Poll Finding

Democratic Women Voters See Vice President Harris As Trusted Messenger on Abortion Policy

Name: Most Democratic Women Voters Say They Trust V.P. Harris to Speak About Abortion Policy, Including Overwhelming Majority of Older Democratic Women
Creator: KFF

Authors: Ashley Kirzinger, Isabelle Valdes, and Liz Hamel

Published: Jul 23, 2024

Long before President Biden announced his decision to withdraw from the 2024 presidential race, Vice President Kamala Harris has been the administration’s voice on abortion rights. As part of her “Fight for Reproductive Freedoms” tour earlier this spring, V.P. Harris was the first sitting U.S. vice president¹ to visit an abortion provider and she has consistently criticized Republican efforts to limit access to reproductive health care.

The KFF Survey of Women Voters finds that many Democratic women voters see the 2024 election as a pivotal moment for reproductive health care access in this country. For example:

A large majority (85%) of Democratic and Democratic-leaning women voters think access to safe and legal abortions has never been more at risk.
Seven in ten (71%) Democratic and Democratic-leaning women voters think this year’s election for president will have a “major impact” on access to abortion and reproductive health care in the U.S.

With President Biden stepping aside in the first presidential election following the Supreme Court Dobbs decision, it is likely that V.P. Harris will now take on an even more important role as the Democratic Party’s spokesperson on the future of abortion policy in this country, particularly if she becomes the party’s new presumptive presidential nominee.

The Survey of Women Voters, fielded before President Biden’s withdrawal, finds that about eight in ten (82%) Democratic and Democratic-leaning women voters say they trust V.P. Harris to speak about abortion policy – including half (49%) who say they trust her “a lot” to speak on this issue.

V.P. Harris is seen as a trusted messenger on abortion among large majorities of White Democratic women voters (85%), Black Democratic women voters (76%), and Hispanic Democratic women voters (72%). She is also trusted by Democratic women, regardless of their age, but notably garners the highest levels of trust among the oldest voting group. About nine in ten (93%) Democratic women voters ages 65 and older say they trust V.P. Harris to speak about abortion policy. The youngest voting bloc – voters ages 18 to 29 – also trust her to speak on this issue but to a lesser extent (69%), perhaps reflecting their overall discontent with the Democratic Party’s action on access to reproductive health care. Three-fourths (74%) of Democratic women voters ages 18 to 29 say the Democratic Party has not done enough to ensure access to reproductive health services, compared to half of Democratic women voters ages 65 and older who say the same.

Most Democratic Women Voters Say They Trust V.P. Harris to Speak About Abortion Policy, Including Overwhelming Majority of Older Democratic Women

In comparison, seven in ten Democratic women voters say they approved of the way President Biden was handling abortion and reproductive health issues, including half (49%) of Democratic women ages 18 to 29.

While abortion is not the top issue overall for Democratic and Democratic-leaning women voters, thirteen percent say abortion is their most important issue in deciding their choice for 2024 president. Among this group, nearly nine in ten (88%) trust V.P. Harris to speak on abortion policy – including about half (53%) who say they trust her “a lot.”

Fielded earlier this summer prior to President Biden’s withdrawal as the Democratic Party’s presidential nominee, the KFF Survey of Women Voters reveals where women voters stand on the issue of abortion and how it could impact their vote in the upcoming presidential election. The KFF Survey of Women Voters Dashboard includes more data from the survey, as well as the topline and methodology.

While Harris was the first sitting U.S. vice president to visit an abortion provider, no sitting U.S. president has visited an abortion provider. ↩︎

Donor Government Funding for HIV in Low- and Middle-Income Countries in 2023

Authors: Adam Wexler, Jennifer Kates, Stephanie Oum, Eric Lief, and Joint United Nations Programme on HIV/AIDS (UNAIDS)

Published: Jul 22, 2024

Section:

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This report, Donor Government Funding for HIV in Low- and Middle-Income Countries in 2023, tracks funding levels of the donor governments that collectively provide the bulk of international assistance for AIDS through bilateral programs and contributions to multilateral organizations. The new report, produced as a partnership between KFF and UNAIDS, provides the latest data available on donor funding disbursements based on data provided by governments. It includes their bilateral assistance to low- and middle-income countries and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria as well as UNITAID.

Key Findings

This report provides an analysis of donor government funding to address the HIV response in low- and middle-income countries in 2023, the latest year available, as well as trends over time. It includes both bilateral funding from donors and their multilateral contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), UNITAID, and Joint United Nations Programme on HIV/AIDS (UNAIDS). Overall, the analysis shows that funding for HIV decreased between 2022 and 2023. While most of this was due to timing, the longer trend shows a shift away from bilateral funding by most donors, one that has not been fully offset by multilateral support. As a result, HIV funding, while fluctuating over time, has not returned to its highest level, reached a decade ago. At the same time, while there has been significant progress in addressing the HIV epidemic, the number of people newly infected by HIV is rising in some regions, some populations are particularly at risk and lack access to prevention services, and almost a quarter of people living with HIV are still not on treatment.¹ Key findings include the following:

Donor government funding for HIV decreased in 2023 compared to the prior year. Disbursements were US$7.86 billion in 2023, a decrease of US$358 million compared to 2022 (US$8.22 billion), in current U.S. dollars (not adjusted for inflation).² Funding decreased even after accounting for exchange rate fluctuations. Looking more broadly, HIV funding in 2023 was essentially the same as in 2008 (US$7.78 billion), and well below the peak level reached in 2014 (US$8.60 billion). As a result, funding has not kept pace with inflation.³
While both bilateral and multilateral funding in 2023 declined, most of the decline was in multilateral support. Bilateral funding declined slightly, by US$46 million, to US$5.58 billion in 2023 compared to US$5.62 billion in 2022. Multilateral funding declined by US$312 million, to US$2.28 billion in 2023 compared to US$2.59 billion in 2022.⁴
The decline in multilateral funding, however, was largely due to the timing of donor government contributions to the Global Fund in 2023, reflecting pledging periods, not reductions in actual support. With 2023 marking the first year of the most recent pledge period (2023-2025), there were large fluctuations in contributions to the Global Fund from most donor governments when compared to 2022 totals. Some donors choose to “front-load” contributions (e.g., the U.K. fulfilled almost its entire pledge for 2023-2025 in 2023), while others choose to fulfill pledges towards the end of the pledge period (e.g., Denmark did not provide any contribution in 2023 and will likely be fulfilling its pledge in future years).⁵
The US continued to be the largest donor to HIV. In 2023, the U.S. disbursed US$5.71 billion, accounting for 73% of total donor government HIV funding (bilateral and multilateral combined).⁶ The U.K. was the second largest donor (US$714 million, 9%), followed by France (US$320 million, 4%), Germany (US$228 million, 3%), and the Netherlands (US$187 million, 2%). When standardized by the size of economy, the U.K. ranked first, followed by the U.S., the Netherlands, Sweden, and France.
More broadly, trends show that donor governments, other than the U.S., have significantly reduced their bilateral HIV support while increasing funding to the Global Fund, although this shift has not fully offset bilateral declines. Since 2011, the first year where detailed bilateral and multilateral data are available for all donors, bilateral funding from donor governments other than the U.S. has declined by US$1.37 billion (-80%). While multilateral funding from these donor governments has increased in recent years and was higher in 2023 (US$1.81 billion) than 2011 (US$1.46 billion), these increases have not been large enough to offset bilateral declines. Increases from the U.S. in some years have, for the most part, countered these declines.
Looking ahead, increases in donor government funding for HIV in low- and middle-income countries seem uncertain at best. There are significant headwinds on the horizon that complicate the funding picture from donor governments. These include multiple geopolitical challenges and broader economic pressures, as well as a crowded global health replenishment schedule, with several global health institutions, including the Global Fund, seeking to raise funds from the same donors over the same time period. Finally, national elections have either recently concluded or are taking place in the coming months in several donor capitals, including the U.S., the outcomes of which could shape future funding for HIV.

Introduction

This report provides the latest data on donor government resources available to address HIV in low- and middle-income countries, reporting on disbursements made in 2023. It is part of a collaborative tracking effort between UNAIDS and KFF that began almost 20 years ago, just as new global initiatives were being launched to address the epidemic. The analysis includes data from all 32 members of the Organisation for Economic Co-operation and Development (OECD)’s Development Assistance Committee (DAC), as well as non-DAC members who report data to the DAC. Data are collected directly from donor governments, UNAIDS, the Global Fund, and UNITAID, and supplemented with data from the DAC. Of the 32 DAC members, 14 provide 98% of total disbursements for HIV; data for these donors are presented individually. For the remaining 18 DAC members, data are provided in aggregate. All totals are presented in current U.S. dollars (amounts are not adjusted for inflation). While totals include both bilateral and multilateral assistance for the entire period (2002-2023), detailed disaggregated bilateral and multilateral amounts for all donors are only available starting in 2011 (see Methodology for more detail).

Findings

Total Funding

In 2023, donor government funding for HIV through bilateral and multilateral channels totaled US$7.86 billion in current USD (not adjusted for inflation) and accounted for approximately 37% of the US$22.1 billion estimated by UNAIDS to be available to address HIV (the total estimated resources is US$19.8 billion when measured in 2019 constant USD).⁷ ^,⁸ ^,⁹ ^,¹⁰ As per UNAIDS estimates, domestic resources accounted for 59%, and the remainder (4%) was from foundations, other multilateral organizations, and UN agencies. This amount is well below the US$29.3 billion that UNAIDS estimates will be needed by 2025 in order to reach global goals, and UNAIDS reports a widening funding gap overall and significant unmet need in funding for HIV prevention.¹¹

Donor government funding for HIV in 2023 declined by US$358 million compared to 2022 (US$7.86 in 2023 compared to $8.22 billion in 2022) (See Figure 1 and Table 1).¹² While there were actual declines in bilateral funding by several donor governments, the overall decrease was largely due to the timing of donor contributions to the Global Fund.

Looking more broadly, HIV funding in 2023 was essentially the same as in 2008 (US$7.78 billion), and well below the peak level reached in 2014 (US$8.60 billion). While funding has fluctuated since 2008, overall amounts have not kept up with inflation.

HIV Funding from Donor Governments, 2002-2023

Donor Government Funding for HIV (bilateral &amp; multilateral), 2011-2023 (current USD in millions)

The U.S. continued to be the largest donor to HIV efforts, providing US$5.71 billion and accounting for 73% of total donor government funding in 2023. The second largest donor was the U.K. (US$714 million, 9%), followed by France (US$320 million, 4%), Germany (US$228 million, 3%), and the Netherlands (US$187 million, 2%). In 2023, 91% of total donor government funding for HIV was provided by these five donors.

