relations Committees, respectively; Congressman and later Sen. Robert Taft, Jr. (R-OH); and Sen. Bob Packwood (R-OR). Another key player in drafting and sponsoring legislation to promote family planning in the United States and abroad was a two-term Republican Congressman from Texas named George H.W. Bush.

In 1967, Congress authorized foreign aid funds for overseas family planning and added a new Title X, Programs Relating to Population Growth, to the Foreign Assistance Act of 1961, the permanent statute governing foreign aid programs, and earmarked $35 million for fiscal year (FY) 1968. Of the original cosponsors of the Senate bill to create the new title, 12 were Democrats along with six Republicans. Congress subsequently earmarked $50 million in FY 1969 for population assistance, and the funding amounts appropriated continued to escalate from there.

Richard M. Nixon

Shortly after his inauguration in 1969, President Nixon formally transmitted to Congress the first presidential message on population. The statement dealt primarily with population growth in the United States but did include brief but direct references to foreign policy and assistance programs, calling the increase in people “a world problem no one can ignore.” More significantly, he stated that, “I have asked the Secretary of State and the Administrator of [USAID] to give population and family planning high priority for attention, personnel, research and funding among our several aid programs.”

One of the other key recommendations of the presidential message was Nixon’s initiation of the Commission on Population Growth and the American Future in 1970. Congressional family planning champions were not prepared to wait for the findings and recommendations of what became commonly known as the Rockefeller Commission after its chairman John D. Rockefeller, III. By the end of 1970, Congress had enacted the Family Planning Services and Population Research Act of 1970 (Public Law 91-572) which the Title X domestic family planning program, establishing the legal framework and authorizing $382 million over three years for family planning services and research in the United States — the equivalent of $2.8 billion today in inflation-adjusted dollars. Representative Bush was joined by original sponsors Sen. Joseph Tydings (D-MD) and Rep. James Scheuer (D-NY). The bill, previously approved by the Senate, passed the House of Representatives by the whopping bipartisan margin of 298 to 32 in December 1970.

The watershed event at the beginning of President Nixon’s short-lived second term was the Supreme Court’s decision to legalize abortion in Roe v. Wade on January 22, 1973. This precipitated the beginning of the linkage between family planning programs and domestic abortion politics and the emergence of a more aggressive crop of Republican opponents in Congress. The Roe decision prompted Sen. Jesse Helms (R-NC) to sponsor and pass later that year the amendment that bears his name — and persists to this day — that restricts the use of U.S. foreign assistance funds to provide or promote “abortion as a method of family planning.”

Gerald R. Ford

While the Roe decision started to signal a change in sentiment, President Ford’s brief tenure in the White House was not particularly noteworthy other than the occurrence of the World Population Conference in Bucharest in the fall of 1974. The official U.S. delegation to the conference that included General Draper was instrumental in the adoption of the World Population Plan of Action by 135 nations — solid and supportive on international family planning, but not much else.

With the enshrinement of opposition to abortion, including public funding, and a call for the appointment of judges “who respect traditional family values and the sanctity of human life,” in the 1980 Republican party platform — along with election of Ronald Reagan — the shift in the attitude on contraception of Republican policymakers accelerated.

Ronald W. Reagan

The tenure of President Reagan ushered in the ongoing policy battles in Congress, dating back to 1984, and established the position on those issues for Republican presidents ever since — namely, enforcement of some iteration of the Global Gag Rule (GGR) and defunding of the United Nations Population Fund (UNFPA).

At the 1984 International Conference on Population held in Mexico City, the U.S. delegation announced that foreign nongovernmental organizations (NGOs) would henceforth be denied U.S. family planning assistance if they performed abortions in cases other than threat to the pregnant woman’s life, rape or incest; provided counseling or referral for abortion; or lobbied to make abortion legal or more available in their own country (even if these activities were performed with funding from other, non-U.S. government sources). Under what was then called the Mexico City Policy, by 1985, the U.S. Agency for International Development (USAID) suspended all financial support to the International Planned Parenthood Federation, one of the largest recipients of USAID family planning grants at the time.

Regarding UNFPA, the Reagan administration initially cut the U.S. voluntary contribution by $10 million and withdrew all funding from UNFPA in 1986 after passage of the Kemp-Kasten amendment by Congress, which was interpreted to preclude funding to UNFPA due to its presence in China and its alleged complicity in human rights violations by the government in its implementation of its “one-child” policy. The Reagan-era USAID also attempted to make concessions to religious conservatives on natural family planning which were thwarted by Congress, and informed consent and referral protections were restored. U.S. expenditures on bilateral family planning programs also dropped during these years.

For an interactive look at trends in international FP/RH funding, including the low budget requests of Republican presidents since Reagan, visit PAI’s Cents and Sensibility page.

