By Ceci Connolly
Washington Post Staff Writer
Monday, July 30, 2001; Page A01

The Bush administration is making a fundamental change in how the federal government approaches issues involving reproductive health, scaling back efforts to promote family planning and contraception while aggressively promoting "abstinence-only" programs.

Since taking office, President Bush and top aides have refused to allow states to expand family planning services for poor women, reimposed a ban on abortion counseling at overseas health clinics, released a report questioning the effectiveness of condoms and proposed eliminating mandatory contraceptive coverage for federal employees.

Most recently, an ordained Catholic deacon working in the Department of Health and Human Services raised questions about a program developed by the Centers for Disease Control and Prevention to help parents talk to youngsters about sexual health because he believes it runs counter to the Catholic beliefs of HHS Secretary Tommy G. Thompson.

At the same time, administration officials are considering plans to consolidate women's health offices and have moved swiftly to boost funding for "abstinence-only" sexual education programs, with the money often going to evangelical Christian groups.

Every new administration brings its partisan politics and governing philosophy to Washington, and Bush is in many ways simply following through on campaign promises. But public health experts inside and outside the federal government are becoming increasingly concerned that the emerging approach is based more on ideology than science, and that the changes may set back recent successes in reducing teen pregnancies and the spread of sexually transmitted diseases such as AIDS.

"At each instance, he has chosen to act not in a moderate way but in an extreme way," said Judith L. Lichtman, president of the National Partnership for Women and Families.

Administration officials defend their approach, saying the president is committed to reducing teen pregnancy and the spread of sexually transmitted diseases, and broadening access to medical care. The new tack is more practical and is aimed at correcting the previous administration's policies, which were skewed too far to the left, officials said.

"If Planned Parenthood wanted it, the previous administration favored it," White House spokesman Ari Fleischer said.

Both sides are anxious to see how Bush handles upcoming decisions on whether the federal government should fund embryonic stem cell research, a proposal to designate "an unborn child" as a person eligible for federal health insurance and attempts to eliminate abortion services for women in prisons or in the military.

Congress is also waiting for the White House to weigh in on legislation restricting access to the abortion pill RU-486 and the Unborn Victims of Violence Act, a House-passed bill making it a federal crime to harm a fetus during an attack on a woman.

Last week, Rep. James C. Greenwood (R-Pa.) complained to Thompson and White House counselor Karl Rove about proposed changes in the Medicaid program to designate the fetus as a person while simultaneously rejecting requests to broaden family planning. "There's no question that religious conservatives have a very significant impact on this administration," he said.

Most of the controversy has emanated from HHS, a department described as "ground zero for the ideological wars in this country" by Kevin Keane, Thompson's top political strategist.

Dennis Smith, who oversees state Medicaid programs as head of HHS's Center for Medicare and Medicaid Services, designed the proposal to guarantee Medicaid coverage for fetuses. Department spokesmen said the goal was to expand prenatal care for poor women, but public health experts, noting that there were other ways to accomplish that, described Smith's language as a backdoor attempt by antiabortion activists to establish a legal precedent protecting the unborn.

Smith, a former Reagan administration official who worked to prevent health providers from offering abortion counseling, was also largely responsible for a new HHS policy rejecting requests by Georgia and New York to provide family planning to more poor women. Many state officials -- including Thompson, then governor of Wisconsin -- applied for the waivers after seeing other states post notable improvements.

The most dramatic case was California, where Republican Gov. Pete Wilson abandoned his Education Now and Babies Later abstinence program in favor of a Medicaid waiver for comprehensive family planning. During 1997-98, researchers found that the program prevented 108,000 unwanted pregnancies, including 50,000 unintended births, 41,000 abortions and 15,000 miscarriages. The state saved more than $512 million in prenatal and birthing costs.

