- Email: [email protected]
Family planning title X, under attack again
Debra M. Hardy, BS, RN, FNP Capitol Associates, Inc. Washington, DC
Family Planning Title X, w Under Attack Again . . . w
0
n Sept. 1, 1987, the Department of Health and Human Services issued a proposed rule in the Federal Register that would require federally funded family planning clinics to have separate facilities from privately funded abortion clinics. The rules would require separate entrances and exits, separate waiting and treatment rooms, and separate medical records for each clinic-an expensive change for many clinics, especially the Planned Parenthood clinics. In addition, under the proposed rules, federally fimded family pkanning clinics could not counsel pregnant women on the availability of legal abortion. Clinics that refer women to doctors or other clinics for abortions would be eliminated from the Title X program. The Department in its notice states, “Family planning is meant to address plans and methods for facilitating or preventing pregnancy, not for terminating it.” According to the proposed rules, the definition of family planning is the process of establishing objectives for the number and spacing of a family’s children, and selecting a means (including natural family planning methods, adoption, infertility service, and general reproductive health care, abstinence, and contraception) by which those objectives may be achieved. Written comments on the proposed rules and regulations were due by Nov. 2, 1987 to the Department of Health and Human Services. Final regulations are intended to be published 45 days after the close of the comment period. As currently operated, the program rules state that a federally funded clinic cannot advise a pregnant woman to have an abortion nor can the clinic provide funds for the abortion. Any advice must be given in a nondirective manner, providing options that include keeping the baby, putting the baby up for adoption, or having an abortion. If the client requests it, the clinic must provide her with a list of abortion facilities operating without federal funds. The pro332
posed revision would prohibit all federally funded clinics from informing a pregnant woman of her options-including providing her with a list of abortion clinics. Rather, it would advise her to seek medical advice outside the program. The family planning program has been in existence for 17 years. The law, enacted in 1970, authorized federal aid to family planning clinics for contraception, infertility, and other related services to women with low incomes and others. However, the law was very clear in forbidding abortion as a method of family planning and prohibited the use of program funds to perform or advocate abortions. Thle issue is abortion. The family planning program once again is under attack over this issue but this time through the regulatory process. In previous years this same debate has occurred on the reauthorization of the family planning program. Currently the program is being funded and operated under the “Continuing Resolution” or an emergency funding bill. The proposed revision of the rules of the program seeks to circumvent what this administration has been unable to do-get Congress to legislate further restriction related to counseling of pregnant women. Countering the Administration, Senator Edward Kennedy (D-MA), introduced S. 1366 on June 16, 1987, which expands Title X family planning and would boost funding from $142.5 million a year to $155.5 million in fiscal year 1988 and $179.5 million by fiscal year 1991. Kennedy reaffirms the purpose of Title X stating, ‘The primary purpose of Title X is simple: the provision of service and information to lower the incidence of unintended pregnancy, to improve maternal health and to reduce abortion.” According to program figures, there are approximately 4500 clinics that receive some or all of their money from the Title X program. These clinics serve about 4.3 million patients a year, with five sixths of these clients classified as having low incomes. The JOURNAL
OF PEDIATRIC
HEALTH
CARE
Journal of Pediatric Health Care
family planning clinic is one of the major providers of contraception, medical advice, and assistanceto women with low income. The family planning program provides about one third of all the public funding for contraceptive programs. The remainder of the money comes from states through Medicaid (where the money is provided for the individual patient) and from several other smaller federal programs. The current battle representsanother attempt to win the war against abortion by the antiabortionists or the “pro-life” groups. The “Moral Majority” or “Right to Life” groups have been successful,both in increased name recognition and in their lobbying efforts on Capitol Hill. During the years, the antiabortionists have been successfulin getting several amendments passed by Congress in favor of their movement. These amendments generally bar those administering federal funds under the Medicaid program, the federal employeeshealth benefit insurance policies, and other programs from use of the funds directly for abortions. The antiabortionist groups haveturned now to other programs, like funilly planning, that they contend use federal mnds indirectly for the purpose of abortion. On the other side of the battlefield lies the “proabortion” groups (eg, National Family Planning and Reproductive Health Association, the National Abortion Rights Action League, and Planned Parenthood). These groups strongly disagree with the amendments and arguments of the antiabortionists and have threatened to block the changesthrough the courts. Most of the interested medical groups, such as the American Medical Association and the American College of Obstetricians and Gynecologists, believe that such a prohibition on counseling between the physician and the patient is contrary to medical standards and severelyerodes the patients’ right to decide on the medical care they wish to receive. The “pro-abortion” side further contends that there is no evidencethat thesefederal funds are being used (directly or indirectly) for abortions and cites studies from the General Accounting O ffice and In-
