The presidential candidates have been challenged with the same question again and again: In our unprecedented economic crisis, what programs or services will you have to cut from the plans you have laid out for our country? 

Perhaps it's not a surprise that neither Sen. Barack Obama or Sen. John McCain dwells too long on what, in particular, will lose its funding in the next year. But truth may be revealed by omission; that is, an issue that the candidates don't discuss much on stump speeches, interviews and debates probably isn't their unqualified spending priority.

That should make those who use and support publicly funded birth control - the "Janes" if you will - nervous.

There are 17 million American women who need subsidized contraception services and supplies, including 4.9 million teenagers and 11.8 million adult women whose income is below or just above the federal poverty line, according to the Guttmacher Institute.

Lauren is one of them. The 20-year-old California native receives a reduced rate for birth control through the Family Planning, Access, Care and Treatment (FamilyPACT) program in her state. FamilyPACT provides no-cost reproductive health services and contraception to men, women and teens of child-bearing age and ability.

Lauren says that lots of her friends and family members "have been just stoked to walk out of Planned Parenthood or their local health department with whatever birth control they want, entirely free. It's almost a foreign concept." But she also said that the positive affects of FamilyPACT reach far beyond any one individual's pocketbook and peace of mind.

"(FamilyPACT has) been shown to reduce rates of unintended pregnancy all around," she says. "It also allows people in California the rare opportunity to have one aspect of their health completely taken care of, free of charge. "

FamilyPACT is sponsored by the California government. Together, federal and state governments spent $1.26 billion on family planning services and supplies in FY 2001. The largest source of those funds: Medicaid, with $770 million spent on reimbursing providers of medical care for the contraceptive services they supply to those who need help to afford care.

Shalyn is an 18-year-old from California who receives a reduced contraception rate through Medicaid.

"I think the impact is enormous and allows people to take their health in their own hands," says Shalyn.

She too sees these services as under threat, however--a threat that she says is caused by the myopia of those who aren't directly affected by the program.

"I get the feeling a lot of the people who do not receive direct benefits from these programs think they are unnecessary and think it wouldn't be a bad idea to cut them drastically in times were money is tight," she says.

Without the support of Medicaid for reproductive health services, "some people would probably resort to methods that are free, but are not as effective, like pulling out," Shalyn says. "Unwanted pregnancies and welfare rates would go up. The people who get help from these programs can't pay for their own medical care, [so] how are they supposed to pay for prenatal care and an unplanned child?"

While Medicaid has a broader health focus, Title X of the Public Health Service Act stands out as the only federal program exclusively dedicated to family planning. Fifteen percent of all public funding for family planning comes from Title X, which, in FY 2001, translated into $189 million. According to the Guttmacher Institute, Title X serves men and women "who do not meet the narrow eligibility requirements for coverage under Medicaid, and sets standards for the provision of family planning services, ensuring that care is voluntary, confidential and available on a sliding-fee scale or free for the poorest of the poor." Funding for Title X is 61% lower today than it was in 1980, when inflation is taken into account, says Guttmacher. An annual Congressional appropriation provides the core funding for Title X programs. This appropriation, plus Medicaid reimbursements and other Federal sources account for more than half of Title X-funded clinics' operational funds.

Each dollar invested in Title X family planning saves $3.80 in Medicaid costs for pregnancy-related health care, including care of newborns.

Without publicly funded birth control and services, Lauren sees a daunting future for her community, where "young and older adults alike wouldn't be able to afford contraception ... I think pregnancy and STI rates would shoot through the roof. ... There's no way in hell many women will be willing to be prodded in stirrups when they'll have to pay an arm and a leg for it, then be sent home with a $420+ prescription for a year of birth control pills."

The threat of that future, though, is uncomfortably present. The last time Lauren went to her clinic, the place was plastered in fliers that urged visitors to write letters to their lawmakers, asking them not to cut funding for FamilyPACT. Not to mention the more coded threat encroaching on their work: Lauren has noticed the tendency for crisis pregnancy centers to set up shop quite close to the clinics that offer a full--and honest--scope of reproductive health services.

In Washington, RH Reality Check's Heather Corinna participates in a program similar to FamilyPACT. It's called Take Charge, and Corinna says that its reproductive services are particularly crucial for minors who are uninsured, who aren't eligible for their parents' insurance coverage, or who don't feel comfortable or safe using their parents' insurance for sexual health care.

"The most effective methods of contraception are costly, particularly those like the implant or an IUD, which means one payment of several hundred dollars upfront," Corinna says.

But through Take Charge, Corinna says, those people who are in the greatest need of contraception, but have the lowest income level, can still obtain reliable forms of birth control.

Instead of being embraced as a standard for all of Washington's citizens, this publicly funded program is also subject to political and economic pressures.  Corinna reports that "it really depends largely on the governor's race this year: if Dino Rossi wins, this (program) absolutely will be under threat.  If Christine Gregoire does, I think it will easily be protected. "

But the security of the program depends on the White House as well.

"[President] Bush not only cut family planning funding over the last eight years; he consistently put individuals in positions of power with that program who patently and openly did not support the very service it is supposed to provide, [people] who were anti-contraception," Corinna says. "I have no reason to believe that a McCain/Palin win would not continue the same sorts of practices."

Should reproductive health services be knifed under the leadership elected on November 4, Corinna says she'll find herself without the yearly check-ups she needs. What's more, she believes that "there certainly are many, many women here who would be far more hurt by the loss of this program than myself."

The numbers are astonishing: even with uncertain footing, publicly supported contraceptive services "help women prevent 1.3 million unplanned pregnancies, which would result in 632,300 abortions, 533,800 unintended births and 165,000 miscarriages," according to the Guttmacher Institute. If these programs didn't exist, there would be a 40% increase in the number of abortions in the U.S.

It must be acknowledged that publicly funded contraception and sexual health services are hardly without their troubles, outside of uncertain funding and political support. Some people who abuse the mission of these programs to serve under-resourced individuals.

Lauren says that at her clinic in California, the program runs on an "honor system" that patients can abuse.

"When you go, they ask you to self-report your income and family size," Lauren says. "Even if they see that you're covered under an insurance policy, it's common knowledge that all you have to say is ‘My parents/partner can't know I'm here,' and you get services for free."

Lauren says that her mother encouraged her to take advantage of the system.

"My mom knew I was sexually active at one point and told me to go to the health department because she didn't want to pay for my pills," she says.

Internal problems notwithstanding, the solution is hardly to decimate the state and federal funding that family planning programs depend on to serve low-income people. The nagging numbers reveal that while services need to improve, they certainly must exist, if not be expanded into a standard of healthcare and human rights.

Research proves, for example, that without publicly funded contraceptive services, an additional 386,000 teens would become pregnant, increasing the rate of teenage births by 25% and teenage abortions by 58%.

It's a direction that nobody wants our society to go in. But, when family planning barely musters as a talking point for most candidates for elected office, when the dollars are draining from every sector in the nation, how could we possibly change the direction we may be headed?

Shalyn and Lauren both have ideas for how we need to take action.

"People need to stop thinking of health care as a commodity," Shalyn says. "People need to realize that birth control and yearly paps and reproductive care are really important parts of life--personally, socially, economically, holistically."

"We must elect a president who is pro-choice and pro-contraception, and continue fighting in our own states to either keep or improve the coverage we have, or demand a family planning program where one doesn't exist," Lauren says. "We first and foremost must support Planned Parenthood and independent, feminist, women-run health clinics that fight and flounder every day to make sure money is no factor for women having a voice in their reproductive health in states with an anti-choice political atmosphere."