
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between
  January 2, 2001 and January 28, 2002]
[CITE: 22USC2151b]

 
               TITLE 22--FOREIGN RELATIONS AND INTERCOURSE
 
                     CHAPTER 32--FOREIGN ASSISTANCE
 
                 SUBCHAPTER I--INTERNATIONAL DEVELOPMENT
 
  Part I--Declaration of Policy; Development Assistance Authorizations
 
Sec. 2151b. Population planning and health programs


(a) Congressional declaration of policy

    The Congress recognizes that poor health conditions and uncontrolled 
population growth can vitiate otherwise successful development efforts.
    Large families in developing countries are the result of complex 
social and economic factors which change relatively slowly among the 
poor majority least affected by economic progress, as well as the result 
of a lack of effective birth control. Therefore, effective family 
planning depends upon economic and social change as well as the delivery 
of services and is often a matter of political and religious 
sensitivity. While every country has the right to determine its own 
policies with respect to population growth, voluntary population 
planning programs can make a substantial contribution to economic 
development, higher living standards, and improved health and nutrition.
    Good health conditions are a principal element in improved quality 
of life and contribute to the individual's capacity to participate in 
the development process, while poor health and debilitating disease can 
limit productivity.

(b) Assistance for voluntary population planning

    In order to increase the opportunities and motivation for family 
planning and to reduce the rate of population growth, the President is 
authorized to furnish assistance, on such terms and conditions as he may 
determine, for voluntary population planning. In addition to the 
provision of family planning information and services, including also 
information and services which relate to and support natural family 
planning methods, and the conduct of directly relevant demographic 
research, population planning programs shall emphasize motivation for 
small families.

(c) Assistance for health programs; special health needs of children and 
        mothers; Child Survival Fund; promotion of immunization and oral 
        rehydration; control of AIDS and tuberculosis

    (1) In order to contribute to improvements in the health of the 
greatest number of poor people in developing countries, the President is 
authorized to furnish assistance, on such terms and conditions as he may 
determine, for health programs. Assistance under this subsection shall 
be used primarily for basic integrated health services, safe water and 
sanitation, disease prevention and control, and related health planning 
and research. This assistance shall emphasize self-sustaining community-
based health programs by means such as training of health auxiliary and 
other appropriate personnel, support for the establishment and 
evaluation of projects that can be replicated on a broader scale, 
measures to improve management of health programs, and other services 
and supplies to support health and disease prevention programs.
    (2)(A) In carrying out the purposes of this subsection, the 
President shall promote, encourage, and undertake activities designed to 
deal directly with the special health needs of children and mothers. 
Such activities should utilize simple, available technologies which can 
significantly reduce childhood mortality, such as improved and expanded 
immunization programs, oral rehydration to combat diarrhoeal diseases, 
and education programs aimed at improving nutrition and sanitation and 
at promoting child spacing. In carrying out this paragraph, guidance 
shall be sought from knowledgeable health professionals from outside the 
agency primarily responsible for administering subchapter I of this 
chapter. In addition to government-to-government programs, activities 
pursuant to this paragraph should include support for appropriate 
activities of the types described in this paragraph which are carried 
out by international organizations (which may include international 
organizations receiving funds under part III of this subchapter) and by 
private and voluntary organizations, and should include encouragement to 
other donors to support such types of activities.
    (B) In addition to amounts otherwise available for such purpose, 
there are authorized to be appropriated to the President $25,000,000 for 
fiscal year 1986 and $75,000,000 for fiscal year 1987 for use in 
carrying out this paragraph. Amounts appropriated under this 
subparagraph are authorized to remain available until expended.
    (C) Appropriations pursuant to subparagraph (B) may be referred to 
as the ``Child Survival Fund''.
    (3) The Congress recognizes that the promotion of primary health 
care is a major objective of the foreign assistance program. The 
Congress further recognizes that simple, relatively low cost means 
already exist to reduce incidence of communicable diseases among 
children, mothers, and infants. The promotion of vaccines for 
immunization, and salts for oral rehydration, therefore, is an essential 
feature of the health assistance program. To this end, the Congress 
expects the agency primarily responsible for administering subchapter I 
of this chapter to set as a goal the protection of not less than 80 
percent of all children, in those countries in which such agency has 
established development programs, from immunizable diseases by January 
1, 1991. Of the aggregate amounts made available for fiscal year 1987 to 
carry out paragraph (2) of this subsection (relating to the Child 
Survival Fund) and to carry out subsection (c) of this section (relating 
to development assistance for health), $50,000,000 shall be used to 
carry out this paragraph.
    (4)(A) Congress recognizes the growing international dilemma of 
children with the human immunodeficiency virus (HIV) and the merits of 
intervention programs aimed at this problem. Congress further recognizes 
that mother-to-child transmission prevention strategies can serve as a 
major force for change in developing regions, and it is, therefore, a 
major objective of the foreign assistance program to control the 
acquired immune deficiency syndrome (AIDS) epidemic.
    (B) The agency primarily responsible for administering subchapter I 
of this chapter shall--
        (i) coordinate with UNAIDS, UNICEF, WHO, national and local 
    governments, and other organizations to develop and implement 
    effective strategies to prevent vertical transmission of HIV; and
        (ii) coordinate with those organizations to increase 
    intervention programs and introduce voluntary counseling and 
    testing, antiretroviral drugs, replacement feeding, and other 
    strategies.

