The President’s Budget: A Mixed Bag for Women’s Health

Susan A. Cohen

In his proposed Fiscal Year 2011 budget, President Obama increases funding for teen pregnancy prevention and international reproductive health, but neglects abortion rights.

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.

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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.

Analysis Politics

Timeline: Donald Trump’s Shifting Position on Abortion Rights

Ally Boguhn

Trump’s murky position on abortion has caused an uproar this election season as conservatives grapple with a Republican nominee whose stance on the issue has varied over time. Join Rewire for a look back at the business mogul's changing views on abortion.

For much of the 2016 election cycle, Donald Trump’s seemingly ever-changing position on reproductive health care and abortion rights has continued to draw scrutiny.

Trump was “totally pro-choice” in 1999, but “pro-life” by 2011. He wanted to shut down the government to defund Planned Parenthood in August 2015, but claimed “you can’t go around and say that” about such measures two months later. He thinks Planned Parenthood does “very good work” but wants to see it lose all of its funding as long as it offers abortion care. And, perhaps most notoriously, in late March of this year Trump took multiple stances over the course of just a few hours on whether those who have abortions should be punished if it became illegal.

With the hesitancy of anti-choice groups to fully embrace Trump—and with pro-choice organizations like Planned Parenthood, NARAL, and EMILY’s List all backing his opponent, Democratic nominee Hillary Clinton—it is likely his stance on abortion will remain a key election issue moving into November.

Join Rewire for a look back at the business mogul’s changing views on abortion.

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News Human Rights

What’s Driving Women’s Skyrocketing Incarceration Rates?

Michelle D. Anderson

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

Local court and law enforcement systems in small counties throughout the United States are increasingly using jails to warehouse underserved Black and Latina women.

The Vera Institute of Justice, a national policy and research organization, and the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge initiative, released a study last week showing that the number of women in jails based in communities with 250,000 residents or fewer in 2014 had grown 31-fold since 1970, when most county jails lacked a single woman resident.

By comparison, the number of women in jails nationwide had jumped 14-fold since 1970. Historically, jails were designed to hold people not yet convicted of a crime or people serving terms of one year or less, but they are increasingly housing poor women who can’t afford bail.

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

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Overlooked: Women and Jails in an Era of Reform,” calls attention to jail incarceration rates for women in small counties, where rates increased from 79 per 100,000 women to 140 per 100,000 women, compared to large counties, where rates dropped from 76 to 71 per 100,000 women.

The near 50-page report further highlights that families of color, who are already disproportionately affected by economic injustice, poor access to health care, and lack of access to affordable housing, were most negatively affected by the epidemic.

An overwhelming percentage of women in jail, the study showed, were more likely to be survivors of violence and trauma, and have alarming rates of mental illness and substance use problems.

“Overlooked” concluded that jails should be used a last resort to manage women deemed dangerous to others or considered a flight risk.

Elizabeth Swavola, a co-author of “Overlooked” and a senior program associate at the Vera Institute, told Rewire that smaller regions tend to lack resources to address underlying societal factors that often lead women into the jail system.

County officials often draft budgets mainly dedicated to running local jails and law enforcement and can’t or don’t allocate funds for behavioral, employment, and educational programs that could strengthen underserved women and their families.

“Smaller counties become dependent on the jail to deal with the issues,” Swavola said, adding that current trends among women deserves far more inquiry than it has received.

Fred Patrick, director of the Center on Sentencing and Corrections at the Vera Institute, said in “Overlooked” that the study underscored the need for more data that could contribute to “evidence-based analysis and policymaking.”

“Overlooked” relies on several studies and reports, including a previous Vera Institute study on jail misuse, FBI statistics, and Rewire’s investigation on incarcerated women, which examined addiction, parental rights, and reproductive issues.

“Overlooked” authors highlight the “unique” challenges and disadvantages women face in jails.

Women-specific issues include strained access to menstrual hygiene products, abortion care, and contraceptive care, postpartum separation, and shackling, which can harm the pregnant person and fetus by applying “dangerous levels of pressure, and restriction of circulation and fetal movement.”

And while women are more likely to fare better in pre-trail proceedings and receive low bail amounts, the study authors said they are more likely to leave the jail system in worse condition because they are more economically disadvantaged.

The report noted that 60 percent of women housed in jails lacked full-time employment prior to their arrest compared to 40 percent of men. Nearly half of all single Black and Latina women have zero or negative net wealth, “Overlooked” authors said.

This means that costs associated with their arrest and release—such as nonrefundable fees charged by bail bond companies and electronic monitoring fees incurred by women released on pretrial supervision—coupled with cash bail, can devastate women and their families, trapping them in jail or even leading them back to correctional institutions following their release.

For example, the authors noted that 36 percent of women detained in a pretrial unit in Massachusetts in 2012 were there because they could not afford bail amounts of less than $500.

The “Overlooked” report highlighted that women in jails are more likely to be mothers, usually leading single-parent households and ultimately facing serious threats to their parental rights.

“That stress affects the entire family and community,” Swavola said.

Citing a Corrections Today study focused on Cook County, Illinois, the authors said incarcerated women with children in foster care were less likely to be reunited with their children than non-incarcerated women with children in foster care.

The sexual abuse and mental health issues faced by women in jails often contribute to further trauma, the authors noted, because women are subjected to body searches and supervision from male prison employees.

“Their experience hurts their prospects of recovering from that,” Swavola said.

And the way survivors might respond to perceived sexual threats—by fighting or attempting to escape—can lead to punishment, especially when jail leaders cannot detect or properly respond to trauma, Swavola and her peers said.

The authors recommend jurisdictions develop gender-responsive policies and other solutions that can help keep women out of jails.

In New York City, police take people arrested for certain non-felony offenses to a precinct, where they receive a desk appearance ticket, or DAT, along with instructions “to appear in court at a later date rather than remaining in custody.”

Andrea James, founder of Families for Justice As Healing and a leader within the National Council For Incarcerated and Formerly Incarcerated Women and Girls, said in an interview with Rewire that solutions must go beyond allowing women to escape police custody and return home to communities that are often fragmented, unhealthy, and dangerous.

Underserved women, James said, need access to healing, transformative environments. She cited as an example the Brookview House, which helps women overcome addiction, untreated trauma, and homelessness.

James, who has advocated against the criminalization of drug use and prostitution, as well as the injustices faced by those in poverty, said the problem of jail misuse could benefit from the insight of real experts on the issue: women and girls who have been incarcerated.

These women and youth, she said, could help researchers better understand the “experiences that brought them to the bunk.”

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