Women’s Health and the Budget

MS. KATTY KAY

10:06:55
Thanks for joining us. I'm Katty Kay of the BBC, sitting in for Diane Rehm. Diane is in Boston for an interview with Maria Hinojosa at WGBH in Boston. In last week's down-to-the-wire 2011 federal budget brawl, two issues related to women's health became major points of contention: disagreement over federal funds for Planned Parenthood and the question of whether D.C. should be allowed to use its own money to help women pay for abortions.

MS. KATTY KAY

10:07:24
Joining me to talk about why women's health issues figure so prominently in the national budget debate, Sarah Brown of The National Campaign to Prevent Teen and Unwanted Pregnancy, Marjorie Dannenfelser, president of the Susan B. Anthony List, and Laura Meckler, White House correspondent of The Wall Street Journal. Thank you so much for joining me, ladies.

MS. LAURA MECKLER

10:07:43
Thank you.

MS. MARJORIE DANNENFELSER

10:07:43
Thank you.

KAY

10:07:44
We'll be taking calls in just a while. The phone number here is 1-800-433-8850. The email address is drshow@wamu.org. And, of course, you can always send us questions and comments on Facebook and Twitter as well. Laura, let me start with you. The House votes tomorrow on the deal that was struck late last Friday night -- very dramatic deal that was struck there -- for funding the federal government for the rest of this fiscal year. You say it wasn't particularly surprising that budget negotiations came down to women's health issues. Why?

MECKLER

10:08:18
Well, these issues, when they deal with abortion in any way, shape or form, often just become dominant in Washington. I think we -- if we think back to the health care debate, abortion was a huge issue there that threatened to sink the entire Obama health care plan. In the end, it didn't, but that also came down to the wire. There are a group of social conservatives in Congress who feel very, very strongly about this issue, and they're willing to push it all the way to the mat. And there are enough supporters who agree with them that will sort of back them up in that, so it ends up being quite contentious. And it really didn't -- on one level, it is surprising because, you know, here we are...

KAY

10:08:56
We need to be dealing with the country's fiscal health...

MECKLER

10:08:57
We're dealing with -- yes.

KAY

10:08:58
...not particularly with women's health, right?

MECKLER

10:08:59
Right. And to some extent, I think that that's maybe even why it came up because a lot of social conservatives have felt like their issues have really been pushed to the side with the Tea Party. A lot of Tea Party activists were sort of very clear about the fact that they were motivated by fiscal issues and not social issues. Many of them, in fact, are social conservatives, but they said that that was not their driving force. A lot of social conservatives felt like, you know, they -- their issues were not getting the attention they would expect with a newly resurgent Republican House. Well, this is -- was an opportunity for them to raise their hands and say, well, we're still here. We still matter. And, in fact, we see that they did.

KAY

10:09:39
Okay. Specifically outline the two points that were the sticking points and how they were resolved.

MECKLER

10:09:43
Okay. The first point dealt with Planned Parenthood. Planned Parenthood offers abortions to women who come to their clinics. It's a small part of what they do, but they are a large abortion provider compared with others in the nation. The question -- they're not allowed to use any federal taxpayer money to provide those abortion services. That's against federal law and has been for a long time. The issue was whether they could continue to get federal money for the other work that they did, for instance, family planning, women's health care exams, Pap smears, that sort of thing. They get a fair amount of money, most of it through the Medicaid program as a Medicaid provider -- as any other doctor or clinic might be -- some of it through a program called Title X.

MECKLER

10:10:25
So there was one proposal by Republicans to basically strip Planned Parenthood of all federal funding. A second proposal dealt specifically with Washington, D.C. Federal law says no federal Medicaid money can be used to provide abortions in that program. But states are allowed to use their own portion of the Medicaid money to fund abortions, and several of them do. For a long time, though, Congress, which is always messing with D.C. in various ways, said, no, D.C., you can't even use your local money for Medicaid abortions. And that ban had lifted in the last couple of years. The attempt was to restore it. And, in the end, that D.C. ban is, in fact, in the compromise that they're going to be voting for. The Planned Parenthood issue is not.

