New Trump efforts to roll back birth control and health care access
In late February, the Trump Administration released the long-awaited funding opportunity announcement (FOA) for Title X family planning service grants, and this year’s application includes drastic changes in the kinds of programs that are likely to be funded.
The FOA provides current and prospective grantees with information about eligibility and standards. Title X is the only dedicated source of federal funding for family planning services and other preventative health care for low-income, underinsured, or uninsured people who may otherwise lack access to health care. And each year, the program has faced the threat of steep budget cuts from conservative lawmakers.
Although less attention-grabbing than 15-week abortion bans and other recent anti-choice initiatives, this year’s FOA signals the wide reach of anti-science, socially conservative ideology that has permeated the federal government since Trump’s election. Changes to this year’s FOA include an emphasis on natural family planning over FDA-approved contraceptive methods, elimination of the requirement that Title X providers follow evidence-based guidelines, and removal of the requirement for providers to offer contraceptive services on site.
“[This year’s] Title X FOA got us all nervous,” said Linda Goler Blount, president and CEO of the Black Women’s Health Imperative, a national advocacy and policy organization. “A lot of money is being diverted from evidence-based methods of contraception and what has been proven to be effective in pregnancy prevention. This will disproportionately impact rural clinics and rural communities, and we will see small, community health clinics close. This will also mean an elimination of accurate information, which will also disproportionately impact Black women and Latinas as well as white rural women.”
Each year, Title X grants prevent an estimated 1 million unintended pregnancies by providing affordable contraceptive care. And women who obtain contraceptive care services at Title X clinics often receive other reproductive health screenings. In 2016 alone, Title X funding supported about 4,000 safety-net family planning sites that collectively served 4 million women, men, and children. The same year, the funding also provided nearly 700,000 Pap tests, over 4 million STI tests (including HIV tests), and nearly 1 million women with breast exams.
Despite Title X’s proven effectiveness, it has been a frequent target of anti-choice lawmakers who have been trying to undermine or eliminate it altogether. This is partly due to the fact that although no Title X funds go toward abortion, some grantees use their own funds to provide abortions. The 2018 FOA is “part of a broader effort to undermine the Title X program,” said Jamila K. Taylor, senior fellow at the Center for American Progress. “It’s very mischievous because if you look at Trump’s budget, Title X is continuing to be funded, but then there are all these efforts to undermine the program, so it’s all a sham.”
The application changes reflect the extent of the influence of President Trump’s anti-science appointments at the Department of Health and Human Services and other top- level ideologues in the administration. “What we’re seeing is a deliberate attempt to shift away from the best possible evidence on effective, results-driven family planning care,” said Audrey Sandusky, director of advocacy and communications at the National Family Planning & Reproductive Health Association. “The priorities outlined in the funding announcement and the attempt to reshape the Title X program could disrupt important progress in public health over the last decade, where the unintended pregnancy rate and teen birth rate in the US are at historic lows.”
While promoting natural family planning over all other forms of contraception, the FOA neglects to even mention the Quality Family Planning Guidelines, nationally recognized standards jointly created by the Centers for Disease Control and the U.S. Office of Population Affairs, noted Kinsey Hasstedt, senior policy manager at the Guttmacher Institute. “The language in the FOA is also notable in promoting abstinence only until marriage, which flies in the face of the evidence-based approach to counseling adolescents articulated in the Quality Family Planning Guidelines. It encourages clinics to push these messages, which are harmful, especially for adolescents.”
The FOA suggests that the Trump administration is “opening the door to Title X going to ideological entities such as anti-abortion counseling centers,” said Hasstedt. “We are seeing a departure from an investment in public health and evidence-based policymaking that is deeply troubling."
Advocates are also concerned about the detrimental impact on other public health initiatives, particularly during a national opioid crisis. “When you change the focus to include natural family planning and abstinence-only programs, millions of women may lose access to options that better fit their health care needs,” Sean Whiting, Missouri manager of public policy and organizing for Planned Parenthood Great Plains Votes. “We have a heightened awareness of the increased risk factors of patients who use opioids. The potential loss in funding could be especially devastating to rural areas which may lack any alternatives to the HIV screening programs currently supported by Title X.”
The 2018 FOA is part of a broad anti-choice agenda, including efforts to block Planned Parenthood clinics from receiving Title X funding. “The applications are requiring proximity to health care facilities, and many Planned Parenthood clinics are in rural and/or remote areas,” said Taylor, who also noted that there is language in the FOA that is similar to that found in TRAP (Targeted Regulation of Abortion Providers) laws, which impose particularly burdensome requirements on doctors that provide abortions, as well as language that would make religious refusal easier. “Contraception and abortion are the low-hanging fruit in the attempt to cut back comprehensive reproductive health care services, and low-income people are easy targets,” she said.
The Trump administration has allowed socially conservative ideology to dictate and alter other public health programs and protocols. Religious Refusals in Health Care: A Prescription for Disaster, a new report from Movement Advancement Project and the National Center for Transgender Equality, details how the growing number of religious exemption laws put low-income people and those living in rural areas at particular risk. “When doctors can pick and choose who to serve and what care to provide based on their personal beliefs rather than medical best practices and patients’ need, it puts everyone at risk,” said Ineke Mushovic, executive director of Movement Advancement Project. “For women and other communities, such as LGBT people, people of color, low-income people, or individuals with disabilities, finding competent and qualified health care providers is already difficult enough, and health care refusals mean they don’t get the health care they need.”
The Teen Pregnancy Prevention Program, a national initiative that serves 1.2 million young people, is another target. “In July 2017, midway through a five-year grant, the Trump administration abruptly terminated Teen Pregnancy Prevention Program funding for over 80 grantees across the country,” said Charisma Troiano, press secretary for Democracy Forward, a legal organization that monitors the executive branch. “As a result, more than $200 million of funding was slashed for critical teen pregnancy prevention programs. The grantees were provided no explanation or justification for why their funding was cut.” Democracy Forward took legal action and was “particularly interested in the role abstinence-only and anti-science officials, recently appointed to posts at [Health and Human Services] by President Trump, played in the termination decision. As a result of our legal action, we have started obtaining documents, which suggest that the termination of the grants was politically motivated and that the Trump administration excluded key experts at HHS from the decision-making process.”
The message that all these actions by the Trump administration sends is clear. “Their priorities and their allegiances do not lie with the women of this country, but with their own ideological biases,” said Molly Oakley, COO for Trust Women Clinics, which provides health care, including abortions, in underserved communities. “In Kansas and Oklahoma, where two of our three clinics are, women already are subjected to punitive, unscientific, and ultimately dangerous obstacles and limitations to access to the full spectrum of reproductive services. So adding one more barrier is frustrating because it shows how little this administration really cares about the well-being of Americans.”
The long-term mission of this administration seems in line with extreme right-wing values. “The purpose is to wrest control from women, and the Trump administration's ideology is that women don't deserve to or cannot make appropriate decisions about our own bodies,” said Goler Blount. “Women of color in particular are being given a very clear message that their value to society is lower than others. It's hard for women to concede that there is a grand plan about controlling our bodies, but if you look at the policies coming out of this administration, it’s clear what's happening.”
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