Key Takeaways

• Less than half of women report that their employer offers paid parental leave such as maternity or paternity leave (43%) or paid family and medical leave which can also be used to take time off to care for a seriously ill family member (44%). A considerably higher share, nearly two-thirds, of women say that their employer offers them paid sick leave (63%). Just 7% of women work for an employer that offers on-site childcare or a childcare subsidy. These estimates are consistently lower for women who work part-time, are self-employed, are low-income, or live in rural areas.
• Among employed parents, more than half of mothers (56%) report they are the ones to care for children when they are sick and cannot attend school, compared to about a fifth of fathers (19%). A substantial share of mothers (24%) and fathers (33%) say they share responsibility with a spouse, partner, or co-parent.
• Compared to 2020, there has been an increase in the share of men reporting that they are usually the ones to care for children when they are sick and cannot attend school, but this activity is still largely done by mothers.
• About half of working parents say they are not paid when they take time off to care for sick kids. Three-quarters (76%) of working mothers with low incomes (below 200% of the federal poverty level) report losing pay when they miss work to care for sick children which is twice the share of those with higher incomes (38%).

Introduction

The persistent challenges that working mothers face in balancing family and work responsibilities were intensified by the COVID pandemic, which exposed the gaps in resources to address the rise in family caregiving needs, a shift to homeschooling, and the dearth of childcare options. While children are now back in the classroom and many workers have returned to offices, the pandemic has left its mark on the challenge of balancing family and workplace responsibilities, particularly for working mothers. For many working women, economic security is strongly connected to workplace benefits such as insurance coverage, paid sick leave, and paid family leave as well as their roles as mothers and the primary managers of their children’s health care.

The 2022 KFF Women’s Health Survey (KWHS) is a nationally representative survey of 5,145 women and 1,225 men ages 18-64 conducted from May 10, 2022, to June 7, 2022. Among several topics related to women’s health and well-being, we asked respondents about employment and family health care needs. This brief highlights how workplace benefits and caring for children’s health care differ by gender and among different subpopulations of women. Data presented in this brief are based on survey respondents’ self-identified gender as “woman” or “man.” We recognize that this approach excludes people who do not identify with either of these categories. We do not have sufficient survey sample size to report on people who are not cisgender. See the Methodology section for more details.

Access to Workplace Benefits

Fewer than half of employed women say their employer offers paid parental leave or paid family and medical leave. So-called “fringe benefits” such as paid leave offer financial security to workers who must balance their personal and family care needs with their work responsibilities. However, just 43% of employed women ages 18-64 say their employer offers paid parental leave and 44% say their employer offers paid family and medical leave. Many more employed women (63%) report that their employer offers paid sick leave (Figure 1).

Fewer than one in ten employed women say their employer offers on-site childcare or a childcare subsidy. As some employers seek to provide more “family-friendly” workplaces, some now offer on-site childcare for workers’ children or subsidies to workers to pay for childcare at another location. This type of benefit may help ease the transition back to work for new parents, reduce the need for extensive commuting, and provide financial support for a service that is consuming an increasing share of workers’ paychecks. However, few (7%) employed women report that their employer offers on-site childcare or a childcare subsidy (Figure 1).

Some women do not know whether their employer offers paid leave and childcare benefits. Benefits are an important component of a worker’s total compensation package, but some women do not know if their employer offers paid parental leave (18%) or paid family and medical leave (17%) (Figure 1). Knowledge of sick leave benefits is higher, with just 7% of women saying they don’t know if their employer offers this benefit. Eleven percent do not know if their employer offers on-site childcare or a childcare subsidy. Women who are employed but don’t have kids at home are more likely than those who have kids to say they don’t know if their employer offers paid family and medical leave (19% vs. 14%, respectively), paid parental leave (22% vs. 12%), and on-site childcare or a childcare subsidy (13% vs. 7%) (data not shown).

Access to these workplace benefits varies widely by employment status, income, geographic location, and educational attainment. Women who work full-time, are not self-employed, and have higher incomes are more likely than their counterparts to say their employer offers any of these paid leave or childcare benefits (Table 1).

For example, approximately seven in ten women who are employed full-time (73%) and women who are not self-employed (69%) report that their employer offers paid sick leave compared to three in ten (31%) who work part-time and about two in ten (18%) who are self-employed. Half of higher-income (>= 200% FPL) employed women (49%) say their employer offers paid family and medical leave compared to one-third (33%) of women who are low-income (< 200% FPL). Employed women with a college degree (52%) are more likely than those with lower educational attainment (36%) to report working for an employer that offers paid parental leave. Four percent of employed women in rural locations work for an employer offering on-site childcare or a childcare subsidy compared to 7% of employed women in urban and suburban areas. Overall, there are fewer differences by race and ethnicity, but a slightly higher share of Black women reported working for an employer that offers paid family and medical leave or paid parental leave.

