I 

109TH CONGRESS 

2D SESSION H. R. 4736 

To amend the Foreign Assistance Act of 1961 to authorize assistance to 

provide contraceptives in developing countries in order to prevent unintended pregnancies, abortions, and the transmission of sexually transmitted infections, including HIV/AIDS. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 8, 2006 

Mr. SIMMONS (for himself, Mr. MOORE of Kansas, Mrs. BIGGERT, Mr. KIRK, 

Mr. OBERSTAR, Mr. RYAN of Ohio, Mr. MICHAUD, and Mr. SNYDER) introduced the following bill; which was referred to the Committee on International Relations 

A BILL 

To amend the Foreign Assistance Act of 1961 to authorize 

assistance to provide contraceptives in developing countries in order to prevent unintended pregnancies, abortions, and the transmission of sexually transmitted infections, including HIV/AIDS. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Ensuring Access to 

5 Contraceptives Act of 2006’’. 
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1 SEC. 2. FINDINGS AND PURPOSE. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) A deepening crisis in developing countries 

5 with respect to the availability of contraceptives 

6 needed for family planning, safe motherhood serv7 ices, HIV/AIDS prevention, and other vital repro8 ductive health care threatens the health and lives of 

9 millions of people. 

10 (2) In the next ten to fifteen years, the largest11 ever generation of young people will enter their re12 productive years. For example, the number of 

13 women of reproductive age is projected to double in 

14 Nigeria in the next 25 years. This demographic 

15 shift, combined with increased demand for modern 

16 methods of family planning, will increase worldwide 

17 the number of people who desire to use contracep18 tion by 40 percent. 

19 (3) The gap between the need for contracep20 tives and funding for such contraceptives is pro21 jected to reach hundreds of millions of United States 

22 dollars annually by 2015. 

23 (4) According to estimates based on national 

24 surveys, more than 200 million women in developing 

25 countries wish to delay or end childbearing but do 

26 not have access to modern contraceptives. 
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1 (5) An estimated 40 percent of married couples 

2 in Haiti, 36 percent of married couples in Ethiopia, 

3 and 32 percent of married couples in Pakistan do 

4 not have access to contraceptives. In each of these 

5 countries, average birth rates among women are two 

6 to three times average birth rates in the United 

7 States. 

8 (6) Access to family planning and contracep9 tives is essential in reducing unintended pregnancies 

10 and, as a result, reducing rates of abortion. 

11 (7) The provision of modern contraceptives to 

12 the more than 200 million women in developing 

13 countries who desire such contraceptives would avert 

14 approximately 52 million pregnancies each year, and 

15 as a result, would prevent an estimated 23 million 

16 unplanned births, 22 million induced abortions, 7 

17 million spontaneous abortions, 1.4 million infant 

18 deaths, 142,000 pregnancy-related deaths, and 

19 505,000 children from losing their mothers. 

20 (8) In January 2001, the White House re21 affirmed President George W. Bush’s commitment 

22 to United States family planning assistance efforts, 

23 stating that ‘‘[the President] knows that one of the 

24 best ways to prevent abortion is by providing quality 

25 voluntary family planning services’’. 
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1 (9) Experiences in a number of countries in re2 cent years indicate that when long-term, effective 

3 family planning methods are available, abortion 

4 rates decline, sometimes drastically. For example, 

5 between 1988 and 2001, the use of modern contra6 ceptives increased in Russia by 74 percent, while the 

7 abortion rate declined by 61 percent. Similar experi8 ences in Bangladesh, Bulgaria, Chile, Estonia, Hun9 gary, Latvia, and Romania have shown that in10 creased use of contraceptives is accompanied by a 

11 decline in abortion rates. 

12 (10) In addition to reducing unintended preg13 nancies and abortions, condoms are a vital compo14 nent in limiting the spread of HIV/AIDS. Con15 sequently, the HIV/AIDS pandemic is contributing 

16 to an increased demand for reproductive health sup17 plies. 

18 (11) The vast majority of HIV infections are 

19 sexually transmitted and condoms are currently the 

20 only contraceptive that can protect against this form 

21 of HIV transmission. Condoms remain an important 

22 intervention in multisectoral approaches to HIV/ 

23 AIDS prevention, along with programs that promote 

24 abstinence and monogamy. 
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1 (12) In sub-Saharan Africa, where HIV preva2 lence rates can reach 40 percent of the adult popu3 lation and women constitute 60 percent of people liv4 ing with HIV/AIDS, donors provide an average of 

5 only 4.6 condoms per adult male annually. 

6 (13) Family planning services, reinforced by de7 pendable supplies of contraceptives, are also a cru8 cial tool in reducing HIV infections transmitted be9 tween infected pregnant women and their infants, a 

10 number that reached 800,000 in 2002. The provi11 sion of family planning services, information, and 

12 counseling can reduce the number of infants infected 

13 with HIV by 35 to 45 percent. 

14 (14) In addition to reducing rates of abortion 

15 and HIV/AIDS, access to contraceptives and other 

16 reproductive health care services saves the lives of 

17 mothers and children by helping women avoid high 

18 risk pregnancies. An increase in the use of contra19 ceptives, which allow women to space the births of 

20 their children over safe intervals, have been proven 

21 to reduce maternal and child mortality. 

22 (15) Complications resulting from pregnancy 

23 and childbirth are the leading causes of death and 

24 disability for women in developing countries, result25 ing in more than 500,000 deaths each year. Almost 
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1 one-third of maternal deaths and illnesses related to 

2 pregnancy could be avoided if women in developing 

3 countries had access to modern, safe, and effective 

4 contraceptives and other reproductive health care 

5 services. 

