Appropriations Bill Marks Victory for Sexual Health, but Vigilance by Advocates Is Needed

After a decade of denial and ideological assault on science-based public health, the passage of the omnibus appropriations bill this past weekend represents a major win for youth advocates who support rights-based, evidence-based sexual and reproductive health programs. Not only did the legislation “flip the switch” on $114 million in federal spending from abstinence-only-until-marriage programs to comprehensive teen pregnancy prevention and sex education programs, it also established an office on adolescent health within the office of the Secretary at HHS.

While these victories are significant, advocates will need to maintain their vigilance given the timidity many Democrats and Administration officials have exhibited when it comes to sexual health issues.

On Sunday, December 13th, the Senate passed the Omnibus Appropriations Bill by a vote of 57 to 35. The House passed the bill late last week by a vote of 221 to 202. This appropriations “catch-all” bill contains all of the remaining FY 2010 spending bills with the exception of Defense. The omnibus bill will now go to the President for his signature.

The Omnibus Appropriations Bill marked two significant victories impacting the sexual health of young people.

First, Congress and the Obama Administration removed all direct funding ($99.5 M) for the ideological-based and harmful Community-Based Abstinence Education program and in its place provided $114.5 million for more comprehensive, evidence-based teenage pregnancy prevention. This is a great first step and a sea change from the Bush Administration. However, we know that young people are not just facing problems related to unintended pregnancy, but also HIV and other sexually transmitted infections (STIs), and that’s why it is important that these funds also be used for comprehensive sex education programs that can address a number of sexual health needs.

Second, Congress placed this sexual health initiative in the newly established Office of Adolescent Health (OAH) under the Secretary of Health and Human Services. This is a major step forward in ensuring that the sexual and reproductive health of young people will be monitored by public health professionals rather than ideologues as in the past. According to the conference summary, “the conferees intend that the Office of Adolescent Health shall coordinate its efforts with the Administration for Children and Families, Centers for Disease Control and Prevention, and other appropriate HHS offices and operating divisions.” We also know that this new Office of Adolescent Health will integrate and coordinate a broad array of adolescent health issues, including wellness, substance abuse, mental health, obesity, etc. This holistic approach is welcomed since it treats young people as human beings rather than as a set of independent, isolated “risk factors.”

As the Administration begins to structure the Office of Adolescent Health, there are a few key principles that we would encourage them to adopt from its inception:

1. Youth Leadership – Young people should be engaged as partners from the very beginning. Too often, governments develop programs and policies that impact young people without ever hearing from young people themselves. Establishing a youth advisory committee should be a priority for OAH. Youth should not be seen and treated just as part of the problem; they must also be seen and treated as part of the solution. .

2. Diversity – When it comes to sexual and reproductive health, one program is not enough. What works in urban areas, may not work in rural areas. What works for African American youth may not work for Latino youth. What works for heterosexual youth may not work for lesbian, gay, bisexual and transgender (LGBT) youth. The Office of Adolescent Health needs to ensure that funding and program development encompasses the needs and concerns of all young people, especially those living in communities with the greatest health care disparities.

3. Evidence-Based AND Rights-Based – Science and evidence must be the foundations of all decisions related to funding and programs. We have just emerged from ten years of pseudo-science and ideological politics. We must ensure that any program that addresses the sexual and reproductive health of America’s youth be grounded in fact, including those that may qualify for the “innovative strategies” grants. We must also ensure that policies are based on the fundamental rights of young people to complete information about their sexual health and access to confidential services.

4. Transparency – There should be clear documentation about how funding decisions are made and what programs are being funded. The OAH should conduct regular update meetings with public health and youth advocates to ensure that communication is open and policy guidelines are clear.

There can be no doubt that the appropriations bill represents a major victory. But, only time will tell how the Obama Administration fulfills the ultimate vision of creating a sexually healthy America. Young people are the cornerstones of that pursuit. We must remain vigilant and continue to provide feedback to an Administration and Democratic Hill leadership that at times appears to be listening with only one ear.