While most funding from donors was provided bilaterally (71%), largely driven by the U.S. (which provided 92% of its funding through bilateral channels), the majority of donors (ten - Canada, European Commission, France, Germany, Ireland, Italy, Japan, Norway, Sweden, and the U.K.) provide a larger share of their resources through multilateral channels (See Figure 2). Since 2011, most donor governments, other than the U.S., have shifted away from bilateral support. In 2011, 54% of their HIV funding was provided through bilateral channels compared to only 16% in 2023 (see below for more on bilateral disbursements and multilateral contributions).

HIV Funding from Donor Governments by Funding Channel, 2023

Bilateral Disbursements

Bilateral disbursements for HIV from donor governments – that is, funding disbursed by a donor on behalf of a recipient country or region – totaled US$5.58 billion in 2023, a decrease of US$46 million compared to 2022 (US$5.62 billion). This decline was due to decreased bilateral funding from half of the donor governments; all other donor governments either increased bilateral support or remained flat (See Figure 3). These trends were the same after accounting for exchange rate fluctuations.

Bilateral disbursements by the U.S. declined slightly, by US$41 million (-1%) in 2023 (US$5.23 billion) compared to 2022 (US$5.28 billion) (See Figure 4) and represented the largest bilateral decrease (in USD) among donor governments. However, the change was due to the timing of disbursements of prior year funding and was not an actual decrease in funding commitments from the U.S. In fact, bilateral HIV funding as specified by the U.S. Congress in annual appropriations has been flat for several years.¹³ When the U.S. decrease is removed, bilateral funding from all other donor governments declined by US$5 million in 2023 (US$343 million) compared to 2022 (US$348 million).

HIV Funding from the United States, 2011-2023

Since 2011, bilateral funding from donor governments, other than the U.S., has decreased by approximately US$1.37 billion (80%) (See Figure 5). As a result, the U.S. has accounted for an increasing share of bilateral resources, rising from 70% in 2011 to 94% in 2023, with fluctuations in U.S. disbursements having an outsized impact on overall bilateral trends.

HIV Funding from Donor Governments, Other than the United States, 2011-2023

Multilateral Contributions

Multilateral contributions from donor governments to the Global Fund, UNITAID, and UNAIDS for HIV – funding disbursed by donor governments to these organizations which in turn use some (Global Fund and UNITAID) or all (UNAIDS) of that funding for HIV – totaled US$2.28 billion in 2023 (after adjusting for an HIV share to account for the fact that the Global Fund and UNITAID address other diseases).¹⁴ Funding was US$2.07 billion for the Global Fund, US$56 million for UNITAID, and US$151 million for UNAIDS.

The decline in donor government multilateral funding in 2023 was largely due to the timing of contributions to the Global Fund, reflecting pledge periods, and not actual decreases in support. With 2023 marking the first year of the most recent pledge period (2023-2025), there were large fluctuations in contributions to the Global Fund from most donor governments when compared to 2022 totals. Some donors choose to “front-load” contributions (e.g., the U.K. fulfilled almost its entire pledge for 2023-2025 in 2023), while others choose to fulfill pledges towards the end of the pledge period (e.g., Denmark did not provide any contribution in 2023 and will likely be fulfilling its pledge in future years). In addition, the timing of U.S. contributions to the Global Fund is based on the amount of funding received from other donors, as the U.S. is required by law not to exceed 33% of total contributions to the Global Fund from all donors, which also results in significant year-to-year fluctuations (See Figure 6). More generally, donor governments have increased contributions to the Global Fund.

HIV Funding from All Donor Governments, 2011-2023

There are different ways to measure donor government contributions to HIV, relative to one another. While the U.S. government provides the largest amount of funding for HIV, for example, it also has one of the largest economies in the world. To assess relative contributions, or “fair share”, two measures were used: ranking by overall funding amount and ranking by funding for HIV per US$1 million GDP, to adjust for the size of donor economies (See Table 2):

Rank by share of total donor government funding for HIV: By this measure, the U.S. ranked first in 2023, followed the U.K., France, Germany, and the Netherlands. The U.S. has ranked #1 in absolute funding amounts since tracking efforts began.
Rank by funding for HIV per US$1 million GDP: By this measure, the U.K. ranks first, followed by the U.S., the Netherlands, Sweden, and France (See Figure 7).¹⁵

Assessing Fair Share Across Donors, 2023

Donor Government Ranking by Funding for HIV per US$1 Million GDP, 2023

Looking Forward

Donor government funding for HIV in low and middle-income countries will continue to be an important part of the sustainability of the HIV response for years to come, particularly given the funding gap for HIV prevention efforts. Yet future donor government funding levels seem uncertain at best, and while there has been significant progress in addressing the HIV epidemic –1.3 million people were newly infected with HIV in 2023, down from 2.1 million in 2010 – new infections are on the rise in some regions, including two (Eastern Europe and Central Asia and the Middle East and North Africa) that UNAIDS reports have the largest funding gaps and are making the least progress against their HIV epidemics.¹⁶ There are significant headwinds on the horizon that complicate the funding picture from donor governments. These include multiple geopolitical challenges, such as costs associated with ongoing conflicts and displacement of refugees, as well as broader economic forces, including continued inflationary pressures. In addition, there is a crowded global health replenishment schedule in the year ahead, with several global health institutions, including the Global Fund, seeking to raise funds from the same donors. Finally, national elections have recently concluded (European Union, France, and the U.K.) or will occur in the coming months (U.S.), the outcomes of which could shape future funding for HIV in 2024 and beyond.

This work was supported in part by the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the Bill & Melinda Gates Foundation. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

Adam Wexler, Jen Kates, and Stephanie Oum are with KFF. Eric Lief is an independent consultant. Joint United Nations Programme on HIV and AIDS (UNAIDS).

This project represents a collaboration between the Joint United Nations Programme on HIV/AIDS (UNAIDS) and KFF. Data provided in this report were collected and analyzed by UNAIDS and KFF.

Totals presented in this analysis include both bilateral funding for HIV in low- and middle-income countries, core contributions to UNAIDS, and the estimated share of donor government contributions to the Global Fund and UNITAID that are used for HIV. Amounts are based on analysis of data from the 32 donor government members of the Organisation for Economic Co-operation and Development (OECD) Development Assistance Committee (DAC) in 2023 who had reported Official Development Assistance (ODA). Bilateral and multilateral data were collected from multiple sources from April 2024 - June 2024. Disaggregated bilateral and multilateral data are only available starting from 2011.

Data on gross domestic product (GDP) were obtained from the International Monetary Fund’s World Economic Outlook Database and represent current price data for 2023 (see: https://www.imf.org/en/Publications/WEO/weo-database/2024/April).

Bilateral Funding:Bilateral funding is defined as any earmarked (HIV-designated) amount, including earmarked non-core (“multi-bi”) contributions to multilateral organizations, such as UNAIDS. Data included in this report represent funding assistance for HIV prevention, care, treatment and support activities, but do not include funding for international HIV research conducted in donor countries (which is not considered in estimates of resource needs for service delivery of HIV-related activities).

The research team collected the latest bilateral funding data directly from twelve governments: Australia, Canada, Denmark, France, Germany, Ireland, Japan, the Netherlands, Norway, Sweden, the United Kingdom, and the United States during the first half of 2024, representing the fiscal year 2023 period. Direct data collection from these donors was desirable because they represent the preponderance of donor government assistance for HIV 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 2022 and do not include all forms of international assistance (e.g., certain funding streams provided by donors, such as HIV components of mixed-purpose grants to non-governmental organizations). Data for all other member governments of the OECD DAC – Austria, Belgium, the Czech Republic, the European Commission, Estonia, Finland, Greece, Hungary, Iceland, Italy, Korea, Lithuania, Luxembourg, New Zealand, Poland, Portugal, the Slovak Republic, Slovenia, Spain, and Switzerland – which collectively accounted for less than 5 percent of bilateral disbursements in each of the past several years, were obtained from the OECD CRS database are from calendar year 2022.

Where donor governments were members of the European Union (EU), the research team ensured that no double-counting of funds occurred between EU Member State reported amounts and European Commission (EC) reported amounts for international HIV assistance. Figures obtained directly using this approach should be considered as the upper bound estimation of financial flows in support of HIV-related activities.

Reflecting deliberate strategies of integrating HIV activities into other activity sectors, some donors use policy markers to attribute portions of mixed-purpose projects to HIV. This is done, for example, by the Netherlands and the U.K. The bilateral figures submitted by the UK Foreign, Commonwealth & Development Office (FCDO) for the financial year 2023/24 are based on an existing FCDO ‘HIV policy marker’. Ireland and Denmark also attribute percentages of multipurpose projects to HIV. Canada breaks its mixed-purpose projects into components by percentage. Germany, Norway, and Sweden provided data much more conservatively, consistent with DAC constructs and purpose codes. Apart from targeted HIV/AIDS programs, bilateral health programs mainly focusing on health systems strengthening are also designed to contribute to the HIV response in partner countries.

Bilateral assistance data represent 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.

Amounts presented are for the fiscal year period, which varies by country. The U.S. fiscal year runs from October 1-September 30. The fiscal years for Canada, Japan, and the U.K. are April 1-March 31. The Australian fiscal year runs from July 1-June 30. The European Commission, Denmark, France, Germany, Italy, Ireland, 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 current US dollars (USD), unless otherwise noted. 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 the OECD.

Funding totals presented in this analysis should be considered preliminary estimates based on data provided and validated by representatives of the donor governments who were contacted directly.

Multilateral Funding:Multilateral funding includes core contributions to UNAIDS, as well as contributions to the Global Fund (see: http://www.theglobalfund.org/en/) and UNITAID (see: http://www.unitaid.org/#end). All Global Fund contributions were adjusted to represent 52% of the donor’s core contribution, reflecting the Fund’s reported grant approvals for HIV-related projects to date and includes funding for HIV/TB activities. UNITAID contributions were adjusted to represent 46% of the donor’s core contribution, reflecting UNITAID’s reported attribution for HIV-related projects.

Data obtained from UNAIDS, the Global Fund, and UNITAID were already adjusted to represent a USD equivalent based on date of receipts.

UNAIDS core contributions reflect 2023 amounts. Global Fund and UNITAID contributions from all governments correspond to amounts received during the 2023 calendar year, regardless of which contributor’s fiscal year such disbursements pertain to. UNAIDS and UNITAID provided contributions data directly to the research team. Global Fund contributions data were compiled by the research team and validated by the Global Fund. The French reported additional set-aside funding for the Global Fund after data collection was complete; this is now pending further review.