    (5)(A) Congress expects the agency primarily responsible for 
administering subchapter I of this chapter to make the human 
immunodeficiency virus (HIV) and the acquired immune deficiency syndrome 
(AIDS) a priority in the foreign assistance program and to undertake a 
comprehensive, coordinated effort to combat HIV and AIDS.
    (B) Assistance described in subparagraph (A) shall include help 
providing--
        (i) primary prevention and education;
        (ii) voluntary testing and counseling;
        (iii) medications to prevent the transmission of HIV from mother 
    to child; and
        (iv) care for those living with HIV or AIDS.

    (6)(A) In addition to amounts otherwise available for such purpose, 
there is authorized to be appropriated to the President $300,000,000 for 
each of the fiscal years 2001 and 2002 to carry out paragraphs (4) and 
(5).
    (B) Of the funds authorized to be appropriated under subparagraph 
(A), not less than 65 percent is authorized to be available through 
United States and foreign nongovernmental organizations, including 
private and voluntary organizations, for-profit organizations, religious 
affiliated organizations, educational institutions, and research 
facilities.
    (C)(i) Of the funds authorized to be appropriated by subparagraph 
(A), not less than 20 percent is authorized to be available for programs 
as part of a multidonor strategy to address the support and education of 
orphans in sub-Saharan Africa, including AIDS orphans.
    (ii) Assistance made available under this subsection, and assistance 
made available under part IV of subchapter II of this chapter to carry 
out the purposes of this subsection, may be made available 
notwithstanding any other provision of law that restricts assistance to 
foreign countries.
    (D) Of the funds authorized to be appropriated under subparagraph 
(A), not less than 8.3 percent is authorized to be available to carry 
out the prevention strategies for vertical transmission referred to in 
paragraph (4)(A).
    (E) Of the funds authorized to be appropriated by subparagraph (A), 
not more than 7 percent may be used for the administrative expenses of 
the agency primarily responsible for carrying out subchapter I of this 
chapter in support of activities described in paragraphs (4) and (5).
    (F) Funds appropriated under this paragraph are authorized to remain 
available until expended.
    (7)(A) Congress recognizes the growing international problem of 
tuberculosis and the impact its continued existence has on those nations 
that had previously largely controlled the disease. Congress further 
recognizes that the means exist to control and treat tuberculosis, and 
that it is therefore a major objective of the foreign assistance program 
to control the disease. To this end, Congress expects the agency 
primarily responsible for administering subchapter I of this chapter--
        (i) to coordinate with the World Health Organization, the 
    Centers for Disease Control, the National Institutes of Health, and 
    other organizations toward the development and implementation of a 
    comprehensive tuberculosis control program; and
        (ii) to set as a goal the detection of at least 70 percent of 
    the cases of infectious tuberculosis, and the cure of at least 85 
    percent of the cases detected, in those countries in which the 
    agency has established development programs, by December 31, 2010.

