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

Outside Witness 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; Department of State
June 27, 2025

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