In addition to contributions supporting the Global Fund’s and UNITAID’s core activities, some donor governments provided significant funding to these multilateral organizations for COVID-related efforts between 2000-2023. These COVID-specific contributions were not included in totals in this analysis. The U.S., for example, provided almost US$1.9 billion in such funding to the Global Fund during 2022.

Other than contributions provided by governments to the Global Fund and UNITAID, un-earmarked general contributions to United Nations entities, most of which are membership contributions set by treaty or other formal agreement (e.g., the World Bank’s International Development Association or United Nations country membership assessments), are not identified as part of a donor government’s HIV assistance even if the multilateral organization in turn directs some of these funds to HIV. Rather, these would be considered as HIV funding provided by the multilateral organization, as in the case of the World Bank’s efforts, and are not considered for purposes of this report.

Donor Government Funding for HIV (current USD in millions), 2022 &amp; 2023

UNAIDS, “2024 UNAIDS Global AIDS Update Report: The Urgency of Now – AIDS at the Crossroads”, July 2024. ↩︎
Between 2020-2023, some donor governments provided COVID-specific emergency contributions to the Global Fund and UNITAID in addition to their contributions for core activities. For the purposes of this report, these COVID-specific amounts have been excluded as they cannot be attributed to a specific area, such as HIV. ↩︎
UNAIDS estimates that US$19.8 billion was available for HIV from all sources (domestic resources, donor governments, multilaterals, and philanthropic organizations) in 2023, expressed in 2019 USD. For purposes of this analysis, this estimate was converted to 2023 USD, or US$22.1 billion. In addition, while the amounts presented in this analysis include donor contributions to multilateral organizations, the UNAIDS estimate of total available resources for HIV includes the actual disbursements made by multilateral organizations in 2023 rather than the donor government contributions to these entities. ↩︎
Donor government contributions to the Global Fund and UNITAID have been adjusted for an HIV-share to account for the fact that these multilateral organizations address other diseases and areas (see Methodology). ↩︎
Personal communication with Danish Ministry of Foreign Affairs, July 2024. ↩︎
U.S. totals represent funding amounts provided through regular appropriations only. In 2021, the U.S. Congress appropriated additional emergency supplemental funding for bilateral HIV activities and for the Global Fund to address the impacts of the COVID-19 pandemic. These emergency supplemental funding amounts are not included in overall U.S. totals. ↩︎
Donor government disbursements are a subset of overall international assistance for HIV in low-and-middle-income countries, which also includes funding provided by other multilateral institutions, UN agencies, and foundations. ↩︎
UNAIDS, “2024 UNAIDS Global AIDS Update Report: The Urgency of Now – AIDS at the Crossroads”, July 2024. ↩︎
UNAIDS estimates that US$19.8 billion was available for HIV from all sources (domestic resources, donor governments, multilaterals, and philanthropic organizations) in 2023, expressed in 2019 USD. For purposes of this analysis, this estimate was converted to 2023 USD, or US$22.1 billion. In addition, while the amounts presented in this analysis include donor contributions to multilateral organizations, the UNAIDS estimate of total available resources for HIV includes the actual disbursements made by multilateral organizations in 2023 rather than the donor government contributions to these entities. ↩︎
The donor share of total available resources includes bilateral disbursements as well as an adjusted share of Global Fund and UNITAID disbursements (the donor government share of contributions to each of the multilaterals in 2022 is applied to the disbursements from these multilaterals for the same year). ↩︎
The UNAIDS resource needs estimate is expressed in 2019 USD. UNAIDS, “2024 Global AIDS Update: The Urgency of Now - AIDS at the Crossroads”, July 2024. ↩︎
KFF & UNAIDS, “Donor Government Funding for HIV in Low- and Middle-Income Countries in 2022”, July 2023. ↩︎
KFF, “The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)”, July 2023. ↩︎
In 2023, 52% of the Global Fund’s disbursements and 46% of UNITAID’s disbursements were directed to HIV activities. These percentages were applied to the full donor government contributions to these multilateral organizations to calculate the “HIV-share” (see Methodology for additional details). ↩︎
GDP estimates are from the International Monetary Fund’s (IMF) World Economic Outlook (WEO) Database (accessed June 2024). ↩︎
UNAIDS, “2024 UNAIDS Global AIDS Update Report: The Urgency of Now – AIDS at the Crossroads”, July 2024. ↩︎

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Immigrants Have Lower Health Care Expenditures Than Their U.S.-Born Counterparts

Authors: Drishti Pillai and Samantha Artiga

Published: Jul 18, 2024

Introduction

As of 2022, there were 45.5 million immigrants residing in the U.S., including 21.2 noncitizen immigrants and 24.2 million naturalized citizens, who together account for about 15% of the total population.¹ While there has been increasing focus among some policymakers on the health care expenses incurred by immigrants, research suggests that they not only have lower health care costs than U.S.-born people but also help subsidize health care for U.S.-born people by paying more into the system through health insurance premiums and taxes than they utilize. This data note provides further insight into health care expenditures for immigrants by analyzing their average per capita health care expenditures and comparing them to expenditures for U.S.-born people overall and by health care services and payment sources using data from the 2021 Medical Expenditures Panel Survey.

This analysis finds that, on average, annual per capita health care expenditures for immigrants, including naturalized citizens and noncitizens, are about two-thirds of those for U.S.-born citizens overall ($4,875 vs. $7,277). This reflects lower spending for most types of health care, including office-based visits, prescription drugs, inpatient care, outpatient care, and dental care. Among average per capita expenditures, the relative amount paid by most payment sources is lower for immigrants compared to U.S.-born people, including private coverage, Medicare, and out-of-pocket spending. There is no significant difference in average emergency room and Medicaid expenditures between U.S.-born citizens and immigrants.

These patterns suggest that immigrants use less health care than U.S.-born people and often rely on the emergency room when they do seek care. Lower use of health care among immigrants likely reflects a combination of them being younger and healthier than their U.S.-born counterparts as well as them facing increased barriers to care, including lower rates of coverage due to more limited access to private coverage and Medicaid eligibility restrictions for immigrants. In general, lawfully present immigrants must have a “qualified” immigration status to be eligible for Medicaid or the Children’s Health Insurance Program (CHIP), and many must wait five years after obtaining qualified status before they may enroll. Undocumented immigrants are not eligible to enroll. Immigrants also face language access challenges and confusion and fears. Increasing coverage and reducing other barriers to care for immigrants could increase the use of preventive and primary care, which could prevent the worsening of conditions and reliance on emergency room care.

Findings

In 2021, annual average overall per capita health care expenditures for immigrants were $4,875 compared to $7,277 for U.S.-born citizens. Annual average per capita spending for immigrants was lower than for U.S.-born citizens on office-based visits ($1,325 vs. $2,126), prescription drugs ($1,159 vs. $1,655) inpatient care ($864 vs. $1,284), outpatient care ($581 vs. $1,001), and dental care ($280 vs. $402) (Figure 1). Average per capita spending on emergency room care was not statistically significantly different between immigrants ($169) and U.S.-born citizens ($200).

Average Annual Per Capita Health Care Expenditures Among Immigrants and U.S.-Born People by Type of Health Care, 2021

Among average annual total per capita expenditures, the relative amount paid for by private coverage ($1,925 vs. $3,075), Medicare ($1,161 vs. $1,999), and out-of-pocket spending ($705 vs. $950) was lower for immigrants compared to U.S.-born people (Figure 2). There was no statistically significant difference in the average amount paid by Medicaid for immigrants ($854) and U.S.-born people ($830). Medicaid eligibility is limited for immigrants. In general, lawfully present immigrants must have a “qualified” immigration status to be eligible for Medicaid or CHIP, and many must wait five years after obtaining qualified status before they may enroll. For children and pregnant people, states can eliminate the five-year wait and extend coverage to lawfully present immigrants without a qualified status. States can also extend pregnancy-related coverage to immigrants regardless of status through the CHIP From-Conception-to-End-of-Pregnancy option. Undocumented immigrants are not eligible to enroll in Medicaid. Medicaid payments for emergency services may be made for individuals who are otherwise eligible except for immigration status to help cover the costs incurred for providing this care. Given these limits, it is likely that a greater share of Medicaid spending for immigrants goes toward pregnancy-related care and emergency care, which tend to be costly. In contrast, U.S.-born enrollees include a high share of children, who typically utilize lower-cost preventive and primary care, resulting in lower spending.

Average Annual Per Capita Health Care Expenditures Among Immigrants and U.S.-Born People by Payment Source, 2021

Methods

The data in this brief are based on KFF analysis of the 2021 Medical Expenditures Panel Survey (MEPS) full-year consolidated data file. The data presented in this brief include the average annual per capita health care expenditures for immigrants (individuals born outside the U.S. or its territories) and U.S.-born citizens both overall and for major types of health care including office-based visits, prescription drugs, inpatient care (including facility and doctor charges), outpatient care (including facility and doctor charges), dental care, and emergency room care (including facility and doctor charges). Health care expenditures are also examined by payment source, that is, the amount of total average per capita expenditures that are paid through private coverage, Medicare, Medicaid, and out-of-pocket spending. A limitation of federal surveys, including MEPS, is the likely underrepresentation of immigrants, particularly recent and undocumented immigrants, and potential undercounting of emergency Medicaid spending.

KFF analysis of 2022 American Community Survey 1-year Public Use Microdata Sample ↩︎

Poll Finding

Polling Insight: 4 Key Takeaways About Hispanic Women Voters Nationally and in Arizona

Authors: Isabelle Valdes, Audrey Kearney, Ashley Kirzinger, and Liz Hamel

Published: Jul 17, 2024

Hispanic Americans account for half the growth of the voting-age population in the U.S. since the 2020 presidential election, and their diversity of opinion and experiences is as great as their numbers. Former President Trump made gains with Hispanic voters between the last two presidential elections, though an analysis shows they voted for President Biden by wide margins in key states in 2020. Across racial and ethnic groups, women voters overwhelmingly cite inflation as the most important issue determining their vote and are similarly dissatisfied with their options for president. However, women of color, including both Hispanic and Black women, are less motivated to vote and less likely to say they plan to vote in this election. Hispanic women in particular are an important segment of American voters, as they have historically turned out at higher rates than Hispanic men and may be more motivated to vote in this election by the inclusion of abortion and other reproductive health measures on state-level ballots. In a close election, the turnout of Hispanic women voters may tip the scale toward either candidate.

This polling insight from the KFF Survey of Women Voters is based on analysis of Hispanic women voters nationally and in Arizona, a key battleground state for the upcoming presidential election where it is projected that one in four voters will be Hispanic¹ . This analysis finds the potential state ballot measure in Arizona which would enshrine abortion rights may motivate younger Hispanic women in particular to cast their vote.

The KFF Survey of Women Voters Dashboard includes more analyses from the survey, as well as the topline and methodology.