George H.W. Bush

Despite his earlier activism in support of domestic and international family planning programs as a Congressman from Texas between 1967 and 1971, President Bush carried on the legacy of his predecessor for whom he had served as vice president for eight years, leaving the Mexico City Policy in place and continuing the U.S. funding boycott of UNFPA.

In 1989, Bush went so far as to veto a $14 billion foreign aid bill over a new $15 million congressional earmark to reestablish a U.S. contribution to UNFPA. The offending provision was removed, and the bill, sans the UNFPA earmark, was quickly signed. An irony pointed out at the time was that Bush, as U.S. ambassador to the United Nations in the early 1970s, penned the foreword in former PAI Executive Director Phyllis Piotrow’s World Population Crisis: The United States Response, a definitive history of the early years of U.S. government involvement in overseas family planning, published in 1973. Bush loftily observed: “Success in the population field, under United Nations leadership, may, in turn, determine whether we can resolve successfully the other great questions of peace, prosperity and individual rights that face the world.”

On the domestic front, the Bush administration implemented the Department of Health and Human Services (HHS) regulations promulgated at the end of the Reagan administration — also dubbed a “gag rule” by pro-reproductive health critics — which prohibited recipients of Title X family planning funds from advocating, counseling or referring patients for abortion, even if requested and done with nonfederal funds. In May 1991, Bush’s Supreme Court appointee David Souter joined the 5-4 majority in the Rust v. Sullivan case in affirming the constitutionality of the regulations, finding them not in violation of the First Amendment right to free speech of federally funded clinics. Again, Bush hamstrung a program to improve contraceptive access that he had a major role in creating years earlier.

In this instance, congressional Republicans took the lead in attempting to roll back the domestic gag rule. In the Senate, a free-standing bill to block the regulations, authored by Senator John Chafee (R-RI), was adopted by voice vote to avoid embarrassing the president after an attempt to uphold the rule failed 64 to 35. In the House, Representative John Porter (R-IL) successfully attached a one-year ban on the use of funds by the secretary of HHS to enforce the rule to the popular Labor-HHS appropriations bill that landed on the president’s desk. Left with little room to maneuver by his pledge to the religious right to oppose any pro-choice legislation, Bush vetoed the bill. Despite the warning of Rep. Bill Green (R-NY), a senior appropriator, that Republicans could “do George Bush no greater political favor than to override this and put this sorry issue behind us,” the override failed by a dozen votes, with 222 Democrats, 53 Republicans and one independent voting to override his veto.

The Bush administration’s budget request for bilateral and multilateral FP/RH programs hovered between about $250 and $300 million annually, which Congress always topped off with an increase in the final bill, sometimes sizable.

Republicans in Congress during the Clinton administration

During the first two years of the Clinton administration, discussion of the FP/RH funding policy was limited as family planning opponents had neither the votes in either house or a friend in the White House. After President Clinton rescinded the GGR, old nemesis Sen. Jesse Helms (R-NC) attempted to reinstate it legislatively in July 1994, just prior to the International Conference on Population and Development in Cairo. His amendment to the fiscal year (FY) 1995 foreign operations appropriations bill sought to prohibit the use of foreign aid funds to change abortion law or policy in other countries or to endorse international agreements that address abortion as a public health issue. His amendment was soundly rejected on a vote of 42 to 58, with eight Republican senators joining most Democrats in opposing the Helms amendment.

The revolutionary change in Congress — resulting from the 1994 election in which Republicans gained control of both houses for the first time in 40 years — caused a profound historical shift for U.S. family planning assistance policy and unleashed a torrent of Republican legislative attacks for the remainder of the Clinton presidency.

During the 104th and 105th Congresses, family planning opponents sought repeatedly to legislatively reimpose the GGR and to cut off a U.S. contribution to UNFPA. The Clinton administration and pro-family planning members on both sides of the aisle in both chambers, especially the Senate, successfully beat back House Republican attempts to place additional policy restrictions on family planning programs. While harsh Republican critics were emboldened and empowered, a number of Republicans in influential positions expended their political capital to limit the amount of damage that could be inflicted by their fellow Republicans. But that success came at a high price, both in terms of the amount and the conditions attached to funding for family planning programs.

The goal of family planning opponents was the codification of the GGR into law, championed by its principal proponent Rep. Chris Smith (R-NJ), the leader of House anti-choice forces for the last 40 years. The GGR amendment — or variations of it that were introduced — would bar organizations from receiving U.S. family planning funds if, with other non-U.S. funds, they provide legal abortion services or engage in any activity or effort to alter the laws or governmental policies of any foreign country concerning the circumstances under which abortion is permitted, regulated or prohibited. In some of its incarnations, the amendment’s provisions were even more expansive than the restrictions contained in the prior executive branch versions of the policy under Reagan and Bush, for example by applying them to both U.S. and foreign NGOs, as well as to multilateral organizations.

