Reproductive Autonomy and Health: A Collective Battle that Confronts the Whole World

Hyun Lee
Vol. 39 Associate Editor

Access to voluntary family planning and reproductive healthcare play a key role in the protection of women’s reproductive rights around the world—it is not only central to gender equality and women’s empowerment, but also critical for reducing poverty.[1] However, many women in developing countries still lack even fundamental reproductive rights and health services, including contraception. As a result, approximately 303,000 women die annually during pregnancy or childbirth as a result of their lack of access to reproductive health services, and roughly one-third of such deaths could be prevented if those women had access to and used effective contraception.[2] Additionally, nearly 47,000 women also die from unsafe abortions on an annual basis.[3]

As one of the donor nations, the U.S. agreed during the 1994 International Conference on Population and Development (ICPD) to financially commit themselves to pay for one-third of the total funding needed to resolve issues related to the lack of contraceptives around the world.[4] One such commitment was to make monetary contributions to the United Nations Population Fund (UNFPA),[5] an agency which aims to provide reproductive healthcare to women and youth around the world, to prevent gender-based violence, and to protect people’s reproductive rights, such as a right to voluntary family planning.[6] Protecting women’s rights to voluntary family planning not only improves women’s reproductive health, but also significantly lowers the likelihood of women in developing countries living in extreme poverty.[7] Having autonomy to decide whether and when to have children enables women to avoid unwanted pregnancies, and to complete a higher level of education. In turn, this can eventually lead to a considerable increase in their potential earning power and economic security.[8]

Given that millions of women in more than 150 countries still lack access to reproductive health services and fundamental reproductive rights,[9] the donor nations’ financial contributions to the agencies like UNFPA play a crucial role in achieving gender equality by protecting women from gender-based violence and unwanted pregnancies. And yet, the U.S. bilateral funding for international family planning has declined by about $100 million since 1995.[10] Furthermore, the U.S. decided to withhold any future funding for UNFPA, claiming that UNFPA “supports, or participates in the management of a programme of coercive abortion or involuntary sterilization” in China.[11] The U.S.’s decision to withhold funding for UNFPA for the fiscal year 2017 is based on its interpretation of the Kemp-Kasten Amendment, a U.S. law that prohibits the U.S. from “funding any organization or program, as determined by the President, that supports or participates in the management of a program of coercive abortion or involuntary sterilization.”[12] The Kemp-Kasten Amendment is subject to Congress’ appropriations legislation, must be renewed annually, and approved by the President.[13] Because of the Trump Administration’s policy change, the U.S. withheld $32.5 million for UNFPA’s core services and “potentially millions more for other projective activities.”[14]

This is not the first time the U.S. decided to deny future funding for UNFPA, however. The Kemp-Kasten Amendment has been used to withhold funding from UNFPA in 16 of the past 33 fiscal years.  The Trump Administration’s decision reinstates a troubling policy despite the fact the U.S. government has found “no evidence that UNFPA directly engages in coercive abortion or involuntary sterilization in China” or that UNFPA “promote[s] abortion as a method of family planning or fund abortion services.”[15]

This is also reflective of the U.S.’s constant failure to meet its financial commitments to this cause. In 2001, the U.S. ranked last out of 22 major donors in its contribution relative to gross national product.[16] Considering the U.S. has already made the commitment to the right of individuals to make reproductive choices freely and autonomously by agreeing to the principles and Programme of Action of the 1994 ICPD, the Kemp-Kasten Amendment is unnecessary to ensure U.S. funding does not support coercive abortion or involuntary sterilization in the international community.[17]

The U.S.’s constant failure to meet its financial commitments under the ICPD is also reflective of the ICPD’s shortcomings. Although the ICPD was adopted by 179 Member States in 1994,[18] it is a consensus document that expresses “political will.”[19] Thus, the ICPD is not legally binding like treaties or conventions.[20] Because of this, the Member States which have adopted the ICPD merely pledged to enact legislation, “to increase domestic funding for population and development programmes, as appropriate, and call upon the international community to provide the resources required to implement activities to reach the goals and objectives of the Programme of Action.”[21]

This does not necessarily mean that the U.N. member nations are not obliged in any way to implement measures to protect women’s reproductive rights, however. Although the U.S. is one of the small number of U.N. member states—and the only country in the Western Hemisphere and the only industrialized democracy[22]—that have not ratified the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), 187 of the 194 U.N. member nations have ratified and/or acceded to the convention.[23] CEDAW which is also known as the Women’s Convention, is a legally binding treaty which, obliges signatories to “eliminate discrimination against women in all areas, and promote women’s equal rights”[24] by guaranteeing the exercise of fundamental human rights and freedoms by women, including “the right to health and health services.”[25] The Article 16(f) of  CEDAW specifically states that the state parties that have ratified the convention shall undertake all appropriate measures to ensure that men and women have, “[t]he same right to decide freely and responsibly on the number and spacing of their children and to have access to the information, education, and means to enable them to exercise these rights.”[26] At this point, CEDAW is the only human rights treaty which specifically affirms the reproductive rights of women, and legally binds the member countries to report on measures they have taken to comply with their treaty obligations and related progress. [27]

Gender-based violence, unwanted pregnancies, unsafe abortions, and poverty threaten the reproductive health, rights, and autonomy of women in developing countries. Because these are at least partially caused by women’s lack of access to comprehensive sexual education and reproductive healthcare facilities and devices,[28] donor nations’ continuous financial contributions to international agencies like UNFPA are crucial to win the on-going fight for gender equality,[29] a battle that all of us have to win together. To do this, wealthy countries like the U.S. must take on responsibility and fulfill their commitments.