Impact of Children’s Health Needs on Working Parents

Among working parents, a higher share of mothers than fathers report they are the ones that care for children when they are too sick to attend school. Workplace benefits play an important role in parents’ ability to care for their family’s health care needs while meeting workplace responsibilities. When children have to miss school because they are too sick to attend, working parents must arrange care for their children. Among mothers who work outside the home, over half (56%) say they are the ones who usually take care of children who are sick and cannot go to school, about three times the share of working fathers (19%) (Figure 2). A quarter (24%) of working mothers and one-third of working fathers (33%) say they share this responsibility equally with a spouse, partner, or co-parent. Just 6% of working mothers say their spouse, partner, or co-parent usually takes on this responsibility, whereas this is the most common response among fathers (41%), nearly seven times the rate of mothers. Roughly one in ten mothers (13%) and fathers (8%) say they can call someone else for childcare or their child can stay home alone.

About half of working parents report losing pay when they miss work to care for sick children who can’t go to school. When parents miss work to take care of their sick children, 53% of mothers and 49% of fathers say they are not paid for that time (Figure 3). This has a disproportionate impact on mothers, as they are more likely to be the ones caring for children when they are sick. Considering that nearly 15% of children missed more than a week of school per year due to illness or injury before the pandemic and that the CDC recommends that people stay home for at least five days if testing positive for COVID-1, when children miss school because they are sick, it can have tangible negative economic implications for many working parents, particularly women.

Mothers who have low incomes are more likely than those with higher incomes to report they usually care for children who are sick and cannot attend school as well as lose pay for this time. A larger share of mothers with low incomes (61%) say they are the ones who usually care for children when they are sick compared to mothers with higher incomes (53%) (Figure 4). Working mothers with low incomes are also less likely to report sharing the responsibility with a spouse or partner. Additionally, 76% of mothers with low incomes report losing pay when they miss work to care for sick children, twice the share of those with higher incomes (38%). As discussed earlier, fewer women who have low incomes have a paid sick leave benefit than those who have higher incomes.

Across demographic groups, the majority of employed mothers report that they are usually the ones to take care of kids when they are sick and cannot go to school, and some share this work with a spouse/partner. However, there are differences between groups of women workers in the economic impact of missing work to care for sick kids. A higher share of working mothers who are Black, single, or work part-time report losing pay for this time off (Figure 5). Three-quarters of part-time workers are not paid when they take time off to care for sick kids, compared to 44% of full-time workers.

Since 2020, the share of fathers who say they are the ones who usually care for children when they are sick and cannot attend school has risen. While mothers are much more likely to report that they are the ones who care for young children when they are sick and cannot go to school, the share of fathers who say they are usually the ones to do so has risen in the past two years. In 2022, 19% of fathers say that they usually cared for children when they are too sick to go to school, up from 9% in 2020 (Figure 6). Among mothers however, these rates remained similar between 2020 and 2022 (61% and 56% respectively). The pandemic and the impact of the spread of COVID-19 continues to keep some children out of school and has also changed many employment patterns and workplace dynamics. Many more people work from home at least some of the time, which may have also changed the distribution of childcare responsibilities in some families, with more fathers spending more time at home.

Conclusion

Women comprise at least half of the nation’s workforce, and roughly seven in ten women with children under the age of 18 are in the labor force, yet the United States remains one of the few industrialized nations that does not require paid leave for health-related events including paid parental leave and sick leave. For many women, taking even a month of unpaid leave after childbirth is unaffordable and unattainable. Gaps in these benefits are larger among women who are lower income and those who work part-time.

Absent federal legislation, guaranteed paid leave (including paid sick, family and medical, and parental leave) is at the discretion of the states. In states that do not have paid leave programs or requirements, some employers offer it voluntarily, but workers who could most benefit from it are less likely to be offered these benefits.

Among parents, women continue to be the primary caregivers when their children are sick, and the pandemic has made this issue top of mind for many parents. Some employed mothers share the responsibility of caring for their sick children with their partners, and notably, in the past two years, there has been an increase in the share of fathers who say they usually take care of sick kids who cannot go to school. However, it is still working moms who carry this responsibility in many families. The increase in people working from home since the pandemic’s start could have contributed to a change in the distribution of parental health care responsibilities, but it is too early to tell whether this trend will continue in the years to come.

For many working parents who lack paid leave benefits, caring for kids because they are sick and cannot go to school comes with an economic cost, and many of these costs are borne by working women. For some women, the system is largely working though is still challenging, but for those who are in low-wage jobs or work part-time hours, caring for their family's health without workplace supports can weaken their own and their family’s financial well-being.

Overview

The 2022 KFF Women’s Health Survey is a nationally representative survey of 6,442 people ages 18 to 64, including 5,201 females (self-reported sex at birth) and 1,241 males, conducted from May 10, 2022, to June 7, 2022. The objective of the survey is to help better understand respondents’ experiences with contraception, potential barriers to health care access, and other issues related to reproductive health. The survey was designed and analyzed by researchers at KFF (Kaiser Family Foundation) and fielded online and by telephone by SSRS using its Opinion Panel, supplemented with sample from IPSOS’s KnowledgePanel.

This work was supported in part by Arnold Ventures. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

Questionnaire design

KFF developed the survey instrument with SSRS feedback regarding question wording, order, clarity, and other issues pertaining to questionnaire quality. The survey was conducted in English and Spanish. The survey instrument is available upon request.

Sample design

The majority of respondents completed the survey using the SSRS Opinion Panel (n=5,202), a nationally representative probability-based panel where panel members are recruited in one of two ways: (1) through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Group through the U.S. Postal Service’s Computerized Delivery Sequence. (2) from a dual-framed random digit dial (RDD) sample provided by Marketing Systems Group.

