A leaked memo obtained by Crooked Media gives a glimpse into the administration’s views on reproductive health, revealing a policy agenda that would gut evidence-based pregnancy prevention and family planning programs in order to fund abstinence-based education and “fertility awareness” initiatives — otherwise known as “the rhythm method,” a type of birth control that fails to prevent pregnancy for one out of every four couples who use it. Among the programs on the chopping block are Title X — the nation’s only federally funded family planning initiative — and the US Agency for International Development’s (USAID) family planning budget, as well as a federal teen pregnancy prevention program and the World Health Organization’s (WHO) “Let Girls Learn” initiative.
If enacted, the funding cuts would undo years of progress in reproductive health outcomes — including record-low rates of teen pregnancy and abortion — and threaten to reverse progress in the fight for gender equity in the United States and abroad.
The memo, which reads like a wish-list straight out of The Handmaid’s Tale, says Title X funding to help low-income women afford birth control “should be cut in half at least.” The money would be diverted in part to “childcare programs” — a move that suggests the Trump administration knows cutting Title X funding would result in more (unintended) pregnancies and births. And it would: according to the Guttmacher Institute, Title X services prevent an estimated one million unintended pregnancies each year.
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The rest of the funding from Title X would be diverted to “fertility awareness” programs. Fertility awareness is another term for the rhythm method, a “natural” form of birth control that relies on abstinence during the period a woman is fertile each month. Used widely among Catholics and other socially conservative Christians, fertility awareness requires women to keep perfect track of their menstrual cycles, which is difficult given that many women have irregular cycles. Furthermore, fertility is not always predictable. A variety of factors, including pheromones in men’s sweat and saliva, can trigger early ovulation and therefore shift the window of fertility. This explains why the rhythm method fails to prevent pregnancy for about 25 percent of those who use it. In comparison, IUD’s and birth control implants have failure rates of less than one percent, while the birth control pill has a failure rate of about 9 percent (though it can be reduced to as low as one percent when used perfectly).
In other words, as the Trump administration makes it harder to access effective forms of contraception, they’d also like to pour more money into teaching women how to use less effective methods.
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Another section of the memo calls for completely defunding the Teen Pregnancy Prevention (TPP) program, an initiative that began under President Obama in 2010 as part of the administration’s embrace of evidence-based policymaking. The memo says the program “needs to be defunded as it has not worked, there is no positive evidence and some negative evidence.”
That’s categorically false.
The teen pregnancy rate has fallen dramatically over the last two decades, a trend that is attributed to increased use of contraception, better sex education in public schools, and initiatives like those funded by the TPP grants. In 1991, the teen birth rate was 61.8 births per 1,000 young women and girls (ages 15–19), according to the Centers for Disease Control and Prevention. By 2014, that figure had dropped to 24.2 births per 1,000 teens.
After the teen pregnancy prevention grants took effect in 2010, the rate plummeted even further. Between 2010 and 2015, the teen birth rate fell from about 34 births per 1,000 teens to 22 per 1,000 — a 35 percent drop. Today, the rate is at an all-time low.
As STAT News reported in April:
“This unprecedented decline suggests that the Office of Adolescent Health’s funding strategy for teen pregnancy prevention has been highly effective.”
While expanding access to affordable contraception plays a critical role in reducing teen pregnancy, it’s only effective if teens know about the methods available to them. This is why the TPP grants are so important, explains Dr. Christine Dehlendorf, director of the Program in Woman-Centered Contraception and an associate professor in the Department of Family and Community Medicine at the University of California-San Francisco:
Teens require especially creative outreach efforts about contraception. Their communication methods are always evolving, their privacy is paramount, and the criteria they use to select birth control can be complex. Outreach to teens must be highly customized and continually evaluated and improved — precisely what the Office of Adolescent Health has made possible through its smart, effective TPP grant making.
The Trump administration is already taking steps to defund this effective initiative. In August, CBS News reported that the Department of Health and Human Services would be cutting off TPP grants two years before they were due to expire. The grants, which were scheduled to run through 2020, will now end in June 2018.
Instead of funding evidence-based teen pregnancy programs, the Trump administration wants to divert the money to promote “sexual risk avoidance” — also known as abstinence-only education.
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Years of research shows that abstinence-only education fails at every single thing it sets out to achieve: it doesn’t delay the initiation of sexual activity, it doesn’t reduce teen pregnancy or STDs, and in some cases it can even lead to riskier sexual behavior. According to the Sexuality Information and Education Council of the United States (SIECUS), students who take abstinence pledges as part of their sex education curricula are six times more likely to have oral sex and four times more likely to have anal sex than their non-pledging peers. These teens are also one-third less likely to use contraceptives and ten percent less likely to use condoms if they do become sexually active, which most do at some point — nine out of ten teens who take a pledge of abstinence from sex before marriage break that pledge. It shouldn’t come as a surprise, then, that states and communities that place a greater emphasis on abstinence-only education also have significantly higher rates of STDs and teen pregnancies.
Beyond being ineffective, researchers and doctors say abstinence-only education is a “morally problematic” approach that “violates medical ethics and harms young people.” In a review of the evidence on abstinence-only programs published in the Journal of Adolescent Health, researchers summed it up like this:
We believe that abstinence-only education programs, as defined by federal funding requirements, are morally problematic, by withholding information and promoting questionable and inaccurate opinions. Abstinence-only programs threaten fundamental rights to health, information, and life.
Just last month, a panel of scientists published another review of abstinence-only until marriage (AOUM) programs, calling them “scientifically and ethically flawed”:
Policies or programs offering abstinence as a single option for unmarried adolescents are scientifically and ethically flawed. AOUM programs have little demonstrated efficacy in helping adolescents to delay intercourse, while prompting health-endangering gender stereotypes and marginalizing sexual minority youth. While abstinence from sexual intercourse is theoretically fully protective against pregnancy and STIs, in actual practice, AOUM programs often fail to prevent these outcomes. AOUM programs have generated considerable political support from social conservatives, despite their lack of scientific evidence of efficacy and the fact that they withhold critical health information.
The leaked memo also outlines a plan to slash USAID’s family planning budget and stipulates that “no other family planning programming for girls should be provided except fertility awareness methods.” Beyond the implications for pregnancy prevention, cutting funds for global family planning initiatives threatens to worsen maternal and fetal health outcomes, reduce the likelihood that girls will complete their education and enter the workforce, and even exacerbate gender based violence.
Welcome to the front line of the war on women.