GAO-02-81R Federal Funds for Reproductive Health

United States General Accounting Office

Washington, DC 20548

November 13, 2001

The Honorable Joseph R. Pitts

The Honorable Christopher H. Smith

House of Representatives

Subject: Reproductive Health: Federal Funds That Supported Four Nonprofit

Organizations

This letter responds to your request that we identify the amount of federal funding

for fiscal years 1999 and 2000 that supported the domestic and international

reproductive health activities of four nonprofit organizations and their affiliates—the

Planned Parenthood Federation of America, the Population Council, the

International Planned Parenthood Federation, and The Alan Guttmacher Institute—

in addition to identifying the federal agencies that provided the funds and the

congressional committees with jurisdiction to authorize or appropriate them. This

information updates our letter of July 18, 2000, that provided funding information for

fiscal years 1997 through 1998.1

In brief, the Planned Parenthood Federation of America and its affiliates, the

Population Council, the International Planned Parenthood Federation and its

affiliated associations, and The Alan Guttmacher Institute used approximately $184

million in federal funds for fiscal year 1999 and about $196 million in federal funds

for fiscal year 2000 to support domestic and international activities related to

reproductive health for individuals. (See table 1.) The Department of Health and

Human Services (HHS) and the U.S. Agency for International Development (USAID)

were the major sources of these funds. Four committees in the Senate—Commerce,

Science, and Transportation; Finance; Foreign Relations; and Health, Education,

Labor, and Pensions--and four committees in the House of Representatives—Energy

and Commerce, International Relations, Science, and Ways and Means—have

jurisdiction over the authorization of the programs under which the funding was

provided. In addition, the Senate and House Committees on Appropriations each

have subcommittees that have jurisdiction over the appropriations for the programs

 

1

Reproductive Health: Federal Funds Provided to Four Nonprofit Organizations (GAO/HEHS-00-147R, July

18, 2000).
2 GAO-02-81R Federal Funds for Reproductive Health

through which the funds are provided.2 We received technical comments on a draft

of this correspondence from HHS, USAID, the Planned Parenthood Federation of

America, the Population Council, and The Alan Guttmacher Institute.

Table 1: Federal Funds That Supported the Domestic and International

Reproductive Health Activities of Four Nonprofit Organizations, Fiscal Years 1999

and 2000

Organizations Fiscal year

1999

Fiscal year

2000

Planned Parenthood Federation of America and its

affiliates

$125,751,924 $137,337,724

Population Council 39,731,387 $41,347,381

International Planned Parenthood Federation and its

affiliated associations

17,169,818 15,768,328

The Alan Guttmacher Institute 890,435 1,113,712

Total $183,543,564 $195,567,145

Source: GAO analysis.

To obtain the information to respond to your request, we collected data from and

held discussions with officials from HHS, USAID, the Planned Parenthood

Federation of America, the Population Council, and The Alan Guttmacher Institute.

Data for the International Planned Parenthood Federation were obtained from

USAID. The nonprofit organizations provided independently audited financial

statements and reports on expenditures of federal funds that were prepared in

compliance with Office of Management and Budget Circular A-133. Except where

noted, we used the expenditure data that the nonprofit organizations reported. We

conducted our work from July through October 2001 in accordance with generally

accepted government auditing standards.

BACKGROUND

The Planned Parenthood Federation of America—a nonprofit organization

headquartered in New York City—and its 128 affiliates, with 850 local health centers,

provide reproductive medical care and birth control education. The affiliates are

independent, separately incorporated organizations with their own boards of

directors and financial autonomy. In 1998, the affiliates provided reproductive health

care to 2.6 million women and men and educational services to 1.5 million

individuals. The affiliates and their clinics provide family planning counseling and

 

2

The Senate Appropriations subcommittees on Labor, Health and Human Services, and Education;

Foreign Operations; and Veterans Affairs (VA), Housing and Urban Development (HUD) and

Independent Agencies and the House Appropriations subcommittees on Labor, Health and Human

Services and Education; Foreign Operations, Export Financing, and Related Programs; and VA, HUD

and Independent Agencies.
3 GAO-02-81R Federal Funds for Reproductive Health

birth control services, pregnancy testing, abortions, cancer screening, human

immunodeficiency virus (HIV) testing, screening and treatment for sexually

transmitted diseases, prenatal and well-baby care, and other reproductive health

care services.

