Federal Block Grants Are Not Budget Neutral

Although President Trump has not yet proposed any specific policy plans regarding American safety net programs, he will need to build a collaborative, if not intentional, relationship with leading Republican officials such as House Speaker Paul Ryan in this policy area. Speaker Ryan’s signature interest focuses on safety net spending reform, and his 2014 Poverty Plan and his 2016 Better Way plan call for the creation of block grants: a strategy of welfare reform that we have significant experience with dating back to the 1960s. This history tells us that block grants are not budget neutral; people of color and those with low to moderate incomes are likely to be disproportionately negatively affected by block grants, and within these groups, those most affected will be single women-headed households with children.

Under a block grants system, each state would essentially receive a lump of federal money from which they can determine the distribution of funds among the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance to Needy Families (TANF), child care, housing assistance, and many other programs, thus ensuring that states control programmatic outcomes.

Federal block grants were first used by democrats in the 1960s and later extended by Republicans in the 1970s and 1980s. The Nixon administration used this tactic to consolidate hundreds of War on Poverty programs into a few block grant programs.

Many of the programs that were consolidated targeted low-income communities and people of color living in impoverished areas. During the War on Poverty, these communities were for the first time empowered to participate in the creation and dissemination of federal program resources,  participation that was rolled-back with the introduction of block grants.

 The Nixon rhetoric is uncannily similar to President Elect Donald Trump’s campaign theme  ‘Make Our Country Safe Again’. The Nixon administration proclaimed that the “War on Poverty” was over and that the era of “law and order” had arrived, which meant a shift in tactics to policing the poor, rather than empowering them. Through the transition to block grants, Nixon was able to defund many of the war on poverty programs.

The Nixon administration consolidated a large amount of federal funding into a pool for states to control and in the process evaded the politics of citizen participation, which was so essential to the war on poverty programs.

This dismantling forced many local officials, residents, and state employees to face their ideological opponents and “duke it out” over resources, programmatic visions, and outcomes that local residents –those most impacted– had once defined and implemented. In some cases, these state-level disputes resulted in denial of funds to local governments, forcing some, like Hennepin County Minnesota, to drain its own resources to keep open clinics like Pilot City now known as the NorthPoint Health and Wellness Center that were formerly funded by the federal government. In the 1980s, the Reagan administration went even further and consolidated the remaining programs into another set of block grants, which provided even less funds for once robust programs.

Block grants aim to reduce federal control over local government and provide fewer federal restrictions and less monitoring and oversight than the previous federal urban renewal programs. The previous federal programs had deemed monitoring essential to ensure equity in access to resources following histories of denial of federal entitlements to some groups. Ultimately, the block grant approach asked states to provide the same services with less funds and forced cities to rely more heavily on private funds, bonds, and other creative growth models for their urban regeneration efforts.

Today, as localities aim to reverse trends of unemployment and disinvestment in central cities caused by developers expanding their focus on the suburbs, the new metropolis is too often compelled to place its fiscal fruition above the needs of its most vulnerable populations. Cities have moved away from asking those most affected what they need and instead are focused on narrow fiscal concerns, spurred by tight budgets.

Like block grants of the past, House Speaker Paul Ryan’s plans will exacerbate this trend by not only providing less funds for entitlement programs and providing fewer services, but will also continue this tradition of denying those most affected by poverty their right to participate in how these resources are distributed and what outcomes are most important.

As co-curator of the Economic Security page, I am interested in interrogating how the 115th Congress’ economic policy agenda will impact the country’s most vulnerable populations and their access to the services they need to survive or move into fiscal stability. I am also interested in the ideological frameworks that our local and national leaders use to justify “access” and who “deserves” economic resources and how these may be code for worth, value, and the right to participate in your own economic fruition. Block grants are just one of many potential policy proposals we will be following on this page.

– Dr. Brittany Lewis, Research Associate, Center for Urban and Regional Affairs, University of Minnesota

Photo from the Jack Rottier Collection




New President, Old Anti-Abortion Policy

Continuing Contradictions in US Global “Family Planning” Policies

On his third day in office, President Donald Trump issued an executive order that prohibits reproductive health NGOs that receive US family planning assistance from providing abortion services, information, or referrals, or participating in advocacy to liberalize abortion laws. Since its introduction by President Reagan’s administration in 1984 at the United Nations Conference on Population and Development in Mexico City, this policy been reinstated by Republican presidents (George H. Bush and George W. Bush) and rescinded by Democratic presidents (Bill Clinton and Barack Obama). In other words, it represents a way of signaling, during the earliest days of each new administration, the government’s stance on global and domestic abortion politics.