6 (16) Access to contraceptives and other repro7 ductive health care services are also needed to help 

8 ease growing population pressures on cropland, 

9 freshwater, and other finite natural resources. In 

10 many biologically rich areas, there is little or no ac11 cess to the health services that allow women and 

12 couples to space or limit births. Consequently, the 

13 population in these ecologically sensitive areas is 

14 growing nearly 40 percent faster than that of the 

15 world as a whole. 

16 (17) The shortfall in reproductive health care 

17 services is chronic and growing. The cost of contra18 ceptives needed for family planning and HIV/AIDS 

19 prevention in developing countries is projected to in20 crease from $954 million in 2002 to $1.8 billion in 

21 2015. In spite of this upward trend in the cost of 

22 contraceptives, donor support for contraceptives in 

23 2002, $197.5 million, was less than 20 percent of 

24 current overall funding needs. 
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1 (18) The consequences of the shortfall in repro2 ductive health care services are devastating. For 

3 every shortfall of $1 million in funding for contra4 ceptives, an estimated 360,000 additional unin5 tended pregnancies, 150,000 additional induced 

6 abortions, 800 additional maternal deaths, and 

7 11,000 additional infant deaths occur. 

8 (19) Although the United States should be com9 mended for its leadership role with respect to the 

10 availability of reproductive health services in devel11 oping countries, United States support for such 

12 services, including funding, has not kept pace with 

13 the increase in demand for contraceptives, which has 

14 resulted from the large number of youth entering re15 productive age and the HIV/AIDS pandemic. Since 

16 1995, United States bilateral assistance for inter17 national family planning programs has decreased by 

18 35 percent (adjusted for inflation) despite an in19 crease of more than 225 million women of reproduc20 tive age worldwide. 

21 (20) In addition to the shortfall in funding by 

22 the United States for reproductive health care serv23 ices, United States policy restrictions have reduced 

24 donations of contraceptives for developing countries. 
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1 (21) Widely shared goals of reducing the need 

2 for abortion and reducing the spread of HIV/AIDS 

3 are unlikely to be achieved when United States-do4 nated contraceptives are subject to policy restric5 tions, such as the Mexico City Policy, that limit ac6 cess to such contraceptives. 

7 (22) The Mexico City Policy, which was rein8 stated in 2001, limits access to contraceptives by 

9 prohibiting United States family planning assistance 

10 to foreign nongovernmental organizations that use 

11 funding from any source to provide abortion serv12 ices, counseling, or referral or to lobby to make 

13 abortion legal or more available in their own coun14 try. 

15 (23) The Mexico City Policy has exacerbated 

16 the existing shortage of contraceptives by ending 

17 shipments of United States-donated contraceptives 

18 to 16 developing countries in Africa, Asia, and the 

19 Middle East and denying contraceptives to leading 

20 family planning agencies in another 12 countries. 

21 (24) As an example, the Mexico City Policy has 

22 forced eight family planning clinics serving thou23 sands of poor women in Kenya to close. Con24 sequently, women’s access to contraceptives, 

25 gynecologic and obstetric care, screening, and treat-
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1 ment for sexually transmitted infections, and vol2 untary counseling and testing for HIV/AIDS in 

3 Kenya has been severely disrupted. 

4 (b) PURPOSE.—The purpose of this Act is to author5 ize assistance to provide contraceptives in developing coun6 tries in order to prevent unintended pregnancies, abor7 tions, and the transmission of sexually transmitted infec8 tions, including HIV/AIDS. 

9 SEC. 3. ASSISTANCE TO PROVIDE CONTRACEPTIVES IN DE10 VELOPING COUNTRIES. 

11 Section 104 of Foreign Assistance Act of 1961 (22 

12 U.S.C. 2151b) is amended— 

13 (1) by redesignating subsection (g) as sub14 section (h); and 

15 (2) by inserting after subsection (f) the fol16 lowing new subsection: 

17 ‘‘(g) ASSISTANCE TO PROVIDE CONTRACEPTIVES IN

18 DEVELOPING COUNTRIES.— 

19 ‘‘(1) ASSISTANCE.—The President, acting 

20 through the Administrator of the United States 

21 Agency for International Development, shall furnish 

22 assistance to provide contraceptives in developing 

23 countries in order to prevent unintended preg24 nancies, abortions, and the transmission of sexually 

25 transmitted infections, including HIV/AIDS. 
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1 ‘‘(2) ELIGIBILITY OF NONGOVERNMENTAL OR2 GANIZATIONS.—Notwithstanding any other provision 

3 of law, regulation, or policy, in determining eligi4 bility for assistance to provide contraceptives in de5 veloping countries under this subsection, a non6 governmental organization shall not be subject to re7 quirements relating to the use of non-United States 

8 Government funds that are more restrictive than re9 quirements relating to the use of non-United States 

10 Government funds that apply to foreign governments 

11 with respect to eligibility for assistance under this 

12 subsection. 

13 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

14 ‘‘(A) IN GENERAL.—There are authorized 

15 to be appropriated to the President to carry out 

16 this subsection $150,000,000 for each of the 

17 fiscal years 2007 and 2008. 

18 ‘‘(B) ADDITIONAL AUTHORITIES.— 

19 Amounts appropriated pursuant to the author20 ization of appropriations under subparagraph 

21 (A)— 

22 ‘‘(i) may be referred to as the ‘Repro23 ductive Health Supplies Fund’; 

24 ‘‘(ii) are authorized to remain avail25 able until expended; and 
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1 ‘‘(iii) are in addition to amounts oth2 erwise available for such purposes.’’. 

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