The Next Federal Budget Matters a Lot for Sexual and Reproductive Health and Rights—Here’s What to Look Out for
With the American Rescue Plan now signed into law, President Biden and Congress are turning their attention to the fiscal year 2022 (FY 2022) budget, the next major demonstration of federal policy priorities. Ideally, the FY 2022 budget will represent a 180-degree turn in policy from that of the previous administration and its allies in Congress, with calls for additional investments in public health and a strengthened role for the federal government in the provision of health care, particularly sexual and reproductive health services.
While early indications from the Biden-Harris administration are encouraging, a true test of the White House’s commitment to sexual and reproductive health and rights will come with the release of the president’s budget request, the toplines of which are expected this week, to be followed by the full proposal in the coming months. Similarly, promising rhetoric from leaders in Congress on issues like the Hyde Amendment will need to be reflected in budget and policy guidance to the House and Senate Appropriations subcommittees as they embark on their work.
Hopefully, both the White House budget request and congressional proposals will include the financial investments and policy recommendations put forward by the Blueprint for Sexual and Reproductive Health, Rights and Justice; many of these were echoed by the Biden-Harris campaign in 2020. The Blueprint, which was endorsed by close to 100 domestic and global organizations, lays out a vision for undoing the harms done by the prior administration and taking bold action to make real and equitable progress.
The Blueprint and associated documents highlight 10 key financial priorities related to sexual and reproductive health that must be included in the FY 2022 budget.
- Increase funding for global family planning programs at the U.S. Agency for International Development (USAID) and the United Nations Population Fund (UNFPA) to $1.74 billion. This would enable the United States to provide its fair share of the funds needed to meet total global need for core family planning services. The increased funding would help close the gap in unmet need for modern contraception currently faced by 218 million women around the world (namely, those who want to avoid a pregnancy but are not using a modern method of contraception).
- Increase the International Organizations budget for the U.S. Department of State and enhance funding for a range of global health programs coordinated by State and USAID. This includes funds for maternal and child health ($984 million), nutrition ($240 million), gender-based violence ($380 million), global HIV/AIDS (at least $5.5 billion for the President’s Emergency Plan for AIDS Relief and $350 million for USAID), the Global Fund to Fight AIDS, Tuberculosis and Malaria (at least $1.56 billion), and other programs.
- Double funding to the National Institutes of Health and USAID for research and development on contraceptives and multipurpose prevention technologies, bringing the program to $75 million. This investment would benefit people both in the United States and around the world, helping avert unintended pregnancies and the transmission of HIV and other STIs.
- Provide $100 million to the Centers for Medicare and Medicaid Services to restore navigator and marketing funds. This would promote open enrollment through the Affordable Care Act’s insurance marketplaces. The FY 2022 appropriation should also remove antiabortion language and policies from the navigator program’s notices of funding opportunity.
- Provide $150 million for the Teen Pregnancy Prevention Program (TPPP) managed by the Office of Population Affairs at the U.S. Department of Health and Human Services. The prior administration repeatedly tried to eliminate or undermine the TPPP by attempting to terminate grants, weakening evidence standards and diverting funds. While lawsuits kept most of these egregious actions from going into effect, they still harmed ongoing research and programs. Increasing the program budget by $49 million would help restore evidence-based implementation of grants. Some of this increased funding could be offset by eliminating $35 million in grants for ineffective, stigmatizing and paternalistic abstinence-only programs.
- Appropriate $150 million for the Administration for Children and Families’ Personal Responsibility Education Program (PREP). Through approximately 80 grants to states, tribes and communities, PREP provides evidence-based information and education that helps more than 100,000 youth annually to prevent unintended pregnancy and STIs. An increase in PREP funding to $150 million annually for the next five fiscal years could double the number of young people served. This funding increase could be offset by eliminating $75 million in grants for non–evidence-based, abstinence-only programs.
- Include $954 million for the Title X family planning program. Despite the program’s crucial role in providing high-quality reproductive health care and the increasing need for that care, Title X has been chronically underfunded for much of its existence. Title X funding has remained at $286.5 million per year since fiscal year 2014, far below the amount if it had even kept up with inflation. The proposed $954 million would go a long way toward supporting care for all people in need of contraception. Further, a 2019 Trump-Pence administration rule caused many providers to leave the Title X program and cut the network’s patient capacity in half, necessitating funds to rebuild the provider network. The increased funding would also support modernizing the program’s infrastructure, such as further use and sustainability of telehealth services by these critical safety-net health centers during the COVID-19 crisis.
- Appropriate $850 million for the Title V Maternal and Child Health Services Block Grant, administered by the Health Resources and Services Administration. These grants to states are a key funding source for programs to promote and improve the health and well-being of low-income pregnant individuals, postpartum individuals and children, including children with disabilities and their families. This program also has an important role as a payer of last resort, filling gaps in coverage and services that are not reimbursed by Medicaid and other third-party payers.
- Provide $100 million for the Safe Motherhood and Infant Health Initiative at the Centers for Disease Control and Prevention (CDC), up from the current level of $58 million. This program supports a broad range of activities that aim to improve mother and infant health and reduce disparities in their health outcomes.
- Provide $100 million for the Surveillance for Emerging Threats to Mothers and Babies initiative at CDC, up from just $10 million. This program coordinates with state, local and territorial health departments to track the effects of new public health threats, such as COVID-19, by collecting information on pregnant people and their children for three years postpartum to assess risks specific to these populations.
In addition to these funds, the White House and Congress should support a number of non-financial policy changes in the FY 2022 budget.
- First, eliminate abortion restrictions such as the Hyde and Weldon Amendments, because no one should be denied access to abortion coverage based on their zip code, income or the personal beliefs of others.
- Second, revise language for foreign assistance programs, namely by removing the Helms Amendment, modifying the Siljander Amendment, replacing the Kemp-Kasten Amendment with revised language on coercion, eliminating the Livingston Amendment and removing unnecessary restrictions on U.S. contributions to UNFPA. These changes would enable agencies involved in global health to provide people the full range of sexual and reproductive health services they want and need, as well as start to repair some of the damage caused to global health relationships by the Trump-Pence administration.
- Finally, eliminate all funding for abstinence-only programs. These programs are ineffective and perpetuate harmful gender stereotypes. Eliminating funding for these programs would allow resources to be redirected into evidence-based programs, like those funded through TPPP and PREP.
As the country and the world emerge from the shadow of the COVID-19 pandemic and the Trump-Pence administration, the Biden-Harris administration and Congress have a unique opportunity to breathe fresh life into the movement for sexual and reproductive health and rights. This starts with providing the funding and policy support needed through the FY 2022 budget, as now is the time for bold action and investment in our collective future.
- Abortion: Insurance Coverage
- Contraception: Affordable Care Act (ACA), Publicly Funded Family Planning