Federal Funds: Fiscal Year 2001 Expenditures by Selected	 
Organizations Involved in Health-Related Activities (16-MAY-03,  
GAO-03-527R).							 
                                                                 
This report responds to a Congressional request that we provide  
information on expenditures of federal funds by several 	 
organizations and their affiliates--the Planned Parenthood	 
Federation of America, the Population Council, the International 
Planned Parenthood Federation, The Alan Guttmacher Institute,	 
Advocates for Youth, and the Sexuality Information and Education 
Council of the United States (SIECUS)--all of which are involved 
in health-related activities. Specifically, we identified (1)	 
fiscal year 2001 expenditures of federal funds that supported the
domestic health-related activities of the organizations, the	 
federal agencies that provided the funds, and the congressional  
committees with jurisdiction over legislation authorizing or	 
appropriating the federal funds, and (2) fiscal year 2001	 
expenditures of federal funds that supported the international	 
health-related activities of the organizations, the federal	 
agencies that provided the funds, and the congressional 	 
committees with jurisdiction over legislation authorizing or	 
appropriating the federal funds. This information updates our	 
November 13, 2001, report that provided expenditure information  
for fiscal years 1999 and 2000. 				 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-03-527R					        
    ACCNO:   A06923						        
  TITLE:     Federal Funds: Fiscal Year 2001 Expenditures by Selected 
Organizations Involved in Health-Related Activities		 
     DATE:   05/16/2003 
  SUBJECT:   Congressional oversight				 
	     Federal funds					 
	     Financial management				 
	     Financial statement audits 			 
	     Independent agencies				 
	     Private sector					 
	     Funds management					 
	     Health care services				 

******************************************************************
** This file contains an ASCII representation of the text of a  **
** GAO Product.                                                 **
**                                                              **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced.  Tables are included, but    **
** may not resemble those in the printed version.               **
**                                                              **
** Please see the PDF (Portable Document Format) file, when     **
** available, for a complete electronic file of the printed     **
** document's contents.                                         **
**                                                              **
******************************************************************
GAO-03-527R

GAO- 03- 527R Federal Funds Spent by Selected Organizations United States
General Accounting Office

Washington, DC 20548

May 16, 2003 The Honorable Christopher H. Smith The Honorable Joseph R.
Pitts House of Representatives

Subject: Federal Funds: Fiscal Year 2001 Expenditures by Selected
Organizations Involved in Health- Related Activities This report responds
to your request that we provide information on expenditures of

federal funds by several organizations and their affiliates* the Planned
Parenthood Federation of America, the Population Council, the
International Planned Parenthood Federation, The Alan Guttmacher
Institute, Advocates for Youth, and the Sexuality Information and
Education Council of the United States (SIECUS)* all of which are involved
in health- related activities. Specifically, as agreed with your staff, we
identified (1) fiscal year 2001 expenditures of federal funds that
supported the

domestic health- related activities of the organizations, the federal
agencies that provided the funds, and the congressional committees with
jurisdiction over legislation authorizing or appropriating the federal
funds, and (2) fiscal year 2001 expenditures of federal funds that
supported the international health- related activities of the
organizations, the federal agencies that provided the funds, and the

congressional committees with jurisdiction over legislation authorizing or
appropriating the federal funds. This information updates our November 13,
2001, report that provided expenditure information for fiscal years 1999
and 2000. 1 In response to your request, we collected information on each
of the selected

organizations and their expenditures of federal funds, the federal
agencies that provided the funds, and the congressional committees with
jurisdiction over legislation authorizing or appropriating the funds. We
obtained documents and held discussions with representatives from several
of the organizations, federal officials, and congressional staff members.
To obtain the organizations* fiscal year 2001 financial information, we
collected information on expenditures of federal funds for

domestic health- related activities from the organizations that had such
expenditures* the Planned Parenthood Federation of America, the Population
Council, The Alan Guttmacher Institute, Advocates for Youth, and SIECUS.
These organizations also provided their independently audited financial
statements and

1 U. S. General Accounting Office, Reproductive Health: Federal Funds That
Supported Four Nonprofit Organizations, GAO- 02- 81R (Washington, D. C.:
Nov. 13, 2001).