Legislative
News
333
Spector General of the Department of Health and Human Servicesthat show there is no evidence to support the charge. Statistics about abortion have been difficult to interpret becauseof the methods used to collect data. However, according to the Center for DiseaseControl, the abortion rate and the ratio of abortions to live births have been declining since 1980. The number of abortions in this country seemsto have stabilized at approximately 1.6 million per year since 1980. Accordingly, about 3% of the American women of childbearing age had abortion. According to the Alan Guttmacher Institute (a researchassociationof Planned Parenthood), which conducts the most up-to-date and complete survey about abortion, nearly half or 46% of all 15year-old girls in the United Statescan be expectedto have at least one abortion by the time they reach the age of 45 years if the current rates continue. Currently, it is also reported that 3 of 10 pregnanciesend in an abortion, This regulatory initiative occurred at the same time that another battle began concerning the confirmation of Appellate Judge Robert H. Bork to replace JusticeLewis Powell, who retired from the Supreme Court in June 1987. The Senatebegan deliberations on Bark’s nomination in mid-September. Many have speculatedthat if Bork is confirmed by the Senate, he could represent the swing vote that could reversethe Court’s decision in Roe v. Wade (I973), ruling that statesmay not restrict a woman’s right to have an abortion during the first three months of pregnancy. In the past severalyears, the Supreme Court has been divided on “social” issues,with Justice Powell often being the swing vote by which the court split 5 to 4. Judge Bork has left little doubt in anyone’s mind about his views on Roe v. Wade, although prediction of votes of the SupremeCourt nomineescan often be risky business. Both of the political spectrums seemingly agree that fewer abortions would be better. The choice of methods to achieve that goal is the point at which the spectrumsdivide. n
Family Planning Title X, w Under Attack Again . . . w
0
n Sept. 1, 1987, the Department of Health and Human Services issued a proposed rule in the Federal Register that would require federally funded family planning clinics to have separate facilities from privately funded abortion clinics. The rules would require separate entrances and exits, separate waiting and treatment rooms, and separate medical records for each clinic-an expensive change for many clinics, especially the Planned Parenthood clinics. In addition, under the proposed rules, federally fimded family pkanning clinics could not counsel pregnant women on the availability of legal abortion. Clinics that refer women to doctors or other clinics for abortions would be eliminated from the Title X program. The Department in its notice states, “Family planning is meant to address plans and methods for facilitating or preventing pregnancy, not for terminating it.” According to the proposed rules, the definition of family planning is the process of establishing objectives for the number and spacing of a family’s children, and selecting a means (including natural family planning methods, adoption, infertility service, and general reproductive health care, abstinence, and contraception) by which those objectives may be achieved. Written comments on the proposed rules and regulations were due by Nov. 2, 1987 to the Department of Health and Human Services. Final regulations are intended to be published 45 days after the close of the comment period. As currently operated, the program rules state that a federally funded clinic cannot advise a pregnant woman to have an abortion nor can the clinic provide funds for the abortion. Any advice must be given in a nondirective manner, providing options that include keeping the baby, putting the baby up for adoption, or having an abortion. If the client requests it, the clinic must provide her with a list of abortion facilities operating without federal funds. The pro332