The Population Council is an international, nonprofit, organization that conducts

biomedical research in reproduction, develops contraceptives and other products

for improving reproductive health, improves the quality and outreach of family

planning and reproductive health services, and conducts research on reproductive

health and behavior. In addition, the Population Council strengthens professional

resources in developing countries through collaborative research, awards,

fellowships, and training. It is headquartered in New York City, and it has an office in

Washington, D.C., 5 regional offices, and 15 offices in developing countries. In 1999,

about half of the Population Council’s staff of about 490 employees was based in

developing countries.

The International Planned Parenthood Federation is a nonprofit, family health care

organization headquartered in London and registered as a charity in the United

Kingdom. It has 6 regional offices, including one in the United States, and 127

affiliated family planning associations, and it operates in 160 countries. It provides

family planning and reproductive health services, including maternal care and

screening and treatment for sexually transmitted diseases. The International Planned

Parenthood Federation is supported by financial contributions from more than 25

governments and by donations from private foundations and individuals.

The Alan Guttmacher Institute was originally a division of the Planned Parenthood

Federation of America and became an independent nonprofit corporation in 1977

with offices in New York City and Washington, D.C. It remains a special affiliate of

the Planned Parenthood Federation of America. The Alan Guttmacher Institute

conducts reproductive health and family planning research and policy analysis,

provides public education nationally and internationally, and publishes journals

about family planning and reproductive health.

FEDERAL FUNDS FOR THE DOMESTIC ACTIVITIES OF THE PLANNED

PARENTHOOD FEDERATION OF AMERICA, THE POPULATION

COUNCIL, AND THE ALAN GUTTMACHER INSTITUTE

The three nonprofit organizations that support domestic reproductive health

activities—the Planned Parenthood Federation of America and its affiliates, the

Population Council, and the The Alan Guttmacher Institute—reported spending

approximately $132 million in federal funds provided for fiscal year 1999 and $143

million for fiscal year 2000.3

 Some of the activities these organizations support

include family planning and reproductive health services for individuals and

 

3

The International Planned Parenthood Federation had no expenditures of federal funds for domestic

activities.
4 GAO-02-81R Federal Funds for Reproductive Health

reproductive health research. HHS programs provided most of this funding through

federal payments and grants to states and territories that disbursed the funds to the

three organizations. The Senate Committee on Health, Education, Labor and

Pensions and the House Committee on Energy and Commerce have jurisdiction over

the authorization of the federal programs that provided most of the funds. (See

tables 2 and 3.)
5 GAO-02-81R Federal Funds for Reproductive Health

Table 2: Sources of Federal Funds Expended by Three Nonprofit

Organizations for Domestic Reproductive Health Activities, Fiscal Year 1999

Nonprofit organizations’ fiscal year 1999 expenditures

Program/

administering

agency

Authorizing

congressional

committeea

Planned

Parenthood

Federation of

America

Population

Council

The Alan

Guttmacher

Institute Total

Family planning grants

HHS, Office of

Population

Affairs

Senate Health,

Education, Labor,

and Pensions;

House Energy and

Commerce

$51,051,270 $0 $350,328 $51,401,598

Medicaid

HHS, Health Care

Financing

Administrationb

Senate Health,

Education, Labor,

and Pensions;

House Energy and

Commerce

38,933,177 0 0 38,933,177

Social services block grants

HHS,

Administration

for Children and

Families

Senate Finance;