#1: Inflation Is the Most Important Election Issue for Hispanic Women Voters; Most Worry About Affording Basic Expenses

Economic issues are top of mind for Hispanic women voters across the country leading into the presidential election, as majorities say they worry “a lot” about affording basic expenses for them and their family, including food and groceries (64%), rent or mortgage (63%), the cost of health care (60%), monthly utilities (56%), and childcare (54% among those with children under age 18). Similar shares of Black women voters say they worry “a lot” about most of these household expenses, while White women voters are less likely than both Black and Hispanic women voters to express worry about affording the items asked about in this survey.

Stacked bar chart showing how much Hispanic women voters worry about affording specific household expenses.

Americans overall have been affected by growing inflation rates after the economy struggled to recover after the COVID-19 pandemic, peaking at 9.1% in June 2022² . Over half (56%) of Hispanic women voters say “inflation, including the rising cost of household expenses” is the most important issue determining their vote in the upcoming election, and the Democratic Party has an advantage over the Republican Party when it comes to addressing the cost of household expenses for this group (35% vs. 22%). However, many still say neither party does a better job (43%).

The KFF Survey of Women Voters Dashboard displays top issues determining the vote of Hispanic women voters and other key groups of women voters.

#2: Hispanic Women Voters Are Frustrated, Dissatisfied With Options for President; Younger Voters Are Particularly Disaffected

About six in ten Hispanic women voters nationally say they are “anxious” (60%) or “frustrated” (57%) about the upcoming presidential election, while half (54%) say they are “hopeful,” and a much smaller share are “enthusiastic” (35%). Negative feelings surrounding the election may be related to dissatisfaction with the candidates themselves. The poll, fielded before the first presidential debate between President Biden and former President Trump, found over half (55%) of Hispanic women voters say they are dissatisfied with their options for president, including a quarter (27%) who say they are “not at all” satisfied.

Younger Hispanic women voters are particularly disaffected this election cycle. One-third (32%) of those ages 18 to 44 say they are less motivated to vote compared to previous presidential elections (19% of Hispanic women voters ages 45 and older respond similarly), and a quarter (26%) say they would not vote if the election were held today. Younger Hispanic women are also more likely to identify as independent compared to those 45 and older (40% vs. 25%). This patten is consistent across racial and ethnic groups nationally, with younger women more likely than their older counterparts to identify as independent.

Stacked bar chart showing how motivated Hispanic women voters are to vote in the upcoming election. Results shown by age.

In addition, the KFF Survey of Women Voters, which was fielded in late May to early June, finds lack of motivation to vote among younger Hispanic women may be related to their mixed views on the candidates’ records. Half (52%) of Hispanic women voters ages 18 to 44 say they were better off financially during Trump’s presidency, compared to one in ten who say they are better off now under President Biden and about four in ten (37%) who say there is no difference. Financial security appears top of mind for this voting bloc, among whom six in ten cite inflation as the top issue determining their vote (62%).

Stacked bar chart showing percent of Hispanic women voters who say they were better off financially under Biden, Trump, or there was no difference. Results shown by age.

Though Trump may have a comparative advantage on voters’ perceptions of their financial situations during his presidency, Biden does better among younger Hispanic women voters on reproductive health issues. This group is over twice as likely to say they trust Biden over Trump to do a better job deciding policy related to abortion access (40% vs. 19%) and birth control access (45% vs. 18%) in the U.S. Though once again, four in ten say they trust neither candidate to do a better job in each of these areas (41% and 37%, respectively).

Stacked bar showing percent of Hispanic women voters who say they trust Biden, Trump, or neither candidate when it comes to deciding policy related to different reproductive health issues. Results shown by age.

#3: In Arizona, a Key Battleground State, the Arizona Right to Abortion Initiative May Drive Turnout Among Younger Hispanic Women Who Support Abortion Rights

Analysis suggests that turnout of young Hispanic voters in Arizona was a key part of President Biden’s narrow victory in the state in 2020. The candidate who wins the 11 electoral college votes in this swing state in 2024 could tip the scale for who wins the presidency, especially if this crucial voting bloc turns out once again.

Fielded in late May to early June, the KFF Survey of Women Voters finds about one third (32%) of younger Hispanic women voters ages 18 to 44 in Arizona say there is a 50-50 chance or less of voting in the upcoming November election. Just 7% of older Hispanic women voters, ages 45 and older, say the same. These younger voters are also more likely to not affiliate with either political party (40% vs. 14% who identify as independents). These patterns among younger Hispanic women voters in Arizona are also found among this group nationally.

If the presidential candidates are not motivating younger Hispanic women in Arizona to vote, a citizen-initiated amendment to the state constitution enshrining abortion rights, which will likely appear on the ballot, may encourage this group to turn out. A large majority (82%) of Hispanic women voters ages 18 to 44 say they support the Arizona Right to Abortion Initiative, which would establish a fundamental right to abortion until fetal viability, typically between 23 and 25 weeks of pregnancy. Notably, two-thirds (67%) of younger Hispanic women voters say they would be more motivated to vote if it makes it on the state ballot. Smaller shares of Hispanic women ages 45 and older say they support the measure (46%) and would be more motivated to vote if it is on the ballot (45%).

Stacked bar showing support for the Arizona Right to Abortion Initiative, by age of Hispanic women voters.

Stacked bar chart showing percent of Arizona women voters who say they would be more motivated to vote, less motivated, or there would be no impact if the Arizona Right to Abortion Initiative appears on the ballot in November. Results shown by total Arizona women voters, age, and party identification.

#4: President Biden Has the Advantage Among Hispanic Women in Arizona on Abortion, Though Many Still Trust “Neither Candidate”

During the first presidential debate in June (held after the field period for the survey), both President Biden and former President Trump reaffirmed their stances on abortion. Biden declared his commitment to restoring Roe v. Wade, which would secure a federal right to abortion until fetal viability, akin to the Arizona Right to Abortion Initiative which young Hispanic women in the state overwhelmingly support. In contrast, Trump stated the legal status of abortion should be left to the states to decide, a policy stance that 77% of younger Hispanic women voters from Arizona oppose. A majority (59%) of Hispanic women voters in Arizona, regardless of age, say this year’s election for president will have a “major impact” on access to abortion and reproductive health care in their state. However, while younger Hispanic women voters are twice as likely to say they trust Biden over Trump when it comes to deciding policy related to abortion and birth control access in the U.S., three in ten or more still say they trust “neither” candidate.

Stacked bar chart showing percent of Hispanic women voters in Arizona who say they trust either Biden, Trump, or neither candidate when it comes to deciding policy about certain reproductive health issues. Results shown by age.

Hispanic women who cast their ballot in the upcoming 2024 presidential election will be deciding between two candidates whose incoming tenure will address policy related to inflation, threats to democracy, immigration, and abortion – all top issues determining the vote of this growing voting bloc. In Arizona, a state with a growing Hispanic electorate that is majority younger and female, it is unclear whether turnout of young Hispanic women who may show up to vote for the Arizona abortion rights measure will translate to an advantage for either candidate. With substantial shares declaring trust in neither candidate to address reproductive health issues, alongside disaffection towards the election overall, the presidential nominees will each need to convince this bloc of largely disaffected voters that his presidency will best address their needs and top issues.

Hispanic women voters include any women voters who identify as Latino or Hispanic, regardless of racial identity. ↩︎
The most recent Consumer Price Index, measuring the rate of inflation between May 2023 and May 2024 is 3.3%. ↩︎

News Release

KFF Analysis Finds That Firearms Were Involved in 79% of Homicides and 55% of Suicide Deaths in 2022

Firearm-Related Deaths Rose Sharply Over the Last Decade, From 92 deaths Per Day in 2012 to 132 Deaths Per Day in 2022

Published: Jul 17, 2024

A new KFF analysis finds that firearms are involved in the majority of all homicides and suicides in the U.S., playing a role in 79% of homicides and 55% of suicide deaths in 2022, the most recent data available.The analysis, based on data from the federal Centers for Disease Control and Prevention, also shows that firearm deaths increased sharply over the decade, from 33,563 deaths in 2012 to 48,204 deaths in 2022. Looked at another way, the firearm-related death toll rose from 92 deaths per day in 2012 to 132 deaths per day in 2022, a period marked by increasing public concern about gun violence in the U.S.

Firearms surpassed motor vehicle accidents to become the leading cause of death for young adults (ages 18 to 25) in 2015, and the leading cause of death among children and adolescents (1-17) in 2020. Over half of adults report a gun-related incident personally or among family, according to KFF polling, and one-fifth report the death of a family member due to a firearm.The new analysis finds overall gun deaths rates rose by 35% from 2012 to 2022, with a sharper rise in firearm homicide rates compared to firearm suicide rates (69% vs. 31%, respectively). While firearm-related homicides have spiked more in recent years, suicides still accounted for a majority (56%) of all firearm deaths in 2022. Cumulatively this translates to nearly 100,000 more firearm suicides compared to homicides over the 2012 to 2022 period (258,062 vs. 164,139).Other key takeaways include:

Males were six times more likely to die from firearms than females in 2022.
In young adults, firearm suicides make up 40% of all firearm deaths and that share steadily climbs with age, up to 91% among older adults (65+). The pattern for homicides is the opposite, with a higher rate in young adults that declines with age. Young adults had the highest overall firearm death rate compared to all other age groups in 2022.
Firearm deaths have sharply increased among Black and American Indian or Alaska Native (AIAN) people, while remaining relatively steady among White people. Further, while about 80% of firearm deaths among White people are due to suicides, about 80% of firearm deaths among Black people are due to homicides in 2022.
Firearm death rates vary widely across states, with a nearly tenfold difference in rates between states with the lowest and highest rate (from 3.1 deaths per 100,000 in Rhode Island to 29.6 in Mississippi in 2022).
The type of firearm death (suicide, homicide, or other) also varies by state, with firearm suicides making up over 80% of all firearm deaths in Utah and New Hampshire, while homicides account for the largest share of deaths in District of Columbia and Maryland.

The full analysis, as well as other data and analyses related to gun violence in the U.S., is available at kff.org.

Contact

Chris Lee

clee@kff.org

Three Questions about Firearm Deaths: Key Patterns from a Decade of Data

Authors: Heather Saunders, Nirmita Panchal, Robin Rudowitz, and Patrick Drake

Published: Jul 17, 2024

Firearm deaths increased sharply over the past decade, rising from 92 deaths per day to 132 deaths per day from 2012 to 2022. During that time, firearms surpassed motor vehicle accidents to become the leading cause of death for young adults in 2015, and the leading cause of death among children and adolescents in 2020. Over half of adults report a gun-related incident personally or among family, according to KFF polling, and one-fifth report death of a family member due to a firearm. On the second anniversary of the Bipartisan Safer Communities Act, the Surgeon General issued an Advisory, declaring gun violence a public health crisis. Headed into the presidential election, debate about firearms is likely to continue to be an area of stark contrast between candidates.

