The 2013 guidelines for the United States’ premiere program for addressing global HIV/AIDS contains a new provision that explicitly prevents it from funding contraceptives and other “family planning commodities.” This provision isn’t mandated by Congress; it’s a purely executive decision that hurts women’s health and rights in the developing world. So why is it there?
The provision is a part of the new Country Operational Plan Guidance for the President’s Emergency Plan for AIDS Relief (PEPFAR), a program created in 2003 to centralize America’s efforts in the fight against HIV/AIDS. The 2013 version, issued in October, says that “PEPFAR funds may not be used to purchase family planning commodities,” a phrase that did not appear in the past three versions of the same document. Moreover, the new version also threatens aid workers who violate these strictures, saying “all USG personnel should be aware of legal restrictions and program requirements relating to family planning, and should consult with relevant Agency legal counsel with any questions in this area.” The insertion of these provisions is at the discretion of PEPFAR’s administrator, the Office of the Global AIDS Coordinator (OGAC), and is not mandated by the original PEPFAR legislation nor the 2008 reauthorization of the bill.
This change isn’t heralding a new policy: PEPFAR has had a restriction on purchasing for family planning commodities for quite some time, but this report is the first time that it’s been formally codified in this fashion. The technical guidance also specifies that PEPFAR may purchase and distribute condoms, providing no formal definition of “family planning commodities” but specifying clearly that contraceptives count.
Nonetheless, the family planning restriction in PEPFAR has been devastating for women’s health. A report from the Guttmacher Institute calls contraception “an important intervention” in preventing the spread of mother-to-child AIDS in Africa, finding that “current levels of contraceptive use among HIV-positive women living in Sub-Saharan Africa may already be preventing some 173,000 HIV-positive births annually.” The report notes that, although other forms of U.S. foreign aid provide contraception (which is PEPFAR’s defense of its policy), those efforts are not enough:
[I]t is undeniable that USAID’s family planning program is currently underfunded and under attack, and unless funding is increased immediately, there will be a serious shortfall of resources to meet the growing demand. At $615 million annually, U.S. funding for family planning is only a fraction of what it should be to meet the needs of women in the developing world, of which 215 million want to avoid a pregnancy but are not using an effective method of contraception. U.S. advocates have been calling for at least $1 billion annually. A recently released report by five former directors of the Population and Reproductive Health Program at USAID goes even further, making the case that funding for USAID’s family planning budget be set at $1.2 billion—and raised to $1.5 billion by fiscal year 2014.11 But these increases are unlikely if congressional House leaders have their way. Three times in 2011 alone, the Republican House has moved to slash funding for international family planning aid.
Moreover, the Guttmacher researchers note, PEPFAR operates in some countries that do not receive other family-planning assistance from U.S. agencies. Those include the three countries with the highest rates of HIV prevalence in the world (Swaziland, Botswana, and Lesotho).
The Obama Administration has made some positive moves on increasing access to family planning abroad. It has overturned the “Mexico City Policy” that defunds all NGOs that even mention abortion and has issued a blueprint document suggesting that PEPFAR plans to improve on its contraception policy going forward. However, anti-AIDS advocates have been critical of cuts to PEPFAR proposed by the Administration.