After a year of Trump administration attacks on reproductive health services, the health and rights of Americans have already suffered measurably. The recent 50-State Report Card on Reproductive Health and Rights issued by my organization, the Population Institute, gave 18 states a failing grade for 2017, and lowered the U.S. grade to a D-. It also cautioned things could take a turn for the worse in 2018.
They just did.
{mosads}Unsuccessful (so far) at defunding federally sponsored family planning programs, the Trump administration is doing the next worst thing. It is now seeking to turn Title X, a 48-year old program that gives low-income women access to modern methods of birth control, into a program that emphasizes “fertility awareness” methods, which is a euphemism for “natural family planning,” including the rhythm method and abstinence. That’s not birth control; it’s a cynical bid to undercut Title X and set family planning back 50 years.
Title X is administered by the Department of Health and Human Services (HHS). It provides grants to family planning clinics serving low-income households. Typically, the grant application process begins around November 1 and grants are awarded by April. This year’s grant application was released on Friday, almost four months late. As a result many Title X grantees risk running out of funds before their grant application is acted upon.
That’s causing major problems, but the new guidelines show there’s more going on at HHS than tardiness. The guidelines favor entities promoting abstinence and “fertility awareness” and inexplicably drop any promotion of Long Acting Reversible Contraceptives (LARCs), a highly effective method of birth control that is rapidly gaining in popularity. The new grant process could put some family planning providers out of business.
Valerie Huber, the acting deputy assistant secretary for population affairs at HHS, likely sees that as a good thing. Huber is a long-time champion of an “abstinence-only” approach to preventing teen pregnancy, even though much government-funded research proves it isn’t effective.
Title X clinics serve a total of four million women every year. Even if they can survive the delay in 2018 funding, they may discover that their funding has been diverted this year to new faith-based entities featuring natural family planning methods which, as documented by HHS, have a high failure rate.
This isn’t incompetence. The Trump administration knows what it is doing: everything possible to deny women and teenage girls access to modern methods of contraception, regardless of where they live. Last year, the administration terminated funding for the United Nations Population Fund (UNFPA), a major provider of family planning and maternal health services in developing nations. Also by executive action, it re-imposed and expanded the scope of the “global gag rule,” which denies U.S. funding for overseas providers of global health services, if they “advocate” for or provide counseling on abortion services.
Last year in his proposed budget, President Trump called for the elimination of all bilateral assistance for international family planning assistance, a proposal rejected by Congress. Only mildly deterred, the Trump administration’s latest proposed budget seeks to slash international funding by 50 percent in 2019.
Here at home, the Trump administration has done everything in its power to eliminate the expansion of contraceptive coverage made possible by the Affordable Care Act (ACA), and it is trying again this year to defund Planned Parenthood, a major provider of family planning services under Medicaid and Title X.
While it failed in its effort to repeal the ACA, it issued new rules aimed at allowing employers with any religious or moral reservations to drop coverage of contraceptives for their employees. That rule change is under court review. Meanwhile the administration has also been trying to substitute “abstinence-only” programming for the Teen Pregnancy Prevention (TPP) programs that support evidence-based sex education curricula.
The Trump administration’s assault on reproductive health and rights is part of a larger national campaign that includes state-level attacks. In recent years several states have slashed their support for Title X clinics operating in their state and enacted anti-abortion restrictions designed to shut down abortion clinics. In an ideal world, a woman’s access to reproductive health services should not depend on where she lives, but increasingly it does, as a growing number of women are losing access to affordable family planning.
If the Trump administration succeeds this year in defunding Planned Parenthood, slashing funding for family planning or turning Title X into a promoter of abstinence and failed natural family planning methods, millions of women could be denied access to their family planning provider. If so, the number of unplanned pregnancies — and abortions — will likely rise, and the administration can tout its great success in boosting “fertility awareness.”
Amnesty International’s latest annual human rights report, released last week, calls out the U.S. for abridging reproductive rights in 2017. It sharply criticizes the Trump administration’s “broad and multifaceted” attacks on women and girls, and what it calls “particularly virulent” attacks and “extreme restrictions” on sexual and reproductive health care. The worst, however, may be yet to come.
Robert Walker is the president of the Population Institute, a Washington-based organization promoting family planning and the reproductive health of women at home and abroad.