This analysis uses the most comprehensive and recent firearm death data available from CDC WONDER to examine firearm deaths from a decade of data (2012-2022), including who is affected, trends, and state-level differences. This analysis of firearm deaths includes suicides, homicides, and other firearm-related deaths (including accidents, legal intervention, and undetermined). Firearm suicide and homicides are often combined under the term, “firearm violence” or “gun violence”.

Key takeaways include the following:

The total firearm death rate increased by 35% from 2012 to 2022. Firearm homicides increased more sharply during the pandemic, but firearm suicides continue to account for over half of firearm deaths. Firearms account for more than half of all suicide and homicide deaths.
Firearm deaths are the leading cause of death among young adults (ages 18-25) and occur at a higher rate in this age group than in any other. Firearm deaths in young adults are predominantly due to homicides, while suicides account for the largest share of firearm deaths in older adults.
Firearm deaths have sharply increased among Black and American Indian or Alaska Native (AIAN) people, while remaining relatively steady among White people. Further, while about 80% of firearm deaths among White people are due to suicides, about 80% of firearm deaths among Black people are due to homicides.
Firearm death rates vary widely across states, with nearly a tenfold difference between the lowest and highest states. Nearly all states experienced an increase in firearm deaths from 2012 to 2022. Further, distribution of type of firearm death varies widely across states – with firearm suicides being predominant in some states, and firearm homicides in others.

How have the amount and distribution of firearm deaths changed over time?

When adjusted for population growth and age, the total firearm death rate has increased by 35% from 2012 to 2022, moving from 10.5 to 14.2 deaths per 100,000 people (Figure 1). Firearm deaths began to steadily rise in 2014, before sharply accelerating during the pandemic. Although there was a small decrease in deaths from 2021 to 2022, these years still have the highest number of firearm deaths in CDC record (since 1999).

Firearm deaths were on the rise before the pandemic but accelerated sharply during the pandemic

Firearm homicides sharply increased in recent years; however, suicides still account for more total firearm deaths, making up 56% of these deaths in 2022. Total firearm homicides increased by 69% from 11,622 to 19,651, and the number of firearm suicides increased by 31% from 20,666 to 27,032. Despite the larger increase in firearm homicides, firearm suicides consistently accounted for more than half of total firearm deaths from 2012 (62%) to 2022 (56%) (Figure 2). Cumulatively this translates to nearly 100,000 more firearm suicides compared to homicides over the 2012 to 2022 period (258,062 vs. 164,139).

Number of firearm deaths and type, 2012 and 2022

Firearms are the leading cause of total suicides and homicides, making up 55% of all suicide deaths and 79% of all homicides in 2022 (Figure 3). Firearm suicides are the most lethal method of suicide attempt, and their recent increase has led to the highest number of total suicides on CDC record. At the same time, non-firearm suicides have decreased. With about half of suicide attempts occurring within 10 minutes of the current suicide thought, access to firearms is a suicide risk factor. Efforts to reduce firearm suicides include the development of 988 and crisis services, increasing education about the link between firearm ownership and suicide risk (lethal means counseling) and providing safety locks to at-risk firearm owners. For homicides, firearms account for 79% of total homicide deaths in 2022 (Figure 3). Focused interventions, such as hospital and community violence intervention programs, have been pointed to as potential paths to reducing firearm homicides.

More than half of suicide deaths and homicide deaths involved a firearm in 2022

What are trends in firearm deaths by demographic?

Firearm death rates vary by demographics and were consistently higher among young adults, Black people, and males compared to their respective peers from 2012 to 2022 (Figure 4). For example:

Young adults (ages 18-25) had the highest rate of firearm deaths compared to all other age groups in 2022; however, adults ages 26-44 have experienced the fastest growth in these death rates over time (Figure 4). Between 2012 and 2022, the firearm death rate among young adults increased by 37%, from 17.7 to 24.3 deaths per 100,000, surpassing motor vehicle accidents as the leading cause of death among young adults in 2015. Adults ages 26 to 44 experienced the fastest growth in these death rates over time, with their rate rising 48% from 2012 to 2022 (13.7 vs. 20.3 per 100,000 people, respectively).
Firearm death rates in 2022 as well as rates of increase from 2012 to 2022 were highest for Black and AIAN people. In 2022, firearm death rates for Black (33.2 per 100,000) and AIAN people (22.2 per 100,000) far exceeded the rate for White people (12.2 per 100,000) (Figure 4). Further, from 2012 to 2022, the firearm death rate increased by 75% for Black people and 90% for AIAN people, compared to 22% for White people. The firearm death rate was lowest for Asian/PI people, at 3.0 per 100,000 people in 2022.
Males were six times more likely to die from firearms than females (24.6 vs. 4.1 per 100,000) in 2022 (Figure 4). Firearm death rates were consistently higher for males compared to females over time, although both groups experienced increases from 2012 to 2022. Men are about twice as likely to own a firearm compared to women. During the pandemic, firearm purchases by women rose, which may lead to shifts in these demographic trends of firearm deaths in coming years.

Young adults, Black and AIAN people, and males have the highest firearm death rates

Patterns in the distributions of firearm suicide and homicide deaths vary across race and ethnicity and age (Figure 5). For example:

Firearm deaths in young adults are predominantly due to homicides, while suicides account for the largest share of deaths among older adults. Firearm homicides peak in young adults, accounting for nearly two-thirds of all firearm deaths in this age group. The share of firearm homicides steadily decreases with age, dropping to less than 10% by age 65+. Conversely, suicides make up a smaller share of firearm deaths in young adults but increase with age, comprising 91% of all firearm deaths in the 65+ age group.
About eighty percent of firearm deaths among White people are suicides, while 80% among Black people are homicides. Among other racial and ethnic groups, the distribution of homicide and suicide firearm deaths is more mixed. These differences may be tied to underlying structural inequities such as poverty and racism, which are linked to higher homicide rates. They may also reflect differences in firearm ownership rates, as White people are more likely to own firearms and firearm availability is closely tied to suicide risk. Although 8 in 10 firearm deaths among Black people are homicides, this share has decreased since 2012, reflecting a sharper relative growth in firearm suicides among Black people. This group has also experienced rising mental health needs and low treatment rates.
Homicides account for a somewhat larger share of firearm deaths among females compared to males. The share of firearm homicides is higher in females (47% vs. 40%), whereas the share of firearm suicides is larger in males. Suicide risk is tied to gun ownership and men are about twice as likely to own a firearm compared to women. Further, many female firearm homicides are linked to intimate partner violence.

Patterns in firearm homicide and suicide vary by age, race, and sex

How do firearm deaths vary by state?

Firearm death rates vary widely across states, with nearly a tenfold difference between the lowest rate in Rhode Island (3.1 per 100,000) and the highest in Mississippi (29.6 per 100,000). In 2022, about two-thirds of states had firearm death rates above the national average of 14.2 per 100,000, with the highest rates in Mississippi, Louisiana, and New Mexico. About one-third of states, including Rhode Island, Massachusetts, and New Jersey, had rates below the national average. From 2012 to 2022, firearm death rates increased in all states - except Rhode Island and New Jersey - with rate increases ranging from 1% in Wyoming to 128% in the District of Columbia (Figure 6). Variations in firearm death rates may be due to a combination of factors, including rates of firearm ownership, and other state policies—which may include child access prevention laws. At the end of last year, the White House Office of Gun Violence Prevention was established with one of its goals being to partner with states to address gun violence. The office recommended that states create their own gun violence prevention offices. While a few states already had similar offices, Maryland recently formed its own and more states may have efforts underway.

Firearm death rates show a tenfold variation between top and bottom states in 2022; different rates of change over the past decade

The type of firearm death varies by state, with suicide predominant in some states, homicide in others, and some states more evenly mixed. Nationally, suicides account for 56% of all firearm deaths, homicides account for 41%, and other firearm deaths account for 3%, but these proportions differ substantially at the state level. For instance, in Utah and New Hampshire suicides account for most firearm deaths (over 80%). In contrast, in the District of Columbia and Maryland, homicides make up about 65% or more of the state’s firearm deaths. Other states, like Pennsylvania and Georgia, have a more even split. Age-adjusted rates show the magnitude of each type of firearm death by state, adjusted for age and population. For instance, Montana has the highest firearm suicide death rate (20.0 per 100,000 people), whereas D.C. has a similarly high rate, but for firearm homicides (21.0 per 100,000 people) (Figure 7). While the reasons behind these variations in distribution aren’t entirely clear, they may be linked to factors like gun ownership rates, policy, and economic factors.

Distribution and rates of firearm death types (suicide, homicide, or other) vary widely across states

Impact of the Mexico City Policy: Literature Review

Authors: Jennifer Kates and Kellie Moss

Published: Jul 17, 2024

Section:

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Overview

There is an increasing literature assessing the impact of the Mexico City Policy over time and during different presidential administrations. We conducted a literature review to identify studies examining this impact, from 2001 to the present, with particular focus on capturing recent studies assessing the policy under the Trump administration. Overall, we identified 71 studies or documents for inclusion in our review. They employed a variety of methodological approaches (including more than one approach in a single study) with the majority using qualitative methods (48), followed by those using quantitative methods (27); seven were scoping or literature reviews. Most of the literature assessed the impact of the policy under the Trump administration (45), followed by the George W. Bush administration (31). Fewer studies looked at the policy under other presidential administrations. Taken together, the literature documents a range of impacts associated with the policy, including: increases in abortion rates and reductions in contraceptive prevalence (among other health outcomes); disruption and gaps in services; reduction in service integration; over-implementation and chilling effects; confusion about the policy; loss of civil society/NGO coordination and partnerships; and increased administrative burden. In addition, several studies sought to calculate or estimate the reach of the policy, as measured by amount of funding, countries, and/or NGOs affected.

Box 1: Impacts Associated with the Mexico City Policy in the Literature

Increased abortion rates
Increased pregnancy
Decreased contraceptive prevalence
Disruption in family planning and other services
Gaps in family planning and other services
Reduced service integration
Over-implementation and chilling effect
Confusion
Loss of civil society/NGO coordination and partnerships
Increased administrative burden

Snapshot of the Literature

We identified 71 studies, published since 2001, for inclusion in this review. Key characteristics are as follows:

Presidential Administration: The studies reviewed included those that assessed the impact of the policy over time and during different presidential administrations; these included times when the policy was not in place, generally to serve as a control or comparison period. Most of the studies reviewed assessed the impact of the policy under the Trump administration (45), followed by studies assessing the impact under the George W. Bush administration (31). Fewer studies looked at the impact under other presidential administrations, with 10 assessing the policy during the George H.W. Bush administration and 9 during the Reagan administration. A small number used the Obama (15), Clinton (13), and Biden (4) administration periods as comparisons.

