On Thursday, May 7, 2009 President Obama released the figures for his Fiscal Year 2010 (FY2010) budget request to the U.S. Congress. This budget, the first of his administration, lays the groundwork for the funding allocations for the next year as well as policy priorities for the coming years. Upon the release of the budget request, President Obama stated, “These efforts are just the next phase of a larger and longer effort needed to change how Washington does business and put our fiscal house in order.”[i]
Abstinence-Only-Until-Marriage Programs and Comprehensive Sex Education
The President’ FY2010 budget request eliminated all funding for existing abstinence-only-until-marriage funds—including funding for the Community-Based Abstinence Education (CBAE) grant program ($110 million) and the Title V state abstinence-only-until-marriage program ($50 million). The President redirected funds to effective, evidence-based teen pregnancy prevention programs and promising prevention models. Seventy-five percent of monies that were formerly in the CBAE account are being reallocated to evidence-based and promising teen pregnancy programs and the remaining 25 percent will fund “research and demonstration grants to develop, replicate, refine, and test additional models and innovative strategies for preventing teen pregnancy.”
Advocates for comprehensive sex education were encouraged by the administration’s commitment to support a new initiative that embraces programs that have evidence behind them and work to help young people make responsible decisions like delaying sexual activity and using contraception when they do become sexuality active. However, as SIECUS President and CEO Joseph DiNorcia, Jr. explained, “the exact language in the President’s budget for this new initiative remains narrowly focused on the silo of preventing teen pregnancy and fails to embrace programs that also help young people avoid acquiring a sexually transmitted disease, including HIV/AIDS.” With one young person in this country becoming HIV positive every hour and an epidemic of sexually transmitted diseases (STDs) among adolescents, many sexual and reproductive health and rights advocates expressed similar concerns and pointed to the need for a broader approach to help adolescents make good, healthy, and responsible decisions.
“The bottom line is there’s some concern that this pot of money is available to interventions that are not comprehensive,” said William Smith, vice president for public policy at SIECUS. “The good news is that the administration has fulfilled its promise to end funding for abstinence-only-until-marriage programs,” he said.
Domestic HIV/AIDS Prevention, Care, and Treatment
In his FY 2010 budget outline, President Obama set forth a vision of increasing “resources to detect, prevent, and treat HIV/AIDS domestically, especially in underserved populations.” This was backed up in his budget request which increased funding for HIV prevention, care, and treatment by $107 million. Specifically, President Obama requested an additional $54 million of funding for the Ryan White Program, which funds primary healthcare and support services for over 500,000 people living with HIV in the United States. The President’s budget also included a $53 million increase for HIV-prevention and surveillance services within the Centers for Disease Control and Prevention’s (CDC) Division of HIV/AIDS Prevention (DHAP). This increased funding for DHAP will allow for greater HIV prevention programs in communities most at risk, such as communities of color and men who have sex with men (MSM), where the HIV epidemic continues to grow. This funding will also support testing initiatives because it is estimated that as many as 20 percent of HIV-positive individuals do not know their status.
Title X Family Planning Funding
In the FY2010 budget request, President Obama included a $10 million increase in funding for Title X, the only federal program dedicated solely to funding family planning and reproductive health care services. Title X clinics offer low income women voluntary contraceptive services, prenatal care, treatment for sexually transmitted diseases, and other services. Last year, the Guttmacher Institute estimated that there are 17.5 million women in need of publicly funded contraceptive services. While advocates for family planning funding were encouraged by the minimal increase, they did not feel it indicated the significant shift necessary to ensure that family planning services are available and accessible to all Americans in need of services.
International HIV/AIDS Prevention, Care, and Treatment
The figures in Obama’s 2010 budget request are significantly below the figures requested by HIV/AIDS advocates. The HIV/AIDS advocacy community had recommended a $650 million increase to $1 billion for the United States Agency for International Development’s (USAID) HIV/AIDS program and a $2.1 billion increase to $2.7 billion for the Global Fund to Fight AIDS, Tuberculosis and Malaria, also referred to simply as the Global Fund. Although spending to fight malaria increased greatly in the budget to $585 million (a $200 million jump), the funds for other important global health programs were either flat-funded or experienced marginal increases.[ii]
For example, money for HIV/AIDS in USAID Child Survival and Health Programs Fund and the Global Fund was flat-funded at $600 million and $350 million, respectively.[iii] Many advocates in the U.S. have expressed concern that the allocated funds will not allow the Global Fund to carry out projects. Moreover, Obama’s 2010 budget request of $5.259 billion for bilateral HIV/AIDS foreign assistance (nearly a $100 million increase), has given rise to some questions about how to meet the $48 billion over 5 years authorized in the renewed PEPFAR legislation.[iv] In order to meet the funding targets for HIV/AIDS, malaria and tuberculosis within this time frame, funding allocations in subsequent years will need to see a sharp increase.[v]
International Family Planning
The FY2010 budget request represents a shift in U.S. policy on funding international family planning and reproductive health (FP/RH) programs. The Obama administration is proposing that $593 million be spent on such international assistance, a modest increase of $48 million or about 9 percent over the $545 million allocated by Congress in the FY2009 Omnibus spending bill approved in March. The figure in the FY2009 bill was also an increase from the previous administration, approximately 18 percent higher than FY2008 enacted levels. If Congress approves the $593 million figure in President Obama’s budget request, it would be the largest amount of funding ever approved for international FP/RH programs.
The budget request also demonstrates the U.S. government’s renewed commitment to the United Nations Population Fund (UNFPA), to which $50 million of the proposed $593 million will be allocated. This is the same figure which was approved by Congress in the FY2009 Omnibus spending bill and discussed by Secretary of State Hillary Rodham Clinton on March 13 when she announced that the United States would resume contributions to UNFPA.
For more information:
The full Fiscal Year 2010 budget can be accessed at: http://www.whitehouse.gov/omb/budget/
Highlight from U.S. Department of Health and Human Services:
Highlights from the U.S. Department of State and Other International Programs:
[i] The White House, “Presidential Transmittal Letter: Budget FY 2010,” Press Release published 7 May 2009, accessed 11 May 2009 <http://www.whitehouse.gov/omb/budget/Message/>.
[ii] The Budget for Fiscal Year 2010: Department of State and Other International Programs (Washington, DC: Office of Budget and Management, 7 May 2009), 819.
[iii] The Budget for Fiscal Year 2010, 818.
[iv] The Associated Press, “House Passes Broader Plan to Fight AIDS,” The New York Times, 25 July 2008, accessed 11 May 2009 <http://www.nytimes.com/2008/07/25/washington/25aids.html?_r=1&scp=11&sq=PEPFAR&st=cse>.
[v] Sheryl Gay Stolberg, “Obama Seeks a Global Health Plan Broader Than Bush’s AIDS Effort,” The New York Times, 5 May 2009, accessed 7 May 2009, <http://www.nytimes.com/2009/05/06/health/policy/06medical.html?_r=3&ref=worldObama>.