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Since Congress authorized it more than 40 years ago to work on family planning and population issues, the US Agency for International Development (USAID), the largest bilateral donor to family planning programs in developing countries, has played a dominant role among donors as a source of money, information and ideas. In this Essay, CGD director of programs and senior fellow Ruth Levine assesses USAID's many accomplishments, including its support for multi-round, multi-country Demographic and Health surveys, which give analysts and policymakers crucial information on family planning, fertility, maternal and child health conditions, health service use and, in recent years, knowledge and practices related to HIV/AIDS. She also discusses the political debates surrounding the use of public dollars to promote contraception and the legacy of the early US focus on family planning to achieve demographic aims (reducing the rate of population growth in high-fertility countries), that have diminished the Agency's efforts to improve family planning.