GAO- 03- 527R Federal Funds Spent by Selected Organizations 2 reports on
expenditures of federal funds. 2 For the organizations that had

expenditures of federal funds for international health- related
activities, we collected expenditure data directly from three of the
organizations* the Population Council, The Alan Guttmacher Institute, and
Advocates for Youth. These organizations also provided their independently
audited financial statements. The U. S. Agency for International
Development (USAID) reported fiscal year 2001 expenditure data for the
International Planned Parenthood Federation*s headquarters and the
International Planned Parenthood Federation*s member family planning
associations. We collected information on the organizations* expenditures
of federal funds and did not determine the total amount of federal funds
that federal agencies provided the organizations. We collected information
from the Department of Health and Human Services* Office of Public Health
and Science to update information it provided for our November 2001
report. We held discussions with staff members from each of the relevant
congressional committees to confirm committee jurisdiction over
legislation authorizing the federal agency programs and funding and
appropriating the program funds that supported the organizations*
activities. In the course of our work, USAID and The Alan Guttmacher
Institute revised fiscal year 2000 expenditures of federal funds for
international activities that we reported in November 2001. (See enclosure
I for this revised information.) We conducted our work from January 2003
through April 2003 in accordance with generally accepted government
auditing standards.

Results in Brief

For fiscal year 2001, the total amount of federal funds expended by the
organizations for domestic and international health- related activities,
such as family planning for individuals and health- related research, was
approximately $225 million. (See table 1.) The Planned Parenthood
Federation of America and its affiliates, the Population Council, The Alan
Guttmacher Institute, Advocates for Youth, and SIECUS reported spending
approximately $170 million in federal funds to support their domestic
health- related activities.

2 With the exception of SIECUS*s financial statements, all the statements
were prepared in compliance with Office of Management and Budget Circular
A- 133. The independently audited financial statements that SIECUS
provided were not subject to the Circular A- 133 requirement because the
organization*s expenditures of federal funds were less than the $300, 000
annual minimum required under Circular A133. The 12- month fiscal year
periods that the organizations* year- end financial statements covered
varied.

GAO- 03- 527R Federal Funds Spent by Selected Organizations 3

Table 1: Organizations* Expenditures of Federal Funds for Domestic and
International Health- Related Activities, Fiscal Year 2001 Fiscal year
2001 expenditures a

Organization Domestic International

Planned Parenthood Federation of America and its affiliates $161,986,202 $
0 Population Council 6,513,859 30,701,137 International Planned Parenthood
Federation*s member family planning associations 0 23,413,217 The Alan
Guttmacher Institute 372,120 798,194 Advocates for Youth 499,734 132,160
SIECUS 218,400 0

Total $169,590,315 $55,044,708

Sources: The Planned Parenthood Federation of America, the Population
Council, USAID, The Alan Guttmacher Institute, Advocates for Youth, and
SIECUS. Note: The International Planned Parenthood Federation*s
headquarters received no federal funds for fiscal year 2001. a The 12-
month fiscal year periods for the organizations* expenditures varied. The
Department of Health and Human Services* (HHS) grants and programs were
the

major sources of the federal funds that the organizations spent for
domestic healthrelated activities. Two committees in the Senate* Finance;
and Health, Education, Labor, and Pensions* and two committees in the
House of Representatives* Energy and Commerce, through its Subcommittee on
Health; and Ways and Means* have jurisdiction over legislation authorizing
the programs through which most of the federal funds were provided. In
addition, the Senate and House committees on appropriations each have
subcommittees that have jurisdiction over legislation appropriating funds
for the federal programs.

The Population Council, the International Planned Parenthood Federation*s
member family planning associations, The Alan Guttmacher Institute, and
Advocates for Youth reported spending more than $55 million for
international health- related activities. (See table 1.) USAID and the
Centers for Disease Control and Prevention

(CDC) within HHS were the sources of the federal funds that the
organizations spent. Two committees in the Senate* Foreign Relations; and
Health, Education, Labor, and Pensions* and two committees in the House of
Representatives* Energy and Commerce, through its Subcommittee on Health;
and International Relations* have jurisdiction over legislation
authorizing the programs through which the federal funds were provided. In
addition, the Senate and House committees on appropriations, through their
subcommittees on foreign operations; and labor, health and human services,
and education, have jurisdiction over legislation appropriating funds for
the federal programs.