KAY

10:11:06
Okay. And we saw the protests here that followed in D.C., and, of course, the mayor himself being arrested during those protests. Marjorie Dannenfelser, explain what Title X is and how the money is used.

DANNENFELSER

10:11:16
People around here usually say Title X, and that is the family planning program...

KAY

10:11:20
Laura referred to it just now.

DANNENFELSER

10:11:22
Exactly. That she was describing. Title X is the family planning program that -- and I want to pick up on a couple of comments that Laura made. This debate has actually -- over Planned Parenthood, has actually been about abortion. And there is no question that the reason for that is that it's the primary abortion provider in the nation. It's not a small part of what they do. It's more than a third of their budget. One in 10 of their clients receives an abortion. There is a mandate on every affiliate that they offer abortions to women.

DANNENFELSER

10:11:56
So it very much is at the heart of what they do. This truly has not been over whether there should be family planning absent abortion. It has been over whether we should be supporting the number one abortion provider in the nation. And, in fact, we have some polling coming out this morning that asked the question of taxpayers: Do you support or oppose family planning services that include abortion services? Thirty-nine percent support, and 54 percent oppose. And I think, significantly, even among the 54 percent who oppose those services -- abortion services, 26 percent are self-described pro-choice. So you don't have to be pro-choice, pro-life. You can just say, we don't necessarily need to be involved in the abortion business, which Planned Parenthood is.

KAY

10:12:45
Susan. Sorry, Sarah.

MS. SARAH BROWN

10:12:48
Well, I think Laura just gave a very good rundown of the complexities of the current policy situation. I think for those of us like me who've been observing this and working on this issue for years, we are actually finding this very, very confusing and very puzzling. Because if, indeed, the issue was true concern about reducing abortion -- and there are many people in this country who are uncomfortable with abortion -- there would have been massive support for Title X, for a number of other programs that provide family planning and contraception. That is the principal sort of weapon in the need to reduce abortion.

MS. SARAH BROWN

10:13:29
It's cost effective. It's widely supported. And this particular argument has been, really, very puzzling. The more intensely somebody feels about opposing abortion, I think the more vocal and powerful they should be in their advocacy for prevention.

KAY

10:13:47
So, Sarah Brown, what do you make of the figures that Marjorie was just citing there?

BROWN

10:13:52
About Planned Parenthood, in particular?

KAY

10:13:53
Yeah, about the poll that they've just come up with.

BROWN

10:13:54
Well, you know, there are many, many polls. We actually have one that shows wide support amongst both Republicans and Independents, showing that they buy -- over 70 percent approve of making it easier for people at all income levels to obtain contraception. And, in fact, 90 percent of evangelical Christians have no objection to hormonal methods of contraception. Even many members -- over 90 percent of the board of the National Association of Evangelicals approve of contraception. So, unfortunately, the sort of sweet spot of being pro-life and pro-family planning has not been carefully articulated. Planned Parenthood is indeed an abortion provider, but their own numbers say that that's about 3 percent of what they do.

BROWN

10:14:45
So if we believe in prevention, if we believe in women's health care, what we would do is do everything we can to support people who are in the business mainly of prevention.

KAY

10:14:58
Marjorie Dannenfelser, do you agree with that?

DANNENFELSER

10:15:00
Well, I think it is important to be very careful how we articulate this issue. And there is no better case study than Planned Parenthood -- that's for sure. It's in every state in our country. One thing that we know is that as its increase in funding has gone up 80 percent, at that same time, abortions have gone up 69 percent. And its adoption referrals have gone down 61 percent.

KAY

10:15:27
Marjorie, do you agree with...

DANNENFELSER

10:15:28
So the -- there is not that correlation, is my point.

KAY

10:15:30
So, do you agree, though, with the principle that if you are opposed to abortion, you should be in favor of doing everything you can to promote contraception?

