On February 1, President Obama sent his proposed budget for the fiscal year starting October 1, 2010 to Congress. On the domestic front, the administration’s top priority for reproductive health and rights is teen pregnancy prevention, for which the administration is recommending a significant boost in funding. With the abstinence-only-until-marriage approach of the bygone era defeated, the new initiative will emphasize an evidence-based approach to reducing teenage pregnancy and the underlying factors that put teens at risk.
On the international front, the administration has unveiled the outlines of the Global Health Initiative that the president first announced last year. Family planning and reproductive health programs and maternal and child health programs figure prominently, and the administration is recommending significant increases in both areas.
On abortion rights, however, the president is taking a pass. There can be little doubt that the fact that health care reform legislation remains in limbo has something to do with that—with the options on an ultimate compromise on abortion coverage ranging from terrible to horrible.
Also tied up in health care reform is the fate of two other key provisions: one to make it easier for states to expand eligibility for family planning under Medicaid and a second to establish new funding for home visiting programs for low-income first-time mothers.
Domestic Family Planning: Modest Improvement
A year into the Obama administration, its much-hyped initiative to reduce unintended pregnancy and thereby reduce the need for abortion has yet to emerge. In the meantime, funding for domestic family planning is nearly stagnant. As it did last year, the Title X family planning program would receive a 3 percent, or $10 million, increase, which would bring funding to $327.4 million. Many publicly funded family planning providers are struggling [19] to meet a growing need for subsidized contraceptive care, which is driven by more women wanting to postpone childbearing during tough economic times [20].
Sex Education: Where the Action Will Be
Teen pregnancy prevention is likely to emerge as a key component of the president’s “common ground” strategy around reducing the need for abortion. The issue may be especially urgent after a recent Guttmacher study [21] found that, for the first time in over a decade, teen pregnancy rates rose in 2006. The administration’s budget proposes to increase the teen pregnancy prevention program created last year by $19 million, bringing the total to $133.7 million. This new initiative is designed to fund proven, as well as promising, programs. It will be housed within the newly created Office of Adolescent Health, which will support and expand teen pregnancy prevention efforts while also addressing a broader range of adolescent health issues, such as those related to mental health, violence, substance use, nutrition and physical activity, and tobacco use. In addition, the administration is recommending that Congress create another program of grants to the states, funded at $50 million per year, to reduce teen pregnancy.
Fatherhood, Marriage and Families: A New Take on Old Themes
The budget proposes to redirect and expand existing funding to a new Fatherhood, Marriage and Families Innovation Fund. The proposed $500 million would support evaluation of comprehensive responsible fatherhood programs and efforts geared toward improving child outcomes by helping custodial parents with serious barriers to self-sufficiency. Funded activities would focus on barriers to employment and could include interventions like home visits, subsidized employment, transitional jobs, and mental health and substance abuse treatment.
Access to Abortion for Low-income Women: Not This Year
As last year, the administration has refrained from even asking Congress to consider repealing the Hyde Amendment banning federal abortion funding under Medicaid. Abortion funding restrictions riddle the federal budget and, technically speaking, come up for review annually on the various appropriations bills. Beyond Medicaid, these funding restrictions ban abortion coverage under the Federal Employees Health Benefits Program, for Native American women seeking care at Indian Health Service facilities, for Peace Corps volunteers and for women in federal prison. Last year, the president did at least ask Congress to repeal the ban on Washington, D.C.’s ability to pay for abortions with its own funds for its residents [22] on Medicaid, the way states have the option to do. Congress agreed, so that new policy would go forward into FY 2011 under the president’s budget.
International Family Planning and Reproductive Health: Steady Progress
Preventing unintended pregnancy is a core goal of the administration’s Global Health Initiative. According to the president’s budget proposal, support for international family planning and reproductive health programs would increase by about 8% to approximately $700 million, $50 million of which would go to the United Nations Population Fund (UNFPA). The increase is in keeping with Secretary of State Hillary Clinton’s January speech, in which she declared the U.S. government’s renewed support for and dedication to international family planning and reproductive health programs [23].
Maternal and Child Health Globally: A Big Leap Forward
Efforts to reduce maternal mortality and improve maternal health would gain significantly under the president’s proposal, with its new focus on maternal and newborn health. By recommending a 28 percent increase in funding, administration officials say they want to make up for lost time in this neglected area, especially in light of the looming deadlines to meet Millennium Development Goal 5, which calls for measurable improvements in maternal health by 2015. The budget proposal notes that the maternal and child health program “will also actively invest in integrating across all health programs, particularly family planning, nutrition and infectious diseases.” A 2009 study by Guttmacher and UNFPA found that maternal deaths in developing countries could be slashed by 70 percent and newborn deaths cut nearly in half if the world doubled investment in family planning and pregnancy-related care. [24]
Global Health Initiative: Up and Running
Along with the budget, the administration published an initial paper providing an overview of the Global Health Initiative [25]. A stated goal of the initiative is to invest a total of $63 billion between FY 2009 and FY 2014 on key global health programs. However, for FY 2011 the administration is recommending $8.5 billion, raising doubts about the trajectory for achieving that funding goal. Among its targets, the initiative calls for preventing 54 million unintended pregnancies by increasing contraceptive prevalence to 35 percent across assisted countries, as well as decreasing maternal mortality by 30 percent by preventing 360,000 deaths across assisted countries.
A main focus of the initiative is to have the various global health programs (including those on HIV, family planning, pregnancy care and nutrition) work better together toward saving lives and improving health in developing countries. In addition, the Global Health Initiative seeks to increase the focus on information and services for adolescent girls, including providing support for “adolescent-friendly health services; behavior change messages promoting healthy reproductive behavior and delaying age of marriage; prevention of HIV and unintended pregnancy [26]; and prevention and treatment of neglected tropical diseases.” The details are still evolving.