Bush Takes Parting Shot at International Family Planning Organizations

Craig Lasher

This year's Bush administration denial of $40 million to UNFPA comes as no surprise. But buried in the statement lies the threat that other international family planning groups who work in China may also have their U.S. government funding cut.

You’ve probably heard that the
Bush administration is once again withholding funding for the United Nations Population
Fund
(UNFPA).
Because UNFPA provides funding for health services, including voluntary
family planning, in China, where the government maintains a "one-child
policy," the Bush administration decided Thursday to unjustly withhold U.S. funding
to UNFPA
, as it
has for the last seven years. That’s no surprise (it’s barely
even news-worthy), though it is disappointing. Contrary to the
administration’s assertions, UNFPA provides alternative and voluntary
approaches to China’s compulsory family planning program.

But you may have missed the
news that might be even bigger. Now the Bush administration
has threatened to dramatically expand

the interpretation of the Kemp-Kasten amendment, which prohibits U.S. funding to organizations that support coerced abortion or involuntary sterilization. Until now, Kemp-Kasten has only been used to withhold funding from UNFPA. Now there’s a threat to cut off funding to other organizations
solely because they operate health programs in China. Buried in the
statement released by Deputy Secretary of State John Negroponte is the
ominous warning:

    During the course of
    our evaluation of UNFPA’s work, we learned of other organizations
    that conduct activities in China. The relevant funding agencies
    are conducting a comprehensive analysis to determine what appropriate
    and lawful actions can be taken.

UNFPA, as well as other organizations
working in China, have sought
to play a positive role

in helping to reform the Chinese government’s program and to end the
occurrence of human rights abuses by promoting the replacement of compulsory
birth control with good counseling and informed consent, a greater range
of contraceptive method choice, and higher quality services. Losing
all of their U.S. funding for important programs in countries all over the world would be the reward
that organizations get for trying to be part of the solution in
China.

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Why is it that the Bush administration is again singling out the organizations
that are making a difference in the lives of women and their families to make
its own political point? As Amy Coen, PAI’s President/CEO, has said,
"When the issue involves family planning, the White House will always
look for new ways to satiate the voracious appetite of its right-wing
political constituency." Political posturing should not endanger women’s
lives.

Opponents of family planning
and reproductive health programs argue that the U.S. government — and
U.S. taxpayers — should have no "complicity" in Chinese government
population practices. Few, if any, disagree. In fact, all of the
activities of UNFPA and the targeted organizations that work in China
are based upon voluntarism and respect for human rights and are supported
with funds provided by other donors — public and private.

Does the administration’s argument even withstand scrutiny for consistency and an absence
of hypocrisy? The answer is a resounding no. There are a number of examples
of other multilateral institutions, U.S. government agencies, and nongovernmental
organizations that partner with the Chinese government in the health
sector, including those Chinese governmental institutions judged by
the State Department to be guilty under the terms of the Kemp-Kasten
amendment to have "support[ed] or participate[d] in the management
of a program of coercive abortion or involuntary sterilization."

Opponents of contraception
inside and outside the Bush administration believe that any financial
relationship with the Chinese government somehow indirectly supports
coercive practices. The real agenda is clear: funding for international family planning groups
is being threatened in pursuit of an ideological agenda that stands
transparently in opposition to contraception for poor women around the
world and in pursuit of a misguided vendetta against these indispensable
organizations.

UNFPA provides international
leadership on population issues and is a key source of financial
assistance for voluntary family planning

and reproductive health programs in poor countries. UNFPA works in more
than 150 countries, providing life-saving maternal and child health
care, HIV/AIDS prevention services, and emergency care for pregnant
women in conflict and disaster situations. Restoring U.S. funding for
UNFPA programs is crucial to improving the health and lives of women
and their families and to addressing demographic trends and promoting
sustainable development — and should be one of the first actions of
the next President.