In response to HHS*s comments on a draft of this report, we revised the
report to better reflect the scope of our work and indicated that this
report updates the information in our November 13, 2001, report.

GAO- 03- 527R Federal Funds Spent by Selected Organizations 4

Background

The Planned Parenthood Federation of America* a nonprofit organization
headquartered in New York City* and its 126 affiliates, with 865 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 2001, the affiliates provided health care to 2.7 million women and men
and educational services to 1.5 million individuals. The affiliates and
their clinics provide family planning counseling and 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 health care
services.

The Population Council is an international, nonprofit research
organization. It is headquartered in New York City, has an office in
Washington, D. C., 4 regional offices, and 14 other offices in developing
countries. In 2002, about half of the Population Council*s staff of about
600 employees was based in developing countries. The Population Council
conducts biomedical research and develops contraceptives and other health
products including those that protect against the transmission of HIV/
AIDS and other sexually transmitted diseases. The Population Council also
conducts research on trends in health and research aimed at improving the
quality and outreach of family planning and reproductive health services.
In addition, the Population Council strengthens professional resources in
developing countries through collaborative research awards, fellowships,
and training.

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 six regional offices, including one
in the United States. The International Planned Parenthood Federation is a
volunteer membership organization of autonomous legal entities called
family planning associations. These associations are linked to the
International Planned Parenthood Federation through common standards and
objectives. The International Planned Parenthood Federation operates in
conjunction with member family planning associations in 180 countries to
provide family planning and reproductive health services, including
maternal care and screening and treatment for sexually transmitted
diseases.

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 an 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.

GAO- 03- 527R Federal Funds Spent by Selected Organizations 5 Advocates
for Youth, established in 1980 as the Center for Population Options, is a

nonprofit organization that works in the United States and developing
countries, supporting efforts to help young people make informed and
responsible decisions about their reproductive and sexual health.
Advocates for Youth provides information, training, and assistance to
educators, health care providers, youthserving organizations, and others
about best reproductive health practices for teens for the prevention of
pregnancy and HIV and other sexually transmitted disease. In 2002,
Advocates for Youth worked with more than 37,000 professionals who
provided information and assistance to more than 10 million teens around
the world to help them make decisions about their reproductive health.

SIECUS, established in 1964, is a nonprofit organization with offices in
New York City and Washington, D. C. SIECUS develops, collects, and
disseminates information; promotes comprehensive education; and advocates
the right of individuals to make responsible sexual choices.

Federal Funds Expended for Domestic Health- Related Activities

For fiscal year 2001, the Planned Parenthood Federation of America and its
affiliates, the Population Council, The Alan Guttmacher Institute,
Advocates for Youth, and SIECUS reported spending approximately $170
million in federal funds for domestic health- related activities. Some of
the domestic health- related activities these organizations support
include family planning and reproductive health services for individuals
and health research. HHS provided most of this federal funding through
grants and the Medicaid program. (See table 2.)

GAO- 03- 527R Federal Funds Spent by Selected Organizations 6

Table 2: Organizations* Expenditures of Federal Funds for Domestic Health-
Related Activities, Fiscal Year 2001 Organizations* fiscal year 2001
expenditures a Federal source of funding

Planned Parenthood

Federation of America

and its affiliates

Population Council

The Alan Guttmacher

Institute Advocates

for Youth SIECUS Total Family planning grants

HHS, Office of Population Affairs $58,711,763 $0 $315,320 $0 $0
$59,027,083

Medicaid

HHS, Centers for Medicare & Medicaid Services 60,878,913 0 0 0 0
60,878,913

Social Services Block Grant

HHS, Administration for Children and Families 19,009,295 0 0 0 0
19,009,295

Maternal and Child Health Services Block Grant

HHS, Health Resources and Services

Administration 5,994,185 0 0 0 0 5,994,185

Research project grants

HHS, National Institutes of Health 0 6,461,613 56,800 0 0 6,518,413

Research grants

National Science Foundation, Directorate for Biological Sciences 0 52,246
0 0 0 52,246

Cooperative agreements

HHS, CDC 0 0 0 499,734 218,400 718,134

Other

Other federal programs 17,392,046 b 0 0 0 0 17,392,046

Total $161,986,202 $6,513,859 $372,120 $499,734 $218,400 $169,590,315

Sources: The Planned Parenthood Federation of America, the Population
Council, The Alan Guttmacher Institute, Advocates for Youth, and SIECUS.
Note: GAO analysis of the organizations* data. a The 12- month fiscal year
periods that the organizations* year- end financial statements covered
varied.

b Data are for the Planned Parenthood Federation of America*s affiliates
that did not identify specific sources of funds and related funding
amounts.