DANNENFELSER

10:15:40
I think, yes, to prevent pregnancy, absolutely. The question that I just gave that data, that references that data, is that the increase that Planned Parenthood has put into increased contraception has actually increased. There has been a correlation of increased numbers of abortions and a decrease in adoption. And I will say, pregnancy services are an important -- we've always been under the impression important aspect of what they do. Pregnancy services -- three percent of pregnancy services are adoption referrals, 97 percent are abortion. So we cannot say that they are not in the abortion business.

KAY

10:16:21
Okay. Laura, let me -- there are a lot of confusing numbers here, and I'm sure that a lot of our listeners are getting confused by the poll numbers and by what's actually happening. Can you give us some clarity, though, on whether the riders that Congressman Pence has been pushing for in this budget deal have support of both Republicans and Democrats?

MECKLER

10:16:40
Well, it's an interesting question. The riders specifically on Planned Parenthood, defunding Planned Parenthood, did not have that much Democratic support. It passed with 240 votes in the House, but that included just 10 Democrats. So there were -- there are some Democrats. But that's a pretty strong contrast to what we saw during the health care debate, where the -- what was then the Stupak Amendment, which was also an anti-abortion amendment, had 64 Democrats supporting it. So this was a little bit more -- I mean, also, we're talking about two different congresses, so there are some differences. But this has been much more of a partisan debate this time.

KAY

10:17:16
And what do you make of the polling that both Sarah Brown and Marjorie Dannenfelser have quoted, supporting both of -- both sides of the argument?

MECKLER

10:17:21
My general rule as a reporter is the more ideological an organization is, the less trusting I am of their polling. And that's not an insult to either of the other people on the panel. I just don't really put a lot of stock in polls that are done by groups that have an interest in what the outcome is because you can word a question in a way to get an answer that you want.

KAY

10:17:45
Well, let me phrase it differently then. Where is...

MECKLER

10:17:47
And I'm not necessarily saying that's the case here.

KAY

10:17:49
Of course.

MECKLER

10:17:49
I haven't looked at either one of these polls.

KAY

10:17:50
Where is American public opinion on this?

MECKLER

10:17:53
In general, American public opinion is in favor of abortion rights, of abortion being legal, not in favor of federal funding of abortion. The question is, is this federal funding of abortion? People who support Planned Parenthood say, no, no federal money is going to abortion. The federal money is going to contraception and all -- and related services. What other people, like Marjorie, would say is that it's all fungible. If you're giving money to Planned Parenthood, then they're going to free up other money for abortion.

KAY

10:18:20
Okay. And we'll have Cecile Richards joining us from Planned Parenthood after this short break. Laura Meckler there from The Wall Street Journal, Marjorie Dannenfelser is here from the Susan B. Anthony List, Sarah Brown from the National Campaign to Prevent Teen and Unwanted Pregnancy is also here -- a very dynamic debate. We'll be taking your calls and questions in just a short while. Do stay with us. I'm Katty Kay, sitting in for Diane Rehm. Stay listening.

KAY

10:20:03
Welcome back. I'm Katty Kay of the BBC. You've joined our conversation on women's health issues and the federal budget. Well, I have with me in the studio Sarah Brown, CEO of The National Campaign to Prevent Teen and Unplanned Pregnancy, Marjorie Dannenfelser, president for Susan B. Anthony List, is here. Laura Meckler from The Wall Street Journal is also here. We're joined on the phone now by Cecile Richards. She is president of Planned Parenthood. Cecile, thank you very much for joining "The Diane Rehm Show."

MS. CECILE RICHARDS

10:20:31
Sure. Thanks for having me, Katty.

KAY

10:20:33
I wonder if you could just clarify a little bit for us because we've been having already a lively discussion here about the nature of your organization and the funding of it. Can you tell us more specifically about Planned Parenthood's budget and how much of it comes from the federal government?

RICHARDS

10:20:48
Sure. Well, Planned Parenthood -- I missed the earlier part of your program. But Planned Parenthood is the largest family planning provider in America, and we run more than 800 health centers. About -- depending on the health center in the state, probably between a third and a half of the financial support for any local health center is federal or public funding.