    (B) There is authorized to be appropriated to the President, 
$60,000,000 for each of the fiscal years 2001 and 2002 to be used to 
carry out this paragraph. Funds appropriated under this subparagraph are 
authorized to remain available until expended.

(d) Administration of assistance

    (1) Assistance under this part shall be administered so as to give 
particular attention to the interrelationship between (A) population 
growth, and (B) development and overall improvement in living standards 
in developing countries, and to the impact of all programs, projects, 
and activities on population growth. All appropriate activities proposed 
for financing under this part shall be designed to build motivation for 
smaller families through modification of economic and social conditions 
supportive of the desire for large families, in programs such as 
education in and out of school, nutrition, disease control, maternal and 
child health services, improvements in the status and employment of 
women, agricultural production, rural development, and assistance to the 
urban poor, and through community-based development programs which give 
recognition to people motivated to limit the size of their families. 
Population planning programs shall be coordinated with other programs 
aimed at reducing the infant mortality rate, providing better nutrition 
for pregnant women and infants, and raising the standard of living of 
the poor.
    (2) Since the problems of malnutrition, disease, and rapid 
population growth are closely related, planning for assistance to be 
provided under subsections (b) and (c) of this section and under section 
2151a of this title shall be coordinated to the maximum extent 
practicable.
    (3) Assistance provided under this section shall emphasize low-cost 
integrated delivery systems for health, nutrition, and family planning 
for the poorest people, with particular attention to the needs of 
mothers and young children, using paramedical and auxiliary medical 
personnel, clinics and health posts, commercial distribution systems, 
and other modes of community outreach.

(e) Research and analysis

    (1) Health and population research and analysis carried out under 
this chapter shall--
        (A) be undertaken to the maximum extent practicable in 
    developing countries by developing country personnel, linked as 
    appropriate with private and governmental biomedical research 
    facilities within the United States;
        (B) take account of the special needs of the poor people of 
    developing countries in the determination of research priorities; 
    and
        (C) make extensive use of field testing to adapt basic research 
    to local conditions.

    (2) The President is authorized to study the complex factors 
affecting population growth in developing countries and to identify 
factors which might motivate people to plan family size or to space 
their children.

(f) Prohibition on use of funds for performance or research respecting 
        abortions or involuntary sterilization

    (1) None of the funds made available to carry out subchapter I of 
this chapter may be used to pay for the performance of abortions as a 
method of family planning or to motivate or coerce any person to 
practice abortions.
    (2) None of the funds made available to carry out subchapter I of 
this chapter may be used to pay for the performance of involuntary 
sterilizations as a method of family planning or to coerce or provide 
any financial incentive to any person to undergo sterilizations.
    (3) None of the funds made available to carry out subchapter I of 
this chapter may be used to pay for any biomedical research which 
relates, in whole or in part, to methods of, or the performance of, 
abortions or involuntary sterilization as a means of family planning.

(g) Authorization of appropriations

    (1) There are authorized to be appropriated to the President, in 
addition to funds otherwise available for such purposes--
        (A) $290,000,000 for fiscal year 1986 and $290,000,000 for 
    fiscal year 1987 to carry out subsection (b) of this section; and
        (B) $205,000,000 for fiscal year 1986 and $180,000,000 for 
    fiscal year 1987 to carry out subsection (c) of this section.

    (2) Funds appropriated under this subsection are authorized to 
remain available until expended.