Methodological Approach: The studies employed a variety of methodological approaches, often using more than one. The majority used qualitative methods, primarily key informant interviews and site visits (48), followed by those that used quantitative methods (27). Seven were scoping or literature reviews, included primarily to help identify additional studies and confirm overall findings.

Geographic Scope: Studies were largely split between those that were multi-country in their geographic scope (29) or single-country focused (29). The remainder did not include a specific geographical analysis (13).

Type of Literature: Twenty-nine studies were peer reviewed analyses, 38 were independent or organizational studies, and four were U.S. government-issued reports.

Findings

Below, we summarize the literature reviewed and provide findings in key areas (see Appendix Table for a complete list of studies, including their findings and other information).

Reach and Impacts of the Policy

Reach

The U.S. government has not routinely provided data (such as data on the amount of funding or number of recipients subject to the policy) when the Mexico City Policy has been in effect. As such, several studies have attempted to calculate or estimate its reach. Our analyses have found that the expanded policy during the Trump administration applied to a much greater amount of U.S. global health assistance, and a greater number of foreign NGOs, across many program areas than during prior periods when the policy was in effect. Specifically, we found that the Trump policy potentially encompassed $7.3 billion in global health assistance, a significantly greater amount than the $600 million in family planning funding that would have been subject to the policy under prior iterations (Moss & Kates 2021). Using prior periods as proxies, we also found that had the expanded Mexico City Policy been in effect during the FY 2013 – FY 2015 period, approximately 1,275 foreign NGOs would have been subject to the policy, and more than 460 U.S. NGOs recipients of U.S. global health assistance would have been required to ensure that their foreign NGO sub-recipients were in compliance (Moss & Kates 2017). Finally, we found that more than half (37) of the 64 countries that received U.S. bilateral global health assistance in FY 2016 allowed for legal abortion in at least one case not permitted by the policy, suggesting that the policy would be at odds with country law in many cases (Kates & Moss 2017).

A Congressionally-requested GAO (GAO 2020) study of the Trump administration’s policy analyzed U.S. government project data from May 2017 through FY 2018 (Sept. 2018) and found that the policy had been applied to more than 1,300 global health assistance awards (that is, grants or cooperative agreements), primarily at USAID and CDC. NGOs had declined to accept the policy in 54 instances, totaling $153 million in declined funding. These included seven prime awards totaling $102 million and 47 sub-awards totaling $51 million (more than two-thirds of sub-awards were intended for Africa).

Effects on Abortion Rates, Contraceptive Prevalence, and Pregnancy

Several studies have sought to estimate the association between the Mexico City Policy and a range of health outcomes among women, including abortion rates, contraceptive prevalence, and pregnancy:

Brooks et al. (2023), using data from eight countries in sub-Saharan Africa between 2014-2019, found that women were significantly less likely to be using any method of contraception when the Trump administration’s policy was in effect, equivalent to a 13% reduction in contraceptive prevalence. They also found that women appeared to be substituting traditional methods of family planning for modern methods. Finally, they found that women were 5.7% more likely to have given birth when the policy was in place.
Kavakli and Rotondi (2022), using data from 134 countries between 1990-2015, found that, when in place, the policy was associated with higher maternal and child mortality and HIV incidence rates. In addition, their analysis of individual data in 30 countries found that women had less access to modern contraception and were more likely to report that their pregnancy was not desired. Finally, they used their findings to estimate that reinstatement of the policy by the Trump administration could result in 108,000 maternal and child deaths and 360,000 new HIV infections over a four year period.
Brooks et al. (2019), using data from 26 countries in sub-Saharan Africa between 1995-2014, found that when the policy was in place, abortion rates rose by 40%, use of modern contraceptives declined by 14%, and pregnancies increased by 12%.
Rodgers (2018), using data from 51 countries between 1994-2008, assessed the impact of the policy on abortion rates before and after its reinstatement in 2001 by President George W. Bush, finding that the policy was associated with a threefold increase in the odds of women getting an abortion in Latin America and the Caribbean and a twofold increase in sub-Saharan Africa; there was no net change in the Middle East and Central Asia. They also found that there was no consistent relationship between strict abortion laws and abortion rates.
Bendavid et al. (2011), using data from 20 African countries between 1994-2008, found that women had 2.55 times the odds of having an induced abortion after the policy’s reinstatement and that the prevalence of contraceptive use was almost 2% lower.

Disruption and Gaps in Family Planning Services

Numerous studies have documented disruption and gaps in family planning services when the policy has been in place. For example, a recent quantitative analysis of the policy during the Trump administration, based on data from eight countries in sub-Saharan Africa, found that health facilities provided fewer family planning services, including fewer short-acting methods, long-acting reversible contraceptives (LARCs), and emergency contraception (Brooks et al., 2023). Studies in Ethiopia also found statistically significant declines in the use of LARCs and short-acting methods under the Trump administration’s policy (Sully et al., 2023) and decreases in the proportions of facilities reporting family planning provision through community health volunteers, mobile outreach visits, and family planning and postabortion care service integration, as well as increases in contraceptive stock-outs (Sully et al., 2022).

A recent GAO analysis (2022) documented delays, gaps, and disruptions in the provision of family planning services in Senegal, Uganda, and the West Africa region due to the Trump administration’s policy. Similarly, the Department of State (2020), in its second review of the expanded policy during the Trump administration, found that although agencies and departments made efforts to transition projects to another implementer to minimize disruption, gaps and disruptions were sometimes reported when recipients of U.S. funding declined to accept the policy. An analysis by Sherwood et al. (2020) found significant decreases in services offered by PEPFAR implementing organizations, including reductions in the delivery of information about sexual and reproductive health, pregnancy counseling, contraception provision, and HIV testing and counseling, due to the policy.

Qualitative analyses have also found disruptions and gaps in family planning and other services – including clinic closures, loss of staff, reduction in services, and increased commodity insecurity – during the Trump administration’s policy, including in: Ethiopia (Vernaelde 2022; PAI 2018), Kenya (Ushie, et al., 2020; Human Rights Watch 2017), Madagascar (Ravaoarisoa et al., 2020; MSI 2018), Nepal (Puri et al., 2020; Adhikari 2019; PAI 2018), Nigeria (PAI 2018), South Africa (du Plessis et al., 2019), and Uganda (MSI 2018; PAI 2018; Human Rights Watch 2017).

Analyses of the impacts of the policy during prior administrations also found disruptions and gaps (see, for example, Jones 2015; GGR Impact Project 2003-2006).

Reduction in Service Integration

Studies have also examined how the policy might affect service integration and/or documented impacts on integration. For example, a study in PEPFAR countries found a high risk of disruption in integration of family planning and HIV services (Sherwood et al., 2018) under the Trump administration’s policy. Disruption of service integration was documented in Cambodia (Frontline AIDS & Watipa 2019), Ethiopia (Sully et al., 2022), and the West Africa region (GAO 2022).

Over-Implementation and Chilling Effect

Several studies have documented an “over-implementation” of the policy (that is, implementers, providers or others taking steps to curtail services beyond what was required by the Mexico City Policy), resulting in further limitations. This was found in a survey of PEPFAR implementers (Sherwood et al., 2020) as well as in qualitative research in Malawi (Iyer et al., 2022), Nigeria (Rios 2019), and interviews with broader groups of stakeholders (Planned Parenthood Global 2019), among other studies. Similarly, several studies cited a “chilling effect” among implementers and others, resulting in reluctance to provide services or partner with certain organizations even where abortion was legal. This was found in Kenya (Maistrellis et al., 2022), Nepal (Maistrellis et al., 2022; Tamang et al., 2020), Nigeria (PAI 2018), and Uganda (PAI 2018).

Confusion

Confusion about the policy, including what is required, has been documented throughout its history. For example, the Department of State (2018), in its initial six-month review of implementation of the Trump administration’s policy, found a number of areas needing clarification to reduce confusion. Specifically, the review directed agencies to provide greater support for improving understanding of implementation among affected organizations and provide additional guidance to clarify terms and conditions. A range of qualitative analyses have similarly documented confusion about the expanded Trump policy including among respondents in Cambodia (Frontline AIDS & Watipa 2019), Ethiopia (PAI 2018), Kenya (Rios 2019), Malawi (Frontline AIDS & Watipa 2019), Nepal (Puri 2020; Rios 2019), Nigeria (Rios 2019), and South Africa (Rios 2019), and among key informants in multiple other settings (PPFA, CHANGE).

Confusion about the policy has even been found during times when it was not in place. For example, one study found that even after the policy was rescinded by the Obama administration, interviewees in Nepal reported a range of misunderstandings from believing that all U.S. abortion restrictions were lifted to believing that the policy was still in place, and interviewees also often conflated the policy with the Helms Amendment, which prohibits U.S. funding for the performance of abortion (Ipas & Ibis Reproductive Health 2015). Similar confusion was found in Ethiopia after the policy was rescinded (Leitner Center for International Law and Justice 2010).

Loss of Civil Society/NGO Coordination and Partnerships

Several studies have documented negative impacts of the policy on civil society, including on partnerships and networks. This was found in Ethiopia (Vernaelde 2022; PAI 2018), Kenya (Maistrellis et al., 2022; Ushie et al., 2020; Rios 2019), Nepal (Dhakal et al., 2023; Maistrellis et al., 2022; Puri et al., 2020; PAI 2018), Senegal (PAI 2018) and South Africa (du Plessis et al., 2019). For example, organizations in Cambodia (Frontline AIDS & Watipa 2019) felt that the policy led to reputational risk and affected their partnerships, and coalitions in Malawi reported that the policy resulted in fragmentation, tension and mistrust.

Increased Administrative Burden

Finally, studies have documented the administrative and cost burden associated with implementing and monitoring compliance with the policy, including that it increased workload and required implementers who refuse to agree to the policy to spend time and resources searching for new partners and training them. This was found, for example, in Kenya (Rios 2019), Nepal (Puri et al., 2020), Nigeria (Rios 2019; PAI 2018), South Africa (Rios 2019), and Uganda (PAI 2019; PAI 2

Methods

To identify literature documenting the impact of the Mexico City Policy, we employed a multi-pronged search strategy. First, we searched for literature using Google Scholar and targeted follow-up searches of key organizations websites for documents that had the keywords “Mexico City Policy” or “Global Gag Rule” and “impact.” We reviewed those documents for relevance and for additional references. We also used selected other scoping and literature reviews to identify additional documents for review. This yielded a total of 129 documents, of which 71 were included for analysis (we excluded documents that were only descriptive or speculative in nature and did not include findings of impact, or documents that reported on impacts from other studies). We included only resources published from 2001 through the present. For each document, we assessed: the method(s) employed; main findings; the presidential administration(s) assessed or studied; geographic scope; and the type of literature (e.g., peer reviewed, government document).