In order to have large enough sample sizes for certain subgroups (females ages 18 to 35, particularly females in the following subgroups: lesbian/gay/bisexual; Asian; Black; Hispanic; Medicaid enrollees; low-income; and rural), an additional 1,240 surveys were conducted using the IPSOS KnowledgePanel, a nationally representative probability-based panel recruited using a stratified ABS design.

Data collection

Web Administration Procedures

The majority of surveys completed using the SSRS Opinion Panel (n=5,056) and all of the surveys completed using the KnowledgePanel (n=1,240) were self-administered web surveys. Panelists were emailed an invitation, which included a unique passcode-embedded link, to complete the survey online. In appreciation for their participation, panelists received a modest incentive in the form of a $5 or $10 electronic gift card. All respondents who did not respond to their first invitation received up to five reminder emails and panelists who had opted into receiving text messages from the SSRS Opinion Panel received text message reminders.

Overall, the median length of the web surveys was 13 minutes.

Phone Administration Procedures

In addition to the self-administered web survey, n=146 surveys were completed by telephone with SSRS Opinion Panelists who are web reluctant. Overall, the median length of the phone surveys was 28 minutes.

Data processing and integration

SSRS implemented several quality assurance procedures in data file preparation and processing. Prior to launching data collection, extensive testing of the survey was completed to ensure it was working as anticipated. After the soft launch, survey data were carefully checked for accuracy, completeness, and non-response to specific questions so that any issues could be identified and resolved prior to the full launch.

The data file programmer implemented a “data cleaning” procedure in which web survey skip patterns were created in order to ensure that all questions had the appropriate numbers of cases. This procedure involved a check of raw data by a program that consisted of instructions derived from the skip patterns designated on the questionnaire. The program confirmed that data were consistent with the definitions of codes and ranges and matched the appropriate bases of all questions. The SSRS team also reviewed preliminary SPSS files and conducted an independent check of all created variables to ensure that all variables were accurately constructed.

As a standard practice, quality checks were incorporated into the survey. Quality control checks for this study included a review of “speeders,” reviewing the internal response rate (number of questions answered divided by the number of questions asked) and open-ended questions. Among all respondents, the vast majority (97%) answered 96% or more of the survey questions they received, with no one completing less than 91% of the administered survey (respondents were informed at the start of the survey that they could skip any question).

Weighting

The data were weighted to represent U.S. adults ages 18 to 64. The data include oversamples of females ages 18 to 35 and females ages 36 to 64. Due to this oversampling, the data were classified into three subgroups: females 18 to 35, females 36 to 64, and males 18 to 64. The weighting consisted of two stages: 1) application of base weights and 2) calibration to population parameters. Each subgroup was calibrated separately, then the groups were put into their proper proportions relative to their size in the population.

Calibration to Population Benchmarks

The sample was balanced to match estimates of each of the three subgroups (females ages 18 to 35, females ages 36 to 64, and males ages 18 to 64) along the following dimensions: age; education (less than a high school graduate, high school graduate, some college, four-year college or more); region (Northeast, Midwest, South, West); and race/ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic-born in U.S., Hispanic-born Outside the U.S., Asian non-Hispanic, Other non-Hispanic). The sample was weighted within race (White, non-Hispanic; Black, non-Hispanic; Hispanic; and Asian) to match population estimates. Benchmark distributions were derived from 2021 Current Population Survey (CPS) data.

Weighting summaries for females ages 18 to 35, females ages 36 to 64, and males ages 18 to 64 are available upon request.

Finally, the three weights were combined, and a final adjustment was made to match the groups to their proper proportions relative to their size in the population (Table 1).

Margin of Sampling Error

The margin of sampling error, including the design effect for subgroups, is presented in Table 2 below. It is important to remember that the sampling fluctuations captured in the margin of error are only one possible source of error in a survey estimate and there may be other unmeasured error in this or any other survey.

KFF Analysis

Researchers at KFF conducted further data analysis using the R survey package, including creating constructed variables, running additional testing for statistical significance, and coding responses to open-ended questions. The survey instrument is available upon request.

Rounding and sample sizes

Some figures in the report do not sum to totals due to rounding. Although overall totals are statistically valid, some breakdowns may not be available due to limited sample sizes or cell sizes. Where the unweighted sample size is less than 100 or where observations are less than 10, figures include the notation “NSD” (Not Sufficient Data).

Statistical significance

All statistical tests are performed at the .05 confidence level. Statistical tests for a given subgroup are tested against the reference group (Ref.) unless otherwise indicated. For example, White is the standard reference for race/ethnicity comparisons and private insurance is the standard reference for types of insurance coverage. Some breakouts by subsets have a large standard error, meaning that sometimes even large differences between estimates are not statistically different.

A note about sex and gender language

Our survey asked respondents which sex they were assigned at birth, on their original birth certificate (male or female). They were then asked what their current gender is (man, woman, transgender, non-binary, or other). Those who identified as transgender men are coded as men and transgender women are coded as women. While we attempted to be as inclusive as possible and recognize the importance of better understanding the health of non-cisgendered people, as is common in many nationally representative surveys, we did not have a sufficient sample size (n >= 100) to report gender breakouts other than men and women with confidence that they reflect the larger non-cisgender population as a whole. The data in our reproductive health reports use the respondent’s sex assigned at birth (inclusive of all genders) to account for reproductive health needs/capacity (e.g., ever been pregnant) while the data in our other survey reports use the respondent’s gender.

