Family Planning in the Bush Administration

Two different pieces came to my attention today:

"Bush Choice for Family-Planning Post Criticized" By Christopher Lee, The Washington Post, November 17, 2006; Page A01.

The Bush administration has appointed a new chief of family-planning programs at the Department of Health and Human Services who worked at a Christian pregnancy-counseling organization that regards the distribution of contraceptives as "demeaning to women."

Eric Keroack, medical director for A Woman's Concern, a nonprofit group based in Dorchester, Mass., will become deputy assistant secretary for population affairs in the next two weeks, department spokeswoman Christina Pearson said yesterday.

Keroack, an obstetrician-gynecologist, will advise Secretary Mike Leavitt on matters such as reproductive health and adolescent pregnancy. He will oversee $283 million in annual family-planning grants that, according to HHS, are "designed to provide access to contraceptive supplies and information to all who want and need them with priority given to low-income persons."

The appointment, which does not require Senate confirmation, was the latest provocative personnel move by the White House since Democrats won control of Congress in this month's midterm elections. President Bush last week pushed the Senate to confirm John R. Bolton as ambassador to the United Nations and this week renominated six candidates for appellate court judgeships who have previously been blocked by lawmakers.

The Keroack appointment angered many family-planning advocates, who noted that A Woman's Concern supports sexual abstinence until marriage, opposes contraception and does not distribute information promoting birth control at its six centers in eastern Massachusetts.

"ABSTINENCE EDUCATION: Efforts to Assess the Accuracy and Effectiveness of Federally Funded Programs," GAO Report to Congressional Requesters (GAO-07-87), October 2006. (PDF, 62 pages.)
What GAO Found:

Efforts by HHS and states to assess the scientific accuracy of materials used in abstinence-until-marriage education programs have been limited. This is because HHS’s ACF (Administration for Children and Families) — which awards grants to two programs that account for the largest portion of federal spending on abstinence-until-marriage education — does not review its grantees’ education materials for scientific accuracy and does not require grantees of either program to review their own materials for scientific accuracy. In contrast, OPA (Office of Population Affairs) does review the scientific accuracy of grantees’ proposed educational materials. In addition, not all states that receive funding from ACF have chosen to review their program materials for scientific accuracy. In particular, 5 of the 10 states that GAO contacted conduct such reviews. Officials from these states reported using a variety of approaches in their reviews. While the extent to which federally funded abstinence-until-marriage education materials are inaccurate is not known, in the course of their reviews OPA and some states reported that they have found inaccuracies in abstinence-until-marriage education materials. For example, one state official described an instance in which abstinence-until-marriage materials incorrectly suggested that HIV can pass through condoms because the latex used in condoms is porous.

HHS, states, and researchers have made a variety of efforts to assess the effectiveness of abstinence-until-marriage education programs; however, a number of factors limit the conclusions that can be drawn about the effectiveness of abstinence-until-marriage education programs. ACF and OPA have required their grantees to report on various outcomes that the agencies use to measure the effectiveness of grantees’ abstinence-until-marriage education programs. In addition, 6 of the 10 states in GAO’s review have worked with third-party evaluators to assess the effectiveness of abstinence-until-marriage education programs in their states. Several factors, however, limit the conclusions that can be drawn about the effectiveness of abstinence-until-marriage education programs. Most of the efforts to evaluate the effectiveness of abstinence-until-marriage education programs included in GAO’s review have not met certain minimum scientific criteria—such as random assignment of participants and sufficient follow-up periods and sample sizes—that experts have concluded are necessary in order for assessments of program effectiveness to be scientifically valid, in part because such designs can be expensive and time-consuming to carry out. In addition, the results of efforts that meet the criteria of a scientifically valid assessment have varied and two key studies funded by HHS that meet these criteria have not yet been completed. When completed, these HHS-funded studies may add substantively to the body of research on the effectiveness of abstinence-until-marriage education programs.

The report notes:

In commenting on a draft of this report, HHS agreed to consider requiring grantees of both ACF programs to sign written assurances in grant applications that the materials they use are accurate. In addition, HHS noted that all federal grant applicants attest on a standard form that information in their applications is correct. However, it is not clear that this serves the purpose of assuring the scientific accuracy of the educational materials. Further, the curricula to be used are not required to be included with states’ applications. HHS’s written comments also stated that ACF requires that the Community-Based Program curricula conform to standards that are grounded in scientific literature by requiring certain types of information. However, the inclusion of certain types of information does not necessarily ensure the accuracy of the scientific facts included in the abstinence-until-marriage materials. In addition, HHS noted in its written comments that we did not define the term scientific accuracy and stated that it disagreed with certain findings of the report because it was difficult to precisely determine the criteria employed by GAO in making the recommendation as to scientific accuracy. However, the objective of our work was to focus on efforts by HHS and states to review the accuracy of scientific facts included in abstinence-until-marriage education materials and not to perform an independent assessment of the criteria used or the quality of the reviews. With regard to effectiveness, HHS agreed that it may be too soon to draw conclusions about the effectiveness of ACF’s and OPA’s programs. (Emphasis added.)

TPM Mudraker.Com comments:

This is kind of fun. In a new report on publicly-funded abstinence programs, a government watchdog charged that the Department of Health and Human Services (HHS) allows programs to distribute inaccurate sex information to kids, and suggested the agency clean up its act.

But in its defense, HHS argued that it doesn't know how to tell whether something is "scientifically accurate."

Comment: The Bush Administration's political agenda, based on the moral views of an influential portion of its constituency, again appears to trump its interest in scientific accuracy in the field or reproductive biology. JAD