Exporting our Culture Wars on Abortion: What’s Happening with PEPFAR, and Why Does it Matter?
By Dilly Severin, Executive Director, Universal Access Project, in conversation with Craig Lasher, Senior Fellow, PAI
Big wins on abortion rights seized headlines last month during U.S. state-level elections in Ohio, Virginia, and Kentucky. In Virginia, voters elected pro-choice candidates into control of the state legislature, thwarting anti-choice plans led by the governor. In Ohio, abortion was directly on the ballot, and voters elected to approve an initiative that enshrines the right to abortion in the state constitution. And in Kentucky, voters reelected a pro-choice governor despite efforts from an anti-choice challenger.
This cements what we know to be true: That abortion rights and bodily autonomy matter to this American electorate, and it will vote accordingly.
What’s less evident in our day-to-day as Americans is that there is a similar battle happening in U.S. foreign policy. Our futures are connected to the futures of communities overseas: What happens domestically in the U.S. is and has always been linked with our foreign policy — and abortion rights are no exception.
This is particularly evident right now as we see our domestic battle around abortion bleeding into negotiations around PEPFAR, or the President’s Emergency Plan for AIDS Relief. Top of mind on this World AIDS Day, this U.S.-led program has been credited with saving more than 25 million lives over the last 20 years and has seen bipartisan support for just as long. Now, as it is up for reauthorization, it’s at the center of an effort by anti-choice policymakers who would seek to export our domestic culture wars on abortion and reproductive rights to communities abroad. As is most often the case, the impact will be felt the most by those who are already marginalized.
To learn more about the status and future of PEPFAR, we spoke with Craig Lasher, Senior Fellow at PAI, a longtime NGO partner of the Universal Access Project which is dedicated to advancing sexual and reproductive health and rights through advocacy, partnerships, and funding:
1. Craig, help us get a lay of the land: What’s happening with PEPFAR, and why is it concerning?
This World AIDS Day will be the first since the creation of PEPFAR in 2003 that Congress has not passed a new five-year statutory authorization governing PEPFAR’s policy and programs by December 1. The most recent authorization technically expired on September 30. In the 20 years since its inception, PEPFAR has routinely been reauthorized by Congress every five years with broad bipartisan support. Previous reauthorizations of PEPFAR by Congress have been largely uneventful.
But this year, opponents of sexual and reproductive health and rights (SRHR) — both inside and outside Congress — have engaged in a mendacious campaign of disinformation, harassment, and misrepresentation of both the laws that govern PEPFAR and the legal activities of organizations that implement U.S. HIV/AIDS activities. The goal of these opposition efforts is to slow and perhaps derail a “clean” PEPFAR reauthorization which would simply roll-over existing programmatic parameters for another five years. These anti-SRHR zealots have sought to leverage the vast popularity of PEPFAR and the reauthorization discussion to force the acceptance of the extreme anti-abortion legal restrictions that they seek but cannot achieve through the regular legislative process. Their explicit goal is to reimpose the expanded Global Gag Rule — a harmful policy in force during the Trump Administration which put restrictions on all U.S. global health assistance — onto global HIV programs.
The situation is concerning because the delay in approving the reauthorization raises the anxiety level of PEPFAR-funded implementing partners and their patients and staff, who worry about losing momentum in stemming the epidemic in their communities. It also invites questions from recipients and other donor governments about the durability of the commitment of the United States to its investments in HIV prevention and treatment over the long-term. The impact of the inability to reauthorize PEPFAR is largely symbolic at the moment, but continuing delay could begin causing real pain.
2. It feels like we’ve seen this playbook before. What’s new and different in the efforts to undermine PEPFAR?
What’s new and different is the use of congressional holds by anti-abortion opponents in the Republican-controlled House to block the release of previously appropriated funds to force concessions in PEPFAR programmatic guidance. These concessions would undermine PEPFAR’s evidence-based and integrated response to HIV and would run counter to the U.S. government’s support for SRHR, LGBTQI+ equality, and gender equity under the current administration. Reportedly, staff on the Republican-controlled House Foreign Affairs Committee have been extremely vigilant in scrubbing PEPFAR program documents and insisting on the removal or revision of references to abortion, sexual and reproductive health and rights, transgender people, sex workers, family planning, and even human rights, along with other internationally-recognized terminology, before giving their blessing to allow blocked HIV funds to be spent.
While it’s not unprecedented for Congress to place holds on the release of foreign assistance funding, the magnitude of the amount stuck in limbo right now has not been seen before, in my recollection. According to The Washington Post, the amount of HIV program funding currently being delayed by Republicans is more than $1 billion, with some other reports suggesting that the amount might be closer to $2 billion. Much of PEPFAR’s funding remains unaffected, but some of the monies currently on hold needed to reach programs in the field by the end of last month to avoid disruptions in life-saving services. Honoring congressional “holds” is a courtesy, and at some point, the Biden Administration should consider blowing through the holds and doing what is needed to ensure the integrity and continuity of U.S. government investments in preventing the spread of HIV and treating those afflicted with AIDS.
3. How else are domestic U.S. politics on abortion impacting U.S. foreign policy?
If nothing else, domestic abortion politics are, as they usually do, going to impact and complicate the negotiations over the appropriations bill for State Department operations and foreign assistance programs to be included in the final fiscal year (FY) 2024 spending package. With a Democratic Senate and a Republican House, international family planning and reproductive health (FP/RH) funding and policy will be significant points of contention in the endgame negotiation early next year, as they have been for the last 13 years. As might be expected, there are stark differences between the House and Senate versions of the State Department-foreign operations bill, with the House-passed bill cutting bilateral FP/RH funding by 20 percent, prohibiting all funding for the United Nations Population Fund (UNFPA), and legislatively codifying an expanded Global Gag Rule. At the same time, its Senate counterpart maintains the status quo on policy, sticking with current law and providing a $25 million bilateral funding increase to USAID as well as preserving a slightly enhanced UNFPA contribution due to the passage of an amendment offered by Senator Jeanne Shaheen (D-NH) during committee markup. Several of the other House Republican drafted appropriations bills contain new anti-abortion restrictions and culture war “riders,” none of which will pass muster with the Senate.
4. What gives you hope for the work ahead?
In the wake of the Dobbs decision overturning the nearly five-decade precedent established by Roe and ending the constitutional right to abortion, it was easy to get depressed after the initial anger and outrage subsided. But since the decision, wins for abortion rights referenda in red-states Kansas, Kentucky, and Ohio and victories by pro-choice Democratic candidates for state legislatures and judgeships have confirmed what we have long thought to be true — the American electorate supports abortion rights and will vote accordingly when abortion rights are taken away or threatened — when it becomes personal and directly affects you or your family or friends. The decision has prompted a sense of urgency and has reenergized and brought new allies into efforts to enshrine reproductive rights in law and to liberalize restrictive abortion laws at home and abroad. This has especially been the case with those involved in the Green Wave movement in Latin America. Anti-abortion zealots may have overreached and turned out to be the proverbial dog that caught the car and will perhaps continue to pay a steep price in the voting booth and ballot box, particularly among women and young people. That gives me hope.
More immediately, while rarely being described as an optimist, it seems to me that international FP/RH advocates are likely to see the continuation of the status quo on funding and policy in the final FY 2024 spending deal for the 14th year in a row, either as part of an omnibus or continuing resolution, which would be classified as a victory in my book in the current hyper-partisan political environment. On PEPFAR reauthorization, predicting how this stalemate may be broken is more difficult. Not laying any odds on that one.
Learn more about PAI’s work at www.pai.org.