GAO- 03- 527R Federal Funds Spent by Selected Organizations 7 The majority
of federal funding that supported the organizations* domestic
healthrelated

activities was provided through the following grants, programs, and
cooperative agreements:

Family planning grants* Title X of the Public Health Service Act (42 U. S.
C. S:S: 300 et seq.) authorizes grants for voluntary family planning
services, primarily for low- income women. Title X grants also provide
funding for general and clinical specialty training programs for family
planning clinic personnel, research to improve the delivery of family
planning services, and information dissemination activities. Title X
grantees include state and

territorial health departments, local health departments, hospitals, and
other organizations. Grantees can disburse title X funds to other agencies
or organizations to provide services or to support clinics. Although there
are no matching requirements for service grants, regulations specify that
no title X grant may fund 100 percent of a project*s estimated costs. For
fiscal year 2001, the Planned Parenthood Federation of America and its
affiliates reported spending about $59 million and The Alan Guttmacher
Institute reported spending more than $315,000 of federal funds provided
through family planning grants.

Medicaid* Title XIX of the Social Security Act (42 U. S. C. S:S: 1396 et
seq.) authorizes federal funding to states and requires state Medicaid
programs to cover family planning services for individuals of childbearing
age who are eligible under the state*s Medicaid plan and seek those
services. Medicaid is a joint federal/ state entitlement program that
annually finances health care coverage for more than 40 million low-
income individuals. The federal government pays 90 percent and states pay
10 percent of Medicaid expenditures for family planning services and
supplies furnished to beneficiaries. Family planning services under
Medicaid include only those services and supplies intended to control
family size, such as counseling and

patient education and methods of contraception. Many other reproductive
health services covered under Medicaid are paid for under standard
federalstate payment formulas. 3 The Planned Parenthood Federation of
America and its affiliates reported fiscal year 2001 expenditures for
services covered by the Medicaid program of about $61 million. Social
Services Block Grant (SSBG) and Maternal and Child Health Services

Block Grant (MCHBG)* Title XX of the Social Security Act (42 U. S. C. S:S:
1397

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

authorizes MCHBG. SSBG and MCHBG funds are distributed by formula to state
and territorial health and social service agencies. Federal MCHBG funds

3 The federal portion of payments for these 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- 03- 527R Federal Funds Spent by Selected Organizations 8 are matched
by state funds; states provide $3 of nonfederal funds for every $4

of MCHBG funds. Each state determines how its funds from each block grant
are to be used. Under each block grant, state agencies may fund family
planning activities directly or purchase them from entities such as an
organization*s affiliates that provide family planning activities. For
fiscal year 2001, the Planned Parenthood Federation of America and its
affiliates reported spending more than $19 million in federal SSBG funds
and about $6 million in federal MCHBG funds that were provided through
state agencies.

Research project grants* Title IV and section 301 of the Public Health
Service Act (42 U. S. C. S:S: 281 et seq. and 42 U. S. C. S: 241,
respectively) authorize research project grants. The National Institutes
of Health (NIH) institutes and centers funding these grants include the
National Institute on Aging, the National Institute of Allergy and
Infectious Diseases, the National Institute of

Child Health and Human Development, and the National Institute of
Environmental Health Sciences. Funds from NIH are provided directly to
recipient organizations. The NIH research grant recipients conduct various
kinds of reproductive health and other population research. For example,
among its research projects, the Population Council explores ways to
prevent the spread or transmission of HIV and trends in health among
elderly Asians. The Alan Guttmacher Institute conducts research that
focuses on the effectiveness of contraceptives in preventing pregnancies.
For fiscal year 2001, the Population Council reported spending about $6.5
million in NIH research project grant funds and The Alan Guttmacher
Institute reported expenditures of about $57,000.

