Last week, the website Crooked Media released a “wish list” reportedly from President Trump’s Domestic Policy Council, basically an in-house think tank tasked with developing administration policy priorities, though the source has not been confirmed. Proposals included in the list would essentially defund domestic and international family planning programs. It proposes to cut many programs funding public health efforts, such as HIV/AIDS prevention and treatment, family planning funding for low-income women and families and teen pregnancy prevention (the first two of which were signed into law by Republican presidents George W. Bush and Richard Nixon).
The proposals on the list are consistent with other Trump administration actions in this area, such as the administration’s announcement two weeks ago that it will allow employers to opt out of covering birth control. If this list is truly an internal White House document, it reveals that some in the administration seek to go much further and take actions that would represent an attack on women’s basic economic well-being. An attack on women’s access to family planning is an attack on their economic rights, diminishing their ability to climb out of poverty.
Having a child is, among many other things, an economic event, one that engenders significant economic and opportunity costs, where the latter implies constraints on mothers’ time spent in the paid labor market. Of course, many women willingly accept that constraint. But that willingness is a function of their ability to control when they become pregnant.
Family planning is essential to women from an economic standpoint. It has been shown to dramatically reduce unintended pregnancy, thereby allowing women to decide when and how frequently to have children. That choice has improved economic (and health and educational) outcomes for the women and their children.
The policy wish list would undermine women’s economic well-being here and abroad in at least two ways. First, by cutting funding for the largest domestic and international programs dedicated to family planning and pregnancy prevention, and second, by shifting much of this funding away from family planning through contraception to “fertility awareness,” i.e., having women track their ovulation to identify and practice abstinence on their most fertile days.
According to the Trump administration’s own Department of Health and Human Services, “fertility awareness” is effective in preventing pregnancy about 75 percent of the time (birth control pills are effective 91 percent of the time). Besides being an intrusion on women’s ability to tap the benefits of modern birth control methods, this assumes that women are able to avoid sex when they are most fertile, which many women around the world cannot do.
The document proposes to defund teen pregnancy prevention, based on the false claim that it “has not worked, there is not positive evidence and some negative evidence.” In fact, as the figure below reveals, the teen birth rate has fallen by two-thirds since 1990, with half of that decline occurring in the last decade alone. Yet, the wish list underscores the Trump administration’s continued push to shift funding from teen pregnancy prevention to fertility awareness, a goal it has already partially achieved.
In a further attack on the social and economic fates of low-income women and their families, the wish-list proposals would cut funding for the Title X family planning program. Title X has provided its recipients with family planning since Nixon signed it into law in 1970, but the proposal would cut Title X “at least” in half, shifting the funding to fertility awareness and child-care programs. After Texas slashed state funding for family planning services and barred Planned Parenthood from participating in Title X in 2011, the number of Title X clients served fell by 64 percent by 2015.
Worldwide, over 200 million women have an unmet need for contraception, and the United States is the largest contributor to international family planning and reproductive health programs. However, the policy wish list would slash several of our investments in international family planning. The U.S. Agency for International Development is our lead agency for international family planning and reproductive health, and the wish list proposes to “cut [its] family planning and require equal funding for fertility awareness methods (including 100% for kids, no other family planning programming for girls should be provided except fertility awareness methods).” We have little doubt that cutting this funding or restricting it for less effective methods of family planning will lead to higher rates of unintended pregnancy, more unsafe abortions, and as such, will prevent women from pursuing economic success.
Let’s be clear about this: There can be no successful, comprehensive anti-poverty agenda for women here or abroad that doesn’t include sufficient investment in effective forms of family planning. By rolling back years of progress on this issue, much of which was bipartisan, the Trump administration would be attacking millions of women’s economic well-being and darkening their prospects. This must not go unchallenged.