KAY

10:21:09
And give us a sense of the range of services that you provide and to whom.

RICHARDS

10:21:13
Sure. Okay, certainly. So we provide services to about 3 million Americans every year in our health centers, and 97 percent of our services are preventive care. And this is, roughly speaking, about 2.5 million patients each year for family planning, birth control, about 830,000 breast exams, nearly a million Pap smears each year. And we now do about 4 million either tests or treatments for STDs, including HIV. There's a few other services, but that's the bulk of the preventive care that we provide. And our client base is, you know, it's young women getting -- just getting into the workforce, a lot of uninsured women. About 74 percent of our patients live at 150 percent of the poverty level or below.

RICHARDS

10:22:04
So, for many women, studies have borne out over and over that women who go to Planned Parenthood or other family planning centers, about 60 percent of them, that will be the only doctor or nurse they see all year. It's their primary health care provider.

KAY

10:22:20
And I think I'm right in saying that one in five American women have visited a Planned Parenthood clinic?

RICHARDS

10:22:25
That's correct. One in five women have been a patient of Planned Parenthood, and it's interesting, though -- as the Internet has really grown and because of the name of Planned Parenthood is known across the country for being a source of reliable information and services for reproductive health care, we now see about 2.5 million visitors each month online to get basic information, again, about family planning and other services.

KAY

10:22:52
Okay. Let's talk about the controversial issue of abortion...

RICHARDS

10:22:54
Okay, sure.

KAY

10:22:54
...because it certainly is a subject that has been at the forefront of the debate here in Washington, in the studio this morning, and you and Planned Parenthood have been right in the front and center of it. There has been a certain amount of misinformation about how much funding you use for abortion and how much of your services are abortion. Can you clarify for us?

RICHARDS

10:23:15
Well, I think that there have been many things thrown around. I think the most important thing that is really the topic of conversation related to the federal budget is that federal funding does not pay for abortion services, neither at Planned Parenthood, nor at hospitals, nor many other health care providers around the country that get federal...

KAY

10:23:34
And how do you guarantee that the federal funds that you receive are not used for abortions? Are there accounts procedures that you use?

RICHARDS

10:23:43
Sure. There's very strict federal auditing. It's actually -- there are very, very strict rules, and we do -- there are annual audits by the federal government about how federal funds are used as well. I think the important thing to remember, because there has been so many, I think, sort of allegations thrown around, federal funds are reimbursed to Planned Parenthood health centers for specific health care. It's not -- I think there's a lot of confusion. Just -- we operate just like hospitals do. So if a woman comes in, she qualifies for a federal program, she comes in to get a Pap smear, a breast exam and birth control services. Those are reimbursed services.

RICHARDS

10:24:24
So -- and the reason why, right now, we're the largest family planning provider in the country through the nation's family planning program is because, actually, we're the most affordable. We see more patients for a lower cost than any other provider. And, I think, that's one of the issues that's been really -- I think it's really germane to the topic, which is whether or not women will continue to be allowed to go to Planned Parenthood to get these services.

KAY

10:24:53
Okay. But you are also the largest provider of abortions in the United States. And if you are getting money from the federal government that you can then use for other services, for mammograms or Pap smears, doesn't that free up part of your budget to allow you to use that for abortions? So whether or not you're actually getting it directly for abortions, it does free up some of your budget.

RICHARDS

10:25:14
Absolutely not. I mean, and that's what I was saying in the first place, Katty. It's really important that the federal funds -- the federal government pays us for services provided, again, whether it's birth control, whether it's STD testing. And one thing I just want to clarify because you just made a misstatement -- I'm sure inadvertently -- we do not provide mammograms. We've never said we provided mammograms. And that's another issue that has somehow been misconstrued by folks on political opponents who, frankly, don't provide health care and seem to be confusing breast exam...

KAY

10:25:44
I'm sorry. That was totally my mistake.

