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Congress’ 2007 Endgame Brings Good and Bad News for Sexual and Reproductive Health Issues

The United States Congress finally completed appropriations for Fiscal Year (FY) 2008 by passing a $555 billion omnibus budget package that included the Fiscal Year 2008 Labor, Health and Human Services, and Education (Labor-HHS) appropriations bill, the State-Foreign Operations appropriations bill, and the nine other FY 2008 appropriations bills that had yet to be completed.  The omnibus also included $11.2 billion in emergency funds and $70 billion in additional funds for the wars in Iraq and Afghanistan.  

The omnibus bill essentially meets the President’s overall Budget request amount, although it does allocate funds to individual programs differently than the President’s original budget.  The Senate voted 76–17 to approve the combined spending package on December 18th.  The House voted the following day 272–142 to give final approval to the FY 08 omnibus spending bill (HR 2764).  President Bush signed the bill into law on December 26, 2007. 

Abstinence-Only-Until-Marriage Programs

Included in the omnibus was the Labor, Health and Human Services (Labor-HHS) spending bill, which, among other items, provides the funding levels for the Community-Based Abstinence Education (CBAE) program and the Adolescent Family Life Act (AFLA).  In the final bill, the House of Representatives finally relented and provided level funding for CBAE, meaning that the program received the same amount of funding as last year, $113 million.  The House had previously proposed increasing funding for CBAE by $28 million, while the Senate sought a $28 million decrease. The final bill also funded abstinence-only-until-marriage programs in AFLA at last year’s level, $13 million. 

During the signing of the bill, President Bush criticized the Congress for including close to 10,000 earmarks totaling about $10 billion.1  Included in these earmarks were 25 abstinence-only-until-marriage earmarks by the President’s fellow Republican, Senator Arlen Specter of Pennsylvania.  In FY 2003 Senator Specter set a new precedent for the federal funding of abstinence-only-until-marriage programs by earmarking money for specific abstinence-only-until-marriage programs outside of the three traditional federal funding streams. In Fiscal Years 2003, 2004, and 2005, Senator Specter granted over $3 million each year for Pennsylvania-based organizations.  This year, Senator Specter’s earmarks totaled just under $1 million. These earmarks are in addition to the $176 million already granted for FY08 through the three traditional abstinence-only-until-marriage funding streams.

 “While hardly an ideal outcome from this new Congress, an increase—which looked to be a near certainty at one point—would have been more disastrous,” said William Smith, vice president for public policy at SIECUS.  “We are hopeful that next year brings better results, and that Congress finally sees fit to end funding for these ineffective programs that waste millions of taxpayer dollars,” continued Smith.

Title X Family Planning Funding

The final FY 2008 omnibus bill included a $16.8 million for the Title X family planning program.   This is the third largest increase in 25 years for the Title X program.   Advocates were pleased to receive an increase this year, although they were disappointed that the increase was not larger as it had been in the House-passed Labor-HHS bill. Title X is the only federal program dedicated solely to funding family planning and reproductive health care services.  Title X clinics offer low income women voluntary contraceptive services, prenatal care, treatment for sexually transmitted diseases (STDs), and other services. 

Throughout the FY 2008 appropriations process, House Appropriations Chair David Obey (D-WI) had insisted on linking the funding levels for the Title X and the CBAE program, dictating that each program receive the same increase in funding.  Linking these programs has led to frustration for advocates as the programs are unrelated—one programs funds programmatic work while the other provides clinical services—as well as the fact that there is a mounting body of evident proving that abstinence-only-until-marriage programs are ineffective while Title X has been shown to positively impact the health of women and communities.  The final omnibus bill indicated a victory over this folly in thinking as the two programs were ultimately not linked in the end, with Title X receiving an increase and CBAE being level-funded for FY 2008.

