U.S. Foreign Policy & Funding


In 1994, the U.S. joined 178 other countries in signing the International Conference on Population and Development (ICPD) Programme of Action. This agreement marked an historic reframing of family planning, refocusing efforts away from population reduction and toward a focus on women’s health and human rights. Women’s groups also succeeded in gaining international recognition of the fundamental rights of reproductive self-determination and reproductive health care.

In 2010, Secretary of State Hillary Rodham Clinton strongly reaffirmed the U.S. commitment to the ICPD framework. However, the U.S. government has not yet translated the principles and priorities of comprehensive sexual and reproductive health and rights into action through its international policies and foreign assistance.

For example, the U.S. response to global sexual and reproductive health issues is segregated. Instead of being addressed holistically, these issues are “siloed” by different offices, agencies, and funding mechanisms. They are governed by different policies and evaluated separately.

In practice, this means that global HIV programs have not typically supported family planning for HIV positive women who want to postpone or avoid childbearing. Women receiving U.S.-supported prenatal care may not receive counseling on effective family planning methods. U.S.-funded HIV testing centers are not required to integrate screening for gender-based violence.

Also, a comprehensive and collaborative approach to sexual and reproductive health has been further complicated by politically-motivated funding restrictions that run counter to the promotion of health and human rights.

See CHANGE's report Reproductive Justice for All: Toward a U.S. Foreign Policy on Comprehensive Sexual and Reproductive Health and Rights

How foreign assistance breaks down:  The Foreign Assistance Dashboard provides a view of U.S. Government foreign assistance funds and enables users to examine, research, and track aid investments in a standard and easy-to-understand format. It was initiated by the Department of State and USAID under the policy guidance of the National Security Staff. 

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Support the Global HER Act

It is time for Congress to permanently end Trump's global gag rule. Join us as we urge Congress to demonstrate their commitment to women’s health and rights.

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Take Action for Rape Survivors

Tell President Obama: Stand with women and girls raped in conflict or crisis. Ensure that U.S. funds can be used to provide safe, voluntary abortion care overseas in cases of rape, incest, and life-endangerment.

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Source$15 billionLaunched in 2003 by President George W. Bush, PEPFAR pledged $15 billion over 5 years to combat global HIV/AIDS.

Source$48 billionPEPFAR was reauthorized on July 30, 2008 and authorized $48 billion through fiscal year 2013.

Source0Emergency contraception (EC) is not distributed by USAID.

Source35In real terms, U.S. support for family planning is at the same level now as it was 35 years ago.

Supreme Court Strikes Down Bush-Era Anti-Prostitution Pledge

While it seems Americans will have to wait until next week to hear word about the fate of gay marriage rights, there was still a very important human rights decision handed down today: The Supreme Court has ruled that the federal government cannot require HIV outreach organizations to sign an anti-prostitution pledge in order to get government funding.

Posted on June 20, 2013

American Prospect: Promoting Human Rights versus Promoting Prostitution

People have always bought and sold sex, sometimes risking shame or punishment. But these days, simply helping a sex worker can have costly legal and financial consequences.Under the U.S.’s flagship international aid program on HIV and AIDS, an organization that gives out free condoms at a brothel, for example, might be deemed in violation of the program’s anti-prostitution policy, and, as a result, risk losing public funding.

Posted on May 24, 2013

Is the GHI Dead, or Is This a Wake up Call?

Global health has been absent from the debates so far. It needs to make an appearance in the third at final debate, because we're about to sacrifice the opportunity to make a difference for women in the name of politics.

Posted on October 22, 2012

Foreign Policy, Akin-Style: How the U.S. Denies Abortions to Women Raped in War

When rape is used as a weapon of war in places like Congo or Bosnia, thousands of women and girls can become pregnant, but a piece of 39-year-old U.S. legislation means that few if any aid groups are allowed to provide or even discuss abortion services with them.

Posted on August 21, 2012

Why the Global Fund Matters

The New York Times, February 1, 2012 - Ten years ago, the heads of the G-8 countries met in Genoa, Italy, to back the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria — a new funding mechanism that dramatically increased resources available to fight preventable, treatable diseases stalking the poor and depleting developing economies around the globe.

Posted on February 1, 2012

UNAIDS and PEPFAR welcome the launch of the Business Leadership Council to end new HIV infections am

UNAIDS, 27 January 2012 — UNAIDS and PEPFAR welcome the launch at the World Economic Forum in Davos, Switzerland of two new initiatives by business leaders—the Business Leadership Council for a “Generation Born HIV Free” and the Social Media Syndicate to end new HIV infections in children.

Posted on January 27, 2012

International Initiatives to Advance the Human Rights of LGBT Persons

The White House, December 6, 2011 - The struggle to end discrimination against lesbian, gay, bisexual, and transgender (LGBT) persons is a global challenge, and one that is central to the United States commitment to promoting human rights. I am deeply concerned by the violence and discrimination targeting LGBT persons around the world whether it is passing laws that criminalize LGBT status, beating citizens simply for joining peaceful LGBT pride celebrations, or killing men, women, and children for their perceived sexual orientation.

