Two recent US Food and Drug Administration (FDA) hearings have focused on barrier contraceptive methods. In the first action, FDA's Obstetrics and Gynecology Devices Panel voted 7 to 1 against approval of Lea's Shield, a device similar to the cervical cap that does not require custom fitting, on the grounds that adequate clinical research on effectiveness was lacking. Only 1 clinical trial, involving 55 women over a 6-month period, was conducted. The panel urged that additional research on effectiveness also investigate whether the device confers protection against sexually transmitted diseases. During another hearing, FDA advisory committees voted 18 to 1 that spermicidal gels and foams containing nonoxynol-9 appear to provide women with some protection against gonorrhea and chlamydia. At the same time, the committees urged FDA to relabel existing spermicides to inform consumers that their effectiveness in preventing pregnancy has not been established. In addition, panelists voted 11 to 8 that spermicides have been proven safe, although concerns were expressed about spermicide-associated vaginal irritation, which may enhance women's susceptibility to human immunodeficiency virus (HIV) infection.
In November 1996 during her address to the Sixth Conference of Wives of Heads of State and Government of the Americas in La Paz, Colombia, and in her weekly newspaper column, US first lady Hillary Rodham Clinton pledged her own and the Clinton administration's complete support for reversing the severe reduction in funds for the international family planning program imposed by the 104th Congress. This revelation reflected the administration's preparation for a strong and vocal defense of the international family planning program, which will be facing its greatest political test in February 1997. Bolivia has the highest maternal mortality rate in South America, and half the deaths are due to illegal, unsafe abortions. Mrs. Clinton presented a $2.25 million USAID award to a $5 million Pan American Health Organization program that aims to reduce maternal mortality. In her December 3, 1996, column, she used family planning campaigns in Bolivia as an illustration of sensible, cost-effective, and long-term strategies for improving women's health, strengthening families, and reducing the abortion rate. Such programs educate people about the benefits of birth spacing, breast feeding, good nutrition, prenatal and postpartum visits, and safe deliveries. Mrs. Clinton has also visited other poor countries to learn about the special needs and conditions of women's lives. UN Ambassador Madeleine Albright has recently been nominated to be the first female Secretary of State. Many people see her commitment to improving the status of women through development efforts and her recognition of the close relationship between development and diplomacy as encouraging. The concern and commitment of these two powerful women could prove valuable in the upcoming test for international family planning aid. Congress must vote on a resolution to approve Clinton's report that the reduced funding is having a negative impact no later than February 28. If both the House and the Senate pass the resolution, already appropriated funds will be released in March rather than in July.
Congressional representatives across the political spectrum agree that the US welfare system needs to be reformed, but no consensus exists on how to do it. Central to the argument in support of making major changes is the high number of out-of-wedlock births, especially among low-income teens. Looking for ways to discourage such pregnancies and births, some people argue that the welfare system itself promotes the births. Republicans are calling for punitive action to regulate fertility such as cutting off welfare payments to unwed teens who give birth. Opponents counter that little evidence exists demonstrating that welfare change will reduce rates of out-of-wedlock births or unintended pregnancy. Few in Congress, however, have stepped forward to point out that many unplanned pregnancies and out-of-wedlock births could be avoided if poor and low-income women had better access to voluntary family planning and abortion services. In failing to provide such services for poor women, Congress is failing to act as reality demands.
Funding for the Title X family planning program was spared the Congressional ax in the first round of budget cuts, with the program's full 1995 appropriation of $193 million surviving the subcommittee process intact. In relative terms, Title X also fared well in the Clinton administration's proposed budget. Most key programs involving reproductive health care were either level-funded or sustained small cuts, but Title X is one of the few programs for which the administration proposed an increase in funding. Moreover, Title X is one of the few categorical programs not incorporated into a block grant by the Administration. It is unknown, however, how much impact the Clinton budget will have in upcoming funding battles. Other programs did not fare as well in the House of Representatives. For example, the House Appropriations Committee voted to overturn current policy requiring states to pay for abortions under Medicaid in cases of rape and incest, as well as in cases of life endangerment. The rescission bill was scheduled to be considered by the full House in one week. AIDS programs lost many of the previously forthcoming increases voted for the year, while funds for other social programs including school lunches and major nutrition programs for low-income pregnant women and children were slashed. The Center for Budget and Policy Priorities determined that two-thirds of the total cuts made by the House committee came from programs which serve low-income families.
Neither House of the US Congress passed health care reform legislation before September 1994, but they may yet pass a small-scale incremental package. It is doubtful that such a package will bring about a major overhaul of the health care system. The collapse of comprehensive reform occurred despite major progress in the last 12 months in coverage of family planning services and treatment of family planning providers. The debates over health care reform have put family planning services and agencies into the mainstream, which was not done during earlier political debates. Just 1 of 5 health care reform bills proposed before Clinton became president included family planning services. All the proposed bills since Clinton took office included family planning services in the mandated benefits package. They even recognized the importance of family planning clinics at the community level. Traditional health insurance does not cover family planning adequately (e.g., 50% of typical policies do not cover reversible contraceptives), probably because it is considered preventive care.