posed revision would prohibit all federally funded clinics from informing a pregnant woman of her options-including providing her with a list of abortion clinics. Rather, it would advise her to seek medical advice outside the program. The family planning program has been in existence for 17 years. The law, enacted in 1970, authorized federal aid to family planning clinics for contraception, infertility, and other related services to women with low incomes and others. However, the law was very clear in forbidding abortion as a method of family planning and prohibited the use of program funds to perform or advocate abortions. Thle issue is abortion. The family planning program once again is under attack over this issue but this time through the regulatory process. In previous years this same debate has occurred on the reauthorization of the family planning program. Currently the program is being funded and operated under the “Continuing Resolution” or an emergency funding bill. The proposed revision of the rules of the program seeks to circumvent what this administration has been unable to do-get Congress to legislate further restriction related to counseling of pregnant women. Countering the Administration, Senator Edward Kennedy (D-MA), introduced S. 1366 on June 16, 1987, which expands Title X family planning and would boost funding from $142.5 million a year to $155.5 million in fiscal year 1988 and $179.5 million by fiscal year 1991. Kennedy reaffirms the purpose of Title X stating, ‘The primary purpose of Title X is simple: the provision of service and information to lower the incidence of unintended pregnancy, to improve maternal health and to reduce abortion.” According to program figures, there are approximately 4500 clinics that receive some or all of their money from the Title X program. These clinics serve about 4.3 million patients a year, with five sixths of these clients classified as having low incomes. The JOURNAL
OF PEDIATRIC
HEALTH
CARE
Journal of Pediatric Health Care
family planning clinic is one of the major providers of contraception, medical advice, and assistanceto women with low income. The family planning program provides about one third of all the public funding for contraceptive programs. The remainder of the money comes from states through Medicaid (where the money is provided for the individual patient) and from several other smaller federal programs. The current battle representsanother attempt to win the war against abortion by the antiabortionists or the “pro-life” groups. The “Moral Majority” or “Right to Life” groups have been successful,both in increased name recognition and in their lobbying efforts on Capitol Hill. During the years, the antiabortionists have been successfulin getting several amendments passed by Congress in favor of their movement. These amendments generally bar those administering federal funds under the Medicaid program, the federal employeeshealth benefit insurance policies, and other programs from use of the funds directly for abortions. The antiabortionist groups haveturned now to other programs, like funilly planning, that they contend use federal mnds indirectly for the purpose of abortion. On the other side of the battlefield lies the “proabortion” groups (eg, National Family Planning and Reproductive Health Association, the National Abortion Rights Action League, and Planned Parenthood). These groups strongly disagree with the amendments and arguments of the antiabortionists and have threatened to block the changesthrough the courts. Most of the interested medical groups, such as the American Medical Association and the American College of Obstetricians and Gynecologists, believe that such a prohibition on counseling between the physician and the patient is contrary to medical standards and severelyerodes the patients’ right to decide on the medical care they wish to receive. The “pro-abortion” side further contends that there is no evidencethat thesefederal funds are being used (directly or indirectly) for abortions and cites studies from the General Accounting O ffice and In-
Legislative
News
333
Spector General of the Department of Health and Human Servicesthat show there is no evidence to support the charge. Statistics about abortion have been difficult to interpret becauseof the methods used to collect data. However, according to the Center for DiseaseControl, the abortion rate and the ratio of abortions to live births have been declining since 1980. The number of abortions in this country seemsto have stabilized at approximately 1.6 million per year since 1980. Accordingly, about 3% of the American women of childbearing age had abortion. According to the Alan Guttmacher Institute (a researchassociationof Planned Parenthood), which conducts the most up-to-date and complete survey about abortion, nearly half or 46% of all 15year-old girls in the United Statescan be expectedto have at least one abortion by the time they reach the age of 45 years if the current rates continue. Currently, it is also reported that 3 of 10 pregnanciesend in an abortion, This regulatory initiative occurred at the same time that another battle began concerning the confirmation of Appellate Judge Robert H. Bork to replace JusticeLewis Powell, who retired from the Supreme Court in June 1987. The Senatebegan deliberations on Bark’s nomination in mid-September. Many have speculatedthat if Bork is confirmed by the Senate, he could represent the swing vote that could reversethe Court’s decision in Roe v. Wade (I973), ruling that statesmay not restrict a woman’s right to have an abortion during the first three months of pregnancy. In the past severalyears, the Supreme Court has been divided on “social” issues,with Justice Powell often being the swing vote by which the court split 5 to 4. Judge Bork has left little doubt in anyone’s mind about his views on Roe v. Wade, although prediction of votes of the SupremeCourt nomineescan often be risky business. Both of the political spectrums seemingly agree that fewer abortions would be better. The choice of methods to achieve that goal is the point at which the spectrumsdivide. n