The arrival of the Obama administration has changed the outlook and terms of debate on a wide range of sexual and reproductive health issues, according to four new articles published in the Winter 2009 issue of the Guttmacher Policy Review.
Together, the articles provide a detailed review of key priorities of the U.S. sexual and reproductive health community. In-depth analyses examine the urgent need to end the era of abstinence-only education, steps the United States can take to restore its role as a leader in global sexual and reproductive health issues, and the ways in which the U.S. family planning program is a model for health care reform that emphasizes prevention.
The articles provide a hopeful, yet realistic, assessment of achieving significant advancements for women’s health both at home and abroad, while noting initial setbacks and persistent political challenges:
A New Era
The first weeks of the Obama administration demonstrated that with strong supporters of reproductive health and rights occupying the White House and leadership positions in Congress, policy change for the better is possible, according to "The New Day at Its Dawn: Evidence Is Back, but Politics Endures," by Susan A. Cohen. They also provided dramatic proof that real progress will not come easily. President Obama quickly made clear his strong support for abortion rights, prevention and international family planning. However, the forward agenda suffered a setback when pressure from social conservatives resulted in the removal from the economic recovery package of a measure to expand family planning services to more low-income women under Medicaid.
"Having strong supporters of women’s health in the White House and among Congressional leaders is a great opportunity," says Cohen. "But it doesn’t guarantee success. Sexual and reproductive health advocates are going to have to work very hard to break the stranglehold of yesterday’s politics if real progress is to be made."
The Future of Abstinence-Only Education
Calls are mounting for policymakers to heed the wealth of evidence that abstinence-only programs have no beneficial effect and to stop funding these programs, according to "Advocates Call for a New Approach After the Era of ‘Abstinence-Only’ Sex Education," by Heather D. Boonstra. Going further, advocates are urging the creation a new funding stream to support programs that are more comprehensive in scope and give young people all the information and skills they will need to make healthy choices about sexual behavior. The Responsible Education About Life (REAL) Act is being held up as a model for federal sex education policy in the future.
"Eliminating abstinence-only programs and moving toward a more comprehensive approach to sex education is both good policy and good politics," says Boonstra. "Comprehensive sex education is based on scientific considerations and in sync with what polls repeatedly show parents want for their children."
Restoring U.S. Leadership
Repairing, rethinking and realigning U.S. foreign policies on sexual and reproductive health will be a formidable task, according to "Reclaiming the Lead: Restoring U.S. Leadership in Global Sexual and Reproductive Health Policy," by Sneha Barot. The Obama administration has already laid some of the groundwork, for instance by rescinding the anti–family planning "global gag rule" and committing to meeting the Millennium Development Goals. Along with a supportive Congressional leadership, the administration should now work to increase foreign aid to international family planning programs; mitigate some of the harmful effects of the Helms Amendment; and advocate strongly on sexual and reproductive health issues at a series of upcoming international conferences.
"It is one thing to rejoin the mainstream on global sexual and reproductive health issues," says Barot. "But it is quite another to be a recognized leader, and the United States needs to catch up to many of its Western European peers."
Family Planning and Health Care Reform
Family planning exemplifies both the benefits of prevention and the challenges inherent in trying to remake the current health financing system to better support preventive care, according to "Family Planning and Health Care Reform: The Benefits and Challenges of Prioritizing Prevention," by Rachel Benson Gold. One core challenge is that health coverage generally is largely based on a curative model, and one that emphasizes "doing" rather than "talking." But for family planning and other preventive care, "talking"—whether it is outreach, education, counseling or client follow-up—is critical. Despite their importance, these time-consuming and expensive activities are inadequately covered, if covered at all, by most health insurance today.
"Family planning exemplifies the potential benefits of a national health care system that truly prioritizes prevention," says Gold. "As a cornerstone of basic health care for women, family planning provides a model that should be examined—and valued as such—by policymakers and payers alike."