(Pub. L. 87-195, pt. I, Sec. 104, as added Pub. L. 93-189, Sec. 2(3), 
Dec. 17, 1973, 87 Stat. 715; amended Pub. L. 93-559, Sec. 4(1), Dec. 30, 
1974, 88 Stat. 1795; Pub. L. 94-161, title III, Sec. 304, Dec. 20, 1975, 
89 Stat. 857; Pub. L. 95-88, title I, Sec. 103(a)-(c), Aug. 3, 1977, 91 
Stat. 534; Pub. L. 95-424, title I, Sec. 104(a), Oct. 6, 1978, 92 Stat. 
945; Pub. L. 96-53, title I, Sec. 102, Aug. 14, 1979, 93 Stat. 360; Pub. 
L. 96-533, title III, Sec. 302, Dec. 16, 1980, 94 Stat. 3145; Pub. L. 
97-113, title III, Sec. 302, Dec. 29, 1981, 95 Stat. 1532; Pub. L. 98-
473, title I, Sec. 101(1) [title V, Sec. 541(a)], Oct. 12, 1984, 98 
Stat. 1884, 1903; Pub. L. 99-83, title III, Secs. 303-305(a), Aug. 8, 
1985, 99 Stat. 214; Pub. L. 99-529, title I, Sec. 103, title IV, 
Sec. 404(1), Oct. 24, 1986, 100 Stat. 3011, 3019; Pub. L. 106-264, title 
I, Sec. 111(a), title II, Sec. 203, Aug. 19, 2000, 114 Stat. 751, 759.)

                       References in Text

    This chapter, referred to in subsec. (e)(1), was in the original 
``this Act'', meaning Pub. L. 87-195, Sept. 4, 1961, 75 Stat. 424, as 
amended, known as the Foreign Assistance Act of 1961. For complete 
classification of this Act to the Code, see Short Title note set out 
under section 2151 of this title and Tables.


References to Subchapter I Deemed To Include Certain Parts of Subchapter 
                                   II

    References to subchapter I of this chapter are deemed to include 
parts IV (Sec. 2346 et seq.), VI (Sec. 2348 et seq.), and VIII 
(Sec. 2349aa et seq.) of subchapter II of this chapter, and references 
to subchapter II are deemed to exclude such parts. See section 202(b) of 
Pub. L. 92-226, set out as a note under section 2346 of this title, and 
sections 2348c and 2349aa-5 of this title.

                          Codification

    Amendment by Pub. L. 98-473 is based on section 303 of H.R. 5119, 
Ninety-eighth Congress, as passed by the House of Representatives May 
10, 1984, which was enacted into permanent law by Pub. L. 98-473.