House Ways and

Means

17,354,752 0 0 17,354,752

Maternal and child health services block grants

HHS, Health

Resources and

Services

Administration

Senate Finance

and Senate Health,

Education, Labor,

and Pensions;

House Energy and

Commerce

5,115,032 0 0 5,115,032

Research project grants

HHS, National

Institutes of

Health

Senate Health,

Education, Labor,

and Pensions;

House Energy and

Commerce

0 5,290,148 88,107c

5,378,255

Research grants

National Science

Foundation,

Directorate for

Biological

Sciences

Senate Commerce,

Science, and

Transportation;

House Science

0 55,914 0 55,914

Other

Other federal

programsd

Not available 13,297,693 0 0 13,297,693

Totals $ 125,751,924 $5,346,062 $438,435 $131,536,421

a

The Senate and House Committees on Appropriations, through their subcommittees on Labor, Health

and Human Services and Education and VA, HUD and Independent Agencies, have jurisdiction over

legislation appropriating funds for these programs and activities.
6 GAO-02-81R Federal Funds for Reproductive Health

b

In fiscal year 2001, the Health Care Financing Administration’s name changed to the Centers for

Medicare and Medicaid Services.

c

Funds were from a research project grant previously awarded by the National Institutes of Health’s

National Institute of Child Health and Human Development’s Center for Population Research,

Demographic, and Behavioral Sciences Branch.

d

Data are for Planned Parenthood Federation of America’s affiliates that did not identify specific

sources of funds and related funding amounts.

Source: GAO analysis of independently audited annual financial reports.
7 GAO-02-81R Federal Funds for Reproductive Health

Table 3: Sources of Federal Funds Expended by Three Nonprofit

Organizations for Domestic Reproductive Health Activities, Fiscal Year 2000

Nonprofit organizations’ fiscal year 2000 expenditures

Program/

administering

agency

Authorizing

congressional

committeea

Planned

Parenthood

Federation of

America

Population

Council

The Alan

Guttmacher

Institute Total

Family planning grants

HHS, Office of

Population

Affairs

Senate Health,

Education, Labor,

and Pensions;

House Energy and

Commerce

$54,578,663 $0 $526,584 $55,105,247

Medicaid

HHS, Health Care

Financing

Administrationb

Senate Health,

Education, Labor,

and Pensions;

House Energy and

Commerce

42,058,942 0 0 42,058,942

Social services block grants

HHS,

Administration

for Children and

Families

Senate Finance;

House Ways and

Means

21,603,526 0 0 21,603,526

Maternal and child health services block grants

HHS, Health

Resources and

Services

Administration

Senate Finance

and Senate Health,

Education, Labor,

and Pensions;

House Energy and

Commerce

4,819,161 0 0 4,819,161

Research project grants

HHS, National

Institutes of

Health

Senate Health,

Education, Labor,

and Pensions;

House Energy and

Commerce

0 4,861,155 0 4,861,155

Research grants

National Science

Foundation,

Directorate for

Biological

Sciences

Senate Commerce,

Science, and

Transportation;

House Science

0 42,686 0 42,686

Other

Other federal

programsc

Not available 14,277,432 0 0 14,277,432

Totals $137,337,724 $4,903,841 $526,584 $142,768,149

a

The Senate and House Committees on Appropriations, through their subcommittees on Labor, Health

and Human Services, and Education and VA, HUD and Independent Agencies, have jurisdiction over

legislation appropriating funds for these programs and activities.

b

In fiscal year 2001, the Health Care Financing Administration’s name changed to the Centers for

Medicare and Medicaid Services.
8 GAO-02-81R Federal Funds for Reproductive Health

c

Data are for Planned Parenthood Federation of America’s affiliates that did not identify specific

sources of funds and related funding amounts.

Source: GAO analysis of independently audited annual financial reports.

