Obama's 2010 budget contains some recommendations that should buoy those of us working to improve women's reproductive health, but it also contains a dose of heartache.
Written by Marilyn Keefe for RHRealityCheck.org - News, commentary and community for reproductive health and justice.
It's here - President Obama's much anticipated (at least among Washington policy geeks) budget request to Congress for fiscal year 2010, which begins on October 1, 2009. While the stripped down budget released in February provided few clues about the direction of the new administration, the more detailed FY 2010 President's Budget Appendix gives us a clear view of the Obama Administration's priorities for FY 2010.
The budget proposal - nearly 1400 pages of it - is our new president's first opportunity to communicate to Congress and the public a comprehensive blueprint for his domestic and international spending goals. While federal lawmakers are unlikely to rubber stamp Obama's requested funding levels and policy proposals, they are certain to carry significant weight as members grapple with shortfalls that will make it impossible to meet all the challenges the nation faces.
The budget contains some recommendations that should buoy those of us working to improve women's reproductive health, but it also contains a dose of heartache. Below are a few of the key reproductive health decisions reflected in the President's Budget.
- Expands Medicaid Family Planning: The Administration is supporting a proposal to allow states to expand family planning services to individuals with incomes up to 200 percent of the federal poverty level, without seeking special permission from the federal government to do so. This is long overdue and was a high priority for the National Partnership and other women's health advocates.
- Provides a Modest Increase to Title X Family Planning Program: The Administration is proposing to increase funding for the national family planning program by a scant $10 million, which would put funding for the beleaguered program at $317.5 million. The Title X clinic system - which provides basic primary reproductive health care services to nearly five million men, women, and adolescents across the country - has suffered serious financial challenges for years. Truth be told, it needs a major influx of money to meet client demands and support the President's stated priority of reducing unplanned pregnancy. Still, even this small increase is a step in the right direction in a tight budgetary environment.
- Increases Support for International Family Planning Programs: In the most straightforward boost for women's health, the president proposes a total of $591 million for international family planning programs, an increase of $46 million over last year's budget of $545 million. $50 million of this funding is slated for the United Nation's Population Fund (UNFPA) for family planning services and information.
- Lets the District of Columbia Support Abortion Services. In the plus column, the proposed budget would allow the District of Columbia to use its own locally raised revenue to fund abortion services for low-income women (yes, DC is currently prohibited from using non-federal funds for abortion - the only jurisdiction in America with this type of prohibition).
- Slashes Abstinence-Only Programs and Replaces them with Teen Pregnancy Prevention Initiative - Better But Far from Perfect: In seeking to shift funding away from abstinence-only programs to those that reduce teen pregnancy, the Administration got part of the equation right. The elimination of $99 million for Community-Based Abstinence Education Programs (CBAE) and $50 million for the Title V undeniably are worth cheering. At the same time, the new budgetary language creates a Teen Pregnancy Prevention Initiative funded at $110 million to support "community-based and faith-based efforts to reduce teen pregnancy using evidence-based and promising models." That may open the door for more federal funds for the ineffective, discredited abstinence-only programs that put our youth at risk. If so, it's a big mistake.
So, what's not to like? As always, the devil is in the details. First, as previously noted, the President's proposal leaves the door open to continue some funding for abstinence-only programs. According to the White House, $75 million is for "programs that replicate the elements of one or more teenage pregnancy prevention programs that have been proven through rigorous evaluation to delay sexual activity, increase contraceptive use (without increasing sexual activity) or reduce teen pregnancy." $25 million would be for research and demonstration grants to "develop, replicate refine and test additional models and innovative strategies for preventing teen pregnancy" - which could well include abstinence-only programs. The budget also includes $50 million for States territories and tribes to use for teen pregnancy prevention.
While this Teen Pregnancy Prevention Initiative is a significant and welcome departure from ideologically charged abstinence-only programs, we know our young people today face myriad challenges when it comes to protecting their sexual and reproductive health. These include preventing an unwanted pregnancy, but also protecting themselves from sexually transmitted infections (STIs), including HIV/AIDS, and managing peer pressures on several fronts. The narrow focus seems to miss an opportunity to expand the availability of more comprehensive sex education programs that also focus on HIV/AIDS prevention, STI prevention, and building healthy relationships.
In addition, the President's budget contains one huge disappointment:
- Fails to Remove Abortion Restrictions. Reproductive health advocates were looking for the budget to draw a line in the sand on abortion care - as the Clinton Administration did - and take the principled stance across-the-board that abortion care should be covered and paid for just the same as all other health services. Unfortunately, the proposed Obama budget falls well short of that goal. Instead, it continues the bans for virtually all women who rely on the government for health care including women covered by Medicaid, federal employees, Peace Corps volunteers and women in prison - a sharp and unacceptable departure from the majority of privately insured women.
There's agony to go with the ecstasy, and perhaps more than anything real disappointment with the too prevalent view that compromise on reproductive health issues is necessary to foster bipartisan dialogue in this country.