Posted on December 7, 2011

Will Obama follow through on Clinton’s ‘AIDS-free generation’ speech?

Miami Herald, November 22, 2011 - Secretary of State Hillary Clinton gave a speech recently that most will never hear. But she said something we all should know: “Creating an AIDS-free generation has never been a policy priority for the United States government — until today.” Or in other words, we can end AIDS.

Posted on November 23, 2011

Global Health, Empowerment and Rights (HER) Act [S.368; H.R.1055]

The Global Health, Empowerment and Rights (HER) Act was introduced by Senator Jeanne Shaheen in the Senate and by Representative Nita Lowey in the House on February 7, 2019. The Global HER Act would permanently end the Global Gag Rule by removing dangerous eligibility restrictions on international recipients of U.S. assistance. Passage of the Global HER Act would guarantee that U.S. foreign aid promotes health care that is free from stigma and discrimination, prioritizes women’s health, and is consistent with the fundamental principles of the United States, including the right to free speech.

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Censorship Exported: The Impact of Trump’s Global Gag Rule on the Freedom of Speech & Association

A policy brief on the impact of Trump's Global Gag Rule on freedom of speech and association.

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Global Gag Rule: Fact Sheet

Read this one page fact sheet to learn more about the global gag rule.

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American Attitudes on the Global Gag Rule: Results of a Bipartisan National Poll

A bipartisan poll commissioned by CHANGE and PAI reveals that across age, education level, gender, race, political party and even abortion stance, the majority of American voters are opposed to “Protecting Life in Global Health Assistance,” also known as the global gag rule.

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Global Gag Rule: Policy brief

Read this policy brief to learn more about the global gag rule and it's previous as well as projected impacts. This policy brief also includes a timeline of policy and legal actions.

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Prescribing Chaos in Global Health: Mozambique Case Study

A case study that explores immediate impacts of Trump's global gag rule in Mozambique.

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Prescribing Chaos in Global Health: Zimbabwe Case Study

A case study that explores immediate impacts of Trump's global gag rule in Zimbabwe.

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Prescribing Chaos in Global Health: The Global Gag Rule from 1984-2018

A groundbreaking report that documents the harms of the global gag rule from 1984-2018, with new data on immediate impacts of Trump's global gag rule in Mozambique and Zimbabwe.

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File Under: U.S. Policy, Fact Sheets

U.S. Foreign Policy & Funding Topics

Anti-Prostitution Pledge

The anti-prostitution pledge requires organizations receiving U.S. funds to explicitly oppose prostitution, which compromises health services for sex workers--one of the groups at highest risk for HIV infection.

Fact Sheets: US Strategies, Policies, and SRHR

The U.S. government has developed policies and strategies to make gender equality a foreign policy priority and to expand the reach and impact of those priorities. Knowing what each of these strategies and policies say about sexual and reproductive health and rights (SRHR) is important for turning plans into programs that meet the SRHR needs of women and girls throughout the world.

Watch: Making U.S. Foreign Assistance Work for Women and Girls in Ethiopia

This video documents CHANGE's 2010 study tour to Ethiopia and makes policy recommendations for improving the effectiveness of U.S. foreign assistance to advance the sexual and reproductive health and rights of women and girls in Ethiopia.

Female Condoms and U.S. Foreign Policy

The female condom is currently the only available dual protection tool that prevents both HIV/STIs and unintended pregnancy.

Family Planning Policy Restrictions and HIV

Attacks on international family planning funding and policy hinder the progress of U.S. efforts to provide effective HIV prevention, care, and treatment.

U.S. Global Health Initiative

The GHI, introduced in 2009, is the first U.S. international development effort that promotes a woman-centered approach to integrated health services.

Global Gag Rule

Documentation and analysis of the Global Gag Rule shows that the policy restricts a basic right to speech and the right to make informed health decisions.

Global HER Act

The Global Health, Empowerment and Rights (HER) Act would permanently end the global gag rule by removing dangerous eligibility restrictions on international recipients of U.S. foreign assistance.

Helms Amendment

The Helms amendment prohibits U.S. funds from being used to provide abortion services or information.

Foreign Assistance Budget

Foreign assistance accounts for about one percent of the total U.S. budget.

Foreign Assistance Reform

To increase the effectiveness of U.S. foreign assistance spending, policy makers are currently working to reorganize foreign assistance and bring greater coherence to the country's aid structure.

Kemp-Kasten Amendment

The Kemp-Kasten Amendment prohibits foreign aid to any organization that the administration determines is involved in coercive abortion or involuntary sterilization.

Abstinence & Fidelity

When Congress reauthorized the President’s Emergency Plan for AIDS Relief in 2008, it loosened, yet maintained, a funding preference for programs that focus on abstinence and faithfulness to the exclusion of condom education.

Advocacy and Foreign Assistance

Listen to CHANGE President Serra Sippel discuss why advocacy is critical to developing effective U.S. global health policy (podcasts)