In mid-January, anti-abortion activist Teresa Manning Wagner, the deputy assistant secretary for the Office of Population Affairs in the Department of Health and Human Services, was escorted from the building after supposedly resigning her post. Her acting replacement, Valerie Huber, has spent her career working against birth control programs and advocating for abstinence-only programs; she had no government experience before joining HHS last summer. HHS is more than two months late in publishing guidelines for the Title X grant program that provides free and low-cost birth control to 4 million low-income people annually. And to make matters worse, HHS is still without a permanent secretary after Tom Price resigned amid a scandal of his own.

What is going on at HHS?

We are one year into the administration of President Trump and Vice President Mike Pence, and little is known about the inner workings of HHS. It is one of the largest and most consequential non-defense agencies in federal government, with a 2018 budget of $1.1 trillion. When it comes to the health of millions of Americans, HHS wields great power to steer the ship and can often steer it quietly, without the help of Congress. The administration’s political appointees can be hugely influential in the policies that ultimately affect ordinary Americans. As they say, personnel is policy.


But despite the enormous influence of HHS, the agency has received relatively little scrutiny from Republicans in Congress. Americans protested in the Capitol and at town halls across the nation to take on the president, Congress, and HHS when it came to efforts to repeal and replace the Affordable Care Act. But even as the ACA fight continued and as the press held former Secretary Price accountable for using private charter aircraft for official trips at taxpayer expense, little attention has been paid to the making of critical appointments and policy changes. Some of the most dangerous changes to women’s health are hiding in plain sight.

Equity Forward, the nonprofit organization I direct, was launched to take on anti-reproductive-health forces wherever they may be. We recently started HHS Watch, a campaign to increase transparency and accountability at the nation’s foremost public health agency. HHS Watch will focus on the appointees and actions of the entire agency, but will zero in on how the department is harming reproductive health care.

One of the areas in which HHS has most egregiously changed course is the Title X family planning program. Instead of hiring qualified public health professionals, the administration has quietly put anti-contraception political activists in charge of reproductive health care for the people who rely on Title X, with no public debate and no meaningful oversight in Congress.

Through HHS Watch, we have already revealed that numerous individuals responsible for this program have either made public statements against contraception and other scientifically backed family planning methods or worked for organizations at odds with the evidence that those approaches work. Some of these appointees work in the Office of Population Affairs, which administers Title X.

Title X is an essential program because it helps people decide when and if to become pregnant. Since 1970, the U.S. has maintained a national commitment through this program to providing low-cost or free birth control to low-income people who don’t qualify for Medicaid. Republican and Democratic presidents alike have used science and scientific results, including demonstrated reductions in unintended pregnancies, as their guide for ensuring the widespread availability of high-quality family planning. We are now at a historic 30-year low for unintended pregnancy while simultaneously saving an estimated $13.6 billion a year, $7 billion of which is directly attributed to Title X programs.

Given that impressive record, why would the Trump administration choose people who do not believe in contraception to run such a program? All signs point to the administration’s intention to dismantle this successful, proven program. A leaked White House memo singles out Title X, claiming it “should be cut in half at least.” It has a partisan target on its back, thanks to people like Pence who would rather use as a political boogeyman Planned Parenthood (which provides care for a substantial number of Title X patients) to rile up the administration’s base than have a serious discussion about providing quality reproductive health care to Americans in need.

As the administration weighs any changes to the Title X program or other essential HHS programs upon which millions of families rely, it must understand that any process should not occur without being fully transparent and accountable to the American people. HHS Watch exists to ensure that the department is truthful and transparent about who is making decisions and why they are being made.

The Trump administration owes all Americans answers to questions about what is going on at HHS. We aren’t holding our breath for its reply. Instead, we will file Freedom of Information Act requests and conduct inquiries about the department because Americans deserve to know more about it.

Mary Alice Carter is executive director of Equity Forward, a nonprofit that runs research-driven campaigns to hold accountable the opponents of reproductive health.

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  • Perhaps you might thank your lucky stars that you are not among the 1/4 women & girls that have been sexually assaulted… many of whom get impregnated or get STDs as well…
    What about the men who do the impregnating?? Are all of them current in their child support?? Is it an adequate amount to raise a child???
    If you wish to have only your own family’s burdens on your shoulders, then go live as a hermit on a deserted island.

    In this country, we are all in society together, interdependent & need to contribute what we can to the common good… sometimes even in sacrificial levels!! Or do you begrudge your freedoms purchased with the blood of veterans in past days, eg???

