The Introduction provides an overview of U.S. foreign aid policy from Truman to Trump, including the creation of key agencies and programs such as USAID, Food for Peace, and the Millennium Challenge Corporation. It highlights the long-standing conflict in U.S. foreign aid policy between supporting the common good and furthering the United States' security interests. The chapter then addresses the many foreign policy tools available to the United States in promoting human rights abroad and situates foreign aid in this context. It concludes by introducing the core argument and structure of the book.

Chapter 1 begins with a discussion of why states resort to the use of violence against their citizens. It then presents a theory of the coercive effect of foreign aid based on the phenomenon of aid fungibility, which enables foreign assistance to be used as a general government resource. The coercive effect of foreign aid explains how bilateral (government-to-government) foreign aid can be as easily channeled into state violence as into economic development. The result is that states may, through foreign aid, come to possess the resources necessary to violently repress their citizens.

This chapter tests the plausibility of the coercive effect of foreign aid through statistical analyses. Data on U.S. bilateral foreign assistance flows over the past forty years is used to identify broad trends in the relationship between foreign aid and various forms of state violence, including state-led killings, torture, and government repression. Other relevant factors such as the country's political regime type, natural resource wealth, level of government service provision, armed forces size, and past history of conflict are taken into account. The results show that U.S. foreign assistance is in fact associated with negative changes in a range of human rights–related behaviors. Economic aid, in particular, is found to worsen human rights.

This chapter presents a deep historical analysis of American (and to a lesser degree, Soviet) foreign assistance to Indonesia from its independence in 1949 to the present. Foreign aid played a direct role in building up Indonesia's military strength. Economic aid from the United States, as well as Export-Import Bank loans, also contributed to the military through an income effect. The U.S. government used economic aid, and in particular, food aid, to provide general budgetary support for Suharto's government. These resources were used to fund the Tentara Nasional Indonesia (TNI), the country's armed forces. In addition to providing evidence of aid's fungibility, Indonesia illustrates the human capital dimension of the coercive effect of foreign aid. By increasing the lethality of the TNI, U.S. aid–funded military training meant that the negative effects of foreign aid for human rights endured well beyond temporary reductions or cutoffs of aid.

This chapter examines how both economic and military assistance from the United States supported the government of El Salvador's brutal civil war with the FMLN. The vast quantity of food aid and cash transfers (which constituted the majority of U.S. economic assistance) not only staved off the country's economic collapse but also underwrote the entirety of El Salvador's military budget. Although many have singled out U.S. military assistance as a factor prolonging the civil war, this chapter demonstrates the additional damage done by economic aid.

In South Korea, more than anywhere else, the United States was directly involved in developing the state's security apparatus through foreign assistance. However, the decades of authoritarian rule that followed the end of the Korean War resulted in significant government repression but few episodes of outright state violence, in spite of sustained high levels of U.S. foreign aid. This chapter argues that the presence of U.S. troops in South Korea, the threat posed by North Korea, and the noncommunist orientation of the country's political opposition constrained but did not completely eliminate the coercive effect of foreign aid.

This chapter uses statistical analysis to examine whether the coercive effect of foreign aid was simply an outcome of Cold War geopolitics, and limited to that period. By examining differences between the Cold War and post–Cold War eras, as well as the impact of the 9/11 attacks and the subsequent wars in Afghanistan and Iraq, this chapter presents evidence that the coercive effect of foreign aid persists today. It offers additional evidence that the harmful effects of U.S. foreign assistance are driven primarily by economic aid. The chapter concludes with an analysis of the human rights impact of U.S. foreign assistance in South Sudan, the world's newest country.

The Conclusion highlights the main findings of the book. It then turns to the current debate over the future of U.S. foreign assistance policy, which is shaped by low levels of American public support for foreign aid and fears over geostrategic competition with China. It explores ways to avoid the coercive effect of foreign aid, including turning foreign aid over to NGOs instead of governments, and dramatically reducing U.S. foreign assistance. It argues that foreign aid will become a tool for promoting human rights only when governments act to remedy the negative effects of U.S. foreign assistance policy.