Roundups Law and Policy

Gavel Drop: Ruth Bader Ginsburg Hints at More Supreme Court Retirements

Imani Gandy & Jessica Mason Pieklo

In a recent interview, Supreme Court Justice Ruth Bader Ginsburg dishes on the last Supreme Court term and hints the next president may have more than one justice to appoint.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

Ruth Bader Ginsburg suggests the next president is going to have a couple of U.S. Supreme Court nominations to make, which means the Court could be effectively up for grabs depending on this election’s outcome.

This summer, the Supreme Court ordered the Obama administration and religiously affiliated nonprofits who object to providing contraception to try and find some kind of compromise. While they hammer one out, a University of Notre Dame student has asked a federal appeals court to let her join in the litigation, to fight the university’s stance of trying to deny access to contraception coverage.

Anti-choice protesters will be descending on Wichita, Kansas, this week to commemorate the 25th anniversary of the Summer of Mercy clinic sieges.

A state judge dismissed a lawsuit filed by Kentucky Gov. Matt Bevin (R) against Planned Parenthood of Indiana and Kentucky for purportedly performing abortions without license.

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Florida officials have not yet appealed a federal district court ruling blocking a law that would have prevented Medicaid funds from going to Planned Parenthood reproductive health care centers. The law would also mandate a state regulator review of patient records from half of the approximately 70,000 abortions in the state each year.

An Ohio appeals court ruled a Cleveland abortion clinic can move forward with its lawsuit challenging requirements that prohibit public hospitals from entering into transfer agreements with clinics, along with another requirement that mandates providers to check for a fetal heartbeat before performing an abortion.

Attorneys from the American Civil Liberties Union (ACLU) sued to block an Indiana law requiring that a patient getting an abortion must have an ultrasound 18 hours before the procedure.

Meanwhile, abortion rights supporters in Wisconsin are urging lawmakers to repeal the state’s admitting privileges requirement.

Anti-choice lawmakers in Texas plan to try to require aborted fetuses to be buried or cremated in an attempt to add additional emotional burden and administrative expense to the procedure.

Free speech for whom, exactly? The man who posted the video of the police killing of Alton Sterling has been reportedly arrested on charges of assault and battery.

Analysis Abortion

Attacks on Abortion Rights Continued in 2015, Ensnaring Family Planning Funding and Fetal Tissue Research

Rachel Benson Gold & Elizabeth Nash

The year will be remembered not only because 17 states enacted a total of 57 new abortion restrictions, but also because the politics of abortion ensnared family planning programs, providers, and life-saving fetal tissue research.

During 2015’s state legislative sessions, lawmakers considered 514 provisions related to abortion; the vast majority of these measures—396 in 46 states—sought to restrict access to abortion services. The year will be remembered not only because 17 states enacted a total of 57 new abortion restrictions, but also because the politics of abortion ensnared family planning programs and providers, as well as critical, life-saving fetal tissue research.

2015 may also be memorable for setting the stage for what is widely anticipated to be one of the most significant Supreme Court rulings on abortion since 1992. In November, the Court agreed to hear a challenge to a Texas law requiring abortion providers to adhere to the standards set for ambulatory surgical centers and to have admitting privileges at a local hospital. At stake is the question of how far states may go in regulating abortion before their actions amount to an unconstitutional “undue burden” on women’s ability to access care. The Court will hear the case in March, with a decision expected in June; it is still considering whether to review a Mississippi admitting-privileges law. (Also in 2016, the Court will revisit the contraceptive coverage guarantee under the Affordable Care Act, weighing its importance and approach against the contention of religiously affiliated employers that they deserve to be entirely exempt from the law.)

At the same time, several states made important advances in 2015 on other sexual and reproductive health and rights issues. Some of the new provisions include measures that allow women to obtain a full year’s worth of prescription contraceptives at one time from a pharmacy, that allow a provider to treat a patient’s partner for an STI without first seeing the patient, that prohibit the use of “conversion therapy” with minors, and that expand access to dating or sexual violence education. See our full analysis for details.

