In the Real World, Contraception Counts

When the most highly qualified health care providers of family planning care are at risk of losing federal funding, and millions of people may be denied a full range of preventive care, we’ve found ourselves in a parallel universe to the one in which then-Rep. George H.W. Bush called family planning “a public health matter” and pushed for federal funding for birth control for all.

Over decades, there has been sustained support for the Title X family planning program, the nation’s only dedicated federal source of funding for affordable birth control and sexual health care services. Yet, in a handful of months, the Trump administration has taken multiple actions to upend this cornerstone of public health.

The administration released its Title X funding opportunity announcement, which set in motion a competition for federal funding. Today, family planning services are offered by a diverse, nationwide network of family planning providers that ultimately translates into health services for 4 million poor and low-income women and men.

The administration’s funding announcement explicitly seeks to divert funds from highly qualified family planning providers, toward non-health care entities or inexperienced providers that emphasize being abstinent until marriage. The administration has removed all references to “contraception” for current year-funding. It has asserted the government’s right to emphasize less-effective methods of contraception, like natural family planning — without seeming to notice that, in 2016, fewer than 0.5% of Title X family planning patients chose that as their contraceptive of choice.

The administration followed on that initial attack by releasing a proposal to overhaul Title X’s regulations. Among many damaging policy changes, the proposal would revive a “gag rule” on U.S. health providers, which would let the government define what’s appropriate for clinicians and other health professionals to share with patients. The proposed rule would prohibit providers from referring patients for abortion care, even upon a patient’s request, and appears to make sharing information about abortion nearly impossible, despite that the standards of care dictate a patient be given the information she or he requests.

The administration’s strategy to undermine the nation’s family planning program is taking place against a backdrop of congressional opposition, too. Recently, a House subcommittee voted to eliminate the Title X family planning program altogether. The full committee was expected to do the same. This is the House committee’s seventh attempt to eliminate the program in nine years.

We know that dangerous public health policymaking has real-world implications.

Today’s diverse network of family planning providers offers the gold standard of family planning care, and year over year is a driving force behind improved sexual health outcomes nationwide. The providers meet real needs in the real world — a 23-year-old single parent speaks to a nurse practitioner about birth control pills so she can hold off on having another child until she’s ready; a college student needs an STD test with results given quickly; a 30-year-old woman comes in with cervical bleeding, and a doctor conducts cervical cancer screening.

In 2015, services provided by health centers that received Title X funding helped women avert 822,300 unintended pregnancies. Without the services provided by Title X–funded health centers, the U.S. unintended pregnancy rate would have been 31 percent higher.

Shifting the Title X program away from its original mission and intent could force long-standing expert providers out of the program, force health centers to close and leave people without any access to care, resulting in increased rates of unintended pregnancies, STDs and unsafe abortions.

A vast majority (93 percent) of respondents to a recent poll by the organization I lead, the National Family Planning and Reproductive Health Association, agree access to birth control methods is important when it comes to preventing unintended pregnancy. But the administration is seeking a different approach — one that is out of touch with the world we live in today.

NFPRHA is committed to protecting the provider network and has filed a lawsuit with the American Civil Liberties Union and Planned Parenthood to challenge the Trump administration’s plans to undercut the Title X family planning program through the funding announcement.

It is in Congress and the administration’s best interest to prioritize the health of our most vulnerable and not disrupt a provider network that has been providing millions of patients with high-quality family planning care for almost half a century. Let’s focus on returning to the world in which family planning care was a bipartisan, national goal, as it was when Title X was signed into law in 1970 by President Richard Nixon.


Clare Coleman is in her ninth year as president and CEO of the National Family Planning and Reproductive Health Association.

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