Trump’s Health Agency Appears to Undermine Family Planning with New Funding Criteria

Reproductive health groups were still analyzing the nuances of the 60-page HHS announcement by press time, but some voiced worry.

[photo: Various forms of contraception spread out on a white background.]
The Trump-era criteria omitted any mention of "contraception" or "contraceptives." Shutterstock

The U.S. Department of Health and Human Services (HHS) on Friday afternoon released its long-delayed Title X grant criteria, and at first glance, the virulently anti-choice arm of the Trump administration appears to prioritize federal family planning money for providers that promote abstinence and natural family planning.

Among the “key issues” in developing a family planning program for some 4 million patients with low incomes are a “meaningful emphasis” on “committed, safe, stable, healthy marriages” as well as “the benefits of avoiding sexual risk or returning to a sexually risk-free status, especially (but not only) when communicating with adolescents.” In the very next line of the funding opportunity announcement, HHS doubled down on reaching adolescents in ways “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.” Of the “core family planning services,” HHS is pushing for a “broad range of acceptable and effective family planning methods and services (including natural family planning methods – also called fertility awareness).”

By contrast, the Obama administration’s Title X grant criteria emphasized “patient access to a broad range of contraceptive options, including long-acting reversible contraceptives (LARC), other pharmaceuticals, and laboratory tests, preferably on site.” The Obama-era criteria further encouraged the “use of performance measures to regularly perform quality assurance and quality improvement activities, including the use of measures to monitor contraceptive use.” The Trump-era criteria omitted any mention of “contraception” or “contraceptives.”

Valerie Huber, the new head of the Title X office, wouldn’t tell reporters on an HHS press call whether the criteria will prioritize funding for providers that don’t offer abortion services or that emphasize natural family planning methods, which take a big commitment to work.

As Martha Kempner wrote for Rewire, Huber initially came to HHS from the Washington, D.C.-based Ascend, formerly the National Abstinence Education Association. Ascend criticizes LARCs, stating in one of its fact sheets that “while LARC is highly effective in preventing pregnancy, it offers no protection against the many other possible consequences of teen sexual activity including healthy family formation and reaching future goals.”

HHS put some $260 million in grant money on the table in the annoucement but noted that the amount was contingent on the fiscal year 2018 budget. Congressional Republicans for years have tried to zero out Title X money.

Reproductive health groups were still analyzing the nuances of the 60-page HHS announcement by press time, but some voiced worry.

“In the initial analysis of the Title X funding announcement released today, it is of concern there are no references to contraception and no reference to nationally recognized clinical standards for the provision of high-quality family planning and sexual health care,” said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association (NFPRHA), which represents Title X providers.

“NFPRHA will continue to closely examine the details of this announcement.”

With the funding opportunity announcement, Dawn Laguens, executive vice president of Planned Parenthood Federation of America, said that the Trump administration is “quietly taking aim at access to birth control.”

“Don’t be fooled—this is a clear attempt to roll back access to the type of birth control that most women want to use,” Laguens said in a statement. “The last thing anyone wants is for Donald Trump or Mike Pence to weigh in on her sex life—but this announcement essentially invites them into the bedroom.”

Huber told reporters on the call that Planned Parenthood is “free to apply for this funding announcement.” But the health-care organization and its affiliates, which serve about one-third, or 1.5 million, of the Title X program’s 4 million patients, is a perennial target of Trump’s public health department. HHS reportedly worked with a hate group to jeopardize Planned Parenthood’s separate Medicaid funding stream.

Attacks on Title X are an issue not only of reproductive health and rights but also of reproductive justice, a framework created by Black women around core principles: the right to have children, not have children, and parent in safe and healthy environments. Of the 4 million Title X patients, 30 percent self-identified as Black or African American, Asian, Native Hawaiian or Pacific Islander, or American Indian or Alaska Native; 32 percent self-identified as Hispanic or Latino; and 13 percent had limited English proficiency, according to the Obama-era HHS’ 2016 annual report on the program. Many patients live at the intersections of multiple oppressions; for example, 64 percent have incomes at or below the 2016 federal poverty level of $24,300 for a family of four in the 48 contiguous states and Washington, D.C., the report found.

The Title X funding opportunity announcement was supposed to drop last November. By the new year, there was still no announcement from Teresa Manning, the Title X chief who had brought her anti-choice beliefs that “contraception doesn’t work” and that “family planning is something that occurs between a husband and a wife and God” without the federal government’s involvement into the federal government. Manning was booted from HHS in January and subsequently replaced by Huber.