The presidential candidates have been challenged with the
same question again and again: In our unprecedented economic crisis, what
programs or services will you have to cut from the plans you have laid out for
Perhaps it’s not a surprise that neither Sen. Barack Obama or Sen.
John McCain dwells too long on what, in particular, will lose its funding in the next
year. But truth may be revealed by omission; that is, an issue that the
candidates don’t discuss much on stump speeches, interviews and debates
probably isn’t their unqualified spending priority.
That should make those who use and support publicly funded
birth control – the "Janes" if you will – nervous.
There are 17 million American women who need subsidized
contraception services and supplies, including 4.9 million teenagers and 11.8
million adult women whose income is below or just above the federal poverty
line, according to the Guttmacher Institute.
Lauren is one of them. The 20-year-old California native receives a reduced rate
for birth control through the Family Planning, Access, Care and Treatment
(FamilyPACT) program in her state. FamilyPACT provides no-cost reproductive
health services and contraception to men, women and teens of child-bearing age
Lauren says that lots of her friends and family members
"have been just stoked to walk out of Planned Parenthood or their local health
department with whatever birth control they want, entirely free. It’s almost a
foreign concept." But she also said that the positive affects of FamilyPACT
reach far beyond any one individual’s pocketbook and peace of mind.
"(FamilyPACT has) been shown to reduce rates of unintended
pregnancy all around," she says. "It also allows people in California the rare
opportunity to have one aspect of their health completely taken care of, free
of charge. "
FamilyPACT is sponsored by the California government. Together, federal and
state governments spent $1.26 billion on family planning services and supplies
in FY 2001. The largest source of those funds: Medicaid, with $770 million
spent on reimbursing providers of medical care for the contraceptive services
they supply to those who need help to afford care.
Shalyn is an 18-year-old from California who receives a
reduced contraception rate through Medicaid.
"I think the impact is enormous and allows people to take their
health in their own hands," says Shalyn.
She too sees these services as under threat, however–a
threat that she says is caused by the myopia of those who aren’t directly
affected by the program.
"I get the feeling a lot of the people who do not receive
direct benefits from these programs think they are unnecessary and think it
wouldn’t be a bad idea to cut them drastically in times were money is tight,"
Without the support of Medicaid for reproductive health
services, "some people would probably resort to methods that are free, but are
not as effective, like pulling out," Shalyn says. "Unwanted pregnancies and
welfare rates would go up. The people who get help from these programs can’t
pay for their own medical care, [so] how are they supposed to pay for prenatal
care and an unplanned child?"
While Medicaid has a broader health focus, Title X of the
Public Health Service Act stands out as the only federal program exclusively
dedicated to family planning. Fifteen percent of all public funding for family planning
comes from Title X, which, in FY 2001, translated into $189 million. According
to the Guttmacher Institute, Title X serves men and women "who do not meet the
narrow eligibility requirements for coverage under Medicaid, and sets standards
for the provision of family planning services, ensuring that care is voluntary,
confidential and available on a sliding-fee scale or free for the poorest of
Funding for Title X is 61% lower today than it was in 1980, when inflation is taken into account, says Guttmacher. An annual Congressional appropriation provides the core funding for
Title X programs. This appropriation, plus Medicaid reimbursements and
other Federal sources account for more than half of Title X-funded
clinics’ operational funds.
Each dollar invested in Title X family planning saves $3.80 in Medicaid costs for pregnancy-related health care, including care of
Without publicly funded birth control and services, Lauren
sees a daunting future for her community, where "young and older adults alike
wouldn’t be able to afford contraception … I think pregnancy and STI rates would
shoot through the roof. … There’s no way in hell many women will be willing to
be prodded in stirrups when they’ll have to pay an arm and a leg for it, then
be sent home with a $420+ prescription for a year of birth control pills."
The threat of that future, though, is uncomfortably present.
