On February 1, 2010, President Obama released his Fiscal Year 2011 budget request. Below is a sample of funding for sexual and reproductive health that was included in the $3.8 trillion request. On the domestic side, advocates saw increases for Presidential priorities of teen pregnancy prevention and HIV/AIDS, while on the international front, family planning, and reproductive health programs and maternal and child health programs received the largest increases as the budget outlined the Global Health Initiative announced last year.
Teen Pregnancy Prevention Initiative, Abstinence-Only-Until-Marriage Programs
The President’s FY11 budget increased funding for the new teen pregnancy prevention initiative by $19.2 million, for a total of $133.7 million. Created last year, the teen pregnancy prevention initiative will make grants available “to public and private entities to fund medically accurate and age appropriate [sic] programs that reduce teen pregnancy.” Of the funding, $85 million is directed for “programs that replicate the elements of one or more teenage pregnancy prevention programs that have been proven through rigorous evaluation to delay sexual activity, increase contraceptive use (without increasing sexual activity), or reduce teenage pregnancy,” and $28 million for “develop, replicate, refine, and test additional models and innovative strategies for preventing teenage pregnancy.” The budget also includes funding for evaluation and technical assistance.
While advocates for more comprehensive approaches to sex education were pleased with the increase, particularly in a tight fiscal year, many felt that the administration missed an opportunity to provide true, comprehensive sex education that promotes healthy behaviors and relationships for all young people, including lesbian, gay, bisexual, and transgender (LGBT) youth, by focusing the funding on teen pregnancy prevention, and not including the equally important health issues of STIs and HIV. “So many negative health outcomes, be they unintended pregnancies, STDs or HIV, stem from the same behavior of unprotected sex, and that is the behavior we need to change,” said Jen Heitel Yakush, director of Public Policy at SIECUS. “We are pleased with the increase in funding and hope that Congress will follow-through on this increase, but we also hope that Congress will focus the discussion on what programs to fund by looking at the evidence and seeing what works, not by limiting ourselves to one strategy right out of the gate,” continued Heitel Yakush.
The budget continues to request that the teen pregnancy prevention initiative be administered by the newly established Office of Adolescent Health, which will support and expand teen pregnancy prevention efforts while also addressing a broader range of adolescent health issues, such as those related to sexual health, mental health, violence, substance use, nutrition and physical activity, and tobacco use. In addition, the budget once again includes zero funding for failed abstinence-only-until-marriage programs. Advocates are hopeful that Congress will follow through with this request for the second year in a row.
HIV/AIDS Prevention, Care, and Treatment
The President’s budget included an expansion and prioritization on domestic HIV/AIDS prevention, care, and treatment activities, noting that the effort was “consistent with the President's pledge to develop a National HIV/AIDS Strategy that will focus on reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related health disparities.”[i]
According to a fact sheet released by the administration, the Budget includes specific appropriations for new HIV-prevention programs, focuses HIV testing among high-risk groups, and increases resources for the Ryan White program to support the care and treatment needs for persons living with HIV/AIDS who are unable to afford health care and related support services. The budget also aims to target specific populations and address health disparities as they relate to HIV/AIDS.
President Obama proposed an increase of $31 million for HIV-prevention programs at the Centers for Disease Control and Prevention (CDC), a four percent increase over last year’s funding level. The increase will be used for several activities including the launch of a multi-year HIV-prevention initiative targeting gay and bisexual men, men who have sex with men, and transgender individuals and to enhance HIV surveillance among at risk populations. While advocates were grateful for a proposed increase during a tight budget year, the amount is far from what is needed to reduce the number of new infections in the United States, which still stands at over 56,000 per year. The CDC believes that in order to adequately address the HIV epidemic in this nation, an additional $878 million is needed over each of the next five years and this budget request comes in far below that number.