RICHARDS

10:25:46
That's okay. I just want to make sure that we don't sort of continue to fuel some political fire that's been raging. One of the things, actually, Katty, I think is very important about -- so there are -- we are reimbursed, again, just like hospitals, for services provided. One of the things, I think, is important -- and I think someone -- I caught the tail end of the conversation you were having a minute ago. One of the problems in America is that there is very little access to affordable family planning. And, in fact, even health centers, like Planned Parenthood or other providers who provide family planning through federal programs, have to raise outside private dollars to help supplement those services because the reimbursement rates are so low, they don't even begin to pay for the cost of family planning in America.

RICHARDS

10:26:34
And, I think, one of the things that is our concern -- unlike the other folks, I think, who are discussing these topics -- we actually provide health care to 3 million women every year. We're very, very familiar with the health care needs that women have. I wish that folks on both sides of these issues could come together and agree we need get more family planning, more availability in America, in order to reduce the rate of unintended pregnancy. You know, Planned Parenthood alone reduces probably -- is more responsible for reducing unintended pregnancy in this country and the need for abortion than any other organization in America. That's our primary work, and that's what we do every single day for women across the country.

KAY

10:27:18
Okay. Cecile, we just have a couple of minutes before we have to take a break. I have people in the studio nodding their heads and people in the studio shaking their heads. Marjorie Dannenfelser of the Susan B. Anthony List -- keep it brief, Marjorie, 'cause we don't have very long.

DANNENFELSER

10:27:30
Real easy. One question is how many of your 3 million unduplicated clients received primary care? My number says 19,700, and that came from your materials -- a very small portion of what Planned Parenthood does. And that has become central to this debate in terms of these claims, that it's all about women's health.

RICHARDS

10:27:50
I'm sorry, I missed -- I assumed that's Ms. Dannenfelser?

DANNENFELSER

10:27:53
Yes, it is Marjorie.

KAY

10:27:53
Yeah.

RICHARDS

10:27:53
I can tell you -- so of the 3 million patients that we saw last year, 2.5 million were provided birth control services. We provided 830,000 breast exams and nearly 1 million Pap smears. So I'm not sure what you're definition is of health care, but...

DANNENFELSER

10:28:11
I'm reading your definition in your materials of how many are primary care providers.

RICHARDS

10:28:14
Well, I think if you're -- I don't know if you're listening to me. But I'm just trying to tell you...

DANNENFELSER

10:28:18
Yes.

RICHARDS

10:28:19
...the services that we provide, and I would welcome you or anyone else who seems to be under a misimpression of what Planned Parenthood services are, welcome you to come to a Planned Parenthood health center and visit and see the wide array of services that are provided, again, to the 3 million patients who come to us every year.

KAY

10:28:41
Okay. Okay.

DANNENFELSER

10:28:41
Not only have I been there, but so have people undercover and have seen what is actually going on there.

KAY

10:28:46
Marjorie, we have to take a break in just a second, and I want Sarah Brown to have a quick chance to ask a question to Cecile as well.

BROWN

10:28:51
Cecile, it's Sarah Brown. I'd like to ask you to talk again about this issue of money being fungible. I have my own view of that. But this notion that, if Planned Parenthood is provided money for family planning, women's health care, that that frees up money for abortion. How do you respond to that?

RICHARDS

10:29:10
Well, it's just absolutely not true. And I -- this is something that has been repeatedly stated. It is -- for more than 30 years, federal funds have been strictly prohibited from paying for any abortion services. And that's true, again, not only for Planned Parenthood, but all hospitals in America. We all operate under the same regulation, and the federal funds that are provided to Planned Parenthood are reimbursed. We are reimbursed for preventive services, again, the ones that I've listed -- STD testing, family planning services, breast and cervical cancer screening.

RICHARDS

10:29:47
And that's -- the important thing here is that's what's at stake. That's what is being attacked by the House leadership, is basically ending access to those services for the millions of women who come to our health centers currently. And, I think, one of the things that's of most concern, that I don't think is being addressed, is where the House leadership expects women to go. Seventy-two percent of our health centers are in medically underserved communities or in rural America...

MECKLER

10:30:16
Can I answer that question?