Impact of Mexico City Policy: Literature Review

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VOLUME 3

July 11, 2024

This is Irving Washington and Hagere Yilma. We direct KFF’s Health Misinformation and Trust Initiative and on behalf of all of our colleagues across KFF who work on misinformation and trust we are pleased to bring you this edition of our bi-weekly Monitor.

KFF Authors:

Irving Washington , and

Hagere Yilma

This edition focuses on intentionally false or misleading information online and its potential impact on public trust in health care. We share a recent report that exposed a covert U.S. military social media disinformation campaign in the Philippines that may have undermined public confidence in vaccines. We also examine how false claims about sunscreen and non-FDA-approved “miracle cures” may be discouraging people from taking important preventative measures and seeking legitimate medical treatment. Finally, we explore the rise of counterfeit diabetes and weight-loss drugs like Ozempic and the potential impact on trust in the pharmaceutical supply chain.

Recent Developments

US Military’s Covert Anti-Vaccine Disinformation Campaign in the Philippines

A photograph of a person holding a vaccine and a syringe — Tetra Images/*Getty Images*

In June, a Reuters investigation revealed that the U.S. military conducted a covert anti-vaccine disinformation campaign in the Philippines between 2020 and 2021. As a part of the campaign, U.S. military officials used fake social media accounts to spread false information to people in the Philippines about COVID-19 equipment from China. This included masks, test kits, and the Chinese Sinovac vaccine, which is the first COVID-19 vaccine that was available in the Philippines. Health experts said these actions put lives at risk and undermined confidence in public health systems. The Philippines, a long-time ally of the U.S., had one of the highest COVID-19 death rates in the region and some of the lowest vaccination rates. Reuters was unable to determine the reach and impact of the disinformation campaign, but it likely hindered vaccination efforts in the Philippines. Studies suggest that any anti-vaccine campaign can potentially undermine overall public trust in vaccines.

Sunscreen Misinformation is Spreading on TikTok

A photograph of a person sitting on a beach applying sunscreen — RuslanDashinsky/*Getty Images*

A recent rise in false or misleading social media posts claiming sunscreen causes cancer is discouraging people from using it. These claims, often linked to past sunscreen recalls involving benzene, confuse consumers about the safety of oxybenzone. Unlike benzene, oxybenzone is a common sunscreen ingredient that experts say does not cause cancer and is important for protecting against UV rays that do.

Sunscreen is an important tool for protecting people from harmful UV rays and skin cancers like melanoma. Despite its proven benefits, these claims reflect concerns that young adults have about sunscreen’s safety. According to a nationally representative survey conducted for the Orlando Health Cancer Institute, one in seven (14%) adults under 35 mistakenly believe that daily sunscreen use is more damaging to the skin than direct sun exposure. Health professionals can work to debunk or refute these claims, as skin cancer is the most common form of cancer in the U.S. and consistent sunscreen use remains one of the most effective ways to prevent it.

A photograph depicting bottles with organic remedies — Iryna Veklich/*Getty Images*

Social media users have seen an increase in “miracle cures” and detoxes for cancer, but many of these remedies lack scientific support and may even be harmful. Memorial Sloan Kettering Cancer Center has debunked several of these unproven treatments, such as cannabis oil, which is often marketed as a cancer treatment despite the lack of clinical trials supporting its efficacy. Similarly, Sloan Kettering debunked the effectiveness of detox diets, explaining that the body naturally detoxifies itself and that these diets can lead to nutrient deficiencies and other health problems.

Social media has also fueled the popularity of unproven supplements marketed to manage menopause symptoms. Concerns and misconceptions about hormone therapy have led some women to seek natural alternatives to relieve hot flashes, night sweats, and other disruptive symptoms. However, experts caution that these menopause supplements are not FDA-approved and usually contain unregulated herbal blends that make them ineffective or dangerous. This trend highlights both the gaps in public knowledge about menopause and the prevalence of misinformation about hormone therapy, which is a safe and effective treatment for moderate-to-severe symptoms.

Emerging Misinformation Narratives

WHO Issues Warning on Rise of Counterfeit Semaglutides Like Ozempic

Fake weight-loss drugs are on the rise, potentially eroding trust in legitimate healthcare providers and pharmaceutical supply chains. In June, The World Health Organization (WHO) issued a warning about a rise in counterfeit versions of Ozempic and other semaglutides, a class of GLP-1 drugs intended for diabetes management and weight-loss.

The FDA had warned about counterfeits in the U.S. last year, but this is the WHO's first formal warning. The new warning resurfaces a false claim that Ozempic contains lizard venom. This claim comes from a misunderstanding of Ozempic’s origins. In the 1990s, researchers studied a hormone in the venom of the Gila monster that helps the lizard regulate its blood sugar during hibernation. These researchers then created a synthetic version of the hormone, ushering in a new class of diabetes drugs, including Ozempic. The Gila monster’s venom is not present in those drugs.

One conspiracy news article promoting the false lizard venom claims was originally published on June 9 and later republished on another conspiracy news website on June 23. The author wrote, “...by labeling reptile venom peptides as ‘FDA-approved medications,’ the western medicine system has quite literally figured out a way to get people to voluntarily maim or kill themselves, even while paying for the privilege of doing so.”

Conversation about the WHO’s warning on Ozempic represents only a slight bump in overall online conversations about the medication over the past two months, accounting for 4.5% of Ozempic-related posts between June 19 and June 26. It’s expected that preexisting false claims about the safety and effectiveness of Ozempic may continue to reemerge—however, these false claims won’t necessarily gain traction.

Polling Insights:

The May 2024 KFF Health Tracking Poll finds that 12% of adults say they have ever used GLP-1 drugs, including 6% who say they are currently using them. The share who report ever taking these drugs rises to about four in ten (43%) among adults who have been told by a doctor that they have diabetes, a quarter (26%) of adults who have been told they have heart disease, and one in five (22%) adults who have been told by a doctor that they are overweight or obese in the past five years (some of whom also have diabetes or heart disease; Figure 2).

One in Eight Adults Say They Have Ever Used GLP-1 Drugs, Rising to Four in Ten Among Adults Who Have Been Diagnosed With Diabetes

While most adults who have ever taken a GLP-1 drug say they got a prescription from their primary care doctor or specialist (79%), some report getting them from an online provider or website (11%), a medical spa or aesthetic medical center (10%), or from some other source (2%; Figure 3).

Most Adults Who Have Taken GLP-1 Drugs Say They Got Them From Their Primary Doctor or Specialist, About One In Four Say They Got Them From Another Source

Health Discussions to Watch

COVID-19 Vaccine Safety: On June 17, the Kansas attorney general filed a lawsuit against Pfizer for allegedly covering up COVID-19 vaccine risks, specifically pregnancy complications and heart inflammation. Social media posts in both English and Spanish used the allegations in the suit to falsely claim that COVID-19 vaccines are unsafe and ineffective. A video of the Kansas attorney general announcing the lawsuit was shared by several social media accounts on X. The single most popular post sharing the video received 782,500 views, 26,000 likes, 5,000 shares, and 459 comments as of June 26. Most comments on the post express support for the lawsuit and distrust in COVID-19 vaccine safety.

Bird Flu: As H5N1 bird flu continues infecting animals in the U.S., false claims about the origins of the outbreak are appearing on social media platforms, primarily on X. Some recent viral posts on X falsely claim that the bird flu outbreak is a “plandemic” created by the government to sway election results, increase profits for pharmaceutical companies, and harm farmers. One social media post on X shared a news clip about a bird flu outbreak on an Australian farm. The text of the post read, “More sinister Globalist tactics to attack farmers, reduce food production & bring back more experimental vaccines.” That post received 319,800 views, 7,200 likes, 4,700 shares, and 1,400 comments as of June 26.

Research Updates

Fact-Checking and Media Literacy Efforts Reduce Misinformation Belief, but Heighten Skepticism Toward Accurate Information

A study published in Nature Human Behaviour looked at how fact-checking and media literacy interventions affect people in the US, Poland, and Hong Kong. The study found that while these efforts were effective in reducing belief in false information, they also increased skepticism about accurate information. This unintended consequence highlights the challenge of maintaining trust in reliable health information amid efforts to combat misinformation. Health professionals may need to adopt nuanced strategies that minimize distrust while effectively addressing health misinformation in public communication.

Source: Hoes, E., Aitken, B., Zhang, J., Gackowski, T., & Wojcieszak, M. (2024). Prominent misinformation interventions reduce misperceptions but increase scepticism. Nature Human Behaviour, 1-9.

Impact of Misinformation Concerns on News Choices

A study from the Harvard Misinformation Review looked at how concerns about misinformation affect people’s news choices. The study found that that people who are more worried about false information tend to choose news that matches their political views. For example, liberals who are worried about misinformation tended to favor sources like MSNBC or the Huffington Post. Democrats were especially likely to favor news that matched their political views when worried about misinformation. Feeling confident about spotting false information did not change this behavior. These findings show how concerns about misinformation can lead people to only read news that aligns with their beliefs. This can deepen political divisions and make it more challenging to address false or misleading information in public discussions.

Source: Harris, E. A., DeMora, S. L., & Albarracín, D. (2024). The consequences of misinformation concern on media consumption. Harvard Kennedy School (HKS) Misinformation Review. https://doi.org/10.37016/mr-2020-149

AI and Emerging Technologies

A photograph of a person typing at a keyboard - with a search box overlaid on top of the photo — Chadchai Ra-ngubpai/*Getty Images*

Google’s AI Overviews Feature

In May, Google unveiled its AI Overview feature, which is designed to help consolidate and streamline searches for users. Now, when you search for something on Google, a short answer summarizing results from reliable sources will appear at the top of that Google search. However, ABC notes concerns that these summaries may prioritize convenience over accuracy. The system pulls from a variety of web sources, including blogs and satirical sites, and has had some early challenges with inaccurate answers that were difficult for users to verify. To address this, Google is limiting how frequently AI Overviews draws its information from these unreliable sources and will begin providing links to the original sources. The potential for AI Overviews to provide users with accurate and reliable health information depends on its ability to adapt to evolving disinformation tactics and improve transparency around information sources.

About The Health Information and Trust Initiative: the Health Information and Trust Initiative is a KFF program aimed at tracking health misinformation in the U.S., analyzing its impact on the American people, and mobilizing media to address the problem. Our goal is to be of service to everyone working on health misinformation, strengthen efforts to counter misinformation, and build trust.

