Reproductive Health: Federal Funds That Supported Four Nonprofit 
Organizations (13-NOV-01, GAO-02-81R).				 
								 
This report identifies federal funding for fiscal years 1999 and 
2000 that supported domestic and international reproductive	 
health activities of four nonprofit organizations--the Planned	 
Parenthood Federation of America, the Population Council, the	 
International Planned Parenthood Federation, and The Alan	 
Guttmacher Institute. These organizations 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 reproductive health for	 
individuals. The Department of Health and Human Services and the 
U.S. Agency for International Development 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 through which the funds 
are provided.							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-02-81R 					        
    ACCNO:   A02466						        
  TITLE:     Reproductive Health: Federal Funds That Supported Four   
Nonprofit Organizations 					 
     DATE:   11/13/2001 
  SUBJECT:   Birth control services				 
	     Block grants					 
	     Congressional committees				 
	     Cooperative agreements				 
	     Federal funds					 
	     Jurisdictional authority				 
	     Nonprofit organizations				 
	     Maternal and Child Health Block Grant		 
	     Medicaid Program					 
	     Social Services Block Grant			 

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GAO-02-81R
     
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).

GAO- 02- 81R Federal Funds for Reproductive Health 2

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.

GAO- 02- 81R Federal Funds for Reproductive Health 3

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.

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

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.)

GAO- 02- 81R Federal Funds for Reproductive Health 5

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 committee a

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 Administration b

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 88,107 c 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 programs d

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.

GAO- 02- 81R Federal Funds for Reproductive Health 6

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.

GAO- 02- 81R Federal Funds for Reproductive Health 7

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 committee a

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 Administration b

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 programs c

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.

GAO- 02- 81R Federal Funds for Reproductive Health 8

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. sect.sect.

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. sect.sect. 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. sect.sect.
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.

GAO- 02- 81R Federal Funds for Reproductive Health 9

et seq.) authorizes the SSBG, and title V of the act (42 U. S. C. sect.sect. 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. sect.sect. 281 et seq. and 42 U. S. C. sect. 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.)

GAO- 02- 81R Federal Funds for Reproductive Health 10

Table 4: Federal Funds Expended by Three Nonprofit Organizations for
International Reproductive Health Activities, Fiscal Years 1999 and 2000

Fiscal year expenditures Organization 1999 2000

Population Council $34,385,325 $36,443,540 International Planned Parenthood
Federation

5,800,000 a 5,000,000 a Contraceptive shipments 1, 465,818 a, b 993,328 a
International Planned Parenthood family planning associations

Direct agreements through USAID 8, 092,000 b 7,531,000 a Subagreements
through U. S.- based agencies

1,812,000 b 2,244,000 The Alan Guttmacher Institute 452,000 b 587,128 Totals
$52,007,143 b $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

GAO- 02- 81R Federal Funds for Reproductive Health 11

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)
*** End of document. ***