RICHARDS

10:30:16
...where women likely have very few options.

KAY

10:30:19
Okay. Laura, you got a quick question in. Then we do have to take a break.

MECKLER

10:30:23
Well, I'll -- you know, putting on my own reported hat, I'll ask Cecile, are you at all concerned about the upcoming vote in the Senate? Part of the agreement that they reached was they would have a vote or an up or down in the Senate on continued funding for Planned Parenthood. I'm sure that was not what the organization wanted to see. But what are your thoughts about that?

RICHARDS

10:30:42
Well, I mean, I think, first, it's just incredible to me that we're holding up the federal budget over the question of whether women can get Pap smears at Planned Parenthood. However, certainly, we'll take that vote in the Senate, and we have been quite heartened by the support of Democratic senators as well as Republican senators. I think, Sen. Lisa Murkowski from Alaska, I think, really articulated the point so well, which is, for women in Alaska, the five Planned Parenthood health centers may be the only preventive women's health care that they can receive. And she is a good example of why folks on both sides of the political aisle are saying we need to quit playing politics with women's health care and get much more serious about reducing unintended pregnancy in America. It's what I hope we can do.

KAY

10:31:27
Okay. Cecile, just before you go, I have one more question, and you raised it, really, there, which is, if Planned Parenthood didn't exist, where would the women who don't have and, perhaps, can't afford a doctor turn to for their health care services?

RICHARDS

10:31:40
Well, Katty, I think you've just hit the nail on the head. That's the question that none of the House leadership is willing to answer. I mean, Planned Parenthood will continue to exist. The question is, will the women that we serve, who are primarily women who are struggling financially, who are not insured, who come to us right now because they see us as the best source of low-cost, affordable, quality reproductive health care, including basic preventive care -- the question is, where are those women going to go? And no one seems to have answered it.

RICHARDS

10:32:13
You know, folks in the -- that are making politics out of women's issues, I don't think really understand. The hundreds of thousands of women who we've heard from since the House took this action, are alarmed and somewhat outraged that the government now seems to be playing politics with what is very serious to women. Preventing breast cancer, early detection of cervical cancer, preventing unintended pregnancy -- this is basic health care that women need. And no one in the House of Representatives is saying where these women are supposed to get health care.

KAY

10:32:45
Okay. Cecile Richards, president of Planned Parenthood. Thank you so much for joining "The Diane Rehm Show," Cecile.

RICHARDS

10:32:49
Thanks so much for having me, Katty.

KAY

10:32:51
I'm Katty Kay of "BBC World News America." You're listening to "The Diane Rehm Show." And if you'd like to join us, please, do call, 1-800-433-8850, or send an email to drshow@wamu.org. Let's go the phones now to Lynn in Dayton, Ohio. Lynn, you've joined "The Diane Rehm Show."

LYNN

10:33:10
Hi, yes. I wonder why don't those who are opposed to federal funding for Planned Parenthood use this freeing up of money argument that we keep hearing over and over again -- why don't they use that to object to all the federal money that goes to faith-based groups? I mean, faith-based groups administer all types of programs with federal funds, such as, you know, free lunches for low-income children, things like that. And you could use the same argument, that money frees up that church organization to use those funds for causes which are prohibited by federal money...

BROWN

10:33:42
But let's...

KAY

10:33:42
Okay. Lynn, that's a good question. I'm going to let everyone jump in on it 'cause everyone's queuing here. First of all, Sarah and then Marjorie and then Laura, you can all jump in. Sarah, go ahead.

BROWN

10:33:50
Yes. I think this argument about money being fungible is particularly distressing in this area. I mean, you know, money can always be moved around in general in life. It doesn't just attach to this area. I mean, it would be like -- I don't know -- Republicans voting against humanitarian aid in Afghanistan because it might inadvertently free up some money that would support terrorists. I mean, you know, this argument could be made for any set of issues. You have somebody who uses their NIH salary to help a daughter pay for an abortion in Florida. You know, this is not a reasonable way to think about things because there are many, many other examples.