View all KFF Monitors

The Monitor is a report from KFF’s Health Information and Trust initiative that focuses on recent developments in health information. It’s free and published twice a month.

Support for the Health Information and Trust initiative is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed do not necessarily reflect the views of RWJF and KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. The Public Good Projects (PGP) provides media monitoring data KFF uses in producing the Monitor.

Poll Finding

Polling Insight: Republican Women Voters on Abortion

Authors: Ashley Kirzinger, Audrey Kearney, and Isabelle Valdes

Published: Jul 10, 2024

Ahead of the 2024 Republican National Convention, the party has softened its language around access to abortion in a draft version of the party platform, mirroring the stance of the former president and Republican nominee, Donald Trump. Many major media outlets report that this platform change is likely a move to reduce vulnerability on the issue of abortion in the run up to the election. In fact, this will be the first time in 40 years that the Republican Party’s platform does not call for a federal ban on abortion.

While a majority of rank-and-file Republicans oppose a law guaranteeing a nationwide right to abortion, many support laws allowing access to abortion in certain situations. For example, most Republican and Republican-leaning independent women voters say they support leaving it up to the states to decide whether abortion is legal (60%) or a law establishing a nationwide ban on abortion after 15 weeks of pregnancy (57%). But large majorities of Republican women also support laws protecting access to abortion for patients who are experiencing pregnancy-related emergencies (79%) and a federal law protecting access to abortions in the case of rape or incest in all states even where abortion is banned (69%).

Republican women of reproductive age, ages 18 to 49, hold slightly less conservative views on abortion policies and a slim majority support a law guaranteeing a nationwide right to abortion (53%). Similar shares of younger Republican women voters support leaving it up to the states to decide whether abortion is legal (54%) or support a nationwide ban on abortion at 15 weeks (53%). With about half of younger Republican women voters supporting each of these three policy proposals, it is clear that there is some uncertainty among these voters on how abortion access should be addressed at the federal level. Still, most younger Republican women support access to abortion in certain cases, most notably in instances where patients are experiencing pregnancy-related emergencies.

Republican Women Voters Support Laws Protecting Abortion Access in Certain Cases, Younger Republican Women Also Support Nationwide Access

Republican women voters’ views on abortion are not monolithic. While most (58%) Republican women voters identify as “pro-life,” many (40%) say on the issue of abortion they are more “pro-choice.” In addition, half of Republican women voters think abortion should be legal in all or most cases, the same as the share who say abortion should be illegal. Just 13%, or about one in eight, Republican women voters say abortion should be illegal in all cases.

Once again, views differ slightly by age, with similar shares of Republican women voters of reproductive age (ages 18 to 49) saying they identify as “pro-life” (49%) and “pro-choice” (51%), while two-thirds of older Republican women voters identify as “pro-life.” In addition, a majority (56%) of younger Republican women voters say abortion should be legal in at least most cases, including one in five who say abortion should be legal in all cases.

Many Republican Women Voters, Especially Younger Women, Say Abortion Should Be Legal, Identify as Pro-Choice

While two-thirds of Republican women voters say they trust former President Trump to do a better job deciding abortion policy in this country compared to President Biden, a quarter of Republican women say they trust neither presidential candidate to do a better job on this issue. Additionally, one in three Republican women voters (34%) say neither political party does a better job of looking out for the interests of women. In fact, 16% of Republican women of reproductive age say they think the Democratic Party does a better job of looking out for the interests of women than the Republican Party.

Most Republican Women Say the Republican Party Does a Better Job of Looking out for Women, but Younger Republican Women Are Divided

Once a cornerstone issue for the Republican Party – with most single-issue abortion voters being pro-life and Republican prior to the Dobbs decision – abortion is no longer a top voting issue for Republican voters since Roe v. Wade was overturned. Fewer than one in ten Republican women (7%) say abortion is the most important issue to their vote (compared to 13% of Democratic women voters), well behind issues such as inflation (47%) and immigration (26%). Abortion also ranks lower than inflation for independent women (10%) alongside immigration and threats to democracy as their most important voting issue. The dashboard shows how abortion ranks as a voting issue for the different groups of women voters including partisans, across age groups, and race and ethnicity.

While the issue may not be motivating Republican women to go to the polls (just 3% of Republican women voters say they would only vote for a candidate who agrees with them on abortion), the party’s overall stance – which had been largely seen as anti-abortion – may be disenchanting some voters.

The KFF Survey of Women Voters, conducted earlier this summer, shows many women voters, including Republican women, are not satisfied with their choices of presidential candidates. While Republican women report being slightly more motivated to vote compared to Democratic women, younger Republican women largely feel like the Republican Party doesn’t share their views on reproductive health issues and want abortion to be legal in most cases. While many early reports about the drafted changes to the Republican National Convention party platform speculate that they are written to appease the Republican nominee for President, these changes also, perhaps coincidentally, could help the party appeal to a key voting base – Republican women.

The Growing Role of Foreign-Educated Nurses in U.S. Hospitals and Implications of Visa Restrictions

Authors: Drishti Pillai, Matthew Rae, and Samantha Artiga

Published: Jul 10, 2024

Registered Nurses (RNs) play a key role in the health care workforce and contribute to the health and well-being of millions of Americans, working in hospitals, nursing homes, physician’s offices, and home health services. The profession has been experiencing shortages, which were exacerbated by the COVID-19 pandemic and are predicted to continue over the next decade as the 65 and older population in the U.S. grows, increasing health care needs. Demand for nurses will also likely increase to meet new requirements for nurse staffing levels in nursing facilities.

Immigrant workers could help address these needs. As of 2022, there were about 500,000 immigrant nurses in the U.S., accounting for about one in six of the close to 3.2 million RNs.¹ However, immigration remains a hot-button political issue with ongoing anti-immigrant rhetoric and recent actions and proposals to limit immigration and immigrants’ role in the workforce. These actions include the federal government extending its pause on the processing of new visa applications for international nurses in June 2024. The pause has been in place since April 2023 and, at this time, the government is only processing applications submitted on or before December 2021. Legislation has been proposed to increase employment-based visas for nurses, although it has remained stalled since 2023. Visa opportunities for nurses could also potentially be expanded through administrative action, for example via H-1B visas, though they would have limitations.

These visa restrictions could exacerbate existing shortages in the nursing workforce and negatively impact the U.S. labor market and economy more broadly, particularly given the growing role of foreign-educated nurses in U.S. hospitals. KFF analysis of data from the American Hospital Association (AHA) Annual Survey shows that the overall share of hospitals reporting hiring foreign-educated RNs has nearly doubled between 2010 and 2022, and a growing share of hospitals report hiring an increasing number of foreign-educated RNs to fill vacancies over time.

Overall, 32% of hospitals accounting for nearly half (45%) of all hospital beds say they hired foreign-educated RNs in 2022, twice the share in 2010, when 16% of hospitals accounting for about a quarter (23%) of all hospital beds said they hired foreign-educated RNs (Figure 1). In addition, between 2010 and 2022, the share of hospitals saying they hired more foreign-educated nurses to help fill RN vacancies compared to the previous year rose from 2% of hospitals representing 3% of hospital beds to 14% of hospitals representing 22% of hospital beds (Figure 2).

The Share of Hospitals That Have Recruited Any Foreign-Educated Nurses Has Nearly Doubled Between 2010-2022

The Share of Hospitals Saying They Recruited More Foreign-Educated Nurses Compared to the Prior Year Has Grown Over Time

KFF analysis of 2022 American Community Survey. ↩︎

Democratic Women Voters See Vice President Harris As Trusted Messenger on Abortion Policy

Also of Interest

Donor Government Funding for HIV in Low- and Middle-Income Countries in 2023

Overview

Key Findings

Key Findings

Report

Introduction

Findings

Total Funding

Bilateral Disbursements

Multilateral Contributions

Fair Share

Looking Forward

Methodology

Appendix

Endnotes

DOWNLOAD

Also of Interest

Immigrants Have Lower Health Care Expenditures Than Their U.S.-Born Counterparts

Introduction

Findings

Also of Interest

Polling Insight: 4 Key Takeaways About Hispanic Women Voters Nationally and in Arizona

#1: Inflation Is the Most Important Election Issue for Hispanic Women Voters; Most Worry About Affording Basic Expenses

#2: Hispanic Women Voters Are Frustrated, Dissatisfied With Options for President; Younger Voters Are Particularly Disaffected

#3: In Arizona, a Key Battleground State, the Arizona Right to Abortion Initiative May Drive Turnout Among Younger Hispanic Women Who Support Abortion Rights

#4: President Biden Has the Advantage Among Hispanic Women in Arizona on Abortion, Though Many Still Trust “Neither Candidate”

Also of Interest

KFF Analysis Finds That Firearms Were Involved in 79% of Homicides and 55% of Suicide Deaths in 2022

Firearm-Related Deaths Rose Sharply Over the Last Decade, From 92 deaths Per Day in 2012 to 132 Deaths Per Day in 2022

Contact

Also of Interest

Three Questions about Firearm Deaths: Key Patterns from a Decade of Data

How have the amount and distribution of firearm deaths changed over time?

What are trends in firearm deaths by demographic?

How do firearm deaths vary by state?

News Release

Also of Interest

Impact of the Mexico City Policy: Literature Review

Issue Brief

Overview

Findings

Reach and Impacts of the Policy

Reach

Effects on Abortion Rates, Contraceptive Prevalence, and Pregnancy

Disruption and Gaps in Family Planning Services

Reduction in Service Integration

Over-Implementation and Chilling Effect

Confusion

Loss of Civil Society/NGO Coordination and Partnerships

Increased Administrative Burden

Appendix Table

DOWNLOAD

Also of Interest

Anti-Vaccine Disinformation Campaign, Sunscreen Myths, and Counterfeit Ozempic on Social Media

KFF Authors:

Recent Developments

US Military’s Covert Anti-Vaccine Disinformation Campaign in the Philippines

Sunscreen Misinformation is Spreading on TikTok

Unproven Health Remedies and Supplements Promoted on Social Media

Emerging Misinformation Narratives

WHO Issues Warning on Rise of Counterfeit Semaglutides Like Ozempic

Health Discussions to Watch

Research Updates

Fact-Checking and Media Literacy Efforts Reduce Misinformation Belief, but Heighten Skepticism Toward Accurate Information

Impact of Misinformation Concerns on News Choices

AI and Emerging Technologies

Google’s AI Overviews Feature

Polling Insight: Republican Women Voters on Abortion

Also of Interest

The Growing Role of Foreign-Educated Nurses in U.S. Hospitals and Implications of Visa Restrictions

Also of Interest