Advocates seek new prevention programs
By Adam Sonfield
Senior Public Policy Associate
Guttmacher Institute
Washington, DC
As the first year of the two-year 110th Congress gets under way — the first time in a dozen years that Democrats have been in charge of both chambers — reproductive health advocates are working with a sense of cautious optimism. The new House leadership, headed by Speaker Nancy Pelosi (D-CA), is firmly supportive of reproductive rights, and Senate Majority Leader Harry Reid (D-NV), although anti-abortion, is a strong advocate of family planning. Yet, the Democratic majorities are slim, and President Bush's veto threats have grown increasingly frequent.
In this fragile environment, pro-reproductive rights policy-makers and advocates are focusing on policies that would help women avoid unintended pregnancies, and the abortions and unintended births that follow. One such proposal — the Unintended Pregnancy Reduction Act, introduced on March 29 by Reid and Sen. Hillary Rodham Clinton (D-NY) — would dramatically expand access to family planning services under Medicaid by requiring states to provide such coverage to individuals up to the same income eligibility ceiling used by the state for pregnancy-related care under Medicaid. That level is at least 133% of the federal poverty level and, in many states, 185% or above; it is far above most states' regular Medicaid eligibility ceiling for adults.
The legislation builds on the demonstrated successes of 25 states that have obtained federal approval, through a typically long and difficult process, to expand Medicaid eligibility for family planning services; 17 of these states have established parity between the eligibility levels for family planning and pregnancy-related care.
The evidence of these programs' effectiveness continues to grow. Most recently, a 2007 article by researchers from the Medical University of South Carolina found that these expansions have significantly reduced states' overall birthrates.1 A 2003 federally funded evaluation of programs in six states found that all yielded significant government savings by averting Medicaid-eligible unintended births.2 And a 2006 report by Guttmacher Institute researchers found that the parity approach to an expansion, instituted nationwide, would save $1.5 billion annually and reduce unintended pregnancy and abortion rates by 15%.3
Reproductive health supporters also will be working during this Congress to challenge the preeminent role of abstinence-only-until-marriage education in the federal government's efforts to prevent teen and nonmarital pregnancy and sexually transmitted infections (STIs). Congress has allocated more than $1 billion over the past decade to promote premarital abstinence through programs that ignore or denigrate the effectiveness of contraceptives and safer-sex behaviors.
Between 1995 and 2002, a period in which abstinence-only funding grew exponentially, the proportion of U.S. teens who received any formal education about birth control methods declined sharply, while the proportion receiving only information about abstinence more than doubled.4 Yet, improved contraceptive use and use of more effective methods — not teens abstaining from sex — were responsible for the vast majority (86%) of the steep declines in teen pregnancy during these same years.5 Indeed, there is strong evidence that comprehensive sex education can both effectively delay sex among young people and increase condom and overall contraceptive use among those who are sexually active.6 In contrast, a nine-year, $8 million, congressionally mandated evaluation of federally funded abstinence-only programs found that these programs have no beneficial impact.7
Members of Congress are discussing various approaches to address the disconnect between the need for realistic sex education and the Bush administration's abstinence-only obsession. Some approaches would curb the worst aspects of the current policy, for example, by requiring medical accuracy in abstinence-only educational materials, by eliminating unscientific and ideologically driven program requirements, or by giving states the flexibility to use their abstinence education funds within a more comprehensive sex education program.
Yet, most advocates are now promoting the Responsible Education About Life Act, sponsored by Reps. Barbara Lee (D-CA), Christopher Shays (R-CT), and Sen. Frank R. Lautenberg (D-NJ). That act would provide funding for state programs that operate under a new, nine-point definition of family life education designed to reverse the flaws of the abstinence-only approach.
Congress has only a limited window for real legislative action before the 2008 elections overwhelm Washington, and the war in Iraq has so far dominated its attention. While the prospects for any of these proposals are uncertain, proponents and opponents will be on the lookout for opportunities.
References
- Lindrooth RC, McCullough JS. The effect of Medicaid family planning expansions on unplanned births. Women's Health Issues 2007; 17:66-74.
- Edwards J, Bronstein J, Adams K. Evaluation of Medicaid Family Planning Demonstrations. Alexandria, VA: CNA Corp.; 2003.
- Frost JJ, Sonfield A, Gold RB. Estimating the impact of expanding Medicaid eligibility for family planning services. Occasional report. New York City: Guttmacher Institute; 2006.
- Lindberg LD, Santelli JS, Singh S. Changes in formal sex education: 1995-2002. Perspect Sex Reprod Health 2006; 38:182-189.
- Santelli JS, Lindberg LD, Finer LB, et al. Explaining recent declines in adolescent pregnancy in the United States: The contribution of abstinence and improved contraceptive use. Am J Public Health 2007; 97:150-156.
- Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy; 2001.
- Trenholm C, Devaney B, Fortson K, et al. Impacts of Four Title V, Section 510 Abstinence Education Programs: Final Report. Princeton, NJ: Mathematica Policy Research; 2007.
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