Under the Trump administration, Title X — the federal family planning program — will prioritize funding for abstinence and faith-based family planning, according to the announcement finally released last week from the Department of Health and Human Services (HHS). The announcement was delayed for months, and now that it’s here, health centers, health departments, care providers, and advocates continue to have many questions and concerns.
Title X is the grant program administered by the federal government to ensure high-quality family planning and sexual health care for people who are low-income, uninsured, or underinsured. The funding goes mostly to public health departments and community health and family planning providers, including Planned Parenthood health centers, throughout the country.
Over four million people every year rely on the health care provided by Title X health care providers. For many, this program is their only source of health care and health education.
It’s also far and away one of the most successful federal programs. For every $1 invested in publicly funded family planning programs, the government saves more than $7 in Medicaid-related costs. According to the Guttmacher Institute, without the contraceptive care these health centers provide, the 2015 rates of unintended pregnancy and abortion would have been 31 percent higher and the unintended pregnancy rate for teens would have been 44 percent higher.
So, Title X saves taxpayers money and helps some of the most vulnerable people in the country — what’s not to like?
But here’s why some healthcare providers and advocates are frustrated. Under the Obama administration, the family planning program clearly focused on the spectrum of contraception options and evidence-based health care programs. In the program’s 2016 Annual Report, health care center services are described this way:
In addition to offering a broad range of effective and acceptable contraceptive methods on a voluntary and confidential basis, Title X-funded centers provide contraceptive education and counseling; breast and cervical cancer screening; sexually transmitted disease (STD) and human immunodeficiency virus (HIV) testing, referral, and prevention education; and pregnancy diagnosis and counseling.
Yet in the most recent funding request, the word “contraception” is not mentioned once. HHS says it’s looking for programs that emphasize “education and counseling that communicates the social science research and practical application of topics related to healthy relationships, to committed, safe, stable, healthy marriages” along with “activities for adolescents that do not normalize sexual risk behaviors, but instead clearly communicate the research informed benefits of delaying sex or returning to a sexually risk-free status.”
The Wall Street Journal reports,
The announcement reshapes the Title X program around conservative priorities. For the first time, it sets up a point system that favors certain characteristics, giving preference, for example, to faith-based clinics and clinics that counsel abstinence for teenagers.
The Trump administration is elevating religious organizations over health care providers and, by extension, over evidence-based healthcare practices as well. We know what works to prevent unintended pregnancy, to ensure a healthy pregnancy and safe childbirth, and to prevent STIs: medically-accurate, comprehensive sexuality education and information, as well as access to contraception and high-quality health care. Abstinence programs are proven failures at preventing pregnancy and sexually transmitted infections.
The administration is outright hostile to Planned Parenthood, and the millions of low-income people who rely on the health centers for necessary health care. Before Obama left office, he implemented a rule that prevented states from being able to discriminate against Planned Parenthood when giving out money for family planning services. But Trump rescinded that rule.
Valerie Huber, a Trump pick for HHS who helps oversee Title X, says that Planned Parenthood is eligible for Title X funding. Then again, Huber is the former President and CEO of Ascend, a large pro-abstinence organization. Title X’s new funding language mirrors Ascend’s — and Huber’s — language, using the term “sexual risk avoidance” in place of abstinence education.
In a 2016 article from Kaiser Health News, Huber seems to reject the evidence that contraception and contraceptive education helped drastically lower teen pregnancy rates:
As public health experts and policymakers, we must normalize sexual delay more than we normalize teen sex, even with contraception.We believe youth deserve the best opportunity for a healthy future.
Planned Parenthood serves 41 percent of all patients served through Title X. Without the funding, many low-income people would be left without access to the full spectrum of contraceptive options, along with non-judgmental, evidence-based sexual and reproductive health care. Dawn Laguens, executive vice president of Planned Parenthood Federation of America, told Politico:
This is a clear attempt to roll back access to the type of birth control that most women want to use. The last thing anyone wants is for Donald Trump or Mike Pence to weigh in on her sex life — but this announcement essentially invites them into the bedroom.
Research and evidence are clear: if we want a healthy society, we need to make sure we’re providing access to the information, education, and services that help people care for their health and lives.