Nearly 50 years after the landmark 1965 Supreme Court decision Griswold v. Connecticut, which legalized family planning and the right to individual privacy in family planning decisions, women in the United States are faced with a looming battle over whether they will maintain access to contraception.
The fact that we find ourselves in this situation is astonishing to say the least, and speaks to how deeply we have succumbed to what are commonly referred to as "culture wars," but in reality is the triumph of pure religious ideology and blibical fundamentalism (on one side) over science, public health, medicine and clinical practice, and human rights on the other.
Family planning--the means through which people exercise their right to decide whether and when to have children, how many children to have and at what intervals--has been cited by the Centers for Disease Control and Prevention (CDC) as one of the ten great public health achievements of the 20th century because of the huge gains it yields in maternal and infant survival and in the health and survival of children ages 0 to 5 years.
Family planning also has vast economic and social benefits. In the United States, analyses conducted by the Guttmacher Institute show that family planning services are vital to the health and well-being of poor and low-income women in general, and marginalized populations in particular. Publicly-funded family planning programs provide:
- a gateway into the U.S. health care system for women who would otherwise only have a tenuous connection to medical care, or none at all;
- a source of urgently needed contraceptive services and other sexual health care for young women in foster care, who are at high risk of unintended pregnancy; and
- a highly successful public health program that saves billions in taxpayer dollars, and averts significant numbers of unintended pregnancies, unplanned births and abortions.
Moreover, support for family planning and contraception is widespread. Ninety-eight (98) percent of women in the United States have used birth control at some point in their lives. Ninety-three percent of all voters believe all couples should have access to birth control. Six in ten women get health care from a publicly-funded family planning center and consider it their regular source of health care.
Results of a new public opinion poll reveal that Americans strongly believe in the importance of family planning as a basic preventive measure. "This sentiment crosses all demographic and political lines and rises to the level of a core value," notes Celinda Lake of Lake Research Partners, the firm that conducted the polling.
Lake also found that support for maintaining access to family planning services outweighs arguments for cutting family planning funding to help address the current budget crisis.
By a margin of roughly two to one, Lake reports:
Americans side with the view that everyone has a right to safe, affordable family planning services over the opposing position that with today’s budget crisis we should not be spending taxpayer money on family planning services. This sentiment is consistent across most demographic groups.
Nonetheless, ideologues have hijacked the U.S. House of Representatives, state legislatures, the media and the public discourse around reproductive and sexual health, and there has been a barrage of legislation and other efforts to reduce access to birth control.
Earlier this year, for example, the House of Representatives voted to completely de-fund Title X (H.R. 1), the national family planning program, for the first time in the program's history. While the bulk of funds were restored, the Final Fiscal Year (FY) 2011 spending bill (H.R. 1473) signed into law by President Obama cut funding for Title X by $18.1 million at a time when more and more low-income women are seeking care and services from this program than ever before.
Title X Funding -- FY 2011
FY 2011 Final
FY 2010 Final
Change FY 2010 to FY 2011
FY 2012 President's Request
FY 2012 NFPRHA's Request
As noted by the National Family Planning and Reproductive Health Association (NFPRHA), some members of Congress are trying to cut Medicaid along with Title X:
[Medicaid] is a critical funding source for family planning and other health care for low-income and poor individuals. [They also are trying to] undermine the Affordable Care Act. Further, an unprecedented effort is underway among states to refuse Title X funds, prohibit certain types of providers from receiving state and/or federal funds, and cut Medicaid enrollees and benefits, all of which would make it harder for low-income women to get birth control.
"De-funding the Title X program, along with cuts to many other important public health programs--especially at a time when the need is so great--is reckless and offensive," states NFPRHA.
Conservative activists are heartlessly going after what is often the only source of health care for the most vulnerable in our society. This is a fiscally irresponsible attack on women's access to essential health care.
The so-called pro-life movement also has been taking advantage of "conscience clauses" and refusal clauses--those that allow pharmacist to refuse to fill prescriptions for birth control--to reduce access at the point of delivery, creating especially onerous obstacles for women in rural areas who have fewer choices from the get-go.
At the state level, there is a widespread movement by GOP- and Tea-Party dominated legislatures to de-fund family planning programs. According to NFPRHA, patient visits are increasing, but public funding, patient fees and private fundraising have all fallen during the recession. "Many Title X-funded systems have cut hours, frozen hiring, furloughed staff, or reduced staff through attrition or layoffs in order to cope with falling revenue in the recession," states NFPHRA.
NFPHRA notes that in addition to the 280,000 people Arizona Governor Jan Brewer (R) proposes eliminating from the state’s Medicaid rolls, she has also called for a 5 percent cut in Medicaid provider rates – which became effective in April. Providers are already struggling to meet the needs of the poor and low-income – a rate cut in the Medicaid serves only to further reduce access to care for the medically under-served.
Alongside these budget cuts, efforts to establish "personhood" laws at the state level have proliferated. So-called personhood laws would decree that life begins at conception, effectively banning both abortion and contraception. Hormonal contraceptives can prevent a fertilized egg from implanting in the uterine lining and establishing, what is according to medical definition, an actual pregnancy. But for the personhood movement, a fertilized egg has more rights than the woman in whose body it floats, so hormonal contraception is anathema.
Attacks on family planning by extremist politicians have been met by relative silence from the Obama Administration, which has done little to challenge the misinformation put out by the far right, to change the public discourse in a more positive way, or to move the ball forward. For one thing, the Administration punted on making birth control part of the primary care package paid for under health reform when it had the momentum behind it and instead sent the issue to the Institutes of Medicine for "review." Now, this issue is set to be decided during the high-stakes debt-ceiling debates and at the beginning of what promises to be a cut-throat Presidential election. For another, President Obama appears to persist in believing that there is "common ground" between those who feel it is an individual's right to act in accordance with their own moral and religious beliefs when it comes to deciding whether and when to have children, and those who seek to impose their own form of biblical law on everyone and sundry.
For the vast majority of Americans, supporting access to family planning services and contraceptive supplies is a no-brainer. Lake's poll shows that 84 percent of Americans view family planning, including contraceptives and birth control, as important to basic preventive health services. "Of these," Lake states, "a full 67 percent feel very strongly [about the issue].
Moreover, Lake notes, "It's an election issue." The poll found that 40 percent of voters said they would be less likely to support elected officials who vote to defund family planning programs. [Listen to an audio briefing at which Lake and others speak on these issues].
But the evidence and the polling notwithstanding, making sure everyone has equitable access to contraception and family planning services at the state and federal level including under the Affordable Care Act, you almost certainly will have to fight for it so get ready for the next battle.