This report provides an analysis of donor government funding to address family planning in low- and middle-income countries in 2021, the most recent year available, as well as trends over time. It is part of an effort by KFF (the Kaiser Family Foundation) to track such funding that began after the London Summit on Family Planning in 2012. Key findings include:

• In 2021, family planning funding from donor governments totaled US$1.39 billion, essentially flat compared to the 2020 level (US$1.41 billion).^1 ,2 
• While the overall amount remained steady in 2021, there were significant variations among several donors. Funding from five donors (Australia, Denmark, Germany, Norway and Sweden) increased, some of which more than doubled their support. These increases offset a significant decline by the U.K., which cut funding by more than 40% in 2021. Funding from the Netherlands also declined slightly while Canada and the U.S. remained flat. These trends were the same after adjusting for inflation and exchange rate fluctuations.
• More broadly, bilateral funding from donor governments for family planning has fluctuated over the past decade, but has generally risen since the London Summit in 2012. Funding in 2021 was approximately US$200 million higher than in 2012 (US$1.19 billion), though this was below the peak level reached over the period (US$1.52 billion in 2019).
• The U.S. continued to be the largest donor to bilateral family planning efforts providing $576.7 million or 42% of total bilateral funding from governments in 2021. The Netherlands was the second largest donor (US$190.5 million, 14%), followed by Sweden (US$180.4 million, 13%), the U.K. (US$157.8 million, 11%), and Canada (US$98.9 million, 7%).
• In addition to bilateral funding for family planning, the donor governments profiled provided US$405.3 million in core contributions to UNFPA in 2021, similar to 2020 levels (US$411.7 million).^3 ,4  Most donors (Australia, Canada, Denmark, France, the Netherlands, Norway and Sweden) provided level funding to UNFPA in 2021, while funding from Germany and the U.K. declined.⁵  The U.S., under the Biden administration, resumed funding for UNFPA in 2021 after the Trump Administration had invoked the Kemp-Kasten amendment, a provision of U.S. law, to withhold funding—both core and non-core contributions—from UNFPA for the prior four years.⁶ 
• While overall bilateral funding for family planning in 2021 does not seem to have been affected by the COVID-19 pandemic, ongoing economic pressures resulting from the pandemic as well as the war in Ukraine, create some uncertainty for the future.

Introduction

This report provides data on donor government funding for family planning activities in low- and middle-income countries in 2021, the most recent year available, as well as trends over time. It is part of an effort by KFF that began after the London Summit on Family Planning in 2012 and includes data from all 30 members of the Organisation for Economic Co-operation and Development (OECD)’s Development Assistance Committee (DAC), as well as non-DAC members where data are available.⁷  Data are collected directly from donors and supplemented with data from the DAC. Direct data collection was carried out for ten donor governments that account for 98% of total funding for family planning.⁸  Both bilateral assistance and core contributions to UNFPA are included. For more detail, see methodology.

Findings

Bilateral Funding

In 2021, donor governments provided US$1.39 billion in bilateral funding for family planning activities (see Figure 1, Table 1, & Appendix), essentially flat compared to the 2020 level (US$1.41 billion).

While the overall amount remained steady in 2021, there were significant variations among several donors (see Figure 2). Funding from five donor governments (Australia, Denmark, Germany, Norway, and Sweden) rose in 2021. Sweden had the largest overall increase, rising by more than $50 million from US$129.3 million in 2020 to US$180.4 million in 2021, and funding from Australia and Germany both doubled in 2021 (Australia increased from US$23.9 million in 2020 to US$49.0 million in 2021; Germany increased from US32.9 million in 2020 to US$66.3 million in 2021). These increases offset a significant decline by the U.K., which decreased family planning funding by US$113 million (-42%) in 2021 (US$157.8 million) compared to 2020 (US$270.9 million). This decline was not unexpected due to the U.K. government’s decision to reduce overall official development assistance (ODA).⁹  Funding from the Netherlands also declined slightly, while Canada and the U.S. remained flat.¹⁰  These trends were the same after adjusting for inflation and exchange rate fluctuations.

More broadly, while bilateral funding from donor governments for family planning has fluctuated over the past decade, it has generally risen since the London Summit in 2012. Funding in 2021 was approximately US$200 million higher than in 2012 (US$1.19 billion), though this was below the peak level reached over the period (US$1.52 billion in 2019). In 2021, seven of the donors profiled provided higher funding than in 2012 (Australia, Canada, Denmark, Germany, the Netherlands, Norway, and Sweden). Since funding from the U.S., the largest government donor to family planning, has been relatively flat, and funding from the U.K. fell in 2021 below the amount provided in 2012, this overall trend has largely been driven by other donors (see Figure 3).

The U.S. was the largest government donor to bilateral family planning efforts in 2021, accounting for 42% (US$576.7 million) of donor government funding (see Figure 4). In each previous year, the U.K. had been the world’s second largest donor, but due to the decline in 2021 it now ranks 4^th (US$157.8 million or 11%) behind the Netherlands (US$190.5 million or 14%) and Sweden (US$180.4 million or 13%).