While the GGR amendment did not become law, severe restrictions were placed on the release of family planning funds in the four fiscal years following the 1994 election (FY 1996-FY 1999). For example, the FY 1996 foreign aid legislation allocated just $356 million, a 35% reduction from the previous year, and enacted restrictions delaying the release of any of the money for months and then only doling out small increments on a month-to-month basis in a tortuous process called “metering.” The funding level recovered only marginally, stagnating at $385 million for the next four fiscal years (FY 1997-FY 2000).

In 1995, no fewer than nine floor votes took place in Congress on amendments that in whole or in part dealt with the issue of the GGR — two in the House on a combined FY 1996-97 foreign aid and State Department authorization bill and seven on the FY 1996 foreign operations appropriations bill, of which five occurred in the House and two in the Senate. The anti-family planning forces led by Rep. Smith that sought to impose the GGR legislatively prevailed on all seven votes in the House, while family planning champions led by Appropriations Committee Chair Mark Hatfield (R-OR) and Sen. Patrick Leahy (D-VT) won both votes in the Senate rejecting the policy. This stalemate over the GGR amendment delayed passage of the foreign ops bill for months, contributed to two government shutdowns and resulted in the House Republican leadership’s insistence on the funding cuts, delayed release and “metering” that were incorporated in a continuing resolution finally passed in January 1996.

During the FY 1997 appropriations process, international FP/RH policy was the subject of what must be one of the most convoluted and complicated legislative compromises ever negotiated, resulting from the escalating insistence by House Republicans that the GGR be imposed legislatively as a condition of their support for foreign aid funding. Under the omnibus spending bill for FY 1997, signed into law on September 30, 1996, no new policy restrictions were imposed, but the funding level for bilateral FP/RH funding was capped at $385 million. Funds would not become available until March 1, 1997 — six months into the fiscal year — unless there was a presidential determination that the funding delay was having a negative impact on the functioning of the program and both chambers voted in agreement with the president’s finding. If either house voted to reject President Clinton’s determination, FY 1997 funds would not be released until July 1, 1997. Regardless of the vote outcome, the funds would be metered out at a rate of 8% of the total over the following 12-and-a-half months. The House approved a joint resolution on February 13, 1997, on a vote of 220 to 209. The Senate followed suit on February 25 by a margin of 53 to 45, and bilateral FP/RH funding began trickling out in small tranches on March 1.

Since family planning opponents were successful in including the GGR amendment in committee-reported bills in the House, no floor votes occurred again until 1997 when Rep. Smith attempted once more to attach the GGR amendment along with a ban on a U.S. contribution to UNFPA to both the FY 1998-99 State Department authorization bill and the FY 1998 foreign operations appropriations bill. Rep. Smith prevailed on all four House floor votes, both in beating two pro-family planning substitutes offered by Rep. Tom Campbell (R-CA) and International Relations Committee Chairman Ben Gilman (R-NY) and in passing his two underlying amendments.

The Senate versions of the foreign operations appropriations bills for each fiscal year between 1996 and 2000 included language co-authored by Sen. Nancy Kassebaum (R-KS), a key Republican champion during the 1980s and 1990s, designed to block the imposition of a GGR-type policy, setting up the disagreement between the House and Senate that resulted in the continuation of the restrictions on the amount of funding and its availability. The amendment required that the funding restrictions applied to NGOs and multilateral organizations can be no more restrictive than those applied to foreign governments (which were exempt) in determining eligibility for U.S. family planning assistance.

After four years of resisting House Republican legislative initiatives to impose the GGR, the Clinton administration was maneuvered into accepting a modified version of the policy in 1999. In order to reach an agreement on the payment of nearly $1 billion in back dues owed to the United Nations, the White House and the House Republican leadership agreed to impose significant restrictions on international family planning programs in an omnibus spending bill for FY 2000, signed by the president in November 1999.

For the first and only time, the agreement legislatively imposed a GGR on foreign NGOs and multilateral organizations receiving U.S. family planning assistance, preventing them from using their non-U.S. government funding sources to either advocate for or against legal abortion or to perform legal abortions in their own countries. The president was allowed to partially waive the bans on the performance of abortion and abortion lobbying, but only against not more than $15 million of total USAID funds, which might be provided to groups that could not or would not agree to abide by the policy restrictions. When the president exercised his waiver authority, the funding level for bilateral assistance of $385 million was subjected to a $12.5 million cut and the funds were reprogrammed to child survival programs.

In 2000, after an unsuccessful attempt to amend in committee the draft House version of the FY 2001 foreign operations appropriations bill, which included the 1999 modified, “waive-able” version of the GGR, pro-family planning members were allowed to offer a “motion to strike” on the House floor. While the vote failed 206 to 221, the effort, led by Reps. Jim Greenwood (R-PA) and Nita Lowey (D-NY), indicated a much higher degree of support than family planning opponents had expected. Meanwhile, language to overturn the 1999 gag rule — a precursor to the Global Democracy Promotion Act and its current incarnation, the Global Health, Empowerment and Rights (Global HER) Act — was included in the companion bill in the Senate.