The following HHS programs provided the majority of federal funding for the

nonprofit organizations’ domestic reproductive health expenditures:

Family Planning Grants—Title X of the Public Health Service Act (42 U.S.C. §§

300 et seq.) authorizes grants for voluntary family planning services, primarily

for low-income women. Title X grants also provided funding for training nurse

practitioners until July 2000 and for health research to improve the delivery of

family planning services. Title X grantees include state and territorial health

departments, local health departments, hospitals, and other organizations.

Grantees can dispense title X funds to other agencies to provide services or to

support clinics. Although there are no matching requirements for grants,

regulations specify that no title X grant may fund 100 percent of a project. The

Public Health Service Act also prohibits the use of title X funds in programs in

which abortion is a method of family planning. Family planning grants

provided about $51 million to the Planned Parenthood Federation of America

and about $350,000 to The Alan Guttmacher Institute for fiscal year 1999 and

about $55 million and $527,000, respectively, for fiscal year 2000. The Alan

Guttmacher Institute receives funds from HHS for compiling and publishing

research and data on the provision of domestic family planning services.

Medicaid-Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.)

authorizes Medicaid grants to the states and requires state Medicaid programs

to cover family planning services. Medicaid is a joint federal/state entitlement

that annually finances health care coverage for more than 40 million lowincome individuals, most of whom are children. The federal government pays

90 percent and states pay 10 percent of Medicaid's payments for family

planning services and supplies furnished to beneficiaries. This sharing formula

applies only to those family planning services and supplies intended to

increase or decrease family size, such as counseling and patient education and

methods of contraception. Other covered Medicaid services provided by

Planned Parenthood centers, including abortion when permitted under law, are

reimbursed under standard federal-state payment formulas.4 Medicaid provided

about $39 million to the Planned Parenthood Federation of America for fiscal

year 1999 and about $42 million for fiscal year 2000.

Social Services Block Grants (SSBG) and Maternal and Child Health Services

Block Grants (MCHBG)—Title XX of the Social Security Act (42 U.S.C. §§ 1397

 

4

The federal portion of payments for most Medicaid services is set annually for each state by a formula based

on state per capita income and may range from 50 to 83 percent.
9 GAO-02-81R Federal Funds for Reproductive Health

et seq.) authorizes the SSBG, and title V of the act (42 U.S.C. §§ 701 et seq.)

authorizes the MCHBG. These two block grant funds are distributed by formula

to state and territorial health and social service agencies. Federal MCHBG

funds are matched by state funds; states provide $3 of nonfederal funds for

every $4 of MCHBG funds. Each state determines the use of the combined

funds for its federal SSBG and MCHBG funds. Under either block grant, state

agencies may fund family planning activities directly or purchase them from

Planned Parenthood affiliates or others. For fiscal year 1999, SSBG provided

about $17 million and MCHBG provided about $5 million to the Planned

Parenthood Federation of America and about $22 million and about $5 million,

respectively, for fiscal year 2000.

Research Project Grants—the National Institutes of Health (NIH) award

research project grants under Title IV and section 301 of the Public Health

Service Act (42 U.S.C. §§ 281 et seq. and 42 U.S.C. § 241 respectively). The NIH

institutes and centers funding these grants include the National Institute of

Allergy and Infectious Diseases, the National Institute of Child Health and

Human Development, the National Institute of Diabetes and Digestive and

Kidney Diseases, and the National Institute of Environmental Health Services.

Funds from NIH are provided directly to recipient organizations. NIH research

project grants provided about $5 million to the Population Council and about

$88,000 to The Alan Guttmacher Institute for fiscal year 1999 and about $5

million to the Population Council for fiscal year 2000.

The National Science Foundation (NSF), through the National Science Foundation

Act of 1950, as amended (42 U.S.C. 1861 et seq.) is authorized to award research

grants. NSF’s Directorate for Biological Sciences, Division of Integrative Biology and

Neuroscience, funds research that focuses on understanding multifaceted

relationships among the central nervous system, hormones, and behavior, especially

in relation to environmental factors. NSF research grants provided about $56,000 to

the Population Council for fiscal year 1999 and about $43,000 for fiscal year 2000.