Access to Abortion Services

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Including the 57 abortion restrictions enacted in 2015, states have adopted 288 abortion restrictions just since the 2010 midterm elections swept abortion opponents into power in state capitals across the country. To put that number in context, states adopted nearly as many abortion restrictions during the last five years as they did during the entire previous 15 years. Moreover, the sheer number of new restrictions enacted in 2015 makes it clear that this sustained assault on abortion access shows no signs of abating.

StateTrends2015-restrictions

The 288 new restrictions enacted since 2010 include a broad range of approaches, from banning certain types of abortions to putting restrictions on the providers allowed to perform the procedures to limiting insurance coverage.

StateTrends2015-access

Thirty-one states—spanning all regions of the country—enacted at least one abortion restriction during the last five years. The ten states that enacted at least ten new restrictions together accounted for 60 percent of the 288 new abortion restrictions adopted over the last five years. These states are overwhelmingly located in the South and the Midwest, and it is likely that access to services for women in these regions has been impacted significantly. Four states—Arkansas, Indiana, Kansas, and Oklahoma—each enacted at least 20 new abortion restrictions, making this handful of states, which together adopted 94 new restrictions, responsible for a third of all abortion restrictions enacted nationwide over the last five years. Kansas has the dubious distinction of leading the pack with 30 new abortion restrictions since 2010.

heat map

Although the 57 new abortion restrictions enacted during 2015 include a wide range of provisions, four topics stood out as the subject of particular attention among lawmakers:

1. Counseling and Waiting Periods

Five states adopted new (Florida and Tennessee) or lengthened existing (Arkansas, North Carolina, and Oklahoma) waiting period legislation in 2015. (The new Florida law has been temporarily blocked by the courts; the Oklahoma law is also being challenged, but a state court allowed it to go into effect while the case is pending.) Including these new laws, 27 states have waiting periods in effect. The new laws in Florida and Tennessee require the pregnant person to receive state-mandated abortion counseling in person, meaning that she must make two separate trips to obtain an abortion. With enforcement of the Florida law blocked, 13 states have two-trip requirements in effect.

2. Medication Abortion

Three states sought to use longstanding strategies to restrict access to medication abortion. Arkansas, Idaho, and Kansas enacted new measures banning the use of telemedicine for the provision of medication abortion. Arkansas also mandated use of the regimen specified in the FDA-approved labeling, which bans the use of the newer evidence-based regimen that is less costly, has fewer side effects, and can be used several days later in pregnancy; the law is not in effect due to a court case. Currently, 18 states ban the use of telemedicine and four require providers to follow an outdated medication abortion regimen.

Arizona and Arkansas debuted a new approach to discourage a woman from obtaining a medication abortion. Both states adopted laws requiring doctors to counsel women that the abortion could be stopped if the woman takes a high dose of progesterone after receiving the first of the two drugs included in the medication abortion regimen. According to the American Congress of Obstetricians and Gynecologists, this new approach is based on scant scientific evidence; it relies on a single flawed study of only six cases that did not have oversight by an institutional review board. The Arizona law is blocked pending a legal challenge; the Arkansas law is in effect.

3. Abortions After the First Trimester

Anti-choice lawmakers unveiled a new strategy in 2015 by moving to ban the use of the procedure used most often for second-trimester abortions. Kansas and Oklahoma both enacted measures to ban this safe and medically proven method that has long been used for abortions after 14 weeks; both laws are enjoined pending court action.

West Virginia and Wisconsin enacted laws banning abortion at or after 20 weeks post-fertilization (which is equivalent to 22 weeks after the woman’s last menstrual period). The West Virginia measure is in effect; the one in Wisconsin is slated to go into effect in February. Currently, 12 states have similar bans in effect.

4. Targeted Regulation of Abortion Providers (TRAP)

Even as the stage was being set for the U.S. Supreme Court to review TRAP laws, as we reviewed above, legislative action continued apace in several states. Five states adopted TRAP laws in 2015. Following a 2014 ballot initiative that granted lawmakers the ability to enact virtually limitless abortion restrictions, Tennessee enacted a new TRAP law that requires abortion providers to meet the standards that apply to ambulatory surgical centers even though these centers typically provide more invasive and risky procedures than abortion and use higher levels of sedation than commonly provided in abortion clinics.