Research grants* 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. For fiscal year 2001, the Population Council
reported spending more than $52,000 in NSF research grant funds. The
grants funded research on the behavioral and biological effects of chronic
social stress.

Cooperative agreements* Title III and sections 311 and 317 of the Public
Health Service Act (42 U. S. C. S: 241 et seq., 42 U. S. C S: 243, and 42
U. S. C. S: 247b respectively) authorize the use of cooperative agreements
and grants. 4 CDC*s National Center for Chronic Disease Prevention and
Health Promotion and

4 Cooperative agreements are to be used when substantial federal
involvement with the recipient during performance is anticipated. The
difference between grants and cooperative agreements is the degree of
federal programmatic involvement rather than the type of administrative
requirements imposed. See 31 U. S. C. S:S: 6304 and 6305.

GAO- 03- 527R Federal Funds Spent by Selected Organizations 9 National
Center for HIV, STD, and TB Prevention enter into cooperative

agreements with entities to provide funding support for the development
and implementation of effective health education to prevent HIV and other
health problems for school- age populations. For fiscal year 2001,
Advocates for Youth reported spending about $500,000 and SIECUS reported
spending more than $218,000 in federal funds provided through cooperative
agreements with CDC.

The Senate Committee on Finance; the Senate Committee on Health,
Education, Labor, and Pensions; the Senate Committee on Commerce, Science,
and Transportation; the House Committee on Energy and Commerce through its
Subcommittee on Health; the House Committee on Science; and the House
Committee on Ways and Means have jurisdiction over legislation authorizing
the program funds that the organizations reported spending for domestic
health- related activities. Also, the Senate Committee on Appropriations,
through its Subcommittee on Labor, Health and Human Services, and
Education; and Subcommittee on VA, HUD and Independent Agencies, and the
House Committee on Appropriations, through its Subcommittee on Labor,
Health and Human Services, and Education; and Subcommittee on VA, HUD and
Independent Agencies, have jurisdiction over legislation appropriating
funds for the programs. (See table 3.)

GAO- 03- 527R Federal Funds Spent by Selected Organizations 10

Table 3: Congressional Committees and Subcommittees with Jurisdiction over
Legislation for the Authorization of Federal Programs and the
Appropriation of Funds That Supported the Organizations* Domestic Health-
Related Activities Program/ administering agency

Authorizing congressional committee/ subcommittee Appropriating
congressional

subcommittee/ committee

Family planning grants/ HHS, Office of Population Affairs Senate Committee
on Health,

Education, Labor, and Pensions and Subcommittee on Health, House Committee
on Energy and Commerce

Subcommittee on Labor, Health and Human Services, and Education, Senate
Committee on Appropriations and Subcommittee on Labor, Health and Human
Services, and Education, House Committee on Appropriations Medicaid/ HHS,
Centers for

Medicare & Medicaid Services Senate Committee on Finance and Subcommittee
on Health,

House Committee on Energy and Commerce

Subcommittee on Labor, Health and Human Services, and Education, Senate
Committee on Appropriations and Subcommittee on Labor, Health and Human
Services, and Education, House Committee on Appropriations SSBG/ HHS,
Administration for

Children and Families Senate Committee on Finance and House Committee on
Ways

and Means Subcommittee on Labor, Health

and Human Services, and Education, Senate Committee on Appropriations and
Subcommittee on Labor, Health and Human Services, and Education, House
Committee on Appropriations MCHSBG/ HHS, Health Resources

and Services Administration Senate Committee on Finance; Senate Committee
on Health,

Education, Labor, and Pensions; and Subcommittee on Health, House
Committee on Energy and Commerce

Subcommittee on Labor, Health and Human Services, and Education, Senate
Committee on Appropriations and Subcommittee on Labor, Health and Human
Services, and Education, House Committee on Appropriations Research
project grants/

HHS, NIH Senate Committee on Health, Education, Labor, and Pensions

and Subcommittee on Health, House Committee on Energy and Commerce

Subcommittee on Labor, Health and Human Services, and Education, Senate
Committee on Appropriations and Subcommittee on Labor, Health and Human
Services, and Education, House Committee on Appropriations Research
grants/ NSF, Directorate for

