January 24, 2018 In the News

STAT First Opinion: Contraception is quietly under siege at HHS

Contraception is quietly under siege at the Department of Health and Human Services

By Mary Alice Carter for STAT

In mid-January, anti-abortion activist Teresa Manning Wagner, the deputy assistant secretary for the Office of Population Affairs in the Department of Health and Human Services, was escorted from the building after supposedly resigning her post. Her acting replacement, Valerie Huber, has spent her career working against birth control programs and advocating for abstinence-only programs; she had no government experience before joining HHS last summer. HHS is more than two months late in publishing guidelines for the Title X grant program that provides free and low-cost birth control to 4 million low-income people annually. And to make matters worse, HHS is still without a permanent secretary after Tom Price resigned amid a scandal of his own.

What is going on at HHS?

We are one year into the administration of President Trump and Vice President Mike Pence, and little is known about the inner workings of HHS. It is one of the largest and most consequential non-defense agencies in federal government, with a 2018 budget of $1.1 trillion. When it comes to the health of millions of Americans, HHS wields great power to steer the ship and can often steer it quietly, without the help of Congress. The administration’s political appointees can be hugely influential in the policies that ultimately affect ordinary Americans. As they say, personnel is policy.

But despite the enormous influence of HHS, the agency has received relatively little scrutiny from Republicans in Congress. Americans protested in the Capitol and at town halls across the nation to take on the president, Congress, and HHS when it came to efforts to repeal and replace the Affordable Care Act. But even as the ACA fight continued and as the press held former Secretary Price accountable for using private charter aircraft for official trips at taxpayer expense, little attention has been paid to the making of critical appointments and policy changes. Some of the most dangerous changes to women’s health are hiding in plain sight.

Equity Forward, the nonprofit organization I direct, was launched to take on anti-reproductive-health forces wherever they may be. We recently started HHS Watch, a campaign to increase transparency and accountability at the nation’s foremost public health agency. HHS Watch will focus on the appointees and actions of the entire agency, but will zero in on how the department is harming reproductive health care.

One of the areas in which HHS has most egregiously changed course is the Title X family planning program. Instead of hiring qualified public health professionals, the administration has quietly put anti-contraception political activists in charge of reproductive health care for the people who rely on Title X, with no public debate and no meaningful oversight in Congress.

Through HHS Watch, we have already revealed that numerous individuals responsible for this program have either made public statements against contraception and other scientifically backed family planning methods or worked for organizations at odds with the evidence that those approaches work. Some of these appointees work in the Office of Population Affairs, which administers Title X.

Title X is an essential program because it helps people decide when and if to become pregnant. Since 1970, the U.S. has maintained a national commitment through this program to providing low-cost or free birth control to low-income people who don’t qualify for Medicaid. Republican and Democratic presidents alike have used science and scientific results, including demonstrated reductions in unintended pregnancies, as their guide for ensuring the widespread availability of high-quality family planning. We are now at a historic 30-year low for unintended pregnancy while simultaneously saving an estimated $13.6 billion a year, $7 billion of which is directly attributed to Title X programs.

Given that impressive record, why would the Trump administration choose people who do not believe in contraception to run such a program? All signs point to the administration’s intention to dismantle this successful, proven program. A leaked White House memo singles out Title X, claiming it “should be cut in half at least.” It has a partisan target on its back, thanks to people like Pence who would rather use as a political boogeyman Planned Parenthood (which provides care for a substantial number of Title X patients) to rile up the administration’s base than have a serious discussion about providing quality reproductive health care to Americans in need.

As the administration weighs any changes to the Title X program or other essential HHS programs upon which millions of families rely, it must understand that any process should not occur without being fully transparent and accountable to the American people. HHS Watch exists to ensure that the department is truthful and transparent about who is making decisions and why they are being made.

The Trump administration owes all Americans answers to questions about what is going on at HHS. We aren’t holding our breath for its reply. Instead, we will file Freedom of Information Act requests and conduct inquiries about the department because Americans deserve to know more about it.

Mary Alice Carter is executive director of Equity Forward, a nonprofit that runs research-driven campaigns to hold accountable the opponents of reproductive health.