Arkansas, Indiana, Ohio, and Oklahoma made existing requirements more stringent.

Family Planning Providers

In the aftermath of the release of a series of deceptively edited sting videos aimed at Planned Parenthood, attempts to defund the organization have flared at both the federal and state levels. By the end of 2015, some 11 states had moved to slash funding either for Planned Parenthood health centers specifically or for any family planning provider that also offers abortion services. A Guttmacher analysis shows that defunding Planned Parenthood could seriously impair women’s access to needed services: In two-thirds of the 491 counties in which they are located, Planned Parenthood health centers serve at least half of all women obtaining contraceptive care from safety-net health centers. In one-fifth of the counties in which they are located, Planned Parenthood sites are the sole safety-net family planning center.

PlannedParenthoodIsCritical

States have targeted a variety of funding streams on which family planning providers rely to fund the breadth of their services and activities, and are likely to continue in this vein in the upcoming 2016 legislative sessions:

Medicaid

Mirroring events in Congress, five states—Alabama, Arkansas, Louisiana, Oklahoma, and Texas—took steps to exclude Planned Parenthood from the Medicaid program in 2015. These efforts were blocked by federal courts in Alabama, Arkansas, and Louisiana; a challenge was just filed in November in Texas. Similar efforts made by Arizona and Indiana in recent years were also rebuffed by federal courts.

Other Family Planning Funding

Following the release of the videos, North Carolina expanded its existing provision blocking state funding of “non-public” family planning providers to explicitly apply to family planning providers that also offer abortion services. (Similar measures to bar funding for family planning providers that offer abortion care were introduced in Illinois, Pennsylvania, and Wisconsin.) In addition, New Hampshire’s Executive Council, an administrative board charged with overseeing large funding streams in the state, excluded Planned Parenthood health centers from receiving federal Title X dollars that flow through the state. (Title X funding that Planned Parenthood receives directly from the federal government is not affected.)

Currently, ten states limit eligibility for family planning funding. Eight of these states—Arizona, Arkansas, Colorado, Indiana, North Carolina, Ohio, Texas, and Wisconsin—prohibit abortion providers from receiving state family planning dollars. Kansas and Oklahoma exclude family planning providers not operated by public entities from eligibility.

Funding for Related Services and Activities

North Carolina and Utah moved to exclude family planning providers from eligibility for funding for related services. Legislation enacted in North Carolina bars family planning providers that offer abortion services from receiving funding for adolescent parenting and teen pregnancy prevention programs. Utah Gov. Gary Herbert (R) directed the state department of health to discontinue any funding for Planned Parenthood health centers, including funding for STI surveillance efforts, STI testing and treatment, and abstinence education; a federal appellate court recently prohibited the state from excluding Planned Parenthood from the funds.

Fetal Tissue Donation and Research

As yet another consequence of the release of the Planned Parenthood sting videos, ten states moved to regulate either the process for fetal tissue donation or biomedical research conducted in the state using fetal tissue resulting from induced abortions. Fetal tissue research has been integral to many of the major medical advances of our age. For example, fetal cell lines were used in the development of the polio vaccine and vaccines for diseases such as measles, mumps, rubella, chickenpox, hepatitis A, and rabies. In short, fetal tissue research has saved and improved the lives of millions of people worldwide.

During the final months of 2015, North Carolina and Arizona moved to regulate fetal tissue donation and research. A law enacted in North Carolina prohibits the sale of fetal tissue for a profit, paralleling federal requirements. Arizona adopted an emergency regulation requiring facilities to report any donation of fetal tissue to the state. Measures related to fetal tissue donation and research were introduced last year in Alabama, California, Michigan, New Jersey, Ohio, New York, and Wisconsin.

Editor’s note: Gwendolyn Rathbun and Zohra Ansari-Thomas also contributed to this analysis.