International Women’s Health? Who’s President Makes The Difference

Craig Lasher

On the global gag rule, on funding for UNFPA, and on PEFPAR -- who holds the office of the Presidency makes the critical difference.

Under the Constitution and
our system of government as it has evolved over the more than 200 years
of the country’s history, the President has been vested with a number
of powers and authorities by which he can imprint his stamp on the interactions
of the United States with the rest of the world, including through development
and humanitarian assistance. As a result, who occupies the White House
can greatly affect what policies govern international family planning
and reproductive health (FP/RH) programs and how much money is spent
on these critical health activities. The President matters. 

The fact that the President
matters is nowhere more obvious in the policymaking arena, in two ways — either
through promulgation of policy directives himself or in interpreting
and enforcing the laws passed by Congress.

In the first instance, it is important to remember that the Mexico City Policy/Global
Gag Rule
, which
prohibits U.S. family planning and reproductive health (FP/RH) assistance from being provided to foreign nongovernmental
organizations (NGOs) that provide abortion services or counsel, refer,
or lobby on abortion with non-U.S. funds, is solely an executive branch
policy. The Global Gag Rule has been a ping pong ball that has bounced
back and forth depending on who was in the White House. President George
W. Bush announced the reinstatement of these restrictions, which were
in effect during the Reagan and Bush administrations in the mid-1980s
and early 1990s, on his second day in office, merely by issuing a "presidential
memorandum" to the Administrator of the Agency for International
Development. President Clinton had rescinded the policy on one of his
first days of his term in 1993 by issuing a similar memorandum. The
next President could choose either course of action — leave in place
or rescind. 

Whether or not the United States
will provide a contribution to the United Nations Population
(UNFPA) is
dependent upon and an example of the second type of leverage that the
President can exert on FP/RH policymaking — the ability to interpret
the law. For the last seven years, President Bush has withheld the U.S. contribution
by employing
an overly broad interpretation of the so-called Kemp-Kasten amendment
(first attached to annual appropriations bills in 1985), which prohibits
funding to any organization that "supports or participates in the
management of a program of coercive abortion or involuntary sterilization,"
and by pointing to the presence of a UNFPA country program in China, where
human rights abuses have occurred, as grounds for denying funding. Conversely,
the lawyers in President Clinton’s State Department employed a different
and more narrow and proper interpretation of the statute to allow U.S.
funds to flow to UNFPA during his tenure. Whether or not the next President
wants to fund UNFPA will determine how the Kemp-Kasten amendment is
interpreted and whether the United States will rejoin the more than
180 nations that now contribute to UNFPA. 

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(The next President might go
even further by expanding the application of the Kemp-Kasten amendment,
following through on the threat of the Bush
administration to defund other organizations working in China
with the same Chinese government institutions
which they have judged to be the enforcers of the "one-child" policy.) 

The President has wide discretion
in the conduct of foreign policy. So unless Congress explicitly prohibits
or restricts something, the President enjoys broad latitude in choosing
how to implement legislative directives and in establishing policy guidance
for the programs the executive branch administers. This separation of
powers will enable the next President to choose how to interpret and
implement various reproductive health-related provisions contained in
the recently-passed
reauthorization of the President’s Emergency Plan for AIDS Relief
(PEPFAR). Suc provisions include the anti-prostitution
requirement and abstinence funding reporting requirement as well
as whether the Office of the Global AIDS Coordinator will explore ways
to better integrate FP/RH
activities into HIV prevention programs
such as prevention-of-mother-to-child
voluntary counseling and testing.

As the old aphorism goes, "The President proposes, Congress disposes."
On the question of funding for FP/RH programs, the President can also
exert considerable influence over the amount appropriated through the
request level in his annual federal budget proposal, but ultimately
Congress has the power of the purse. Nevertheless, a low request from
the President such as the 25 and 29 percent cuts
to FP/RH proposed by President Bush

in the last two fiscal years, taxes the ability of family planning champions (especially the chairs of the House and Senate State-foreign operations
appropriations subcommittees) to find additional funding and to balance
many important competing priorities within a limited overall budget
ceiling within which they have to work.

Bottom line, whether it is policymaking or funding for U.S. involvement
in family planning and reproductive health programs around the world,
the President matters — and matters greatly.

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