The 1994 International Conference on Population and Development held in Cairo recognized the centrality of reproductive health to human rights and development. Progress on the Cairo agenda has slowed for numerous reasons, however. The United States, once an enthusiastic promoter of this agenda and still the world's leading reproductive health donor, has revised its reproductive health policies radically since the 2000 presidential election of George W. Bush. This study examines how policies have been reconfigured in five key reproductive health areas, sparking controversy both in the United States and internationally. These categories are the content of sex education, access to emergency contraception and to abortion services, condom effectiveness, and HIV/AIDS prevention. The analysis presented here elucidates how ideological considerations have superseded public health and ethical concerns and reflects on health and ethical consequences.