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
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.

News Politics

NARAL President Tells Her Abortion Story at the Democratic National Convention

Ally Boguhn

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates.

Ilyse Hogue, president of NARAL Pro-Choice America, told the story of her abortion on the stage of the Democratic National Convention (DNC) Wednesday evening in Philadelphia.

“Texas women are tough. We approach challenges with clear eyes and full hearts. To succeed in life, all we need are the tools, the trust, and the chance to chart our own path,” Hogue told the crowd on the third night of the party’s convention. “I was fortunate enough to have these things when I found out I was pregnant years ago. I wanted a family, but it was the wrong time.”

“I made the decision that was best for me — to have an abortion — and to get compassionate care at a clinic in my own community,” she continued. “Now, years later, my husband and I are parents to two incredible children.”

Hogue noted that her experience is similar to those of women nationwide.

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“About one in three American women have abortions by the age of 45, and the majority are mothers just trying to take care of the families they already have,” she said. “You see, it’s not as simple as bad girls get abortions and good girls have families. We are the same women at different times in our lives — each making decisions that are the best for us.”

As reported by Yahoo News, “Asked if she was the first to have spoken at a Democratic National Convention about having had an abortion for reasons other than a medical crisis, Hogue replied, ‘As far as I know.'”

Planned Parenthood Federation of America President Cecile Richards on Tuesday night was the first speaker at the DNC in Philadelphia to say the word “abortion” on stage, according to Vox’s Emily Crockett. 

Richards’ use of the word abortion was deliberate, and saying the word helps address the stigma that surrounds it, Planned Parenthood Action Fund’s Vice President of Communication Mary Alice Carter said in an interview with ThinkProgress. 

“When we talk about reproductive health, we talk about the full range of reproductive health, and that includes access to abortion. So we’re very deliberate in saying we stand up for a woman’s right to access an abortion,” Carter said.

“There is so much stigma around abortion and so many people that sit in shame and don’t talk about their abortion, and so it’s very important to have the head of Planned Parenthood say ‘abortion,’ it’s very important for any woman who’s had an abortion to say ‘abortion,’ and it’s important for us to start sharing those stories and start bringing it out of the shadows and recognizing that it’s a normal experience,” she added.

Though reproductive rights and health have been discussed by both Democratic Party presidential nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) while on the campaign trail, Democrats have come under fire for failing to ask about abortion care during the party’s debates. In April, Clinton called out moderators for failing to ask “about a woman’s right to make her own decisions about reproductive health care” over the course of eight debates—though she did not use the term abortion in her condemnation.

Commentary Economic Justice

The Gender Wage Gap Is Not Women’s Fault, and Here’s the Report That Proves It

Kathleen Geier

The fact is, in every occupation and at every level, women earn less than men doing exactly the same work.

A new report confirms what millions of women already know: that women’s choices are not to blame for the gender wage gap. Instead, researchers at the Economic Policy Institute (EPI), the progressive think tank that issued the report, say that women’s unequal pay is driven by “discrimination, social norms, and other factors beyond women’s control.”

This finding—that the gender pay gap is caused by structural factors rather than women’s occupational choices—is surprisingly controversial. Indeed, in my years as a journalist covering women’s economic issues, the subject that has been most frustrating for me to write about has been the gender gap. (Full disclosure: I’ve worked as a consultant for EPI, though not on this particular report.) No other economic topic I’ve covered has been more widely misunderstood, or has been so outrageously distorted by misrepresentations, half-truths, and lies.

That’s because, for decades, conservatives have energetically promoted the myth that the gender pay gap does not exist. They’ve done such a bang-up job of it that denying the reality of the gap, like denying the reality of global warming, has become an article of faith on the right. Conservative think tanks like the Independent Women’s Forum and the American Enterprise Institute and right-wing writers at outlets like the Wall Street Journal, Breitbart, and the Daily Caller have denounced the gender pay gap as “a lie,” “not the real story,” “a fairy tale,” “a statistical delusion,” and “the myth that won’t die.” Sadly, it is not only right-wing propagandists who are gender wage gap denialists. Far more moderate types like Slate’s Hanna Rosin and the Atlantic’s Derek Thompson have also claimed that the gender wage gap statistic is misleading and exaggerates disparities in earnings.

According to the most recent figures available from the Census Bureau, for every dollar a man makes, a woman makes only 79 cents, a statistic that has barely budged in a decade. And that’s just the gap for women overall; for most women of color, it’s considerably larger. Black women earn only 61 percent of what non-Hispanic white men make, and Latinas earn only 55 percent as much. In a recent survey, U.S. women identified the pay gap as their biggest workplace concern. Yet gender wage gap denialists of a variety of political stripes contend that gender gap statistic—which measures the difference in median annual earnings between men and women who work full-time, year-round—is inaccurate because it does not compare the pay of men and women doing the same work. They argue that when researchers control for traits like experience, type of work, education, and the like, the gender gap evaporates like breath on a window. In short, the denialists frame the gender pay gap as the product not of sexist discrimination, but of women’s freely made choices.

