It’s here – President Obama’s
much anticipated (at least among Washington policy geeks) budget request
to Congress for fiscal year 2010, which begins on October 1, 2009. While
the stripped down budget released in February provided few clues about
the direction of the new administration, the more detailed FY 2010 President’s
Budget Appendix gives us a clear view of the Obama
Administration’s priorities for FY 2010. 

The budget proposal – nearly
1400 pages of it – is our new president’s first opportunity to communicate
to Congress and the public a comprehensive blueprint for his domestic
and international spending goals. While federal lawmakers are unlikely
to rubber stamp Obama’s requested funding levels and policy proposals,
they are certain to carry significant weight as members grapple with
shortfalls that will make it impossible to meet all the challenges the
nation faces.  

The budget contains some recommendations
that should buoy those of us working to improve women’s reproductive
health, but it also contains a dose of heartache. Below are a few of
the key reproductive health decisions reflected in the President’s
Budget.   

• Expands
  Medicaid Family Planning: The Administration is supporting a proposal
  to allow states to expand family planning services to individuals with
  incomes up to 200 percent of the federal poverty level, without seeking
  special permission from the federal government to do so. This is long
  overdue and was a high priority for the National Partnership and other
  women’s health advocates.

• Provides a Modest
  Increase to Title X Family Planning Program: The Administration
  is proposing to increase funding for the national family planning program
  by a scant $10 million, which would put funding for the beleaguered
  program at $317.5 million. The Title X clinic system – which provides
  basic primary reproductive health care services to nearly five million
  men, women, and adolescents across the country – has suffered serious
  financial challenges for years.  Truth be told, it needs a major
  influx of money to meet client demands and support the President’s
  stated priority of reducing unplanned pregnancy. Still, even this small
  increase is a step in the right direction in a tight budgetary environment.

• Increases Support
  for International Family Planning Programs: In the most straightforward
  boost for women’s health, the president proposes a total of $591 million
  for international family planning programs, an increase of $46 million
  over last year’s budget of $545 million. $50 million of this funding
  is slated for the United Nation’s Population Fund (UNFPA) for family
  planning services and information.

• Lets the District
  of Columbia Support Abortion Services. In the plus column, the
  proposed budget would allow the District of Columbia to use its own
  locally raised revenue to fund abortion services for low-income women (yes, DC is currently prohibited from using non-federal
  funds for abortion – the only jurisdiction in America with this type
  of prohibition).  

• Slashes
  Abstinence-Only Programs and Replaces
  them with Teen Pregnancy Prevention
  Initiative – Better But Far from Perfect: In seeking to shift
  funding away from abstinence-only programs to those that reduce teen
  pregnancy, the Administration got part of the equation right. The elimination
  of $99 million for Community-Based Abstinence Education Programs (CBAE)
  and $50 million for the Title V undeniably are worth cheering. At the
  same time, the new budgetary language creates a Teen Pregnancy Prevention
  Initiative funded at $110 million to support "community-based and
  faith-based efforts to reduce teen pregnancy using evidence-based and
  promising models." That may open the door for more federal funds
  for the ineffective, discredited abstinence-only programs that put our
  youth at risk.  If so, it’s a big mistake.

So, what’s not to like?
As always, the devil is in the details. First, as previously noted,
the President’s proposal leaves the door open to continue some funding
for abstinence-only programs. According to the White House, $75 million
is for "programs that replicate the elements of one or more teenage
pregnancy prevention programs that have been proven through rigorous
evaluation to delay sexual activity, increase contraceptive use (without
increasing sexual activity) or reduce teen pregnancy." $25 million
would be for research and demonstration grants to "develop, replicate
refine and test additional models and innovative strategies for preventing
teen pregnancy" – which could well include abstinence-only programs.
The budget also includes $50 million for States territories and tribes
to use for teen pregnancy prevention.    

While this Teen Pregnancy Prevention
Initiative is a significant and welcome departure from ideologically
charged abstinence-only programs, we know our young people today face
myriad challenges when it comes to protecting their sexual and reproductive
health.  These include preventing an unwanted pregnancy, but also
protecting themselves from sexually transmitted infections (STIs), including
HIV/AIDS, and managing peer pressures on several fronts. The narrow
focus seems to miss an opportunity to expand the availability of more
comprehensive sex education programs that also focus on HIV/AIDS prevention,
STI prevention, and building healthy relationships.     

In addition, the President’s
budget contains one huge disappointment: 

• Fails
  to Remove Abortion Restrictions. Reproductive health advocates were
  looking for the budget to draw a line in the sand on abortion care –
  as the Clinton Administration did – and take the principled stance
  across-the-board that abortion care should be covered and paid for just
  the same as all other health services. Unfortunately, the proposed Obama
  budget falls well short of that goal. Instead, it continues the bans
  for virtually all women who rely on the government for health care including
  women covered by Medicaid, federal employees, Peace Corps volunteers
  and women in prison – a sharp and unacceptable departure from the
  majority of privately insured women. 

 

There’s agony to go with
the ecstasy, and perhaps more than anything real disappointment with
the too prevalent view that compromise on reproductive health issues
is necessary to foster bipartisan dialogue in this country.