Biological Sciences Senate Committee on Commerce, Science, and

Transportation; Senate Committee on Health, Education, Labor, and
Pensions; and House Committee on Science

Subcommittees on VA, HUD, and Independent Agencies, Senate and House
Committees on Appropriations Cooperative agreements/ HHS, CDC Senate
Committee on Health,

Education, Labor, and Pensions and Subcommittee on Health, House Committee
on Energy and Commerce

Subcommittee on Labor, Health and Human Services, and Education, Senate
Committee on Appropriations and Subcommittee on Labor, Health and Human
Services, and Education, House Committee on Appropriations Source:
Congressional committees and subcommittees. Note: GAO analysis of
congressional information.

GAO- 03- 527R Federal Funds Spent by Selected Organizations 11

Federal Funds Expended for International Health- Related Activities

For fiscal year 2001, the Population Council, the International Planned
Parenthood Federation*s member family planning associations, The Alan
Guttmacher Institute, and Advocates for Youth* reported spending more than
$55 million in federal funds for international health- related activities
such as family planning and health research. (See table 4.) The Population
Council, the International Planned Parenthood Federation*s member family
planning associations, and The Alan Guttmacher Institute received
financial support for international activities from USAID. Advocates for
Youth received financial support for its international activities through
a cooperative agreement with CDC. Table 4: Organizations* Expenditures of
Federal Funds For International Health- Related Activities, Fiscal

Year 2001 Organization Fiscal year 2001 expenditures a

Population Council $30,701,137 International Planned Parenthood
Federation*s member family planning associations Contraceptive shipments
3,374,689 b Direct agreements through USAID 18,663,788

Subagreements through U. S.- based agencies 1,374,740 The Alan Guttmacher
Institute 798,194 Advocates for Youth 132,160

Totals $55,044,708

Sources: USAID, the Population Council, The Alan Guttmacher Institute, and
Advocates for Youth. Note: The International Planned Parenthood
Federation*s headquarters received no federal funds for fiscal year 2001.

a The 12- month fiscal year periods for the organizations* expenditures
varied. b Dollar value of the contraceptive shipments.

Expenditures of federal funds supported the following organizations*
international health- related activities:

The Population Council spent its USAID grant funds to, among other things,
conduct 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, treatment, and mitigation of HIV/ AIDS and
other sexually transmitted diseases; and

undertake research on new and improved contraceptive methods and products
that protect against HIV and other diseases.

GAO- 03- 527R Federal Funds Spent by Selected Organizations 12

The International Planned Parenthood Federation*s family planning
association members used USAID funds to support various international
health- related activities, such as providing contraceptives and
contraceptive counseling. The support included direct funding through
agreements between USAID and the family planning associations and indirect
funding through agreements between USAID and U. S.- based agencies that
have subagreements with other entities. In fiscal year 2001, USAID resumed
a policy of providing family planning assistance only to foreign
nongovernmental organizations that chose to sign agreements to neither
perform nor actively promote abortion as a method of family planning in
other nations with the organization*s own funds or funds received from any
other donor source. According to USAID, since 1973, organizations have
been legally prohibited from using USAID funds to support or encourage
abortion as a method of family planning. The Alan Guttmacher Institute
used USAID funds for publishing an

international journal about family planning and reproductive health issues
in English, French, and Spanish.

Advocates for Youth used federal funds provided through a cooperative
agreement with CDC to help foster relationships between HIV/ AIDS service
organizations in the United States and those working in developing
countries. Specifically, Advocates for Youth created a network of service
providers from the Washington, D. C. area, El Salvador, Honduras, and
Guatemala to share strategies on HIV prevention services for at- risk
Latino youth. Advocates for Youth also provided technical assistance and
training to its Central American partners on organizational development,
peer education, and outreach.

The Senate Committee on Foreign Relations and the House Committee on
International Relations have jurisdiction over legislation authorizing
USAID programs. The Senate Committee on Appropriations, through its
Subcommittee on Foreign Operations, and the House Committee on
Appropriations, through its Subcommittee on Foreign Operations, Export
Financing, and Related Programs, have jurisdiction over legislation
appropriating funds for USAID programs and operations. The Senate
Committee on Health, Education, Labor, and Pensions and the House
Committee on Energy and Commerce, through its Subcommittee on Health, have
jurisdiction over legislation authorizing CDC programs. The Senate
Committee on Appropriations, through its Subcommittee on Labor, Health and
Human Services, and Education, and the House Committee on Appropriations,
through its Subcommittee on Labor, Health and Human Services, and
Education have jurisdiction over legislation appropriating funds for CDC
programs.