By October 2000, the White House, after months of noncommittal statements regarding the GGR, began to unequivocally say that they would veto any bill that included it. As a result, Chairman Sonny Callahan (R-AL) and Ranking Member Nancy Pelosi (D-CA) of the House Appropriations Subcommittee on Foreign Operations met and forged a deal. The final bill included no gag rule, an increase in funds of up to $425 million and a delay in disbursement of funds until February 15, 2001, allowing the new president time to establish his own policy governing international family planning programs. That is exactly what newly inaugurated President George W. Bush did in reinstating the GGR on January 22, 2001.

George W. Bush

After President Clinton’s two-term tenure in office, George W. Bush followed in his father’s path to the White House. In what has become a tradition for Republican presidents to restore the GGR as one of their first official acts after being inaugurated — just as Democratic presidents rescind the GGR when they take office — President Bush reimposed the GGR by executive action. And other than his first year in office, when a $21.5 million contribution to UNFPA somehow snuck through, Bush continued to deny congressionally earmarked funds to UNFPA, usually about $34 million per year.

To his credit, when President Bush reinstated the GGR, there was an understanding that population funds should be at or around $425 million. This “understanding” was upheld and enforced by Secretary of State Colin Powell, and presidential budget requests remained between $425 million and $450 million for his first five years in office. However, budget request levels dropped precipitously the last three years during Condoleezza Rice’s tenure as secretary of state. Congress, on the other hand, routinely increased this amount with FP/RH funding climbing to $545 million in the FY 2009 omnibus spending package.

One positive action that Bush took was rejecting calls from conservative religious supporters to extend GGR restrictions to HIV/AIDS programs, funding that had exploded under his signature President’s Emergency Plan for AIDS Relief (PEPFAR). (In the same memorandum, Bush also explicitly ruled out application of the GGR to multilateral organizations.) In this instance, pragmatism and programmatic sense carried the day. Unfortunately, good public health practice did not prevail later during the Trump administration when the GGR was applied to all U.S. global health assistance, including HIV/AIDS.

The Bush family as a mirror of the GOP’s evolution on birth control

As George H.W. Bush recounted in his foreword to Phyllis Piotrow’s 1973 history of U.S. government involvement in overseas family planning, his “first awareness of birth control as a public policy issue came with a jolt” during the U.S. Senate campaign of his father, Prescott, who lost the 1950 election in Connecticut by several hundred votes out of nearly a million cast after nationally syndicated columnist Drew Pearson outed him as a Planned Parenthood supporter on the Sunday before election day. Political observers thought that it might have swayed enough voters to have cost him the election. (He subsequently won a special election in 1952 and served in the Senate until 1963.) Prescott Bush had been the treasurer of Planned Parenthood’s first national fundraising campaign in 1947. Not only his father, but his mother, Dorothy Walker Bush, was a lifelong birth control backer and a faithful donor to the local Planned Parenthood affiliate near her winter home in Florida.

As a two-term U.S. Representative from Texas from 1967 to 1971, George H.W. Bush carried on the family legacy and was one of the biggest champions of family planning in Congress of either party as the lead Republican sponsor of the legislation creating the Title X domestic family planning program that has furnished essential reproductive health services to tens of millions of low-income Americans over the last 50 years. While in Congress, he also served as chairman of the special Republican Task Force on Population and Earth Resources. His activism and enthusiasm for birth control even earned him the moniker “Rubbers” among some of his colleagues.

But as the Republican party moved to the right in the 1980s and his presidential ambitions grew, he was compelled to move as well, embracing the GOP’s anti-abortion platform as Ronald Reagan’s vice president for eight years and carrying on the anti-birth control policies of his predecessor both at home and abroad when he succeeded him. His eldest son, George W. Bush, reinstated the Reagan-Bush era GGR and cut off funding to UNFPA once in office, reversing the pro-birth control policies of President Clinton.

His other son Jeb, as Governor of Florida from 1999 to 2007, cut state funding for family planning services and Planned Parenthood and signed legislation banning late-term abortion and mandating parental notification for minors seeking abortions. But even after all he had done, Jeb Bush struggled to convince the right wing of the GOP and evangelicals of his anti-choice credentials during the 2016 Republican presidential primary that selected — in an act of cosmic irony — Donald Trump.

The microcosm of the Republican party on birth control that is the Bush family culminates with Jeb’s son George P. Bush, who embraced Senate Bill 8, the radical Texas abortion law, and dutifully courted the endorsement of former President Trump in his recent, unsuccessful Republican primary challenge to the incumbent Texas attorney general.

Throughout the generations, however, the Bush women have remained steadfast in their support for access to abortion and contraception — from the family matriarch through pro-choice former First Ladies Barbara and Laura Bush, to Barbara Pierce Bush, George P.’s cousin and founder of the Global Health Corps, an organization that has partnered with Planned Parenthood affiliates to train future women leaders.

