The More Things Change, The More They Stay the Same: Amidst the Dismantling of U.S. Foreign Aid, International Family Planning Funding & Policy Remains the Same for 16th Year in a Row

The More Things Change, The More They Stay the Same: Amidst the Dismantling of U.S. Foreign Aid, International Family Planning Funding & Policy Remains the Same for 16th Year in a Row

After a chaotic and bleak year in which the world witnessed the intentional destruction of the U.S. government’s foreign assistance infrastructure, the National Security, Department of State, and Related Programs (NSRP) appropriations bill is surprisingly status quo.
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On February 3, Congress approved, and President Trump signed the fiscal year (FY) 2026 NSRP appropriations bill, part of the minibus (H.R. 7148) that funds the five bills comprising the majority of the federal government’s defense and domestic discretionary spending for the eight months remaining in the fiscal year.

The fact that the NSRP bill in the minibus includes a continuation of the status quo for the 16th year in a row with no cuts to bilateral and multilateral family planning and reproductive health (FP/RH) funding and no new hostile anti-sexual and reproductive health and rights (SRHR) policy “riders” attached, demonstrates that sometimes the more things change, the more they stay the same.

Total international FP/RH funding remains steady at $607.5 million, including $575 million earmarked for bilateral programs and $32.5 million earmarked for a U.S. contribution to the United Nations Population Fund (UNFPA). This amount has remained flat since FY 2011, despite the evidence that investments in FP/RH yield between $4 and $8 in return for every dollar spent, and the increased need for investments to adequately address the unmet need for modern contraception and other reproductive health services, not to mention the need to offset the effects of inflation and account for the growth of the population of reproductive age in low- and middle-income countries over those 16 years.

On policy, all hostile anti-SRHR policy riders included in the House version of the NSRP bill  (H.R. 4779) by the Republican majority were dropped in the end-game negotiations, including a legislative codification of the Trump expanded Global Gag Rule (GGR) and a prohibition on any funding for UNFPA. And there was even a policy advancement with the inclusion of new statutory language that requires the Secretary of State to “promptly inform” the relevant congressional committees of the planned destruction of U.S. government-purchased commodities,  such as the contraceptives and emergency food supplies that were destroyed or threatened with destruction by the Trump administration last year.

The favorable outcome of the negotiation on international FP/RH funding and policy is reportedly attributable to Senate Democratic appropriations champions, most notably newly minted subcommittee ranking member Brian Schatz (D-HI), who declared that making any changes to family planning provisions was one of his red lines. With support from full committee ranking member Patty Murray (D-WA)—and perhaps even some encouragement from like-minded Republican counterparts—along with House Democratic ranking members on the full committee and subcommittee, Representatives Rosa DeLauro (D-CT) and Lois Frankel (D-FL), respectively, the deep cut to bilateral FP/RH funding, legislative codification of the GGR, and the UNFPA funding prohibition contained in the House committee-passed bill were rejected and not included in the minibus. The fact that there was no Senate version of the bill—not even a partisan version filed by subcommittee chair Lindsey Graham (R-SC)—did not seem to weaken the Senate’s negotiating position.

Here is a rundown of the key funding and policy issues supported by SRHR advocates and their resolution.

Funding

On international FP/RH funding, the minibus bill stipulates that “not less than” $575 million “should” be provided to bilateral FP/RH programs, the bulk of which—$524 million—is allocated within the Global Health Programs (GHP) account. After the dismantling of the U.S. Agency for International Development (USAID), it is unclear where at the State Department this funding will be managed, and whether the department will assemble the appropriate staff to spend it.

The remainder is allocated from within what is now called the National Security Investment Programs (NSIP) account, under which the former Economic Support Fund (ESF) and Development Assistance were subsumed. In prior fiscal years, ESF has been consistently used to finance FP/RH activities in a small number of strategically important countries, such as Afghanistan, Egypt, and Jordan. The joint explanatory statement accompanying the minibus contains a line-item budget of $51.05 million from the NSIP account for FP/RH.  Consistent with sticking to the status quo, congressional appropriators continued to resort to the perennial practice of using the account — now referred to as NSRP — to bolster the FP/RH level in the face of competing pressures for scarce resources available under the overall funding allocation for GHP programs and to meet the overall statutory earmark of $575 million from all bilateral accounts.