The last time Lauren went to her clinic, the place was plastered in fliers that
urged visitors to write letters to their lawmakers, asking them not to cut
funding for FamilyPACT. Not to mention the more coded threat encroaching on
their work: Lauren has noticed the tendency for crisis pregnancy centers to set
up shop quite close to the clinics that offer a full–and honest–scope of
reproductive health services.
In Washington, RH Reality Check’s Heather Corinna participates in a program similar to FamilyPACT. It’s called Take Charge, and
Corinna says that its reproductive services are particularly crucial for minors
who are uninsured, who aren’t eligible for their parents’ insurance coverage,
or who don’t feel comfortable or safe using their parents’ insurance for sexual
"The most effective methods of contraception are costly,
particularly those like the implant or an IUD, which means one payment of several
hundred dollars upfront," Corinna says.
But through Take Charge, Corinna says, those people who are
in the greatest need of contraception, but have the lowest income level, can
still obtain reliable forms of birth control.
Instead of being embraced as a standard for all of
Washington’s citizens, this publicly funded program is also subject to
political and economic pressures.
Corinna reports that "it really depends largely on the governor’s race
this year: if Dino Rossi wins, this (program) absolutely will be under
threat. If Christine Gregoire does, I
think it will easily be protected. "
But the security of the program depends on the White House
"[President] Bush not only cut family planning
funding over the last eight years; he consistently put individuals in positions
of power with that program who patently and openly did not support the very
service it is supposed to provide, [people] who were anti-contraception,"
Corinna says. "I have no reason to believe that a McCain/Palin win would not
continue the same sorts of practices."
Should reproductive health services be knifed under the
leadership elected on November 4, Corinna says she’ll find herself without the
yearly check-ups she needs. What’s more, she believes that "there certainly are
many, many women here who would be far more hurt by the loss of this program
The numbers are astonishing: even with uncertain footing,
publicly supported contraceptive services "help women prevent 1.3 million
unplanned pregnancies, which would result in 632,300 abortions, 533,800 unintended
births and 165,000 miscarriages," according to the Guttmacher Institute. If
these programs didn’t exist, there would be a 40% increase in the number of
abortions in the U.S.
It must be acknowledged that publicly funded contraception
and sexual health services are hardly without their troubles, outside of
uncertain funding and political support. Some people who abuse the mission of
these programs to serve under-resourced individuals.
Lauren says that at her clinic in California, the program
runs on an "honor system" that patients can abuse.
"When you go, they ask you to self-report your income and
family size," Lauren says. "Even if they see that you’re covered under an
insurance policy, it’s common knowledge that all you have to say is ‘My parents/partner
can’t know I’m here,’ and you get services for free."
Lauren says that her mother encouraged her to take advantage
of the system.
"My mom knew I was sexually active at one point and told me
to go to the health department because she didn’t want to pay for my pills,"
Internal problems notwithstanding, the solution is hardly to
decimate the state and federal funding that family planning programs depend on
to serve low-income people. The nagging numbers reveal that while services need
to improve, they certainly must exist, if not be expanded into a standard of
healthcare and human rights.
Research proves, for example, that without publicly funded
contraceptive services, an additional 386,000 teens would become pregnant,
increasing the rate of teenage births by 25% and teenage abortions by 58%.
It’s a direction that nobody wants our society to go in.
But, when family planning barely musters as a talking point for most candidates
for elected office, when the dollars are draining from every sector in the
nation, how could we possibly change the direction we may be headed?
Shalyn and Lauren both have ideas for how we need to take
"People need to stop thinking of health care as a commodity,"
Shalyn says. "People need to realize that birth control and yearly paps and
reproductive care are really important parts of life–personally, socially,
"We must elect a president who is pro-choice and
pro-contraception, and continue fighting in our own states to either keep or
improve the coverage we have, or demand a family planning program where one
doesn’t exist," Lauren says. "We first and foremost must support Planned
Parenthood and independent, feminist, women-run health clinics that fight and
flounder every day to make sure money is no factor for women having a voice in
their reproductive health in states with an anti-choice political atmosphere."