On February 1, President Obama sent his proposed budget for
the fiscal year starting October 1, 2010 to Congress. On the domestic front,
the administration’s top priority for reproductive health and rights is teen
pregnancy prevention, for which the administration is recommending a
significant boost in funding. With the abstinence-only-until-marriage approach of
the bygone era defeated, the new initiative will emphasize an evidence-based
approach to reducing teenage pregnancy and the underlying factors that put
teens at risk.

On the international front, the administration has unveiled
the outlines of the Global Health Initiative that the president first announced
last year. Family planning and reproductive health programs and maternal and
child health programs figure prominently, and the administration is recommending
significant increases in both areas.

On abortion rights, however, the president is taking a pass.
There can be little doubt that the fact that health care reform legislation
remains in limbo has something to do with that—with the options on an ultimate
compromise on abortion coverage ranging from terrible to horrible.

Also tied up
in health care reform is the fate of two other key provisions: one to make it
easier for states to expand eligibility for family planning under Medicaid and
a second to establish new funding for home visiting programs for low-income
first-time mothers.

Domestic Family
Planning: Modest Improvement

A year into the Obama administration, its much-hyped
initiative to reduce unintended pregnancy and thereby reduce the need for
abortion has yet to emerge. In the meantime, funding for domestic family
planning is nearly stagnant. As it did last year, the Title X family planning
program would receive a 3 percent, or $10 million, increase, which would bring funding
to $327.4 million. Many publicly funded
family planning providers are struggling to meet a growing need for
subsidized contraceptive care, which is driven by more women
wanting to postpone childbearing during tough economic times.

Sex Education: Where
the Action Will Be

Teen pregnancy prevention is likely to emerge as a key
component of the president’s “common ground” strategy around reducing the need
for abortion. The issue may be especially urgent after a recent Guttmacher
study found that, for the first time in over a decade, teen pregnancy rates
rose in 2006. The administration’s budget proposes to increase the teen
pregnancy prevention program created last year by $19 million, bringing the
total to $133.7 million. This new initiative is designed to fund proven, as
well as promising, programs. It will be housed within the newly created Office
of Adolescent Health, which will support and expand teen pregnancy prevention
efforts while also addressing a broader range of adolescent health issues, such
as those related to mental health, violence, substance use, nutrition and
physical activity, and tobacco use. In addition, the administration is
recommending that Congress create another program of grants to the states,
funded at $50 million per year, to reduce teen pregnancy.

Fatherhood, Marriage
and Families: A New Take on Old Themes

The budget proposes to redirect and expand existing funding
to a new Fatherhood, Marriage and Families Innovation Fund. The proposed $500
million would support evaluation of comprehensive responsible fatherhood
programs and efforts geared toward improving child outcomes by helping
custodial parents with serious barriers to self-sufficiency. Funded activities
would focus on barriers to employment and could include interventions like home
visits, subsidized employment, transitional jobs, and mental health and
substance abuse treatment.

Access to Abortion
for Low-income Women: Not This Year

As last year, the administration has refrained from even
asking Congress to consider repealing the Hyde Amendment banning federal
abortion funding under Medicaid. Abortion funding restrictions riddle the
federal budget and, technically speaking, come up for review annually on the
various appropriations bills. Beyond Medicaid, these funding restrictions ban
abortion coverage under the Federal Employees Health Benefits Program, for
Native American women seeking care at Indian Health Service facilities, for
Peace Corps volunteers and for women in federal prison. Last year, the
president did at least ask Congress to repeal the ban on Washington, D.C.’s
ability to pay for
abortions with its own funds for its residents on Medicaid, the way states
have the option to do. Congress agreed, so that new policy would go forward
into FY 2011 under the president’s budget.

International Family
Planning and Reproductive Health: Steady Progress

Preventing unintended pregnancy is a core goal of the
administration’s Global Health Initiative. According to the president’s budget
proposal, support for international family planning and reproductive health
programs would increase by about 8% to approximately $700 million, $50 million
of which would go to the United Nations Population Fund (UNFPA). The increase
is in keeping with Secretary of State Hillary Clinton’s January speech, in
which she declared the U.S. government’s renewed
support for and dedication to international family planning and reproductive
health programs.

Maternal and Child
Health Globally: A Big Leap Forward

Efforts to reduce maternal mortality and improve maternal
health would gain significantly under the president’s proposal, with its new
focus on maternal and newborn health. By recommending a 28 percent increase in
funding, administration officials say they want to make up for lost time in
this neglected area, especially in light of the looming deadlines to meet
Millennium Development Goal 5, which calls for measurable improvements in
maternal health by 2015. The budget proposal notes that the maternal and child
health program “will also actively invest in integrating across all health
programs, particularly family planning, nutrition and infectious diseases.” A
2009 study by Guttmacher and UNFPA found that maternal deaths in developing
countries could be slashed by 70 percent and newborn deaths cut nearly in half if the
world doubled
investment in family planning and pregnancy-related care.

Global Health
Initiative: Up and Running

Along with the budget, the administration published an initial
paper providing an overview of the Global Health Initiative. A stated goal
of the initiative is to invest a total of $63 billion between FY 2009 and FY
2014 on key global health programs. However, for FY 2011 the administration is
recommending $8.5 billion, raising doubts about the trajectory for achieving
that funding goal. Among its targets, the initiative calls for preventing 54
million unintended pregnancies by increasing contraceptive prevalence to 35 percent
across assisted countries, as well as decreasing maternal mortality by 30 percent by
preventing 360,000 deaths across assisted countries.

A main focus of the initiative is to have the various global
health programs (including those on HIV, family planning, pregnancy care and
nutrition) work better together toward saving lives and improving health in
developing countries. In addition, the Global Health Initiative seeks to
increase the focus on information and services for adolescent girls, including
providing support for “adolescent-friendly health services; behavior change
messages promoting healthy reproductive behavior and delaying age of marriage; prevention of HIV
and unintended pregnancy; and prevention and treatment of neglected
tropical diseases.” The details are still evolving.