Trump administration family planning strategy is under fire
By DAVID CRARY
Feb. 27, 2018
NEW YORK (AP) — The Trump administration has adopted a new strategy for how it issues tens of millions of dollars in federal family-planning grants, giving preference to groups that stress abstinence and making it harder for Planned Parenthood to do business.
Major reproductive health organizations are voicing serious concerns about changes that the president of the American College of Obstetricians and Gynecologists on Monday described as turning "back the clock on women's health."
Dr. Haywood Brown depicted the shift as part of the administration's "continued move away from scientific, evidence-based policies and toward unscientific ideologies."
The catalyst for the criticism was an announcement Friday by the Department of Health and Human Services of its guidelines and priorities for the next round of Title X grant applications, projected to total about $260 million.
The new HHS document makes repeated favorable mention of "natural family planning" — which encompasses the rhythm method and other strategies for avoiding pregnancy without using contraceptives like the birth-control pill. According to HHS, of 100 couples each year that use natural family planning methods, up to 25 women may become pregnant.
Planned Parenthood, which currently serves about 1.6 million of the 4 million beneficiaries of Title X, expressed concern that the guidelines were crafted to reduce or eliminate its role in the program.
"It reads as them trying to stack the deck against any specialized reproductive health provider," said Planned Parenthood spokeswoman Erica Sackin.
Planned Parenthood has been the target of repeated attempts by the administration and congressional Republicans to cut off its federal funding and weaken its nationwide operations because it provides abortions.
For example, President Donald Trump signed last year a bill lifting protections established under President Barack Obama and giving states the option of blocking Title X funding to Planned Parenthood. Some conservative states like Arizona took steps to cut off that funding after the Trump-signed measure became law.
The organization says abortions make up only 3 percent of its business, with the bulk of its services focusing on birth control, screening for sexually transmitted diseases and cancer prevention.
Valerie Huber, who oversees the Title X office at HHS, said Planned Parenthood was eligible to apply for the new round of grants.
"It's impossible to speculate who's going to get funded," Huber said. "An objective grant committee looks at every proposal."
Before joining HHS, Huber headed Ascend, an advocacy group previously called the National Abstinence Education Association.
That organization opposes comprehensive sex education and advocates that adolescents be urged to practice "sexual risk avoidance" — a concept promoted in the new guidelines.
The administration says it will favor programs for adolescents that "that do not normalize sexual risk behaviors, but instead clearly communicate the research-informed benefits of delaying sex or returning to a sexually risk-free status."
Asked if organizations receiving grants would be required to counsel adolescents in this manner, Huber replied, "It is encouraged."
Throughout its nearly 50-year existence, Title X has stipulated that adolescents, as well as adults, were entitled to obtain contraception through the program on a confidential basis.
Clare Coleman, CEO of the National Family Planning & Reproductive Health Association, expressed concern that HHS might be shifting priorities in a way that would disrupt the steady progress in reducing the U.S. rate of teen pregnancies and unintended pregnancies.
"We know different administrations have had different approaches," she said. "But if this announcement indicates a deliberate shift away from Title X being strongly focused on increasing access to contraceptive care to a model more focused on behavior change ... that would be a significant concern to public health."
Haywood Brown said his obstetrician/gynecologists group had hoped the Trump administration would adhere to long-established, evidence-based Title X practices.
Instead, he said, the changes "will effectively block Title X patients from the qualified providers of their choice, steering them toward organizations or providers singularly focused on abstinence and fertility awareness methods — political interference at its worst."
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