This bill represents a legislative victory that is the best-case scenario advocates could have hoped for.  In appropriating flat funding, appropriators rejected the House proposal imposing a ceiling on funding at $461 million—a 25% cut of $146.5 million—and zeroing out all funding to UNFPA. Because no subcommittee bill was introduced and no committee markup was held in the Senate, there was no competing Senate funding proposal, which typically includes a modest funding increase above the prior year’s enacted level after the committee adopts an amendment offered by Senator Jeanne Shaheen (D-NH) with bipartisan support.

The U.S. contribution to UNFPA is earmarked at $32.5 million from within the International Organizations and Programs (IO&P) account, which includes all the voluntary contributions made by the United States to United Nations programs and agencies.

​​​​​Flat funding for international FP/RH programs looks pretty good right now, particularly relative to the treatment of the overall international affairs budget. According to the U.S. Global Leadership Coalition (USGLC), international affairs programs, the bulk of which is contained in the NSRP bill, receives an overall total of $51.3 billion in funding—a $9.8 billion (or 16%) cut compared to the FY 2025 enacted level but $20.4 billion or two-thirds (66%) higher than the president’s FY 2026 budget request.

The minibus includes approximately $9.7 billion for global health programs in the GHP account, a reduction of $615 million from the FY 2025 enacted level, which amounts to a 6% cut, according to KFF.  Funding for the Global Fund to Fight AIDS, Tuberculosis, and Malaria (some nuance here) and for bilateral HIV, tuberculosis, global health security, neglected tropical diseases, and vulnerable children decreased, while maternal and child health, malaria, nutrition, and FP/RH programs are flat-funded.

But when compared to the FY 2025 enacted level and the president’s FY 2026 budget request, it is important to highlight the magnitude of the increase for FP/RH programs approved in the minibus—essentially a 100% increase—since FP/RH was the single target of the $500 million rescission of FY 2025 funds in the GHP account approved by the Republican Congress in adopting the Trump regime’s first rescissions package focused on foreign assistance and public broadcasting. (Think my math’s better than Trump’s is on prescription drug prices.) And let’s not forget that the president’s FY 2026 budget request proposed completely zeroing out all bilateral and multilateral FP/RH funding.

Global Gag Rule

The minibus contains no language on the GGR—neither negative (imposing) nor positive (codifying its repeal). The House-passed bill contained a provision to legislatively impose the expanded version of the GGR in place during the first Trump term, known as Protecting Life in Global Health Assistance (PLGHA), by prohibiting appropriated funds “for global health assistance … to any foreign nongovernmental organization that promotes or performs abortion, except in cases of rape or incest or when the life of the mother would be endangered if the fetus were carried to term.” The provision would enshrine in statute what has previously otherwise only been an executive branch policy under Republican presidents. Fortunately, not having a Senate committee-approved bill, even if it was just silent on the GGR to counter the House provision in the negotiation, did not matter in the end.

After negotiations on the NSRP bill were concluded, three final rules were published by the Trump regime in the Federal Register on January 27, dramatically expanding the GGR to:

• All “non-military” U.S. government foreign assistance;
• New activities beyond abortion to diversity, equity, and inclusion and LGBTQ+ rights; and
• New entities beyond foreign NGOs to U.S. NGOs, international organizations, and foreign governments.

