Advocates press agenda for new administration
By Adam Sonfield
Senior Public Policy Associate
With the inauguration of President Barack Obama and with expanded Democratic majorities in both chambers of Congress, reproductive health supporters — in the administration, in Congress, and outside the government — are entering the new year with renewed optimism.
Although policy-makers will need to devote considerable attention to the economy, the wars in Iraq and Afghanistan, and other priorities, they also will look to reverse eight years of setbacks for reproductive health, and even make real progress.
Anticipating the change in administration, a coalition of 63 national organizations supporting women's and reproductive health spent 2008 working on a unified proposed agenda for the president's first 100 days and beyond. The agenda was submitted to the president's transition team in November and published on the transition team's web site in accordance with its policy of transparency.1 (Editor's note: The Guttmacher Institute is among the list of co-signers.)
Several items on the coalition's proposed agenda were ones that the new president could accomplish in his first days in office (and, indeed, they might already have been accomplished by the time this column sees print). One expected action is an executive order rescinding the "global gag rule," which denies U.S. family planning funds to indigenous foreign organizations that use their own money for abortion-related services, information, or advocacy. President Obama also is expected to signal his intent to restore a U.S. contribution to the United Nations Population Fund (UNFPA).
The Obama administration, and perhaps Congress as well, is expected to move swiftly to reverse a "midnight" regulation that expands the right of health care personnel and institutions to refuse to provide or assist in the provision of services on moral or religious grounds. The Department of Health and Human Services finalized the rule in December 2008, despite receiving more than 200,000 letters in opposition from the general public and from a long list of medical professional associations, state officials, members of Congress (including Obama himself), advocacy groups, and even other federal agencies. Critics of the rule cite its potential to impede patients' access to necessary services and information, in the field of reproductive health and far beyond, and its conflicts with established standards of medical ethics and the government's own antidiscrimination policies.
Funding on way?
As the administration works to submit a FY 2010 federal budget, the reproductive health coalition is hoping to make up for eight years of stagnant funding. It is requesting major increases for domestic and international family planning, as well as for sexually transmitted infection (STI) prevention and maternal and child health programs, including more than double the current appropriation for the Title X national family planning program (to $700 million) and for international family planning assistance (to $1 billion).
The budget also gives the president an opportunity to support the establishment of new programs and the reversal of current legislative restrictions. To that end, the coalition's agenda asks that the budget "assume" that Congress will act to require all states to expand Medicaid coverage of family planning services up to the same income eligibility levels used for pregnancy-related care. That move would help women prevent 500,000 unplanned pregnancies annually and, in the process, achieve considerable federal and state savings. President Obama was a co-sponsor of such legislation in the Senate.
At the same time, advocates are asking that the president signal his opposition to a range of perennial "riders" on the annual appropriations laws that bar federal funding for abortion in almost any circumstance under Medicaid and numerous other programs. They also are looking for a request to de-fund abstinence-only education programs, which have received more than $1.3 billion from the federal government despite mounting evidence of their ineffectiveness and potential for harm. They hope eventually to replace those programs with new investments in proven, comprehensive sex education that promotes abstinence while providing scientifically accurate information about contraception and STI prevention.
The coalition's proposed agenda includes several additional priorities, for the first 100 days of the Obama presidency and beyond. High on the list of shorter-term requests are regulatory and administrative action to reverse harmful and unscientific decisions made by the Bush administration, including those that:
- increased the price of birth control and other drugs at college health centers and many other safety net providers;
- restricted or limited women's access to and information about emergency contraception;
- hindered HIV prevention efforts under the U.S. President's Emergency Plan for AIDS Relief.
Reproductive health advocates also have joined the far broader chorus of voices lending their support to the president's call for health care reform, and emphasized the importance of comprehensive, high-quality, and affordable health care for all. This goal, and many others, will require considerable cooperation, patience, and political capital, particularly in a time of war and recession, and with a new president committed to seeking common ground and bipartisanship.
- Advancing Reproductive Rights and Health in a New Administration; November 2008. Accessed at http://otrans.3cdn.net.