Show Me the Money: Appropriations Season Underway

Major Victories for Family Planning in Funding Bill

In mid-May, the House Appropriations Committee met to consider the FY 2020 State Department/Foreign Operations spending bill, which funds U.S. international family planning programs. By every measure, the underlying bill was a marked improvement over previous years.

It called for a minimum of $750 million for bilateral international family planning programs, a robust increase over the most recent enacted level of $575. The committee request was a dramatic rebuke of the Trump administration’s   pathetic request of $237 million.

The spending bill also earmarked $55.5 million for the U.S. contribution to the United Nations Population Fund (UNFPA), a $23 million increase over the most recent level. More importantly, the bill removed the prohibition on funding that had been included in previous years’ House bills. The new UNFPA funding, however, even if enacted, can still be withheld by the White House, due to a provision known as the Kemp-Kasten amendment.

During debate on the bill, Rep. Chuck Fleischmann (R-TN-3) offered an amendment to strike the contribution to UNFPA and reinstate the ban on U.S. funding to the organization. The Fleischmann amendment was defeated 23–29, with all Democrats present voting “no” and all Republicans voting “yes.”

Additionally, the bill included the operative language of the Global Health, Empowerment, and Rights (HER) Act (S. 368/H.R. 1055). Sponsored by Sen. Jeanne Shaheen (D-NH) and Rep. Nita Lowey (D-NY-17), the Global HER Act would permanently repeal the Global Gag Rule. Its inclusion in the appropriations bill is an enormous victory.

The Global Gag Rule, a fixture of every Republican presidency since Ronald Reagan—and dramatically expanded under Donald Trump—cuts off U.S. aid to any overseas NGO that uses its own funds to offer abortion services, referrals, or counseling to its patients.

A recent study, published in The Lancet, found that by cutting off funding for contraception and other basic health care programs, the Global Gag Rule causes the incidence of abortion—particularly unsafe abortion—to go up. In fact, the researchers found that abortion incidence increased by 40 percent in the most affected countries during George W. Bush’s Global Gag Rule.

Rep. Andy Harris (R-MD-1) offered an amendment to strip the Global HER Act language from the spending bill. His amendment failed, 22–29, along party lines.

The spending bill was ultimately approved by the committee by a vote of 29–23, also along party lines.

In mid-June, the bill came to the full House floor as part of a “minibus”—a package of five separate funding bills bundled to be debated and passed together. Floor debate gave anti-family planning members a second opportunity to attempt to remove provisions they opposed. Rep. Debbie Lesko (R-AZ-8), along with 14 Republican cosponsors, offered an amendment to eliminate the family planning funding requirement. It failed 188–225. All Democrats present voted against the amendment, with two exceptions: Rep. Dan Lipinski of Illinois (3rd district) and Rep. Collin Peterson of Minnesota (7th district). All Republicans present voted in support of eliminating the family planning funding requirement.

At the time of our deadline, the Senate had not yet begun work on its version of the bill. However, with two pro-family planning Republicans on the Appropriations Committee (Sens. Susan Collins of Maine and Lisa Murkowski of Alaska), there may be opportunities here to advance our policy and funding goals that simply weren’t available in recent years, when family planning opponents controlled the House.

ECHO Trial Results: a Relief, and a Warning

Back in 2011, a study from the University of Washington set off alarm bells among family planning and HIV/AIDS groups when it found that women who used hormonal contraception—specifically the Depo-Provera injectable contraceptive—were at an increased risk of contracting and/or spreading HIV. The difference wasn’t small: The study indicated the risk for Depo users might be twice as high as for users of non-hormonal methods. The 2011 study also found higher rates of HIV transmission among pill users, though the participant sample was too small for the researchers to be confident about the implications.

The pill remains one of the most popular forms of contraception in the world, while Depo is one of the only reliable methods available to people who don’t want a partner to know they’re using contraception. If the study’s finding was accurate, it would seriously complicate the picture for millions of people.

The ECHO (Evidence for Contraception Options and HIV Outcomes) trial was intended to provide a definitive answer to the question. The trial, involving more than 7,800 women across four countries—Eswatini (formerly Swaziland), Kenya, South Africa, and Zambia—tested three contraceptive methods (a hormonal implant, an injectable contraceptive, and the copper IUD).

The results, released in late May, were a tremendous relief to family planning advocates: There was no difference in HIV infection rates among users of the tested methods. The study did, however, have one alarming finding. Despite extensive counseling and the use of PREP (pre-exposure prophylaxis) medications, rates of HIV acquisition were unacceptably high across the study population, highlighting the continuing need for efforts to fight the epidemic.

The ECHO trial highlights the importance of serious, careful science in questions of public health. It also throws into sharp relief the haphazard way the United States approaches such questions, especially when it comes to reproductive health.

Appeals Court Upholds Domestic Gag Rule

In our last issue, we reported that a federal court in Washington state had delayed Trump’s Domestic Gag Rule nationwide. The rule cuts off Title X funds to family planning providers that offer abortion services or referrals, along with several other measures that would undercut the program.

Trump’s department of Health and Human Services appealed the ruling, and on June 20, a three-judge panel from the 9th Circuit Court of Appeals reversed the lower court’s ruling, lifting the injunction and allowing the rule to go into effect immediately.

The National Family Planning and Reproductive Health Association, one of several plaintiffs challenging the rule, filed an emergency motion asking that the entire 9th Circuit Court of Appeals reconsider the decision. It did, on July 11, but rather than reject the panel’s ruling, the full court affirmed it. Parts of the rule—the gag on abortion referrals, for one—are already going into effect, while others will be phased in over time.

For now, the Trump administration is winning this battle, but advocates have vowed to continue the fight.

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