Kathleen Sebelius served as secretary of health and human services from 2009 to 2014.
Congressional candidates have deluged voters in recent weeks with debates about the Trump administration’s efforts to peel away protections for Americans with preexisting health conditions. Yet there is another, equally insidious effort from the administration that could undermine access to health care, and Americans have no idea it is happening: a proposal to drastically reduce information on and access to contraception.
Decades of health data make it clear that helping young women avoid unwanted pregnancies can be a critical factor in their success in life. With freedom from an unexpected pregnancy, they can finish school, pursue a career and better prepare for parenting. Even people who believe that abortion services should be legally available also believe that abortion is not the preferred method of family planning. We are making considerable progress in the United States in reducing teen pregnancies and abortion rates, thanks in large part to the availability of birth control.
But pending rules from the Department of Health and Human Services would dramatically limit access to contraception for low-income women, “gag” health providers from discussing or referring women to abortion services and divert taxpayer resources now used to provide access to contraception to largely ineffective abstinence-only programs.
The proposal targets Title X, the federal grant program enacted in 1970 that supports family planning services and contraceptive care to about 4 million low-income women at little or no cost — though federal law bars any federal funds from being used to provide abortion services. The $260 million program helps to fund services in about 4,000 health clinics throughout the country.
The draft rules, issued in June, not only would block any federal funding for family planning clinics that also offer abortion services, such as Planned Parenthood, but also would eliminate the current requirements that all health clinics receiving federal family planning funds offer a broad range of approved family planning methods, including prescription contraception. It excludes all reference to contraception or the federal government’s clinical guidelines for quality family planning, stressing instead “natural family planning.”
Under these rules, women — particularly low-income and younger women — will likely never learn what affordable options, depending on their insurance, are available to them. And for the first time, women’s health providers could exclude any discussion of contraception choices other than less-reliable “natural methods.”
With this rule change to Title X, the government would impose significant barriers for contraception and could rapidly undermine the significant progress made on teen pregnancies and reduced abortion rates. According to the Guttmacher Institute, U.S. teen pregnancy rates have fallen to historic lows. Compared with 1990, only a third as many young women ages 15 to 19 became pregnant in 2013. Abortion rates also declined by 74 percent over the same period. Health experts say this correlates with improvements in contraception use in the United States, particularly among younger and lower-income women.
Millions of women now have private health plans that cover, with no out-of-pocket costs, all forms of contraception approved by the Food and Drug Administration. And with expanded Medicaid plans across the country, low-income women also have access to family planning choices, including long-lasting contraception.
But for women without that coverage, the pending Title X rules could have a devastating impact for generations. Either HHS must abandon this ill-advised move or Congress needs to act to curtail this destructive new proposal. The United States still lags behind other developed countries in terms of teen pregnancies, but real progress has been made. This is the wrong time to undermine those proven successes.