This unfortunate, but not unexpected, development will require increased vigilance to ensure that there is no legislative codification of the dramatic expansion in the FY 2027 and future appropriations bills. (A Washington Memo on the dramatically expanded GGR is forthcoming.)​​

Longstanding Abortion-Related Restrictions

Language restricting abortion-related activities is incorporated as it is year after year, including: the inclusion of the 1973 Helms amendment restricting the use of U.S. foreign assistance funds to provide “abortion as a method of family planning”; restrictions on abortion coverage for Peace Corps Volunteers; and prohibitions on the use of foreign aid funds for biomedical research on abortion and involuntary sterilization (Biden amendment) or to lobby for or against abortion (Siljander amendment). These boilerplate restrictions have been included in the foreign aid appropriations bill for decades and were reiterated verbatim in both the House and Senate versions of the bill.

UNFPA

The minibus earmarks a U.S. voluntary contribution to UNFPA of $32.5 million out of the IO&P account, an amount identical to the contribution level enacted for the last 10 fiscal years and just slightly less than the amounts appropriated for the preceding five years, when Republicans, in an arbitrary and punitive move, slashed $2.5 million from UNFPA’s funding. The House bill had zeroed out a UNFPA contribution.

Much more significantly, the final spending agreement drops the House-passed bill’s statutory prohibition on funding for UNFPA from any account (“none of the funds appropriated or otherwise made available by the Act…”). As written, the funding prohibition would apply not just to the voluntary contribution provided through the IO&P account but to funding provided to UNFPA through other accounts. Under the Biden administration, the amount of U.S. funding provided to UNFPA for its work providing maternal health care and addressing gender-based violence in humanitarian crisis settings was in excess of $300 million—or more than 10 times the size of the annual voluntary contribution through IO&P.

The minibus reiterates all the long-standing boilerplate restrictions requiring UNFPA to maintain U.S. funds in a segregated account—none of which may be spent in China—nor fund abortions. In addition, the minibus retains the dollar-for-dollar reduction in the U.S. contribution to UNFPA by the amount UNFPA spends in China each year, which usually amounts to between $1 and $2 million in recent years. The minibus also restates the requirement that any funding withheld from UNFPA due to the “operation of any provision of law” is to be reprogrammed for bilateral family planning, maternal, and reproductive health programs.

The minibus also makes no modification in the Kemp-Kasten amendment, which prohibits furnishing U.S. foreign assistance to any organization that “supports or participates in the management of a program of coercive abortion or involuntary sterilization.” This is the legal provision that all Republican presidents have improperly invoked since 1985 to bar funding to UNFPA.

None of the funding earmarked for UNFPA out of the IO&P account and no funds from humanitarian accounts will be provided to UNFPA during FY 2026 as a result of both Secretary of State Rubio’s invocation of the Kemp-Kasten amendment on May 1, 2025 and the recent issuance of presidential memorandum “Withdrawing the United States from International Organizations, Conventions, and Treaties that Are Contrary to the Interests of the United States” on January 7 that named UNFPA as one of the 31 UN agencies from which the United States will “ceas[e] participation in or funding to.”

Measure to prevent contraceptive commodity destruction

One potentially impactful new provision in the minibus is a statutory notification requirement that the Secretary of State “promptly inform” the Appropriations Committees of the diversion or destruction of U.S. government assistance, including the type and amount of assistance, the circumstances of the occurrence, and the Department of State’s response. The joint explanatory statement, which while not legally binding an important expression of congressional intent, further specifies that the Secretary of State shall make the notification not later than 10 days prior to the planned destruction of U.S. government-purchased commodities that are in the possession of the State Department or an implementing partner, “including a description and the cost of the commodities to be destroyed, a justification for the destruction, and a description of efforts made by the agency or implementing partner to find alternative uses for such commodities.” The term “promptly inform” is defined to require the Secretary of State to notify the appropriate committees within five days of receiving information on the pending destruction.

The inclusion of this notification requirement was precipitated by the State Department’s confirmation in late July that the decision had been made to incinerate $9.7 million worth of U.S. government-purchased contraceptive commodities—such as condoms, IUDs, oral contraceptive pills, injectables, and implants—that have been sitting in a warehouse in Belgium since January, when a foreign aid freeze was instituted. This was in addition to press reports of U.S. food aid rotting on docks and ready-to-use therapeutic food biscuits expiring and being used as animal feed.