GAO- 03- 527R Federal Funds Spent by Selected Organizations 13

Agency and Other Comments and our Response

We provided a draft of this report to HHS, USAID, the Planned Parenthood
Federation of America, the Population Council, The Alan Guttmacher
Institute, Advocates for Youth, and SIECUS for review.

In its written comments, HHS raised concern about our data collection
methodology (see enclosure II). HHS commented that the major question
posed in the congressional request was not addressed because we presented
expenditure data rather than total federal funding and that its records
indicate that two organizations received from about two to three times the
amount of federal funds presented in the draft report. We acknowledge that
there could be a difference in the amount of federal funds the
organizations received and the amount they reported spending. However,
determining the amount of federal funds the organizations received was
beyond the scope of our work. We agreed with the requesters* staff to
update the information presented in our November 2001 report. In that
report, we presented information that the organizations provided on their
expenditures of federal funds for fiscal years 1999 and 2000. This report
updates those data by presenting information on the organizations*
expenditures of federal funds for fiscal year 2001. We added information
to clarify that the scope of our work focused on expenditures rather than
the total amount of federal funding the organizations received from the
federal agencies. HHS also commented that we had not requested information
from the department*s

agencies as we have done in the past, such as with our November 2001
report. However, we contacted the HHS agency that provided information for
our November 2001 report, for updated information. For consistency, the
methodology that we used to collect data for this report was similar to
the methodology we used for our November 2001 report.

Throughout the draft report we used the term *reproductive health* in
discussing the organizations* expenditures and the type of activities they
support. HHS commented that our use of the term reproductive health made
it unclear whether we requested information only on funding for
reproductive health activities or whether we characterized all
expenditures of federal funds by the organizations as funds to support
reproductive health activities. We agree with HHS* comment that the focus
on reproductive health should be changed and have revised the report to
reflect the broader health- related activities that the data represent.

HHS, USAID, and the organizations we reviewed provided technical comments
that we incorporated in the report where appropriate.

GAO- 03- 527R Federal Funds Spent by Selected Organizations 14 - - - - -

We are sending copies of this report 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. In addition, the report
is available at no charge on GAO*s home page at http:// www. gao. gov. If
you have any questions about this report, please contact me at (202) 512-
7101 or James O. McClyde at (202) 512- 7152. Claude B. Hayeck made major
contributions to this report.

Marjorie E. Kanof Director, Health Care* Clinical

and Military Health Care Issues Enclosures - 2

Enclosure I Enclosure I 15 GAO- 03- 527R Federal Funds Spent by Selected
Organizations Revised Fiscal Year 2000 Expenditures for International
Health- Related Activities In providing the nonprofit organizations*
fiscal year 2001 expenditures of federal funds for health- related
activities, the U. S. Agency for International Development (USAID) also
revised fiscal year 2000 international health- related expenditure data it

provided for the International Planned Parenthood Federation and its
affiliated associations. 5 As shown in table 5, fiscal year 2000
expenditures for contraceptive shipments increased more than $2.6 million,
expenditures related to direct agreements increased about $3.9 million,
and expenditures related to subagreements decreased about $1.3 million.
The Alan Guttmacher Institute also revised its fiscal year 2000
expenditures of federal funds for international activities that USAID
provided for our November 2001 report. These expenditures increased by
$5,000.

Table 5: Federal Funds Expended by Three Nonprofit Organizations for
International Health- Related Activities, Fiscal Year 2000 Organization

Fiscal year 2000 expenditures reported

in November 2001 Revised fiscal year 2000 expenditures

Population Council $36,443,540 $36,443,540 International Planned
Parenthood Federation 5,000,000 a 5,000,000 a International Planned
Parenthood Federation*s affiliated family planning associations
Contraceptive shipments 993,328 a 3,631,903

Direct agreements through USAID 7,531,000 a 11,394,423 Subagreements
through U. S.- based agencies 2,244,000 951,260 The Alan Guttmacher
Institute 587,128 592,128

Total $52,798,996 $58,013,254

Source: USAID, the Population Council, and The Alan Guttmacher Institute.
Note: GAO analysis of the organizations* data. Revised expenditure data
provided by USAID and The Alan Guttmacher Institute. a These figures
represent obligations.