                               Amendments

    2000--Subsec. (c)(4) to (7). Pub. L. 106-264 added pars. (4) to (7).
    1986--Subsec. (c)(2)(B). Pub. L. 99-529, Sec. 103(b), substituted 
``$75,000,000 for fiscal year 1987'' for ``$25,000,000 for fiscal year 
1987''.
    Subsec. (c)(3). Pub. L. 99-529, Sec. 103(a), inserted provision 
allocating $50,000,000 of the amounts available for fiscal year 1987 for 
carrying out par. (3).
    Subsec. (g)(1)(B). Pub. L. 99-529, Sec. 404(1), substituted 
``$180,000,000 for fiscal year 1987'' for ``$205,000,000 for fiscal year 
1987''.
    1985--Subsec. (c)(2)(B). Pub. L. 99-83, Sec. 304, inserted 
provisions authorizing specific appropriations for fiscal years 1986 and 
1987.
    Subsec. (c)(3). Pub. L. 99-83, Sec. 305(a), added par. (3).
    Subsec. (g). Pub. L. 99-83, Sec. 303, in amending subsec. (g) 
generally, substituted in par. (1) provision authorizing appropriations 
of $290,000,000 and $205,000,000 to carry out subsecs. (b) and (c), 
respectively, for fiscal years 1986 and 1987 for provisions authorizing 
$211,000,000 and $133,405,000 to carry out such subsecs. for fiscal 
years 1982 and 1983, and in par. (2) struck out provision that not less 
than 16 percent of available subsec. (b) appropriations or $38,000,000, 
whichever amount is less, be available in fiscal years 1982 an 1983 only 
for the United Nations Fund for Population Activities.
    1984--Subsec. (c). Pub. L. 98-473 designated existing provisions as 
par. (1) and added par. (2).
    1981--Subsec. (f)(3). Pub. L. 97-113, Sec. 302(b), added par. (3).
    Subsec. (g). Pub. L. 97-113, Sec. 302(a), substituted provision 
authorizing appropriations of $211,000,000 and $133,405,000 to carry out 
subsecs. (b) and (c) for fiscal years 1982 and 1983 for provision 
authorizing $238,000,000 and $145,300,000 to carry out such subsections 
for fiscal year 1981 and provision that not less than 16 percent of 
available subsec. (b) appropriations or $38,000,000, whichever amount is 
less, be available in fiscal years 1982 and 1983 only for the United 
Nations Fund for Population Activities for provision making minimum of 
$3,000,000 available in fiscal year 1981 only to support the World 
Health Organization's Special Program of Research, Development and 
Research Training in Human Reproduction.
    1980--Subsec. (b). Pub. L. 96-533, Sec. 302(a), made provision for 
information and services relating to and supporting natural family 
planning methods.
    Subsec. (g). Pub. L. 96-533, Sec. 302(b), substituted in par. (1) 
appropriations authorization of $238,000,000 for fiscal year 1981 for 
authorization of $201,000,000 for fiscal year 1980 and made $3,000,000 
available for World Health Organization's Special Human Reproduction 
Program, and in par. (2) appropriations authorization of $145,300,000 
for fiscal year 1981 for authorization of $141,000,000 for fiscal year 
1980, which made $4,000,000 available for development of John Sparkman 
Center for International Public Health Education at University of 
Alabama at Birmingham.
    1979--Subsec. (d)(1). Pub. L. 96-53, Sec. 102(b), inserted 
provisions respecting use of community-based development programs.
    Subsec. (g)(1). Pub. L. 96-53, Sec. 102(a), substituted provisions 
authorizing appropriations of $201,000,000 for fiscal year 1980, for 
provisions authorizing appropriations of $224,745,000 for fiscal year 
1979.
    Subsec. (g)(2). Pub. L. 96-53, Sec. 102(a), substituted provisions 
authorizing appropriations of $141,000,000 for fiscal year 1980, for 
provisions authorizing appropriations of $148,494,000 for fiscal year 
1979, and inserted provisions relating to the Sparkman Center for 
International Public Health Education.
    1978--Pub. L. 95-424 amended section generally placing greater 
emphasis on programs and efforts to change social and economic 
conditions which produce high birth rates.
    1977--Subsec. (a). Pub. L. 95-88, Sec. 103(a), transferred to 
subsec. (b) provisions covering the President's authority to furnish 
assistance for health purpose and, in the provisions covering population 
planning remaining in subsec. (a), struck out provisions authorizing the 
appropriations of $145,000,000 for fiscal year 1974, $165,000,000 for 
fiscal year 1975, $243,100,000 for fiscal year 1976, and $275,600,000 
for fiscal year 1977, struck out provisions requiring that not less than 
67 percent of the funds made available under this section be used for 
population planning, and inserted provisions authorizing an 
appropriation of $167,000,000 for fiscal year 1978.
    Subsec. (b). Pub. L. 95-88, Sec. 103(a), added subsec. (b), 
consisting of provisions transferred from subsec. (a) covering the 
President's authority to furnish assistance for health purposes, 
inserted references to disease prevention and environmental sanitation, 
and inserted provisions authorizing an appropriation of $107,700,000 for 
fiscal year 1978. Former subsec. (b) redesignated (c).
    Subsec. (c). Pub. L. 95-88, Sec. 103(b), redesignated former subsec. 
(b) as (c).
    Subsec. (d). Pub. L. 95-88, Sec. 103(c), added subsec. (d).
    1975--Subsec. (a). Pub. L. 94-161, Sec. 304(1)-(3), designated 
existing provisions as subsec. (a), authorized appropriations of 
$243,100,000 and $275,600,000 for fiscal years 1976 and 1977, and 
prescribed minimum percentage (67) of funds available for any fiscal 
year to be used for population planning, either in separate programs or 
as an element of health programs.
    Subsec. (b). Pub. L. 94-161, Sec. 304(4), added subsec. (b).
    1974--Pub. L. 93-559 increased appropriations authorization for 
fiscal year 1975 to $165,000,000 from $145,000,000.