Organizations that receive US family planning assistance are required to certify in writing that they will not use their own funds to engage in abortion-related activities and services prohibited by the policy. Reproductive health advocates have dubbed President Reagan’s 1984 Mexico City Policy “the Global Gag Rule” for its silencing effect on abortion research, services, and advocacy by international NGOs.  Despite the policy’s goal to reduce abortion, evidence suggests that declines in abortion rates have stalled in developing countries.   The anti-abortion stance of the 1984 Mexico City Policy belies an earlier interest on the part of the US government in deploying abortion as a mechanism of population control in developing countries.  Until the early 1970s, the US government significantly invested in the research, development, and global distribution of not only contraception but also abortion technologies.

The current iteration of the “Global Gag Rule” in many ways represents the culmination of a long history of the US government’s involvement in the field of global population and development, in which domestic debates about women’s access to abortion and contraception have been inextricably intertwined with foreign policy related to reproductive health.

By the mid-1950s, to respond to the perceived problem of overpopulation in developing countries, population experts in the Ford and Rockefeller Foundations, the Population Council, and Pathfinder International were actively engaged in global family planning programming and research.  In contrast, US foreign policy remained silent on the issue of population until the mid-1960s.  In 1965, the same year that the US Supreme Court legalized contraceptive use for married couples in its Griswold v. Connecticut ruling, President Lyndon B. Johnson characterized population control as a matter of national security in his State of the Union address.  As countries decolonized in the global South, US policymakers grew increasingly concerned that the strain on resources caused by overpopulation in newly sovereign nations would render them sympathetic to socialism.  By the late 1960s, the USAID had officially incorporated family planning into development aid and was actively funneling money to organizations such as International Planned Parenthood Federation (IPPF) and the United Nations Fund for Population Activities (UNFPA) that provided family planning services in developing countries.

During the early 1970s, the Office of Population of the United States Agency for International Development (USAID) supported the manufacture and distribution of a syringe technology now known as the Manual Vacuum Aspiration (MVA) syringe. In 1973, the same year that the US Supreme Court legalized abortion upon request for American women, Congress passed the Helms Amendment to the Foreign Assistance Act, which prohibited the “promotion of abortion as a form of family planning.”

Under the Helms Amendment, federal funds could not be used to procure abortion services, drugs, or devices.  It signaled the growing influence of a domestic anti-abortion movement, galvanized by Roe v. Wade, that aimed to curb the application of federal funds to abortions at home and abroad.

In response to these new restrictions, the USAID delegated the manufacture and distribution of the MVA device to NGOs such as the International Pregnancy Advisory Service (now known as Ipas).  By 1978 approximately 175,000 MVA devices had been distributed to developing countries through Ipas, IPPF and the International Research Fertility Program (IRFP) for the purpose of menstrual regulation, a euphemism for abortion [1-3].

Despite the USAID’s continuing commitment to family planning as an essential development strategy, President Reagan introduced increasingly anti-abortion policies into foreign development plans during the early 1980s. The USAID continued to donate contraceptives and support family planning training for health workers, but stopped funding biomedical research on abortion and training of medical providers in abortion techniques. Additionally, the USAID began to promote natural family planning methods such as the fertility awareness method, also known as the rhythm or calendar method.

In 1984, the US delegation to the United Nations Population and Development conference in Mexico City unveiled the Reagan administration’s population policy.  While the US had taken a strong “population control” stance since the mid-1960s, at this conference the US no longer perceived high fertility as an impediment to economic development.  Instead, US delegates identified neoliberal reform as the solution to underdevelopment. Within the health sector, this meant scaling back state investments in primary health care recommended by the Alma Ata Declaration of 1978 and increasing user fees for health services.

Although the US reaffirmed its commitment to family planning in the Mexico City Policy, it categorically precluded funding for abortion services, referral or counseling, even in countries where abortion was legal. Additionally, in contrast to previous USAID language on contraceptive use as a matter of voluntarism and informed choice among women and couples, the 1984 policy framed contraception in terms of “preserving maternal and child health” and “meeting the interests of families” [3].

In other words, this policy prioritized access to contraception for mothers as a matter of family health rather than women’s sexual and reproductive health and choice.

