A Follow-Up on Women's Preventive Health Services Guaranteed by the Obama Administration

This post is part of a weekly “Did You Know” blog series that highlights important, but not well known features of the health reform law about prevention, wellness, and personal responsibility for our health.   

WomanDid you know that, in an HHS ruling last week, the Obama administration reaffirmed the Affordable Care Act’s commitment to improving the health and well-being of America’s women?

If you’ve been tuning in to our weekly “Did You Know” blog series on preventive health and the Affordable Care Act, you might remember that last summer the U.S. Department of Health and Human Services (HHS) required health insurance companies to cover a set of women’s preventive health services without charging a co-payment (effective August 2012). The comprehensive set of free women’s preventive health services recommended by the Institute of Medicine includes, among many other necessary services, Food and Drug Administration-approved contraceptives, or birth control. This issue affects millions of Americans. There are approximately 43 million sexually active women who do not want to become pregnant in the United States; 89% of them use contraception. 

Last summer’s interim rule allowed certain nonprofit religious employers offering health insurance to their employees to qualify for a religious exemption and therefore be able to decide for themselves whether or not to cover contraceptive services in their employer-sponsored coverage. This religious exemption was narrowly defined, pertaining only to those religious institutions that employ and serve people of the same religious beliefs, like churches or synagogues. The exemption did not include religiously affiliated institutions, like hospitals and schools. When HHS asked for public comment on this part of the rule, it received an outpouring of input from groups supporting the narrow exception and groups wanting it expanded.

On Friday of last week, HHS announced its final ruling on this issue, concluding that the narrow definition of the religious exemption will stand. Religious places of worship like churches will be exempt from the rule, but institutions with religious affiliations like hospitals and schools will not. This means, for example, that churches will not have to cover contraceptive health for their employees, but religiously affiliated hospitals will have to offer that coverage to their doctors, nurses, and other employees. The only change to the rule from last August is the decision to give employers who don’t currently offer contraceptives in their employer-sponsored health coverage because of a religious belief an extra year (until 2013) to comply with the mandate. The Secretary of HHS, Kathleen Sebelius, said that she believes this proposal “strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services.”

This blog post was coauthored by Rachel Gielau.


Sex Education: The Debate Continues

New research and new legislation on abstinence-only sex education has brought the ongoing debate between abstinence-only and comprehensive sex education to a new pitch.

A little context: abstinence-only sex education received small amounts of funding in the 1980s, but got its real start during the Clinton administration with the 1996 welfare reform law. As part of that law, Title V of the Social Security Act was amended. This amendment established funding for abstinence-only programs and outlined the eight requirements for a program to receive funding, including the promotion of abstinence until marriage, and teaching that abstinence is the only way to avoid pregnancy and sexually transmitted diseases (STDs), and that sex before marriage would likely be psychologically and physically harmful (the law is codified at 42 U.S.C. § 710). Every state, with the exception of California, applied for funds, and loosely interpreted the eight requirements, which largely went unenforced.

Under President George W. Bush there was a significant increase in federal funding for abstinence-only programs, including Title V and the Community-Based Abstinence Education program. The federal funding combined with state matching funds catapulted spending on abstinence-only programs to over $200 million per year by 2005 (up from $9 million in 1997). The Bush administration also began more stringently enforcing the requirements for funding, and states, wary of the restrictions on teaching about birth control and safe sex, slowly began to drop their federal funding requests.

Meanwhile, study after study showed abstinence-only sex education to be not only ineffective, but sometimes even harmful to adolescents. In 1997, teen pregnancy rates in the US went up for the first time in 15 years, along with teen STD rates. The Obama administration finally ended funding for abstinence-only sex education, allowing Title V to expire, and instead redirected funds toward comprehensive, evidence-based programs.

Now, in 2010, the Journal of Pediatrics and Adolescent Medicine has released a study claiming to have at last found an abstinence-only program that works. The study, “Efficacy of a Theory-Based Abstinence-Only Intervention Over 24 Months,” raised new hopes for proponents of abstinence-only education, but the kind of abstinence-only program used in this study is vastly different from the Bush-era programs – so much that it would not have qualified for federal funding. The program in this study was neither moralistic nor disparaging toward sex or contraception, and only advocated abstinence until “a time later in life,” not until marriage. 

These changes are certainly steps in the right direction, but withholding critical information from teens on safe sex still raises serious questions, especially given the fact that 25 percent of the 12 year-olds who participated in this study were self-reportedly already having sex. For more information about this study and its findings, see our latest WomanView

Much to the dismay of teen pregnancy prevention advocates, Bush-era abstinence-only programs have not gone away – far from it, actually. Renewed funding for Title V, to the tune of $50 million a year over the next five years (plus state matching funds, up to an additional $38 million per year), was part of the health care reform bill, signed into law last week. 

Preventing teen pregnancy is, of course, important. The Shriver Center supports medically accurate, comprehensive sex education that is appropriate to students’ age, developmental level, and cultural background, not more failed abstinence-only programs. Through our Ensuring Success in School Initiative, we also support teens who are already parents or expectant parents so that they can stay in school, graduate, get good jobs, and raise healthy families.

For more information on sex education policy or on our efforts to support teens who are parents or expectant parents, please contact the Women’s Law and Policy Project.

WomanView is a publication of the Women’s Law and Policy Project at the Shriver Center, focusing on legal and policy issues affecting low-income women and girls. You can subscribe to WomanView here

Shana Heller-Ogden coauthored this blog post.