Donor Contributions to UNFPA

While the majority of donor government assistance for family planning is provided bilaterally, donors also provide support for family planning activities through contributions to the United Nations Population Fund (UNFPA). Most of UNFPA’s funding is from donor governments, which provide funding in two ways: 1) donor directed or earmarked contributions for specific activities (e.g. donor contributions to the UNFPA Supplies), which are included as part of bilateral funding above; and 2) general contributions to “core” activities that are untied and meant to be used for both programmatic activities (e.g. family planning, population and development, HIV/AIDS, gender, and sexual and reproductive health and rights) and operational support as determined by UNFPA.¹¹ 

In 2021, the donor governments profiled provided US$405.3 million in core contributions to UNFPA, similar to the 2020 level (US$411.7 million). While most donors remained flat in 2021, funding from Germany and the U.K. both declined. German funding was still higher than earlier levels following a significant increase in 2020 that was aimed at supporting UNFPA’s efforts to address the impacts of COVID-19. The decrease by the U.K. was the result of an overall reduction in ODA as well as a plan to reduce support for some multilateral organizations.¹²  The U.S., under the Biden administration, resumed funding for UNFPA in 2021 after the Trump Administration had invoked the Kemp-Kasten amendment, a provision of U.S. law, to withhold funding—both core and non-core contributions—from UNFPA for the prior four years.¹³ 

The ranking of donor contributions to UNFPA differs from that of their bilateral family planning funding. Sweden provided the largest core contribution to UNFPA in 2021 (US$64.1 million), followed by Norway (US$54.3 million), Germany (US$47.8 million), and the Netherlands (US$40.5 million), (see Figure 5 and Table 2). Two donors – Denmark and Norway – provided larger contributions to UNFPA’s core resources than their total bilateral funding for family planning.

Looking Ahead

Donor government funding for family planning activities in 2021 did not seem to be affected by the pressures of the COVID-19 pandemic. How this plays out in the future, however, is uncertain and will depend on several broader factors. The COVID-19 pandemic is ongoing as are the related economic challenges that many countries have faced, including pressures on donor capitals and downturns in low- and middle-income countries. In addition, the war in Ukraine has compounded these pressures as countries address an influx of refugees, as well as other emergency priorities such as global food insecurity and rising inflation. While family planning funding from the U.S. increased slightly in 2022, Congress has yet to finalize the 2023 level. Given that the U.S. is the largest donor to global family planning efforts, any changes would have an outsized impact on the overall amount and trends over time.

Methodology

Bilateral and multilateral data on donor government assistance for family planning (FP) in low- and middle-income countries were collected from multiple sources. The research team collected the latest bilateral assistance data directly for 10 governments: Australia, Canada, Denmark, Germany, France, the Netherlands, Norway, Sweden, the United Kingdom, and the United States during 2022.¹⁴  Data represent the fiscal year 2021 period. Direct data collection from these donors was desirable because they represent the preponderance of donor government assistance for family planning and the latest official statistics – from the Organisation for Economic Co-operation and Development (OECD) Creditor Reporting System (CRS) (see: http://www.oecd.org/dac/stats/data) – are from 2020 and do not include all forms of international assistance (e.g., funding to countries such as Russia and the Baltic States that are no longer included in the CRS database). In addition, the CRS data may not include certain funding streams provided by donors, such as FP components of mixed-purpose grants to non-governmental organizations. Data for all other OECD DAC member governments – Austria, Belgium, Czech Republic, the European Union, Finland, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, New Zealand, Poland, Portugal, the Slovak Republic, Slovenia, Spain, and Switzerland – which collectively accounted for approximately 1 percent of bilateral family planning disbursements, were obtained from the OECD CRS and are from calendar year 2020.

For purposes of this analysis, funding was counted as family planning if it met the OECD CRS purpose code definition: “Family planning services including counselling; information, education and communication (IEC) activities; delivery of contraceptives; capacity building and training.”  Where it was possible to identify funding amounts, family-planning-related activities funded in the context of other official development assistance sectors (e.g. education, civil society) are included in this analysis. Project-level data were reviewed for Canada, Denmark, France, Germany, the Netherlands, Norway, and Sweden to determine whether all or a portion of the funding could be counted as family planning. Family-planning-specific funding totals for the United States were confirmed through communication with government representatives. Funding attributed to Australia and the United Kingdom is based on a revised Muskoka methodology as agreed upon by donors at the London Summit on Family Planning in 2012. Funding totals presented in this analysis should be considered preliminary estimates based on data provided by representatives of the donor governments who were contacted directly.

It was difficult in some cases to disaggregate bilateral family planning funding from broader population, reproductive and maternal health totals, as the two are sometimes represented as integrated totals. In addition, family-planning-related activities funded in the context of other official development assistance sectors (e.g. education, civil society) have in the past remained largely unidentified. For purposes of this analysis, we worked closely with the largest donors to family planning to identify such family-planning-specific funding where possible. In some cases (e.g. Canada), specific FP percentages were recorded for mixed-purpose projects. In other cases, it was possible to identify FP-specific activities by project titles in languages of origin, notwithstanding less-specific financial coding. In still other cases, detailed project descriptions were analyzed (see Appendix for detailed data table).