The grants funded research on the behavioral and biological effects of chronic social

stress.

FEDERAL FUNDS FOR THE INTERNATIONAL ACTIVITIES

OF THE POPULATION COUNCIL, INTERNATIONAL PLANNED PARENTHOOD

FEDERATION AND ITS AFFILIATES, AND THE ALAN GUTTMACHER INSTITUTE

For fiscal years 1999 and 2000, the Population Council, the International Planned

Parenthood Federation and its affiliated family planning associations, and The Alan

Guttmacher Institute received financial support for international activities from

USAID. The total amount of federal funding was about $52 million for fiscal year

1999 and $53 million for fiscal year 2000. (See table 4.)
10 GAO-02-81R Federal Funds for Reproductive Health

Table 4: Federal Funds Expended by Three Nonprofit Organizations

for International Reproductive Health Activities, Fiscal Years 1999 and 2000

Organization Fiscal year expenditures

1999 2000

Population Council $34,385,325 $36,443,540

International Planned Parenthood

Federation

5,800,000a 5,000,000a

 Contraceptive shipments 1,465,818a,b 993,328a

 International Planned Parenthood family planning associations

 Direct agreements through USAID 8,092,000b7,531,000a

 Subagreements through U.S.-based

agencies

1,812,000b 2,244,000

The Alan Guttmacher Institute 452,000b587,128

Totals $52,007,143b $52,798,996

Notes: The Senate Committee on Foreign Relations and the House Committee on International

Relations have jurisdiction over the authorization of USAID activities. The Senate and House

Committees on Appropriations, through their subcommittees responsible for foreign operations, have

jurisdiction over legislation appropriating funds for these activities. All funds were provided by

USAID.

a

These figures represent obligations.

b

Amounts differ from those reported in our July 2000 correspondence because they have been

updated by USAID.

Source: USAID's Office of Population and the Population Council.

USAID provides funding support through direct grants and other mechanisms, such

as cooperative agreements. Under a cooperative agreement, substantial involvement

is anticipated between USAID and the recipient—called a cooperating agency—

during the performance of a funded activity.

USAID grants to the Population Council are used, among other things, to promote

the use of research to improve the quality, accessibility, and cost-effectiveness of

reproductive health programs; conduct research on adolescent livelihoods and the

transition to marriage and adulthood; conduct field-based research in developing

countries to identify best practices for the prevention of HIV/AIDS and other

sexually transmitted diseases; and undertake research on new and improved

contraceptive methods, including methods that protect against HIV and other

diseases. USAID provides grant funding to the International Planned Parenthood

Federation headquarters. These grants are used to introduce, expand, and improve

family planning and reproductive health information and services through its

affiliated network of indigenous family planning associations. USAID also provides
11 GAO-02-81R Federal Funds for Reproductive Health

support to family planning associations. This support includes funding directly

through agreements between USAID and the associations and indirectly through

agreements between USAID and U.S.-based agencies that have subagreements with

other entities. The Alan Guttmacher Institute receives funding from USAID for

publishing an international journal about family planning and reproductive health

issues in English, French, and Spanish.

We provided a draft of this correspondence to HHS, USAID, and others for their

review. HHS, USAID, the Planned Parenthood Federation of America, the Population

Council, and The Alan Guttmacher Institute provided technical comments, which we

incorporated where appropriate.

We are sending copies of this letter to the relevant congressional committees, the

Secretary of Health and Human Services, and the Administrator of the U.S. Agency

for International Development. We will also make copies available to others on

request. This letter will also be available on GAO’s home page at http://www.gao.gov.

Please contact me at (202) 512-7119 if you have any questions. Major contributors to

this letter were James O. McClyde and Darryl W. Joyce.

Janet Heinrich

Director, Health Care—Public Health Issues

(290092)