Peggy Handrich, administrator of the Wisconsin Division of Health Care Financing, said that when she received a call from Washington warning that Wisconsin will not be allowed to develop a similar program, she was "very disappointed." Family planning services, she said, "help women make good decisions about their lives."

Smith did not return phone calls, but Keane said HHS is trying to find a compromise allowing states to expand family planning services in conjunction with primary care.

HHS officials said the rejection of New York's and Wisconsin's waivers was not specifically because they were for family planning; instead, the department had decided it would no longer approve waivers for only one type of health service and was encouraging states to apply for comprehensive waivers covering all types of service.

When Surgeon General David Satcher released a report touting sex education that included discussions of abstinence and contraception, White House officials quickly distanced themselves from the study and began circulating names of a possible replacement.

Last week, officials at the CDC and National Institutes of Health tried in vain to halt release of a report that concluded there was "insufficient evidence" that condoms prevented most sexually transmitted infections. Former representative Tom Coburn (R-Okla.) seized upon the report to demand the resignation of CDC Director Jeffrey P. Koplan for propagating a "safe-sex myth."

Health care providers, meanwhile, warned that the report was dangerously misleading. Although condoms may not protect against certain infections that can be transmitted through the skin, they protect against diseases spread through bodily fluids, said Bernadine Healy, who headed the NIH in the first Bush administration. "Just because it doesn't protect against everything doesn't mean it's not effective and useful," she said.

The debate over how to prevent teen pregnancy and sexually transmitted diseases such as AIDS has sparked the greatest passions.

In February 2000, a group named Advocates for Youth developed a package of videos and pamphlets guiding parents on how to discuss sexual health with their children. The CDC paid the group $200,000 for the materials, which were to be offered through its Business Responds to AIDS program. Last fall, CDC staffers forwarded the packets to HHS, where a career civil servant named Boyd Work, a deacon, detailed his objections in an e-mail.

"You should know that the secretary is a devout Roman Catholic. . . . Do you think he'll buy off on the nature and scope of the content?" he wrote. "Advocates for Youth, on their Web site and in their press releases, are ardent critics of the Bush administration. Mmmm."

On Friday, Keane said that the e-mail was withdrawn and that he would review the materials. Thompson "is not an ideologue; he's a pragmatist," Keane said.

In the meantime, youngsters remain at risk, said James Wagoner, president of Advocates for Youth. "In the seven months the administration has held up this project, nearly 12,000 young people have contracted HIV in this country."

Rick Williams, a former Polaroid executive who was part of the development team, said workers "are desperate for help in talking to their children. This is badly needed."

Keane and other administration officials did not dispute the new emphasis on abstinence education, despite limited data on whether the approach is effective. The last administration was "slanted toward other options, like condoms," he said. "Abstinence hasn't been given the same level of attention; that's our goal. The word used is 'parity.' "

For the current fiscal year, Congress approved a $20 million increase in funding for abstinence-only programs. Next year, funding would rise by $30 million. Bush administration officials say their goal is to spend $135 million annually on abstinence education, which would match current spending for family planning. At the same time, the administration has proposed no increase in spending for traditional family planning programs.

"We're getting nothing but support from the Bush administration," said Leslee J. Unruh, president of the National Abstinence Clearinghouse. "He has personally talked to me about doing anything and everything he can to support abstinence-until-marriage education."

In Chattanooga, organizers of the Why kNOw abstinence program were celebrating news they had received a $254,000 federal grant.

"Our falling pregnancy rate in this country is directly measurable to when the program began," Assistant Director Marcia Swearingen said. "I know it's not scientific, but we're encouraged."

At the Hamilton County public health offices, Tammy Burke speculated that the drop was due to the abstinence education in Chattanooga and distribution of Depo Provera, a contraceptive injected in women every three months.

This weekend, when several hundred abstinence advocates gathered for a conference in Miami, they were greeted with an effusive letter from Bush. "Abstinence is not just about saying 'no,' " he wrote. "It's about saying yes to a happier, healthier future."