Republicans in Congress during the Obama administration

The last floor vote on the GGR in either the House or Senate occurred shortly after the newly inaugurated President Obama rescinded the GGR on January 23, 2009. During the floor debate on a bill to reauthorize the unrelated State Children’s Health Insurance Program, Sen. Mel Martinez (R-FL) offered an amendment that would have restored the GGR by nullifying the presidential memorandum rescinding the policy and prohibiting U.S. FP/RH assistance to “any private, nongovernmental or multilateral organization that performs or actively promotes abortion as a method of birth control.” His amendment was roundly rejected 37 to 60, with four Republican senators opposing GGR reinstatement.

On UNFPA, the last floor vote in either chamber also occurred only a few months after the arrival of the Obama administration in March 2009 when Sen. Roger Wicker (R-MS) offered an amendment to the FY 2009 omnibus spending bill to delete a provision to allow a U.S. contribution to UNFPA, notwithstanding a negative Kemp-Kasten decision, for a list of six specified reproductive health activities in any of the other countries where UNFPA worked, except China. The Wicker amendment was rejected 39 to 58, with three Republicans voting to support a UNFPA contribution.

For the final seven years of Obama’s presidency after Republicans regained the House majority in the 2010 midterm election, battles over FP/RH funding, the GGR and UNFPA were waged in the Appropriations Committee during markups and negotiations on the annual spending bills. That dynamic has persisted to this day, when, in the negotiation over the final spending bill for the last 12 fiscal years, House and Senate negotiators have defaulted to the status quo on the constellation of FP/RH issues to be resolved — level bilateral funding, a U.S. contribution to UNFPA with restrictions and no reinstatement or permanent repeal of the GGR or other new policy “riders,” either positive or negative.

Donald J. Trump

The destruction wrought by the Trump administration on international FP/RH programs is so fresh in our minds that it is probably unnecessary to chronicle. If interested in the down and dirty details, there are multiple Washington Memos on PAI’s website detailing the vandalism.

But the Trump-Pence administration managed to find new and creative ways to wreak havoc, most notably, by expanding the GGR to apply to all U.S. global health assistance, increasing the amount of funding impacted 15-fold and rebranding the GGR as “Protecting Life in Global Health Assistance” (PLGHA). The administration also rallied other anti-choice governments at the United Nations to support the so-called “Geneva Consensus Declaration,” which promoted a regressive, alternative vision of women’s health and human rights and was neither an official U.N. declaration nor a consensus negotiated in Geneva.

Trump’s elimination of all international FP/RH funding in his first budget request for foreign assistance for FY 2018 is unprecedented. Since the inception of the USAID population assistance program in 1965, the only similar historical episode was an aborted proposal by the Office of Management and Budget to eliminate all funding for international FP/RH programs for FY 1983, not a full year into President Reagan’s first term in December 1981. The gambit by executive branch anti-contraception activists was quickly beaten back by career officials at the State Department and USAID. But never before had such a radical proposal to slash the budget completely advanced to the final budget proposal sent to Congress. For the remainder of his term, Trump’s budget requests came up to Capitol Hill at a level roughly half the amount that Congress had appropriated for FP/RH in the preceding years.

Blocking an international family planning funding increase was a top priority of the White House and Senate Republicans in the FY 2020 omnibus in late December 2019. International family planning funding was literally the last issue to be resolved in the negotiations over the final deal and was tied to the resolution of White House demands on building a wall on the southern border with Mexico. The specific issue was even highlighted in the president’s signing statement:

We continue to defend America’s most vulnerable, the unborn. The legislation preserves all pro-life protections like the Hyde Amendment; rejects Senator Jeanne Shaheen’s anti-life amendment that could have increased funding for pro-abortion organizations; and rejects all anti-life riders in the partisan versions of these bills that originally passed the House, including one that would have undermined my Administration’s pro-life Title X rule.

At home, the Trump-Pence administration also revived a more onerous version of President George H.W. Bush’s domestic Title X gag rule. It, along with the PLGHA-branded expanded GGR, UNFPA contribution cut-off and “Geneva Consensus Declaration” were summarily disposed of in President Biden’s January 28, 2021 memorandum on “protecting women’s health at home and abroad.”

In 2022, this is not your father’s — or grandfather’s — Republican party.

The Collapse of Republican Support for International Family Planning in Congress

As asserted in the introduction of this analysis, there are currently no supportive Republicans left in the House of Representatives and only two Republican women left in the Senate to protect and advance a pro-sexual and reproductive health and rights (SRHR) legislative agenda. The most objective manner to test the assertion that Republican support in Congress for international FP/RH has drastically declined over the years is to look at floor votes and sponsorship of bills or amendments.