Ryan White CARE Act

The Ryan White CARE Act, which funds primary healthcare and support services for people living with HIV/AIDS, received a disappointing increase totaling only $29 million in the FY 2008 omnibus.  This included a $23 million increase for Title I, which provides funds to eligible metropolitan areas; an increase of $5 million for Title III, which funds community-based organizations; and an increase of close to $2 million for Title IV, which targets grants to women, infants, children, and youth with HIV/AIDS.  The AIDS Drugs Assistance Program (ADAP), a part of Title II, also received an increase of $19 million; however, this came at a steep cost to the rest of Title II’s base, which funds grants to states to provide clinical care, as the section’s funding was decreased by a parallel $19 million, making it the largest reduction in the history of the program.

Other Domestic Provisions

One of the untold disgraces of this Congress is that funding for the Centers for Disease Control and Prevention’s HIV Prevention and Surveillance Program was decreased by $3.5 million.  This continues an unfortunate trend for CDC’s HIV Prevention program which received only $692 million dollars in the FY08 omnibus bill and has suffered steady losses totaling $70 million since 2003.  

The National Institutes of Health (NIH) received an increase of only $330 million over the FY07 funding level, for a total of $29.23 billion.  The amount of this increase disappointed advocates, particularly after the Senate appropriations committee had proposed a $1 billion increase earlier in the year.

HIV-prevention advocates were pleased, however, that the omnibus bill lifts the ban on local funding for syringe exchange programs in Washington, DC.  Since 1999, the District has been the only city in the United States barred by federal law from using local funds for syringe exchange programs.  Soon after the end of the ban was signed into law, DC officials announced an investment of $650,000 in needle exchange programs.  Mayor Adrian Fenty also plans to include needle exchange programs within the District’s larger plan to reduce the spread of HIV and will allocate $1 million in city funds for syringe exchange programs in 2008.  Injection drug use is the second most common cause of HIV transmission in the city.

Global HIV/AIDS and Reproductive Health Programs

Also included in the omnibus was the FY08 foreign operation spending bill.  This bill funds the Department of State, USAID, and other global health and international aid programs.  The final omnibus provided $6.5 billion for United States and global health activities, which is an increase of $1.4 billion over FY07 and $796 million over the President’s budget request.  Five billion dollars of the foreign operation spending bill increase will go to the President’s Emergency Plan for AIDS Relief (PEPFAR), an increase of just over $1.2 billion from its FY07 spending level.

The bill also includes a provision that allows the U.S. President to waive the abstinence-until-marriage earmark under PEPFAR. The abstinence-only earmark, put in place by Congress in 2003, mandates that at least 1/3 of HIV-prevention funding under PEPFAR be spent on abstinence-only-until-marriage programs. This requirement exists despite the stark lack of evidence that abstinence-until-marriage programs are effective in halting the spread of HIV/AIDS. It is unlikely, however, that President Bush will waive the abstinence-until-marriage earmark under PEPFAR this year.

The omnibus also included funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which will receive about $841 million.  This amount includes $546 million in the State-Foreign Operations section of the omnibus and $295 million in the Labor-HHS section.  In addition, the measure provides $1.8 billion for global health and child survival programs, including $347 million for HIV/AIDS programs.  Funding for maternal and child health programs increased by $101 million, and malaria and TB funding increased by $101 million and $72 million, respectively.  Also included in the Labor-HHS bill is $121 million for the Centers for Disease Control and Prevention’s (CDC’s) Global AIDS program; this represents a $2 million decrease from last year’s funding level.

Bowing to a veto threat from President Bush, advocates were disappointed that Congress removed from the final omnibus bill language that would have softened the so-called Global Gag Rule for international family planning organizations.   The Global Gag Rule denies U.S. family planning aid to foreign health care providers who offer legal abortions, provide counseling or referrals for legal abortion, or publicly support legal abortion within their own countries even if these activities are conducted with other sources—including their own governments.

President Bush is expected to release his Fiscal Year 2009 Budget Request on February 4, 2008. 


  1. Amy Gardner, “Bush Signs Domestic Spending Bill but Criticizes Pet Projects,” WashingtonPost, 27 December 2007, accessed 10 January 2008, <>.