Bilateral funding is defined as any earmarked (FP-designated) amount and includes family planning-specific contributions to multilateral organizations (e.g. non-core contributions to UNFPA Supplies). UNFPA contributions from all governments correspond to amounts received during the 2021 calendar year, regardless of which contributor’s fiscal year such disbursements pertain to.

With some exceptions, bilateral assistance data were collected for disbursements. A disbursement is the actual release of funds to, or the purchase of goods or services for, a recipient. Disbursements in any given year may include disbursements of funds committed in prior years and in some cases, not all funds committed during a government fiscal year are disbursed in that year. In addition, a disbursement by a government does not necessarily mean that the funds were provided to a country or other intended end-user. Enacted amounts represent budgetary decisions that funding will be provided, regardless of the time at which actual outlays, or disbursements, occur. In recent years, most governments have converted to cash accounting frameworks, and present budgets for legislative approval accordingly; in such cases, disbursements were used as a proxy for enacted amounts.

For the U.S., funding represents final, Congressional appropriations (firm commitments that will be spent) to the U.S. Agency for International Development (USAID), rather than disbursements, which can fluctuate from year-to-year due to the unique nature of the U.S. budget process (unlike most other donors, U.S. foreign assistance funding may be disbursed over a multi-year period). U.S. totals for 2017-2020 also include some funding originally appropriated by Congress for UNFPA that was transferred to the USAID family planning & reproductive health (FP/RH) account due to specific provisions in U.S. law including the Kemp-Kasten amendment (see KFF “UNFPA Funding & Kemp-Kasten: An Explainer”). Some prior reports presented disbursements. For this report, all prior-year amounts have been changed from disbursements to appropriations. This change in methodology does not alter the overall trend in total funding from donor governments over time.

UNFPA core contributions were obtained from United Nations Executive Board documents. UNFPA estimates of total family planning funding provided from both core and non-core resources were obtained through direct communications with UNFPA representatives. Other than core contributions provided by governments to UNFPA, un-earmarked core contributions to United Nations entities, most of which are membership contributions set by treaty or other formal agreement (e.g., United Nations country membership assessments), are not identified as part of a donor government’s FP assistance even if the multilateral organization in turn directs some of these funds to FP. Rather, these would be considered as FP funding provided by the multilateral organization, and are not considered for purposes of this report.

The fiscal year period varies by country. The U.S. fiscal year runs from October 1-September 30. The Australian fiscal year runs from July 1-June 30. The fiscal years for Canada and the U.K. are April 1-March 31. Denmark, France, Germany, the Netherlands, Norway, and Sweden use the calendar year. The OECD uses the calendar year, so data collected from the CRS for other donor governments reflect January 1-December 31. Most UN agencies use the calendar year and their budgets are biennial.

All data are expressed in US dollars (USD). Where data were provided by governments in their currencies, they were adjusted by average daily exchange rates to obtain a USD equivalent, based on foreign exchange rate historical data available from the U.S. Federal Reserve (see: http://www.federalreserve.gov/) or in some cases from the OECD. Data obtained from UNFPA were already adjusted by UNFPA to represent a USD equivalent based on date of receipts.

1. Totals represent funding specifically designated by donor governments for family planning as defined by the OECD DAC (see methodology), and include: standalone family planning projects; family planning-specific contributions to multilateral organizations (e.g., contributions to UNFPA Supplies); and, in some cases, projects that include family planning within broader reproductive health activities. ↩︎
2. At the time of publication, data from France for 2021 were not available. France’s prior year amount was used as a temporary estimate to calculate the overall donor government total in 2021. ↩︎
3. Includes core-contributions from members of the OECD DAC only; core contributions from non-DAC donors are not included in this total. ↩︎
4. UNFPA, “Delivering On The Transformative Results: UNFPA Annual Report 2021”, 2021. See also UNFPA Donor Contributions portal. ↩︎
5. Germany’s decline in 2021 was a return to prior year levels following a significant increase in 2020 that was aimed at supporting UNFPA’s efforts to address the impacts of COVID-19. ↩︎
6. See KFF’s “UNFPA Funding & Kemp-Kasten: An Explainer”. ↩︎
7. Includes funding from 29 DAC member countries and the European Union (EU). ↩︎
8. At the time of publication, data from France for 2021 were not available. France’s prior year amount was used as a temporary estimate to calculate the overall donor government total in 2021. ↩︎
9. U.K. Foreign Commonwealth & Development Office (FCDO), “Statistics on International Development: Provisional UK Aid Spend 2021,” April 2022. ↩︎
10. For the period between FY17-FY20, the Trump administration invoked the Kemp-Kasten amendment to withhold funding - both core and non-core contributions - from UNFPA (see KFF "UNFPA Funding & Kemp-Kasten: An Explainer"). Congress requires any withheld funding for UNFPA (core-only) be transferred to other global health activities, including family planning. In FY21, the Biden administration resumed funding for UNFPA. When the FY17-FY20 UNFPA transfers to FP are removed, the overall levels match FY21. ↩︎
11. In 2021, UNFPA spent approximately US$488.7 million (45% of UNFPA’s total program expenses) on family planning activities. This includes US$278.8 million for family-planning specific activities (such as enabling environments for family planning, contraceptives and related supplies, provision of services, and family planning systems strengthening) and US$209.9 million for activities with an impact on family planning results in other areas of work under UNFPA’s mandate. Direct communication, UNFPA, October 2022. ↩︎
12. U.K. Foreign Commonwealth & Development Office (FCDO), “Statistics on International Development: Provisional UK Aid Spend 2021,” April 2022. ↩︎
13. See KFF’s “UNFPA Funding & Kemp-Kasten: An Explainer”. ↩︎
14. At the time of publication, data from France for 2021 were not available. France’s prior year amount was used as a temporary estimate to calculate the overall donor government total in 2021. ↩︎