  • Everyone knows how to make a baby…They need to learn how to get a job and pay for their babies…I don’t like the fact that my children, grandchildren and great children will be paying for someone else’s children…AMERICA FIRST…LETS JUST PAY OUR OWN WAY…..🇺🇸🇺🇸

  • Every day brings sad, shocking, outrageous and unbelievable news from the Trump administration. Cutting back funding for family planning service is just the latest example how government decisions are not based on data, experience and evidence, but on prejudice, racial biases, ignorance and religious believes. It does not matter to Trump supporters and officials that contraception reduces abortion, improves maternal health, reduces poverty and saves millions of dollars in Medicaid expenditures. We in the USA now live in a dictatorship of ignorance.
    Roswitha Moehring, M.D.

    • Thank you Dr. Moehring for your clarity and passion. I do hope you have written or will write these same words to your senators and congressperson and to as many others in congress as you have time to correspond with. (I’ve found that when you use congress/senate websites to send emails they screen for professionals right up front. I think a letter is more effective but be sure and put your name with M.D. on the envelope. )

    • The evidence clearly shows that teen birth rates are in a steep decline. So, yes, it is evidence-based.

      The graph line shows that the decline started in 1990. In 2004 the decline slowed. Then in 2006 it continued its steep, downward trend.

      In 2010 the Teen Pregnancy Prevention Program started spending $100 million/year to reduce teen birth rates. The graph line didn’t even experience a ripple from the infusion of that new federal money.

      No doubt there are wonderful benefits from the TPP Program. But, at least in this important statistic, it isn’t evident. It appears that evidence-basing can’t really be relied on to tell the whole story.

      It’s unfortunate that this program was cut, as it is when any program is cut. But it might be best to reserve the use of “sad, shocking, outrageous and unbelievable news” to describe more serious attacks on our health programs.

  • Women who will be affected by this attempt to force them into unwanted pregnancies need to be prepared to Just Say No to men until this stops.

    If men can’t get women to engage with them they might be more likely to get to the ballot box this fall and begin the process of saving this nation from the likes of Trump et al. Then we can return to a sane public health policy regarding the right to contraception.

    Either this happens for the need for abortion will increase exponentially. Women will set up their own less-than-safe abortion clinics and all of us who value life will have to live with more sorrow.

  • Par for the course for the whole administration of 45 — put enemies in charge of govt agencies, drastically cut their budgets, then claim they need to be eliminated, since they aren’t working well!!

  • I was genuinely, if only casually, curious in finding out more about this.

    But this op-ed was pretty thin on details.

    I never found out what actions or words are attributed to the head of that division to earn her the “anti-contraception” moniker. And whether people are allowed to have personal opinions as long as it doesn’t interfere with their official duties (I’m guessing in this case, no…)

    Was being “escorted out” an unusual action? Which day in mid-january? If it was minutes after the swearing in of a new President, that would be significant (and probably highlighted). If before the new President was sworn in, then that’s a whole ‘nuther story. Potentially disingenuous language.

    • Typically GOP administrations want individuals to pay their own way, with less government assistance in general. This isn’t targeting women.

      They don’t seem to be denying anyone oral contraception, they just seem to be denying some people *free* contraception. There is a big difference. Anyone can still go to a clinic and get a prescription.

      “Free stuff under siege” would be a better headline.

      The government doesn’t buy men condoms.

    • JC, your argument infers that every woman goes on oral contraception just to prevent pregnancy, which is incorrect. Treatment for polycystic ovary syndrome, treatment for acne, to lower risk for cancer, to lower risk of anemia, regulation of menstrual periods and decrease menstrual cramps… Condoms are used solely for sexual activity; pregnancy prevention and decrease chances of disease transmission, so comparing it to “the government buying men condoms” isn’t the same.

    • I understand. But the headline says “Contraception”.

      And if it’s prescribed for other medically necessary conditions, it doesn’t say that it’s not covered — presumably medically necessary conditions would be from insurance which isn’t under Title IX.

      (And I can’t stand Trump, I’m not defending him)

    • Charles: I admire anyone who seeks more details and context in news stories. I do too. Two things to note about this article though:

      1) It’s an op-ed, as opposed to a news story, so inherently, it will be a more general overview than a news article would be.

      2) Many details you seek are actually there. Click on the links throughout the article. That’s how a lot of information and research is shared these days. Again, if this were a news piece vs an op-ed, more details probably would’ve been cited directly. I hope.

      I appreciate the issues this article brings attention to. They’re important and I hope STAT and others continue to follow this topic.

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