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The EPI study’s co-author, economist Elise Gould, said in an interview with Rewire that she and her colleagues realized the need for the new report when an earlier paper generated controversy on social media. That study had uncovered an “unadjusted”—meaning that it did not control for differences in workplace and personal characteristics—$4 an hour gender wage gap among recent college graduates. Gould said she found this pay disparity “astounding”: “You’re looking at two groups of people, men and women, with virtually the same amount of experience, and yet their wages are so different.” But critics on Twitter, she said, claimed that the wage gap simply reflected the fact that women were choosing lower-paid jobs. “So we wanted to take out this one idea of occupational choice and look at that,” Gould said.

Gould and her co-author Jessica Schieder highlight two important findings in their EPI report. One is that, even within occupations, and even after controlling for observable factors such as education and work experience, the gender wage gap remains stubbornly persistent. As Gould told me, “If you take a man and a woman sitting side by side in a cubicle, doing the same exact job with the same amount of experience and the same amount of education, on average, the man is still going to be paid more than the woman.”

The EPI report cites the work of Harvard economist Claudia Goldin, who looked at the relative weight in the overall wage gap of gender-based pay differences within occupations versus those between occupations. She found that while gender pay disparities between different occupations explain 32 percent of the gap, pay differences within the same occupation account for far more—68 percent, or more than twice as much. In other words, even if we saw equal numbers of men and women in every profession, two-thirds of the gender wage gap would still remain.

And yes, female-dominated professions pay less, but the reasons why are difficult to untangle. It’s a chicken-and-egg phenomenon, the EPI report explains, raising the question: Are women disproportionately nudged into low-status, low-wage occupations, or do these occupations pay low wages simply because it is women who are doing the work?

Historically, “women’s work” has always paid poorly. As scholars such as Paula England have shown, occupations that involve care work, for example, are associated with a wage penalty, even after controlling for other factors. But it’s not only care work that is systematically devalued. So, too, is work in other fields where women workers are a majority—even professions that were not initially dominated by women. The EPI study notes that when more women became park rangers, for example, overall pay in that occupation declined. Conversely, as computer programming became increasingly male-dominated, wages in that sector began to soar.

The second major point that Gould and Schieder emphasize is that a woman’s occupational choice does not occur in a vacuum. It is powerfully shaped by forces like discrimination and social norms. “By the time a woman earns her first dollar, her occupational choice is the culmination of years of education, guidance by mentors, parental expectations, hiring practices, and widespread norms and expectations about work/family balance,” Gould told Rewire. One study cited by Gould and Schieder found that in states where traditional attitudes about gender are more prevalent, girls tend to score higher in reading and lower in math, relative to boys. It’s one of many findings demonstrating that cultural attitudes wield a potent influence on women’s achievement. (Unfortunately, the EPI study does not address racism, xenophobia, or other types of bias that, like sexism, shape individuals’ work choices.)

Parental expectations also play a key role in shaping women’s occupational choices. Research reflected in the EPI study shows that parents are more likely to expect their sons to enter male-dominated science, technology, engineering, and math (often called STEM) fields, as opposed to their daughters. This expectation holds even when their daughters score just as well in math.

Another factor is the culture in male-dominated industries, which can be a huge turn-off to women, especially women of color. In one study of women working in science and technology, Latinas and Black women reported that they were often mistaken for janitors—something that none of the white women in the study had experienced. Another found that 52 percent of highly qualified women working in science and technology ended up leaving those fields, driven out by “hostile work environments and extreme job pressures.”

Among those pressures are excessively long hours, which make it difficult to balance careers with unpaid care work, for which women are disproportionately responsible. Goldin’s research, Gould said, shows that “in jobs that have more temporal flexibility instead of inflexibility and long hours, you do see a smaller gender wage gap.” Women pharmacists, for example, enjoy relatively high pay and a narrow wage gap, which Goldin has linked to flexible work schedules and a professional culture that enables work/life balance. By contrast, the gender pay gap is widest in highest-paying fields such as finance, which disproportionately reward those able to work brutally long hours and be on call 24/7.

Fortunately, remedies for the gender wage gap are at hand. Gould said that strong enforcement of anti-discrimination laws, greater wage transparency (which can be achieved through unions and collective bargaining), and more flexible workplace policies would all help to alleviate gender-based pay inequities. Additional solutions include raising the minimum wage, which would significantly boost the pay of the millions of women disproportionately concentrated in the low-wage sector, and enacting paid family leave, a policy that would be a boon for women struggling to combine work and family. All of these issues are looming increasingly large in our national politics.

But in order to advance these policies, it’s vital to debunk the right’s shameless, decades-long disinformation campaign about the gender gap. The fact is, in every occupation and at every level, women earn less than men doing exactly the same work. The right alleges that the official gender pay gap figure exaggerates the role of discrimination. But even statistics that adjust for occupation and other factors can, in the words of the EPI study, “radically understate the potential for gender discrimination to suppress women’s earnings.”

Contrary to conservatives’ claims, women did not choose to be paid consistently less than men for work that is every bit as valuable to society. But with the right set of policies, we can reverse the tide and bring about some measure of economic justice to the hard-working women of the United States.