[1] UNFPA, Family Planning, https://www.unfpa.org/family-planning (last visited Mar. 4, 2018).

[2] Kaiser Family Foundation, The U.S. Government and International Family Planning & Reproductive Health Efforts, KFF.org (Jul. 10, 2017), https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-international-family-planning-reproductive-health-efforts/

[3] CHANGE, Helms Amendment, http://www.genderhealth.org/the_issues/us_foreign_policy/helms/ (last visited Mar. 3, 2018).

[4] CHANGE, Foreign Assistance Budget, http://www.genderhealth.org/the_issues/us_foreign_policy/foreign_assistance_budget/ (last visited Mar. 4, 2018).

[5] See Note 4.

[6] UNFPA, About us (Jan. 2018), https://www.unfpa.org/about-us.

[7] See Note 6.

[8] UNFPA, Family planning empowers women, https://www.unfpa.org/family-planning (last visited Mar. 4, 2018).

[9] See Note 6.

[10] See Note 4.

[11] UNFPA, Statement by UNFPA on U.S. Decision to Withhold Funding, UNFPA (Apr. 4, 2017), https://www.unfpa.org/press/statement-unfpa-us-decision-withhold-funding.

[12] See Note 2; CRS, The U.N. Population Fund: Background and the U.S. Funding Debate (Jul. 15, 2010), https://www.everycrsreport.com/files/20100715_RL32703_ae82453b32fba2e6bf97c27588ad966e1daf3858.pdf.

[13] PAI, KEMP-KASTEN AMENDMENT AND THE GLOBAL GAG RULE—WHAT’S THE DIFFERENCE?, Pai.org (last visited Mar. 16, 2018), https://pai.org/advocacy-guides/kemp-kasten-amendment-global-gag-rule/.

[14] Kaiser Family Foundation, UNFPA Funding & Kemp-Kasten: An Explainer, KFF.org (May 12, 2017) https://www.kff.org/global-health-policy/fact-sheet/unfpa-funding-kemp-kasten-an-explainer/.

[15] See Note 14.

[16] Ctr. for Reproductive Rights, International Family Planning and Reproductive Health Programs: When Will the U.S. Government Fulfill Its Commitments?, 1, 16 (Jul. 2, 2001), https://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/pub_bp_familyplanning.pdf.

[17] CHANGE, Kemp-Kasten Amendment, CHANGE, http://www.genderhealth.org/the_issues/us_foreign_policy/kemp/ (last visited Mar. 4, 2018).

[18] UNFPA, International Conference on Population and Development, UNFPA (last visited Mar. 15, 2018), https://www.unfpa.org/icpd.

[19] Dr. Carmel Shalev, Rights to Sexual and Reproductive Health – the ICPD and the Convention on the Elimination of All Forms of Discrimination Against Women, UN (Mar. 18, 1998), http://www.un.org/womenwatch/daw/csw/shalev.htm.

[20] See Note 19.

[21] UNPOPIN, 94-09-04: Cairo Declaration on Population & Development, ICPPD, UN (Sept. 4, 1994), http://www.un.org/popin/icpd/conference/bkg/egypt.html.

[22] Amnesty International, A Fact Sheet on CEDAW: Treaty for the Rights of Women, Amnesty International (last visited Mar. 16, 2018), https://www.amnestyusa.org/files/pdfs/cedaw_fact_sheet.pdf.

[23] UN WOMEN, Country Reports, UN WOMEN (Dec. 28, 2007), http://www.un.org/womenwatch/daw/cedaw/reports.htm#u; Lisa Baldez, U.S. drops the ball on women’s rights, CNN (Mar. 8, 2013, 11:34 PM ET), https://www.cnn.com/2013/03/08/opinion/baldez-womens-equality-treaty/index.html.

[24] Pooja Khanna et al., Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) for Youth, UN WOMEN 1,1 (2016), http://www.unwomen.org/en/digital-library/publications/2016/12/cedaw-for-youth.

[25] See Note 21.

[26] UN WOMEN, Article 16(f), The Convention on the Elimination of All Forms of Discrimination Against Women, UN WOMEN (Dec. 18, 1979), http://www.un.org/womenwatch/daw/cedaw/text/econvention.htm#article16.

[27] UN WOMEN, Text of the Convention, UN WOMEN (last visited Mar. 16, 2018), http://www.un.org/womenwatch/daw/cedaw/cedaw.htm.

[28] See Note 6.

[29] Id.

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