Floor votes

The last Senate floor votes occurred in 2009, shortly after President Obama was inaugurated, as recounted in part II of this analysis series. Based on votes prior to 2009 and contemporaneous head counting since then, it is apparent that international FP/RH programs enjoyed majority support on the substance of the issue in the Senate — regardless of which party controlled the chamber — from 1984 until 2015 when Republicans regained the majority in the party breakdown. But since the victories of Democratic Senators Raphael Warnock and Jon Ossoff in the Georgia special election on that fateful day of January 6, 2021, international FP/RH supporters have regained a slim 51-49 advantage with Republican Sens. Susan Collins (ME) and Lisa Murkowski (AK) offsetting a lone Democratic defector, Joe Manchin (WV). Unfortunately, having a slim, simple majority does not matter. In the absence of an exemption from the filibuster, finding the 60 votes necessary to invoke cloture and end debate that are required to pass anything in the Senate these days is probably an insurmountable obstacle for any pro-SRHR legislative initiatives.

Since 1985, PAI has tracked 38 House floor votes on FP/RH funding and policy (not including a 2019 procedural, highly partisan vote on a “motion to recommit”). The House has not gone on record on international FP/RH policy issues like the Global Gag Rule (GGR) or restrictions on the U.S. contribution to the United Nations Population Fund (UNFPA) since 2007 but has very recently taken votes on FP/RH funding, perhaps an even better indicator of how support for a governmental role in the provision of contraceptives among House Republicans has cratered.

The highest level of Republican support on policy issues was an identical tally of 46 pro-FP/RH votes on three separate amendments that occurred in 1999 and 2000 — a Ben Gilman (R-NY)-Tom Campbell (R-CA) substitute amendment on UNFPA to the fiscal year (FY) 2000 State Department authorization and two Jim Greenwood (R-PA)-Nita Lowey (D-NY) amendments on the GGR to the FY 2000 and FY 2001 appropriations bills. Abortion-related policy votes are more challenging for members than funding votes.

But even on what should be politically easier votes on funding, Republican legislators are voting in opposition to FP/RH programs. In 2019, Representative Debbie Lesko (R-AZ) offered a very illuminating amendment that would have struck the proviso in the FY 2020 appropriations bill that earmarked that not less than $750 million be provided to bilateral FP/RH programs. As drafted, the Lesko amendment would not have technically resulted in a reduction in the amount of funding available for FP/RH funding, but passage would have left the allocation of global health funds among various health sectors totally at the discretion and mercy of a hostile Trump administration that had requested only $259 million for FP/RH programs in its FY 2020 budget proposal.

The Lesko amendment was defeated on a largely straight party-line vote of 188 to 225, with all Democrats present voting against, except for two, and all 186 Republicans present voting in support of eliminating the earmarking of funds. For historical perspective, in August 1999, more than a third of House Republicans at the time (79) voted with pro-FP/RH Democrats and opposed a much harsher version of a funding amendment offered by Rep. Ron Paul (R-TX), which would have zeroed out all funding for international FP/RH programs. No House Republican would be likely to cast that vote today.

The roll call result confirms that the abandonment of support for U.S. government involvement in the provision of contraceptive services overseas by House Republicans is now complete. Over these last two decades, the Republican party has totally shifted on the issue of contraceptive access.

Sponsorship of amendments and bills

On offering pro-SRHR amendments to foreign aid authorization and appropriations bills on the floor, a number of Republicans have joined with Democrats in proposing bipartisan amendments, but only as recently as 2007 in the Senate, when Sen. Olympia Snowe (R-ME) joined Sen. Barbara Boxer (D-CA) on a successful GGR repeal amendment, and 2000 in the House, when Rep. Jim Greenwood partnered with Rep. Nita Lowey in a losing effort to eliminate GGR restrictions from the FY 2001 appropriations bill noted just above. Another supportive House Republican amendment sponsor not previously named was Rep. Jan Meyers (R-KS), who was active in the mid-1990s. On the Senate side, fellow Kansas Republican Sen. Nancy Kassebaum was a key, behind-the-scenes player on GGR repeal efforts in the appropriations process pairing with senior Democratic appropriator Patrick Leahy (D-VT) in the 1990s and early 2000s.

Conversely, all of the major boilerplate restrictions on bilateral and multilateral FP/RH programs are named for their Republican authors, except one: the 1981 Biden amendment prohibiting use of foreign aid funds for biomedical research on abortion or involuntary sterilization. Eponymous Republican amendments enacted from the early 1970s through the late 1990s include the:

  • Helms (R-NC) amendment restricting use of foreign aid funds to promote or provide abortion (1973);
  • Siljander (R-MI) amendment prohibiting use of foreign aid to lobby for or against abortion (1981);
  • Kemp (R-NY)-Kasten (R-WI) amendment prohibiting U.S. foreign aid to any organization or program that “supports or participates in the management of program of coercive abortion or involuntary sterilization,” disingenuously interpreted by Republican presidents since Reagan to cut off the U.S. contribution of UNFPA (1985);
  • Livingston (R-LA) amendment promoting the right of natural FP grantees not to counsel or refer clients to sources of modern contraceptive methods (1986); and
  • Tiahrt (R-KS) amendment codifying and expanding on long-standing U.S. Agency for International Development guidance on voluntarism and informed consent (1998).