In 1985, under the Kemp-Kasten Amendment, the Reagan administration withdrew funding from UNFPA because of its alleged involvement in enforcing China’s One Child Policy through “coercive abortion and forced sterilization.” US funding was restored to UNFPA in 2009 under the Obama administration. Some groups interpret Trump’s Executive Order as once again defunding UNFPA.

Not surprisingly, the 1984 Mexico City Policy did not achieve its goal of reducing abortion in countries receiving US aid.  To the contrary, evidence suggests that in response to family planning service cutbacks and clinic closures among NGOs affected by the policy, undesired pregnancies and abortions increased in these countries. A 2011 study of 20 African countries shows that the odds of abortion more than doubled during periods when the policy was in effect [4]. In Ghana, abortion increased among low-income and rural women and child health outcomes declined under the policy [5].

The US is one of the most generous donors of global family planning assistance, providing up to $575 million in 40 countries [6].

The Mexico City Policy hinders the USAID’s ability to donate contraceptives and support health providers in developing countries where access to family planning is key to preventing unwanted pregnancy and reducing maternal mortality.  Additionally, it infringes on the sovereignty of national health authorities to address public health matters as they see fit [7].

In Nepal, for example, complications of unsafe abortion account for up to 50% of maternal mortality.  In 2002, the government legalized abortion to address the public health problem of unsafe abortion. When the Family Planning Association of Nepal (FPAN), the country’s largest family planning provider, refused to comply with the Mexico City Policy, it lost up to $400,000 worth of contraceptives donated by the USAID. To continue operations in its national network of clinics, FPAN had to introduce user fees and lay off health workers.  Given that FPAN provides between 25 to 30% of Nepal’s reproductive health services, including contraception, infertility diagnosis and treatment, gynecological exams, and legal abortion, the Global Gag Rule directly restricts Nepalese women’s access to reproductive health care [8].

When President George W. Bush reinstated the Mexico City Policy in 2001, he exempted various services, programs, and institutions, including post-abortion care (emergency treatment for abortion complications), hospitals, governments, and the President’s Emergency Plan for AIDS Relief (PEPFAR).  The 2017 policy makes no such exceptions and goes even further by extending to all organizations receiving US global health assistance, which totals approximately $9 billion in 60 countries [6].  Under President Trump, the Mexico City Policy could potentially threaten the ability of NGOs, governments, and hospitals in developing countries to treat life-threatening complications of abortion and diagnose and treat infectious disease such as HIV, malaria, tuberculosis, Zika, and Ebola.

There is no fiscal, geopolitical, or public health rationale for the “Global Gag Rule.”  The 1973 Helms Amendment already prevents the application of US tax dollars towards abortion-related services or devices abroad.

It has not contributed to declines in abortion in countries that receive US family planning assistance. In fact, while abortion rates have declined significantly in developed countries since 1990, they remain the same in much of the developing world [9].  The aim of the “Global Gag Rule” is simple: to restrict women’s reproductive autonomy.  In this sense, ironically, it echoes rather than disrupts the population control logics of the Cold War era.  The Mexico City Policy has simply shifted, and in its latest iteration, expanded the mechanisms through which women’s bodies are controlled.

—  Siri Suh, PhD, MPH, Assistant Professor, Gender, Women & Sexuality Studies/Institute for Global Studies,University of Minnesota

Photo Credit: PBS News Hour

References

  1. Kulczycki, A., The abortion debate in the world arena. 1999: Taylor & Francis.
  2. Murphy, M., Seizing the means of reproduction: Entanglements of feminism, health, and technoscience. 2012, Durham, NC.: Duke University Press.
  3. Dixon-Mueller, R., Population policy & women’s rights: Transforming reproductive choice. 1993: Praeger Publishers.
  4. Bendavid, E., P. Avila, and G. Miller, United States aid policy and induced abortion in sub-Saharan Africa. Bulletin of the World Health Organization, 2011. 89(12): p. 873-880c.
  5. Jones, K., Evaluating the Mexico City Policy: How US foreign policy affects fertility outcomes and child health in Ghana. 2011, International Food Policy Research Institute: Washington, DC.
  6. Lederer, E., Trump expands anti-abortion ban to all US global health aid, ABC News. January 24, 2017.
  7. Cohen, S.A., Abortion politics and US population aid: coping with a complex new law. International Family Planning Perspectives, 2000. 26(3): p. 137-145.
  8. PAI, Access denied: The impact of the Global Gag Rule in Nepal. 2006, Population Action International.
  9. Sedgh, G., et al., Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. The Lancet, 2016. 388(10041): p. 258-267.