With Barack Obama's inauguration this month, observers expect that one of his early moves may be to stop action on a controversial federal abortion regulation.
The regulation, issued during the final weeks of the Bush administration, withholds federal payment and funding from providers who do not certify that they do not discriminate against physicians and midlevel providers who refuse to perform abortion or sterilization procedures.
The regulation has been stirring controversy among abortion rights advocates since it was first proposed in August 2008. They contend that the regulation is overly broad and as a result would decrease access to reproductive health services, including contraception.
Meanwhile, supporters, such as the Christian Medical Association, say the Bush administration's approach is balanced and helps clear up misconceptions about the conscience protections already in place under existing law.
Democrats in Congress have already indicated their willingness to act to reverse the regulation. At the end of the last session of Congress, Sen. Patty Murray (D-Wash.) and then-Sen. Hillary Clinton (D-N.Y.), introduced a bill that would stop all action on the regulation.
Aside from addressing the conscience refusal issue, reproductive health advocates expect that the Obama administration's health care agenda may include changes to expand access to emergency contraception, increase funding for family planning, and take a more comprehensive approach to sex education.
“We certainly have a pent up agenda,” said Susan Cohen, director of government affairs at the Guttmacher Institute, a nonprofit research and education organization focused on sexual and reproductive health.
One area in which Ms. Cohen and her colleagues hope to see some action early in the Obama administration is increasing funding for Title X, which provides federal funds for family planning and preventive screening services. The National Family Planning and Reproductive Health Association estimates that if Title X funding had kept pace with medical inflation since 1980, it would be funded at $759 million today, instead of its current $283 million budget.
Sex education is another area ripe for a change in course under a Democratic president and Congress. During the Bush administration, the federal government invested millions in abstinence-only education. However, many reproductive rights advocates say policy makers should look at evidence favoring a comprehensive sex education approach, which includes teaching teens about contraception as well as abstinence. President Obama should eliminate funding for abstinence-only sex education and shift those funds to comprehensive sex education, said Dr. Suzanne T. Poppema, chairwoman of the board of Physicians for Reproductive Choice and Health.
Reproductive rights advocates also are hopeful that the new president will eliminate the Mexico City policy or “global gag rule,” which bars nongovernmental organizations that receive U.S. funds from performing abortions or providing referrals for abortion overseas.
Dr. Poppema also said that the Obama administration should take action to expand access to emergency contraception. The president-elect could significantly expand the number of women who could obtain emergency contraception by directing the Department of Defense to add the medication to its formulary and instructing the Justice Department to mandate that emergency contraception be made available to all victims of sexual assault.
Aside from the list of possible policies that could be quickly changed, abortion rights advocates said they are relieved to be able to stop constantly fighting the federal government. “We have been having to constantly fight what we consider to be bad policy,” said Ms. Crepps.
Though the new Congress will be controlled by Democrats, the majority are not uniformly in favor of abortion rights, she said. However, a solid majority favor family planning and she predicted that they can make some headway in expanding access to contraceptives as one way to prevent abortions.