On sponsorship of free-standing bills, the last and most noteworthy example of a sweeping bipartisan, bicameral vision on these issues was a comprehensive population and FP funding and policy bill authored by Sens. Tim Wirth (D-CO) and Alan Simpson (R-WY) and Reps. Tony Beilenson (D-CA) and Connie Morella (R-MD) in the early 1990s that did not move through committee to the floor of either chamber. In the current 117th Congress, no House Republicans are cosponsors of the Global Health, Empowerment and Rights (Global HER) Act (H.R. 556), an authorization bill to amend the Foreign Assistance Act of 1961 to prevent a future president, hostile to SRHR, from unilaterally reinstating the GGR through executive action. In the Senate, only the aforementioned Sens. Collins and Murkowski are sponsors of the Senate counterpart bill (S. 142).

Recent years have witnessed the unprecedented introduction of multiple Republican-led anti-SRHR bills: the Protecting Life in Foreign Assistance Act (S. 137, H.R. 534), whose name and text are inspired by the dramatically expanded iteration of the GGR imposed during the Trump administration, and No Taxpayer Funding for the U.N. Population Fund (H.R. 2488), a one-sentence bill which aims to do exactly what its title says. The lead sponsors of the pro-GGR bills are Sen. Mike Lee (R-UT) and Rep. Virginia Foxx (R-NC), joined by 25 and 50 cosponsors, respectively — all Republicans. In the case of the Lee-led GGR bill, those 25 GOP cosponsors represent exactly half of the Republican caucus in the Senate. Rep. Chip Roy (R-TX) is joined by 51 cosponsors of the anti-UNFPA bill, again all Republicans. Although a detailed comparison has not been performed, one can confidently surmise that there is considerable overlap between those five dozen House Republicans, and many have signed on to both the pro-GGR and anti-UNFPA bills.

Coalition-building efforts

A Congressional Coalition on Population and Development, a bipartisan group of House members that developed legislative strategy on key FP initiatives, also once existed during a time in the 1980s and 1990s — seemingly long since passed — when FP advocates could still count on the votes of several dozen Republicans on pro-FP amendments. The chairmanship of the coalition alternated between the two parties. Among the Republicans who served as chair was John Porter (R-IL), an influential member of the Appropriations Committee who had fought to end the Title X domestic gag rule during President George H.W. Bush’s term in office. Such a bipartisan, pro-SRHR affinity group has never formed in the Senate.

The Last Bastion of Bipartisan Cooperation?

There is an old joke that there are three parties in Congress —Republicans, Democrats and appropriators. Historically, the work of the Appropriations Committees has been bipartisan, politically pragmatic and focused on getting the job done. And Congress really has only one job that it must do every year: appropriate money to fund the operation of the federal government.

There was a time when Republican appropriators were among some of the international FP/RH program’s biggest champions. The most prominent that comes to mind is Sen. Mark Hatfield (R-OR), who chaired the Appropriations Committee from 1981 to 1987 and again from 1995 to 1997. He kept his own counsel on a range of issues, including FP, and frequently put conscience above party loyalty. During his 30 years in the Senate, Sen. Hatfield consistently voted to ban or restrict abortion while at the same time being an ardent proponent of FP as a means to prevent unintended pregnancy in order to reduce the number of abortions. During his second stint as chair, Sen. Hatfield fought valiantly against the efforts of the newly installed House Republican majority led by Speaker Newt Gingrich (R-GA) to enact the GGR. When they failed to convince the Republican Senate to go along, he fought against the House Republican leadership’s next endeavor to mandate a punitive 35% cut to bilateral FP/RH funding, delayed release and “metering” out of funds in the initial FY 1995 continuing resolution (CR).

Disturbed by the unfair treatment of FP/RH programs, which he calculated was an 85% effective cut in funding because of all the conditions put in place, Sen. Hatfield attempted to remove the funding restrictions in the final CR adopted in April 1996. While successfully beating back a motion to strike his amendment on the Senate floor, Hatfield relented in the face of the intransigence of the House Republican leadership and the threat of a third government shutdown that year. Hatfield said this during one of the numerous debates on three Senate amendments that were offered to try to break the stalemate:

For those of us who take a pro-life position, this is the most effective way to reiterate our profound opposition to the practice of abortion. All the anti-abortion speech this chamber can tolerate will not reduce the number of unintended pregnancies as swiftly or as surely as our support for voluntary family planning.

Republicans winning the majority in the House for the first time in 40 years after the 1994 congressional election, two years into President Clinton’s first term, was the watershed event after which Republican support in Congress started to wane, as illustrated by the fight around the FY 1996 CR and began a long and precipitous decline after the inauguration of George W. Bush in 2001.