Key Findings

While some competitive races and control of the U.S. Senate are still to be determined, voting in the 2022 midterm elections is over. Voters weighed a variety of different factors including former President Trump’s endorsement of candidates, the candidates’ characteristics, as well as the issues facing the country. While inflation was clearly at the top of voters’ minds as they cast their ballots in this midterm election, the issue of abortion played a role in many ways. Four states had ballot initiatives that all went in the direction of supporting abortion rights, and many voters, including in key voting blocs and in some highly competitive races, said they were motivated to turn out by the recent Supreme Court decision overturning Roe v. Wade. This analysis focuses on the KFF/AP supplemental questions on AP VoteCast of midterm voters to further examine the role that the Supreme Court decision overturning Roe v. Wade played in the 2022 midterm election.

• In a midterm election where issues largely centered on inflation and rising prices, about a quarter of voters said the Court’s decision was the single most important factor in their midterm vote. This share increases to more than three in ten among some groups that tend to be pro-choice, including Democratic voters, younger women voters, first time voters, and those who say they are angry about the Court’s decision. These groups are more likely to say the Court’s decision had a “major impact” on their voting decisions – both to turn out and which candidates to support. Majorities of Black and Hispanic women also report the Supreme Court decision impacted their voting behavior, and older women of color were more likely than older White women to report this.
• Voters who said the Supreme Court overturning Roe was the single most important factor in their vote went more than 2:1 for Democratic candidates. Democratic candidates also had advantage of voters who were angry in the wake of the Dobbs Among the one-third of voters who said they were angry about the Supreme Court’s decision to overturn Roe, eight in ten cast ballots for Democratic House candidates.
• There were several states with competitive races where the Supreme Court’s decision to overturn Roe may have played a role in motivating voters both to turn out and to vote for candidates who share their opinion on abortion access. For example, in Pennsylvania, the Supreme Court decision to overturn Roe was the most important factor in the vote of about one in ten Republican voters, and 21% of these Republican voters cast ballots for the Senate Democratic candidate. A small share overall, but it was an election where small margins mattered. A majority of key voting groups in the state, including younger voters, women voters 18-49, and voters who supported the Democratic candidates, also said the Court’s decision had a “major impact” on their decision to vote and who they supported.
• In all four states where voters were asked to vote directly on state initiatives regarding abortion access, about four in ten say the Supreme Court decision overturning Roe had a “major impact” on their decision to turn out to vote. The Court’s decision was an even stronger turnout motivation for women 18-49 years old, the group most directly impacted by the state ballot initiatives. Large shares women voters under 50 in each of the four states said the Supreme Court overturning Roe had a “major impact” on whether they voted in the 2022 midterm election including more than half of women voters under the age of 50 in California (55%), Michigan (55%), Vermont (51%) and nearly half (45%) of Kentucky women voters under 50.

Democrats More Motivated By Supreme Court Decision

The 2022 midterm election was widely expected to hinge on economic issues, and results of AP VoteCast bear that out: half of voters said inflation increasing prices for gas, groceries, and other goods was the “single most important factor” when thinking about voting in the 2022 midterm election. However, in an election where Democrats outperformed expectations, survey findings also indicate that the Supreme Court decision overturning Roe v. Wade was a motivating factor for many voters. Seven in ten said the Court’s decision was an important factor in their vote, including one quarter who said it was the single most important factor. Voters chose other factors, too, including 44% who said the future of democracy was the single most important factor in their vote and 25% who said the same about rising violent crime rates.

The overturning of Roe ranked even higher as a voting issue among some key voting blocs. Almost four in ten first-time voters (38%) and voters who identify as Democrats (37%), as well about a third of all voters under age 30 (34%) and women voters under age 50 (34%) said the Court’s decision was the “single most important factor” in their vote choice. These groups, voters who largely disapproved of the Dobbs decision that ultimately overturned the precedent set by the Court’s decision on Roe, may have contributed to a stronger showing among Democratic candidates, especially in places where the contests were decided by marginal shifts in turnout. Early estimates suggest that overall youth voter turnout was among the highest in three decades.

To provide a deeper look at the role of abortion in motivating both turnout and vote choice, KFF added supplemental questions to AP VoteCast. Four in ten voters overall say the Supreme Court overturning Roe had a “major impact” on their decision about whether to vote in this election, rising to more than half of those who voted for a Democratic candidate for Congress (56%). The share of voters who say the Court’s decision was a major factor in their turnout was also higher among first time voters (54%), voters under age 30 (52%), women voters under age 50 (51%), and those who said they were angry about the Supreme Court decision (63%).