These real examples of “waste, fraud, and abuse,” in contrast to the manufactured ones that Department of Government Efficiency (DOGE) and Trump lackeys successfully used as a pretext to dismantle USAID, prompted the Democratic leadership of the foreign aid authorizing and appropriations committees to introduce the Saving Lives and Taxpayer Dollars Act in both the Senate (S.2252) and the House (H.R. 4516). The bill aims to prevent the destruction of foreign assistance commodities, including food and medical supplies, unless every effort is made to sell, donate, or transfer the commodities before their expiration. The freestanding bill is unlikely to be enacted into law, certainly not in time to spare the $9.7 million in contraceptives currently at risk of imminent incineration. But the notification requirement included in the just-passed minibus should ensure that the State Department is not able to surreptitiously incinerate the contraceptives before there is at least the possibility of congressional intervention, albeit within a very short time window, to block or further delay the destruction.

Guardrails to Attempt to Rein in the Trump Administration

Since the very first days of the second term, the Trump administration in the person of Russell Vought, Director of the Office of Management and Budget (OMB) and one of chief architects of the Heritage Foundation’s Project 2025, has demonstrated a complete lack of respect for Congress’s “power of the purse,” clearly spelled out in Article 1 of the Constitution. “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.”

Vought has repeatedly refused to spend appropriated funds for the purposes Congress had designated and questioned the constitutionality of the 1974 Budget and Impoundment Control Act, enacted by Congress in the post-Watergate era to reassert congressional authority on spending and to combat a rise in the use of impoundment of congressionally appropriated funds by presidents to unilaterally override appropriations laws.

In the NSRP section of the minibus, there is a bipartisan agreement among appropriators to establish some guardrails to prevent the State Department from ignoring congressional directives and intent, including:

• Enhanced congressional notifications;
• Adherence to funding tables contained in the joint explanatory statement at not less than the amounts designated;
• Delivery of reports required by previous appropriations bills and posting the reports publicly;
• Submission of a “spend plan” for foreign assistance;
• Preparation of a report on previously obligated funds that have not expired or been cancelled, but which have been terminated;
• Requirement for a pre-obligation report; and
• Report on the global health compacts and bilateral agreements negotiated in support of the administration’s “America First Global Health Strategy,” which included no mention of FP/RH programs as a component, and requirement to submit any new bilateral global health agreements to relevant congressional committees within 15 days of signature.

Whether OMB Director Vought will cease his lawless behavior in withholding taxpayer dollars for the purposes for which Congress appropriated the money—absent the intervention of the federal courts, all the way up to the Supreme Court—seems dubious, but congressional appropriators have tried to slow down his subversion of the separation of powers and the rule of law.

What’s Next

One might ask oneself, why is it important that Congress passed and the president signed an NSRP bill as part of the minibus? Most significantly, Congress has put its imprimatur on specific, revised foreign assistance line-item appropriations rather than defaulting to a continuing resolution with two-year old funding levels and without any recognition of the completely altered landscape for foreign aid.

Throughout this year’s appropriations process, SRHR advocates have prioritized the necessity of preserving the statutory earmark of funds for bilateral and multilateral FP/RH programs. But the Trump administration has made it abundantly clear in a myriad of ways that it has little to no interest in spending those earmarked funds and no existing capacity to spend them even if it wanted to, after dismantling USAID and unceremoniously firing the more than 125 USAID technical staff that had a role in designing and managing the international FP/RH program until their dismissal.

The task now is to bolster Congress in compelling the Trump administration to respect its appropriations directives and create the bureaucratic mechanisms and structures that will enable it to spend the funds for their intended purposes. To be clear, this is not a problem unique to international FP/RH or even foreign aid, but is rampant government-wide. But for SRHR advocates, it’s the 600-million-dollar question of the moment.