After moderate GOP incumbents — who would today be branded as “RINOs” (Republicans in name only) — began to be defeated by pro-choice Democratic challengers or chose to retire in increasing numbers, the center of political gravity began to shift rightward in the House Republican caucus in the first decade of the new century. As a result, Republican members aspiring to chair committees or rise within the leadership ranks were forced to toe the party line. On the Appropriations Committee, this party loyalty test caused the last two Republicans to chair the committee — Reps. Rodney Frelinghuysen (R-NJ) and Kay Granger (R-TX) — to abandon their prior records of support, to varying degrees, for international FP/RH programs.

Ever since Republicans retook the majority in the House after the 2010 midterm congressional election, intense battles over bilateral FP/RH funding, GGR and UNFPA have been waged in the Appropriations Committees during markups and negotiations on the annual spending bills for the last 12 fiscal years. Each year for the prior 19 fiscal years, up until FY 2020, the Senate committee-approved bill had included a legislative repeal of the GGR, increased funding and a UNFPA contribution either inserted in the base bill or successfully offered in full committee markup initially by the late Sen. Frank Lautenberg (D-NJ) and in recent years by Sen. Jeanne Shaheen (D-NH). Both have prevailed with bipartisan support from Sens. Collins and Murkowski and earlier Sen. Mark Kirk (R-IL) and with the able backing of Sen. Leahy, the senior Democrat on the committee as either chair or ranking member.

But three years ago, when Republicans were in the majority, Chairman Richard Shelby (R-AL) initially refused to mark up the FY 2020 State Department-foreign operations bill knowing the Shaheen amendment would prevail if it was able to be offered in full committee. (The FY 2020 bill was eventually marked up and approved in committee after Sen. Shaheen relented on the GGR repeal language and accepted two unrelated, pro-SRHR provisions in the base bill in exchange.) On the other side of Capitol Hill, the House committee-approved bill contained a legislative reinstatement of the GGR, severe funding cuts and prohibition on a UNFPA contribution each year, until Democrats regained the majority after the FY 2018 midterm election and turned the tables on their Republican counterparts for the last three appropriations cycles.

With a Democratic majority back in charge of the committee in 2021, there were high expectations that the Senate committee could return to “regular order” and mark up and approve a version of the bill that would include a permanent GGR repeal. With the House-passed bill containing the GGR repeal, the political stars seemed to be aligning for it to emerge from the House-Senate conference negotiation on the final bill and land on President Biden’s desk for him to finally sign the repeal into law. Unfortunately, the GGR repeal again fell victim to Republican obstructionists, who blocked committee consideration and approval of a State-foreign operations bill, forcing Democrats to issue a “chairman’s mark” reflecting only Democratic foreign aid and diplomatic aims.

During the bicameral negotiations over the FY 2022 omnibus spending package, the GGR repeal language was quietly dropped along with other policy “riders” at the insistence of Senate Republican leaders and with the acquiescence of Democratic negotiators, who reluctantly agreed in exchange for inclusion of other higher priority Democratic policy objectives in the final deal.

Most infuriating to Democratic appropriators during the latest round of negotiations was a new Republican assertion that they considered any FP/RH funding increase a “poison pill,” a term up until then exclusively reserved for unacceptable policy provisions that should in the mind of the opponent be off the table for discussion. Negotiating funding levels is the sole jurisdiction of appropriators with setting policy the domain of the authorizing committees, in theory if not practice. What is the job of appropriators if not but being the decision-makers on funding?

As a result of this breakdown in comity among appropriators and in adherence to the committee’s traditional norms and practices, in the negotiation over the final spending bill for the last dozen fiscal years, House and Senate negotiators have been unable to find a bipartisan compromise and settled largely at the status quo on the constellation of FP/RH issues to be resolved. This includes level bilateral funding, a U.S. contribution to UNFPA with restrictions and no repeal, reinstatement or revision of the GGR or other new policy “riders,” either positive or negative. The prospects for the committee returning to the customary way of operating as in the past and achieving a different outcome during FY 2023 appropriations cycle appear remote.


The commonsensical, conscientious argument of the late Senator Hatfield on why Republicans who are truly and honestly motivated by a desire to reduce the number of abortions should support expanded access to contraception is as unassailable today as it was more than 25 years ago. But let’s not kid ourselves, the rising opposition in the Republican party to contraception is about forced birth and sex for procreation, not pleasure.

At this point, when longtime advocates contemplate the collapse of Republican support for U.S. government investments in providing contraceptive services to people at home and abroad — and the possibility of ever rebuilding the bipartisan consensus around contraception in Washington — they might knowingly reflect on the opening lines of Shakespeare’s Sonnet 30 and lament:

When to sessions of sweet silent thought

I summon up remembrance of things past,

I sigh the lack of many a thing I sought,

And with old woes new wail my dear time’s waste

Not a hopeful way to end this look back, but this fairy tale does not appear to have a happy ending within sight.

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