                    Effective Date of 1985 Amendment

    Amendment by Pub. L. 99-83 effective Oct. 1, 1985, see section 1301 
of Pub. L. 99-83, set out as a note under section 2151-1 of this title.


                    Effective Date of 1979 Amendment

    Amendment by Pub. L. 96-53 effective Oct. 1, 1979, see section 
512(a) of Pub. L. 96-53, set out as a note under section 2151 of this 
title.


                    Effective Date of 1978 Amendment

    Amendment by Pub. L. 95-424 effective Oct. 1, 1978, see section 605 
of Pub. L. 95-424, set out as a note under section 2151 of this title.


                    Effective Date of 1977 Amendment

    Section 103(d) of Pub. L. 95-88 provided that: ``The amendment made 
by subsection (a) of this section [amending this section] shall take 
effect on October 1, 1977.''

                         Delegation of Functions

    For delegation of functions of President under this section, see Ex. 
Ord. No. 12163, Sept. 29, 1979, 44 F.R. 56673, as amended, set out as a 
note under section 2381 of this title.


                                Findings

    Pub. L. 106-264, title II, Sec. 202, Aug. 19, 2000, 114 Stat. 758, 
provided that: ``Congress makes the following findings:
        ``(1) Since the development of antibiotics in the 1950s, 
    tuberculosis has been largely controlled in the United States and 
    the Western World.
        ``(2) Due to societal factors, including growing urban decay, 
    inadequate health care systems, persistent poverty, overcrowding, 
    and malnutrition, as well as medical factors, including the HIV/AIDS 
    epidemic and the emergence of multi-drug resistant strains of 
    tuberculosis, tuberculosis has again become a leading and growing 
    cause of adult deaths in the developing world.
        ``(3) According to the World Health Organization--
            ``(A) in 1998, about 1,860,000 people worldwide died of 
        tuberculosis-related illnesses;
            ``(B) one-third of the world's total population is infected 
        with tuberculosis; and
            ``(C) tuberculosis is the world's leading killer of women 
        between 15 and 44 years old and is a leading cause of children 
        becoming orphans.
        ``(4) Because of the ease of transmission of tuberculosis, its 
    international persistence and growth pose a direct public health 
    threat to those nations that had previously largely controlled the 
    disease. This is complicated in the United States by the growth of 
    the homeless population, the rate of incarceration, international 
    travel, immigration, and HIV/AIDS.
        ``(5) With nearly 40 percent of the tuberculosis cases in the 
    United States attributable to foreign-born persons, tuberculosis 
    will never be controlled in the United States until it is controlled 
    abroad.
        ``(6) The means exist to control tuberculosis through screening, 
    diagnosis, treatment, patient compliance, monitoring, and ongoing 
    review of outcomes.
        ``(7) Efforts to control tuberculosis are complicated by several 
    barriers, including--
            ``(A) the labor intensive and lengthy process involved in 
        screening, detecting, and treating the disease;
            ``(B) a lack of funding, trained personnel, and medicine in 
        virtually every nation with a high rate of the disease;
            ``(C) the unique circumstances in each country, which 
        requires the development and implementation of country-specific 
        programs; and
            ``(D) the risk of having a bad tuberculosis program, which 
        is worse than having no tuberculosis program because it would 
        significantly increase the risk of the development of more 
        widespread drug-resistant strains of the disease.
        ``(8) Eliminating the barriers to the international control of 
    tuberculosis through a well-structured, comprehensive, and 
    coordinated worldwide effort would be a significant step in dealing 
    with the increasing public health problem posed by the disease.''


 Progress Report on Implementation of Immunization and Oral Rehydration 
                           Promotion Programs

    Section 305(b) of Pub. L. 99-83 provided that: ``Each annual report 
required by section 634 of the Foreign Assistance Act of 1961 [22 U.S.C. 
2394] shall describe the progress achieved during the preceding fiscal 
year in carrying out section 104(c)(3) of such Act [22 U.S.C. 
2151b(c)(3)].''

                  Section Referred to in Other Sections

    This section is referred to in sections 1727c, 1727e, 2151a, 2151d, 
2151q, 2151u, 2293, 5453 of this title.