The largest component of the federal HIV/AIDS budget is health care for people living with HIV/AIDS in the U.S., which totals $14.1 billion in the FY 2011 request, including Medicare and Medicaid funding. The Ryan White Program, the largest HIV-specific discretionary grant program in the U.S. and third largest source of funding for HIV care, is funded at $2.3 billion in the budget, a $39.5 million increase over FY 2010. The increase would be used to expand access to care, particularly for medications through the AIDS Drug Assistance Program (ADAP) which receives $855 million in the request (a $20 million increase). Additional resources are also provided to other parts of the Ryan White program, including resources to reduce health-related disparities in communities of color.[ii]
Additionally, the administration’s request included a $53 million increase for minority AIDS prevention and treatment activities.
Title X Family Planning Program
The President’s FY11 budget includes $327.4 million, an increase of just $9.9 million, or three percent, for the Title X family planning program. This mirrors the increase received last year. Title X is the only federal program exclusively dedicated to family planning and reproductive health services and offers low income women voluntary contraceptive services, prenatal care, treatment for sexually transmitted diseases, and other services. Family planning advocates are concerned that the funding will not stretch far enough to meet the needs of Title X health centers across the country who have seen increases in the number of women seeking basic preventive care in these difficult economic times.
Fatherhood, Marriage and Families Innovation Fund
The FY 2011 budget proposes to redirect and expand existing funding to a new Fatherhood, Marriage and Families Innovation Fund. The proposed $500 million which will provide competitive grants to States to conduct and rigorously evaluate, comprehensive, responsible fatherhood programs and demonstrations geared towards improving child outcomes by improving outcomes for custodial parents with serious barriers to self-sufficiency. Funded activities would focus on barriers to employment and could include interventions like home visits, subsidized employment, transitional jobs, and mental health and substance abuse treatment.
Global Sexual and Reproductive Health
The President’s budget proposal would increase funding for global health issues by nine percent and includes a pledge to spend more to combat preventable diseases and reduce maternal and child mortality. The budget includes a total request of $9.6 billion for global health in the U.S. Department of Health and Human Services, the State Department, the U.S. Agency for International Development (USAID), and the Department of Defense. The budget enacted for FY 2010 allocated $8.8 billion for those departments.[iii]
Under the President’s request, the State Department and USAID would receive $700 million to target maternal and child mortality under the proposal, an increase from the $474 million allocated in 2010. International family planning would receive a $65 million funding increase under the budget, from $525 million to $590 million. A majority of the requested funding—approximately $7 billion—would go to the President’s Emergency Plan for AIDS Relief (PEPFAR), including $5.74 billion for bilateral HIV/AIDS programs, $251 million for bilateral TB programs, and a $1 billion contribution to the Global Fund To Fight AIDS, Tuberculosis and Malaria.
In addition to requested funding levels, the administration also released the release of a set of ambitious global health targets to be achieved by 2014, including getting 1.6 million more people into drug treatment for HIV/AIDS, cutting the prevalence of malaria by 50%, and reducing maternal mortality by 30% in assisted countries, and reducing mortality rates of children under 5 years old by 35% in assisted countries.
Although recognizing that is a tight budget year, many HIV/AIDS and other health advocacy groups said the amounts the President requested in his budget were insufficient for achieving the goals outlined by the administration. Of particular concern was the small proposed increase in spending for HIV/AIDS programs for the second year in a row.
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[i] “Department of Health and Human Services,” accessed 23 February 2010, <www.whitehouse.gov/omb/budget/fy2011/assets/health.pdf>.
[ii] “U.S. Federal Funding for HIV/AIDS: The President’s FY 2011 Budget Request,” Kaiser Family Foundation, February 2010, accessed 23 February 2010, <http://www.kff.org/hivaids/upload/7029-06.pdf>.
[iii] Betsy McKay, “White House Proposes 9% Increase in Global-Health Funding,” Wall Street Journal, 1 February 2010, accessed 23 February 2010, <http://online.wsj.com/article/SB10001424052748704107204575040063950909540.html?mod=WSJ