If you’re old enough to remember the days when our country led global efforts to improve women’s health, last week’s headlines from London may have brought back old times. Health ministers, philanthropists, and heads of state gathered there on World Population Day to reenergize the global family planning movement– and the United States showed up to champion the effort rather than sabotage it. The U.S. Agency for International Development, back from eight years in exile during the Bush era, is now investing $640 million annually to support voluntary birth control efforts in poor countries. Last week it joined more than 20 nations in vowing to strengthen women’s health and rights between now and 2020. The Gates Foundation announced it would invest an additional $1.1 billion in global family planning during the same period. The United Kingdom pledged $800 million, and New York Mayor Michael Bloomberg committed $50 million through his foundation. Together with fresh commitments from 20 developing countries, these actions will give 120 million women access to contraceptives by the end of this decade, preventing an estimated 110 million unintended pregnancies, 50 million abortions, and 100,000 maternal deaths.
So why am I feeling so perplexed? Because large swaths of our own country are moving backward. Even as the United States reclaims its leadership role in global health and development, a radicalized U.S. House of Representatives is working to curtail reproductive rights here at home, and state governments are aggressively dismantling family-planning programs on which millions of Americans depend. I run a Planned Parenthood affiliate in New York City,where women’s rights are well established and the religious right doesn’t dictate health policy. But it doesn’t take an urban activist to see that the national assault on reproductive rights defies public sentiment and common sense. If we want a country that embodies the kind of hope it projects to the world, it’s time for a domestic reawakening on the scale of lasts week’s London summit. Birth control is as central to public health in Texas as it is in Tanzania, and many of the women in greatest need still lack access.
Nationally, the need for affordable birth control has grown steadily over the past decade. Some 17.4 million American women needed publicly-supported contraceptive care in 2008 (up from 16.4 million in 2000), but only 7.2 million received it -– leaving 10 million vulnerable and underserved. Narrowing that gap would have myriad public benefits. Publicly supported family planning services prevent an estimated 1.5 million unintended pregnancies in the United States each year, helping women avoid 650,000 unplanned births and more than 600,000 abortions –- and every dollar invested saves taxpayers $3.74 in Medicaid costs down the line. Yet 43 states sought to cut family planning funds in 2011 alone, and many succeeded. In Texas, where one million women already lacked access to affordable birth control, lawmakers slashed support by two thirds – from $111 million to $38 million for 2012 – leaving 300,000 more women at risk of pregnancies they don’t want and can’t afford. These overt attacks have declined this year, but the stakes are still high, thanks to the politics surrounding the Affordable Care Act.
As signed into law two years ago, the act expanded the Medicaid safety net to provide coverage for 15 million uninsured Americans – two-thirds of them non-elderly women. The Supreme Court recently upheld the act itself, but its ruling could undermine the Medicaid expansion by freeing states to opt out of it. The states have strong incentives to participate – the federal government will cover all of the increased cost until 2016, 95 percent until 2019, and 90 percent from 2020 onward – but at least a half dozen governors are vowing to block the expansion despite the threat to their own constituents’ health.
And, as usual, the fiercest resistance is coming from states like Texas and Florida, where the unmet need is greatest and the cost of inaction highest. Analysts predict that states joining the expansion will boost the number of insured people by 25 percent with only a three percent increase in state spending – and those increases will more than pay for themselves by reducing the demand for uncompensated care. By opting in, Florida could extend basic health coverage to roughly one million of its four million uninsured residents while reducing total health care costs. Unfortunately, partisan zeal still trumps simple math.
“This is just another government program where the federal government will run out of money and they’ll put it on the states again,” Florida Governor Rick Scott declared on Fox News over the weekend.
New Yorkers live in a far less hostile environment; our top elected officials champion reproductive health care, and they have warmly embraced health care reform. But we face the same immense challenges as the rest of the country. Statewide, we are meeting less than half (41 percent) of the need for publicly supported birth control. Here in New York City, teen pregnancy still significantly exceeds the national rate, despite a 30-percent decline over the past 15 years, and women in the city’s poorest neighborhoods still lag on every measure of sexual and reproductive health, from birth control and unintended pregnancy to HIV and maternal and infant mortality. From 2001 to 2005, women living in Bedford Stuyvesant and Crown Heights, Brooklyn, died of pregnancy complications at a higher rate than those in Libya, Mongolia or Tajikistan.
Planned Parenthood of New York City is on the frontlines every day, working through its health centers and outreach programs to ease disparities and meet women’s needs. But organizations like ours can’t meet the challenge alone. It’s time to set aside politics and recommit ourselves – as a city, a state and a nation – to family planning and sexual health. As recently as the 1980s, these were civic ideals that united us. If the global community can revive them in 2012, so can we.