This information changes the total amount of fiscal year 2000 expenditures
of federal funds that supported the domestic and international health-
related activities of the four nonprofit organizations discussed in our
November 2001 report* 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* from about $196 million to approximately $201 million. (See
table 6.)

5 See U. S. General Accounting Office, Reproductive Health: Federal Funds
That Supported Four Nonprofit Organizations, GAO- 02- 81R (Washington, D.
C.: Nov. 13, 2001).

Enclosure I Enclosure I

GAO- 03- 527R Federal Funds Spent by Selected Organizations 16

Table 6: Federal Funds That Supported the Domestic and International
Health- Related Activities of Four Nonprofit Organizations, Fiscal Year
2000 Organization Fiscal year 2000

expenditures reported in November 2001 Revised fiscal year

2000 expenditures

Planned Parenthood Federation of America and its affiliates $137,337,724
$137,337,724 Population Council 41,347,381 41,347,381 International
Planned Parenthood Federation and its affiliated associations 15,768,328
20,977,586 The Alan Guttmacher Institute 1,113,712 1,118,712

Total $195,567,145 $ 200,781,403 Source: GAO analysis of the
organizations* data. Note: Revised expenditure data provided by USAID and
The Alan Guttmacher Institute.

Enclosure II Enclosure II 17 GAO- 03- 527R Federal Funds Spent by Selected
Organizations Comments from the Department of Health and Human Services

Enclosure II Enclosure II

GAO- 03- 527R Federal Funds Spent by Selected Organizations 18

Enclosure II Enclosure II

GAO- 03- 527R Federal Funds Spent by Selected Organizations 19 (290255)

This is a work of the U. S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
its entirety without further permission from GAO. However, because this
work may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this material
separately.

GAO*s Mission The General Accounting Office, the audit, evaluation and
investigative arm of Congress, exists to support Congress in meeting its
constitutional responsibilities and to help improve the performance and
accountability of the federal government for the American people. GAO
examines the use of public funds; evaluates federal programs and policies;
and provides analyses, recommendations, and other assistance to help
Congress make informed oversight, policy, and funding decisions. GAO*s
commitment to good government is reflected in its core values of
accountability, integrity, and reliability.

The fastest and easiest way to obtain copies of GAO documents at no cost
is through the Internet. GAO*s Web site (www. gao. gov) contains abstracts
and fulltext files of current reports and testimony and an expanding
archive of older products. The Web site features a search engine to help
you locate documents using key words and phrases. You can print these
documents in their entirety, including charts and other graphics.

Each day, GAO issues a list of newly released reports, testimony, and
correspondence. GAO posts this list, known as *Today*s Reports,* on its
Web site daily. The list contains links to the full- text document files.
To have GAO e- mail

this list to you every afternoon, go to www. gao. gov and select
*Subscribe to daily E- mail alert for newly released products* under the
GAO Reports heading.

The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent of
Documents. GAO also accepts VISA and Mastercard. Orders for 100 or more
copies mailed to a single address are discounted 25 percent. Orders should
be sent to: U. S. General Accounting Office 441 G Street NW, Room LM
Washington, D. C. 20548 To order by Phone: Voice: (202) 512- 6000

TDD: (202) 512- 2537 Fax: (202) 512- 6061

Contact: Web site: www. gao. gov/ fraudnet/ fraudnet. htm E- mail:
fraudnet@ gao. gov Automated answering system: (800) 424- 5454 or (202)
512- 7470 Jeff Nelligan, managing director, NelliganJ@ gao. gov (202) 512-
4800

U. S. General Accounting Office, 441 G Street NW, Room 7149 Washington, D.
C. 20548 Obtaining Copies of GAO Reports and

Testimony Order by Mail or Phone

To Report Fraud, Waste, and Abuse in Federal Programs Public Affairs
*** End of document. ***