Nancy Pelosi, the former Democratic House speaker, and George W. Bush, the former Republican president, don’t always see eye to eye. However, earlier this year, they, along with Irish rock star Bono via video, came together to celebrate the 20th anniversary of America’s most successful foreign aid program: the President’s Emergency Program for AIDS Relief (PEPFAR).
PEPFAR, created in 2003 by President Bush, has saved 25 million lives over the past two decades and has been a powerful tool for soft diplomacy, showcasing America’s moral leadership in the world. It has received bipartisan support from liberal and Christian conservative groups.
Unfortunately, PEPFAR now faces the threat of becoming a victim of abortion politics. As the State Department organizes for its permanent continuation, House Republicans have not moved forward with a bill to reauthorize PEPFAR for another five years because abortion opponents are insisting on adding abortion-related restrictions.
This is part of a larger trend where Republicans, using their majority in the House, are pushing their conservative social views on the federal government. Abortion has been a major focus, especially since the Supreme Court overturned Roe v. Wade last year. House Republicans have recently included provisions to limit abortion access and transgender care in the annual military policy bill.
The fight over PEPFAR, a $7 billion-a-year program operating in over 50 countries, is similar to these other battles because it risks being entangled in a partisan fight over cultural and social issues. PEPFAR still enjoys widespread support from both sides of the aisle, including Representative Michael McCaul, the Republican chairman of the Foreign Affairs Committee, but the objections of anti-abortion advocates are hindering its reauthorization.
Representative Christopher H. Smith of New Jersey, one of the leading anti-abortion voices in Congress, is a major obstacle to reauthorization. He insists on implementing the Mexico City policy, which bars PEPFAR from partnering with organizations that provide abortion services, regardless of funding sources. Democrats, on the other hand, demand a clean reauthorization without added policy restrictions.
The stalemate intensifies due to influential outside groups like the Family Research Council, the Heritage Foundation’s political action arm, and Susan B. Anthony Pro-Life America. These groups have aligned with Smith and plan to score the vote on their annual ratings of members of Congress, making it politically toxic for most Republicans to support PEPFAR without anti-abortion language.
Advocates of the program are deeply concerned about this situation. Bono, in an email, deemed the impasse “madness” and called on Congress to protect PEPFAR from political interference. Representative McCaul is actively working to resolve the dispute, engaging with supporters both inside and outside the government, including Bono.
PEPFAR, an important legacy for Republicans like Bush, Bill Frist, and Rick Santorum, has received praise for its impact on both the country and humanity. Santorum, a former senator and prominent pro-life advocate, emphasized the need for a clean extension of the program.
However, in recent months, Smith and right-wing groups have accused the Biden administration of politicizing PEPFAR. They argue that new language in the program’s operational plan promotes abortion under the guise of advocating for women’s rights.
The Biden administration has denied these claims and clarified that PEPFAR does not fund abortions. The program has not used federal tax dollars for abortion services, although certain grantees may provide abortion-related services using other funding sources.
Despite efforts to address the misconceptions, the prospects for a five-year extension of PEPFAR appear bleak. Christopher H. Smith proposed an alternative that would allow the program to continue operating for a year without reauthorization but subject to anti-abortion restrictions. However, this would lead to certain programs, including those for orphans and vulnerable children, lapsing after September 30.
PEPFAR’s supporters argue that such a move would be devastating. It would signal to other nations that the U.S. is abandoning its bipartisan commitment to end the AIDS epidemic and would be seen as a setback for global health. PEPFAR’s infrastructure of clinics in poor nations also provides other essential services like Covid-19 testing and vaccines.
In conclusion, the battle over PEPFAR’s reauthorization demonstrates how abortion politics have become entangled with foreign aid programs and other social issues. The impact of this stalemate extends beyond politics, affecting the lives of millions who depend on PEPFAR’s vital support.
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