PEPFAR Is Subsidizing Abortion Advocacy, Say Lawmakers, Pro-Lifers, and African Leaders

The legacy media, congressional Democrats, and left-wing foreign aid experts are accusing Republicans in Congress of making a mountain out of a molehill in demanding guardrails against abortion funding for “the President’s Emergency Plan for AIDS Relief,” or PEPFAR, which is scheduled to expire on October 1, among a press of surging budget deadlines.

PEPFAR is the nation’s foremost program for combatting HIV/AIDS in the developing world and directs billions of dollars annually to poor communities in Africa, Asia, and the Caribbean. It originated under President George W. Bush in 2003 and has been reauthorized three times (in five-year increments) on a bipartisan basis, based on the law’s conscience protections and deliberate avoidance of abortion funding.

However, 30 pro-life leaders wrote to Congress on May 1, expressing concern that PEPFAR grants “are used by nongovernmental organizations that promote abortions and push a radical gender ideology abroad” and contending that “a five year reauthorization of PEPFAR could lead to nearly $30 billion in new appropriations, with no clear guardrails over the largest single source of U.S. foreign aid.”

“Since President Reagan first instituted the Mexico City Policy in 1984, it has been the policy of the United States that taxpayer funds should not be used to perform or promote abortion abroad,” they wrote. “It is imperative that a similar policy be applied to PEPFAR so that no grantees or subgrantees are using taxpayer funds to promote a radical sexual and reproductive health agenda.”

When PEPFAR was last reauthorized in 2018, President Trump had instituted the Mexico City Policy, which prohibited recipients of U.S. foreign aid to use those dollars to provide or promote abortion overseas. The Trump administration also expanded the policy to cover organizations that subcontracted with the primary aid recipients (the expanded policy was renamed Protecting Life in Global Health Assistance, PLGHA).

The mainstream media has portrayed the concerns of pro-life advocates as “baseless” and framed the PEPFAR controversy as a case of Republican culture war aggression. PEPFAR “has been abruptly bogged down in a domestic political fight, with Republicans citing allegations that the program’s funding is being used to indirectly support abortions — claims that health advocates, Democrats and PEPFAR officials say are baseless,” wrote The Washington Post.

The Post is not alone. “PEPFAR is in danger of becoming a victim of abortion politics,” warned The New York Times. “House Republicans are not moving forward with a bill to reauthorize it for another five years, because abortion opponents … are insisting on adding abortion-related restrictions.” Politico chimed in, “Republican lawmakers’ claims that President Joe Biden is using PEPFAR to support abortion rights have caused the unique coalition that’s long supported it to fray.”

Congressional Democrats agree. “This is not an issue that at all involves abortion,” added Senator Ben Cardin (D-Md.), “it’s about having health care facilities in countries to deal with pandemic type of challenges.”

Foreign aid experts are similarly dismissive of the pro-life concerns. Jennifer Kates, director of global health and HIV policy at the left-wing Kaiser Family Foundation, said the fight is “broader than PEPFAR — it’s really about the larger politics around abortion, electoral politics, and the partisan divide.” David P. Fidler, a senior fellow for the Council on Foreign Relations, distilled the problem to the generalization, “populism, nationalism, and polarization have undermined domestic collective action and solidarity” on global health priorities such as PEPFAR.

Yet none of these declarations address the underlying argument, pro-lifers say. “When PEPFAR funds are given to organizations that promote and/or perform abortions,” Travis Weber, vice president for Policy and Government Affairs at Family Research Council, told The Washington Stand, “even if those organizations don’t use those actual PEPFAR dollars to promote or perform abortions, the PEPFAR money is still enriching the organizations — giving them health, vitality, life support, and allowing them to continue to exist and do their thing (which in this case is to promote or perform abortions).”

“So, it doesn’t matter that the PEPFAR money itself may or may not be used to promote or perform abortions,” Weber continued. “It is being used to further, advance, and give life support to abortions and abortion promotion. That is unacceptable for a program whose very purpose is to stop the scourge of AIDS in Africa.”

“Opponents of wanting to add pro-life protections to PEPFAR may claim we can’t prove the money is being used to perform abortions. True, we can’t prove that. But it’s also not the central point. What matters is that some organizations taking PEPFAR money (over $1.34 billion of it) are rabidly pro-abortion,” added Weber. “They have used PEPFAR money to try to change pro-life laws in Africa. We know — from their own words — they promote and/or perform abortions. None of that should be accomplished with PEPFAR money.”

In fact, PEPFAR has funneled billions of dollars to abortion groups over its 20-year history. The non-governmental organizations (NGOs) who have raked in the most PEPFAR cash are Family Health International (FHI) 360 ($2.4 billion), Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) ($1.5 billion), and Population Services International (PSI) ($768 million, according to a database of PEPFAR funding. Together, the three groups account for more than a quarter of all PEPFAR grants to NGOs. In 2021, EGPAF explicitly tied abortion to their anti-AIDS work, stating, “The repeal of the Mexico City policy is essential to women’s health equity globally and to the fight to #endAIDS.”

But PEPFAR’s controversial allocations are not confined to NGOs, nor to the abortion issue. The South Africa-based health system Anova Health Institute has received $238 million from PEPFAR. The May 1 letter from 30 pro-life leaders highlighted Anova because the group “decried laws enacted in U.S. states that designate bathroom use based on biological sex while also promoting abortions to teens as young as 14.”

The letter linked to a 268-page curriculum Anova designed to promote an ideologically left-wing view of sex to teenagers, which is no longer available at that web address. According to the internet’s Wayback Machine, the page was last archived on May 11, 2023, 10 days after the letter linked to it.

One of PEPFAR’s six program areas, HIV/AIDS prevention, “ranges from contraceptives to voluntary circumcision programs to reproductive health education.” “According to progressives, ‘reproductive health’ necessarily includes abortion. We would be naive to ignore these code words for abortion,” wrote Arielle Del Turco, director of the Center for Religious Liberty at Family Research Council, and Weber.

The “prevention” category is subdivided into biomedical prevention categories — preventing mother-to-child transmission, male circumcision, blood safety, and injection safety — abstinence education programs, drug use programs, and “other sexual prevention.” 30% of PEPFAR’s “prevention” dollars — a total of $3 billion — are spent on the category, “other sexual prevention.” The top allocations for “other sexual prevention” have gone to FHI 360 ($284 million) and PSI ($217 million), with EGPAF coming in ninth ($35 million). Spending in the “other sexual prevention” prevention category increased 90% from 2019 to 2020, the most recent year for which data is available.

Weber warned that PEPFAR is “being used as a massive slush fund for abortion and LGBT advocacy,” and the Biden administration is working to expand this agenda.

When President Biden assumed office in January 2021, he repealed PLGHA and its pro-life protections. Then in September 2022, the State Department published a document “Reimagining PEPFAR’s Strategic Direction,” which called for PEPFAR’s HIV programming to integrate “sexual reproductive health, rights, and services” and for greater coordination between PEPFAR and “other U.S. government global health and development programs, including for … sexual and reproductive health and rights … LGBTQI+, and human rights.”

The Biden administration’s pro-abortion PEPFAR agenda is so clear that 111 African leaders wrote the U.S. Congress on June 6 to express “concerns and suspicions that this funding is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion.”

“We ask that PEPFAR remain true to its original mission and respect our norms, traditions, and values,” said the Africans. “We ask that those partner organizations with whom the U.S. government partners to implement PEPFAR programs in ways that are cognizant and respectful of our beliefs and not cross over into promoting divisive ideas and practices that are not consistent with those of Africa.”