The ‘perfect storm’: Redirecting family planning funds could undercut STD fight

Jun 12 2018

A Trump administration effort to shift family planning funding toward groups that may not provide comprehensive services and away from organizations that provide abortions could cripple other federal efforts to curb an explosion in sexually transmitted diseases (STDs), some public health officials fear.

"This is the perfect storm, and it comes at absolutely the worst time," said Daniel Daltry, program chief of the HIV/AIDS, STD and Viral Hepatitis Program at the Vermont Department of Health.

In 2016, there were more than 2 million cases of chlamydia, gonorrhea and syphilis reported to the federal Centers for Disease Control and Prevention. It was the highest number of reported cases ever.

Now the Department of Health and Human Services has proposed changes to the rules for the federal family planning services program, known as Title X. Daltry and other public health officials fear the changes will make testing and treatment for STDs harder to get.

The new rules, if adopted in their current form, would require that Title X services be physically and financially separate from abortion services.

Many family planning clinics are committed to offering comprehensive services, including contraception and abortion referrals, said David C. Harvey, executive director of the National Coalition of STD Directors, a membership group of public health department STD directors and community organizations. "These principles are near and dear to them, and if the changes are enacted we fear many programs would decide not to take Title X funding."

With less funds, they'd have fewer resources available for STD screening, treatment and outreach.

Title X funds have never been permitted to be used for abortions. But President Donald Trump and other Republicans have vowed to cut off all federal funding for Planned Parenthood and other organizations that provide abortions.

It's too soon to know what will happen. The proposed rule was published June 1 and is available for public comment until the end of July.

Title X provides grants that fund family planning, STD screening and breast and cervical cancer screening at nearly 4,000 sites nationwide.

The program primarily serves low-income, young women, although a growing number of men receive services at Title X funded clinics as well.

The clinics are recognized primarily for providing contraceptive services, but the STD screening and treatment services they provide also are critical. Young people ages 15 through 24 accounted for half of all new STD cases in 2016 (the most recent figures available), according to the CDC. One in 4 four adolescent girls who were sexually active had a sexually transmitted disease.

People who are infected typically don't have symptoms. The diseases are generally easy to cure with antibiotics but without treatment can cause serious health problems, such as pelvic inflammatory disease, and may lead to infertility.

Even if young people have coverage through their parents' insurance, many avoid using it, concerned that the health plan may notify their parents that they've been tested or treated for a sexually transmitted disease. Instead, they may visit a clinic receiving Title X funding where they can receive confidential services that they pay for on a sliding scale based on their income.

Daltry and other public health experts are concerned that proposed changes to the Title X family planning program rules may result in the closing of some Planned Parenthood and other family planning clinics that also provide abortion services.

The number of STD clinics funded by local or state governments has dwindled over the past decade, and many states rely on other providers for testing and treatment, Harvey said.

With 12 sites in Vermont, "Planned Parenthood has operated as our STD clinic," said Daltry. No one should live more than a 45-minute drive from a site. And while there are other providers throughout the state, "the same continuum of care might not be offered at all sites."

However, advocates of the Trump administration's plan point out that some new clinics may also now get Title X funding. Earlier this year, the administration made a point of encouraging providers that emphasize natural family planning methods, sometimes called fertility awareness, to apply for money.

The Catholic Medical Association, which on its website emphasizes the need for any national health care legislation to provide "respect for human life” and to not fund "or mandate abortion as a 'health care benefit,'" applied for Title X funding this year. The organization also notes the importance of "conscience rights for health professionals."

Some Catholic medical practices - like the one where she works — choose not to prescribe birth control pills or other Food and Drug Administration-approved methods of contraception, said Dr. Anne Nolte, a family physician at St. Peter's Gianna Center, a gynecology and infertility practice in New York City. But "patients are welcome to come to us for STD screening and treatment," she said.

The proposed regulation doesn't focus on sexually transmitted disease testing and treatment, but it appears in one provision that some advocates find concerning.

The rule would require that teenagers who come to a Title X clinic with an STD or who are pregnant be screened to ensure they aren't victims of sexual abuse.

"The idea that every single young person under the age of 18 who is there because they either have [a sexually transmitted infection] or because they need a pregnancy test has to be screened is troubling," said Kinsey Hasstedt, a senior policy manager at the Guttmacher Institute, a reproductive health research and advocacy organization. "They're there for health care support, and instead they get another level of screening."

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