Half of all voters say the Court’s decision had a “major impact” on which candidates they supported in this election, including nearly two-thirds (64%) of those who voted for Democratic House candidates.

More than half of Black and Hispanic women ages 50 and older said the Supreme Court decision had a “major impact” on their decision to vote and which candidates to support, compared to smaller shares of older white women voters. Among women voters under 50, the racial differences are smaller but Black and Hispanic women are still slightly more likely to say the Dobbs decision had a “major impact” on their voting decisions.

Democratic candidates overwhelmingly supported by Voters For Whom Abortion Was Most Important Voting Factor

Democratic candidates garnered large support among the quarter of voters who said the Court’s decision on abortion was the single most important factor in their vote with seven in ten of these voters casting ballots for the Democratic candidates for the U.S. House, compared to a quarter who voted for the Republican candidates. On the other hand, Republican candidates fared better – but to a lesser degree – among voters who said inflation was their single most important issue.

Democratic candidates also had the advantage among voters who were angry in the wake of the Dobbs decision. Among the one-third of voters who said they were “angry” about the Supreme Court’s decision to overturn Roe, eight in ten cast ballots for Democratic House candidates. Neither party’s candidates had an advantage among the quarter of voters who said they were “dissatisfied by the Court’s decision but not angry,” while Republican candidates garnerd more support among voters who said they were either happy about the Court’s decision or “satisfied, but not happy.”

The Role of Supreme Court Decision in Competitive States

There were several states with competitive races where the Supreme Court’s decision to overturn Roe may have played a role in motivating voters to both turnout and to vote for candidates who share their opinion on abortion access. Nationally, 13% of Republicans and Republican-leaning independents said the Supreme Court decision was the most important factor in their vote, and relatively few of this group (9%) ended up casting ballots for Democratic candidates. But in certain states with competitive races, like Pennsylvania and Arizona, one in five of these Roe-focused Republican voters voted for the Democratic Senate candidate. Though small as a share of total voters, these kinds of crossover votes may have mattered in these close races.

In addition to motivating some Republican voters to vote for Democratic candidates, the Supreme Court Dobbs decision may have influenced turnout. In key competitive states including Georgia, Pennsylvania, Arizona, Nevada, and Wisconsin, more than one-third of voters said the Supreme Court overturning Roe had a “major impact” on their decision about whether to vote in this election and at least four in ten said it had a “major impact” on which candidates they supported.

While many competitive races have yet to be called, the Democratic candidates have garnered enough votes to win the Senate and gubernatorial election in Pennsylvania. While the gubernatorial election was deemed less competitive, the Senate race between Fetterman and Oz was one of the most closely watched races during this election cycle. In addition to the role of President Trump’s endorsement of Oz and the health of Fetterman, the candidates held very different views on abortion rights in the state and the issue was a major part of the campaign rhetoric. Overall, about four in ten Pennsylvania voters said the Supreme Court decision to overturn Roe had a “major impact” on their decision to turnout and half said it had a “major impact” on which candidates they supported. These shares are larger among those who voted for Fetterman, younger voters, women voters under 50, and voters who were angry about Roe being overturned.

Abortion Ballot Measures

Voters in four states voted on ballot initiatives related to state constitutional rights to abortion in the 2022 midterm elections. Three states (California, Michigan, and Vermont) voted on ballot initiatives to amend those states’ Constitutions to establish an explicit right to abortion. All three of these ballot initiatives passed. On the other hand, Kentucky voters rejected a ballot initiative that would have amended its state Constitution to declare that there is no right to abortion. In all four states, about four in ten voters say the Supreme Court decision overturning Roe had a “major impact” on their decision to turn out to vote.

The Supreme Court decision was also a strong motivator for women, 18-49 years old, the group most directly impacted by the state ballot initiatives. Large shares of women voters under 50 in each of the four states said the Supreme Court overturning Roe had a “major impact” on whether they voted in the 2022 midterm election including more than half of women voters under the age of 50 in California (55%), Michigan (55%), Vermont (51%) and nearly half (46%) of Kentucky women voters under 50.

aBORTION ON THE BALLOT IN MICHIGAN

In addition to a gubernatorial election and district races, Michigan voters also voted on a ballot measure to amend the state Constitution to establish a broad individual right to reproductive freedom that includes abortion. Three-fourths of Michigan voters said the outcome of the gubernatorial election was “very important” to them, while six in ten said the same about the outcome of the ballot measure, which passed. Among key groups, there was a smaller difference in the share of voters who said each, the gubernatorial election and the ballot measure, was important to them. For example, similar shares of Democratic voters, women voters under 50, and voters who were angry about the Supreme Court decision, said both outcomes were “very important” to them.

The AP VoteCast is a national survey and 48 state surveys of 2022 midterm voters conducted by NORC at the University of Chicago for the AP and FoxNews beginning on Oct. 31 and concluding as polls close on Nov. 8, 2022, in English and Spanish. The national survey was conducted using the NORC’s probability-based AmeriSpeak panel, while the individual state surveys were conducted from a random sample of state voter files and from self-identified registered voters selected from non-probability online panels. Find more details at AP VoteCast’s methodology at https://www.ap.org/content/politics/elections/ap-votecast/about.