BROWN

10:34:30
And as many people have said already this morning -- Cecile, in particular -- we know that Planned Parenthood and all other recipients of Title X money are not able to use those funds for abortion. So we need to move on from this fungibility issue and get down to the fundamental question of how are we going to reduce abortion, the need for abortion in America, which is an important question. And that is for prevention and contraception straight up.

KAY

10:34:57
Okay, Marjorie.

DANNENFELSER

10:34:59
Well, first of all, if you give money to the government of Afghanistan, it's not going to be a natural conduit to the terrorist, but that's another story. I want to answer the question that is a very astute question, which is, where will these women go? There are 1,097 pre-qualified federal programs where that money can go, and they do not provide abortions. And, another thing, $600 million was just cut from community health centers where there are a full range of services, including mammograms, but not abortions, are provided. Not one penny was cut from the number one abortion provider in the nation, and yet no one is talking about -- women are not talking about why $600 million has been cut where they could actually be used for the full range of services, absent abortion, in community health centers.

DANNENFELSER

10:35:50
This is what taxpayers insist they do not want their money in any way participating in an organization who performs abortions. Whether you say that it can leak over or not, it raises the water of the reservoir high. Anybody who's got a teenager knows you give them a whole bunch of money to handle, you know, to handle their tuition, and they're in charge of that. Who knows where some of that money is going to end up?

KAY

10:36:13
Laura.

MECKLER

10:36:14
I'll say two things. One is, I think, those are two separate issues. The funding for community health centers, I suspect most of the people on the pro-Planned Parenthood side of the debate also opposed the cut in community health centers as probably they put many...

DANNENFELSER

10:36:26
It's the abortion separation that's the issue.

MECKLER

10:36:28
Right. But, I mean, they are separate issues in the budget. I mean, there are a lot of things that got cut in the budget that people weren't happy about. So these arguments kind of have been a little bit segmented, I think.

KAY

10:36:38
Is Sarah right in saying that the fungibility argument, when applied to abortion, I mean, actually could be applied to many areas of the budget as well?

MECKLER

10:36:46
Well, I mean, you can apply any argument that you like. I mean, it's just a matter of whether you buy it or not. I mean, the real answer to the caller's question about why are people not making that argument is because there is not a strong constituency of people who object to religious activity in this country, which is what the fungibility by-product would be. So who's going to be out there getting upset about that? So, I mean, it's a political question. I mean, people don't like Planned Parenthood because they don't like abortion. That's what's going on here. So they're objecting to any support for that organization. Now, whether you believe this fungibility thing is right or not, I think we've explained it pretty well. And listeners can decide for themselves.

KAY

10:37:24
Okay. Laura Meckler of The Wall Street Journal, Marjorie Dannenfelser of the Susan B. Anthony List, Sarah Brown of The National Campaign to Prevent Teen and Unplanned Pregnancy. We're going to take a quick break. We'll be taking more of your calls, questions and comments on this very lively discussion on Planned Parenthood, women's health and abortion issues. Do stay with us. We'll be right back.

KAY

10:40:03
Welcome back. I'm Katty Kay of the BBC, and you're listening to "The Diane Rehm Show," where you've joined our discussion on women's health issues and the federal budget and, of course, this incredibly thorny issue of abortion. Let's go to John in Rochester, N.Y. John, you've joined the program.

JOHN

10:40:23
Hello. Thanks for having me.

KAY

10:40:24
Good morning.

JOHN

10:40:25
Actually -- so the reason why I'm calling is because -- as you can tell, I'm a male, so my profile is a little bit different than, you know, maybe the kind of...

KAY

10:40:35
We're very happy to have you on the program, John.

BROWN

10:40:36
We love men.

JOHN

10:40:39
Well, recently, I needed to get checked for a STD, and I'm uninsured. And the only place that offers a comprehensive STD exam is Planned Parenthood in Rochester, N.Y. There are other options, but those exams are not nearly as comprehensive, like I said. So, I guess, my question is, if that service wasn't available to someone like me, where would I seek a STD -- a comprehensive STD exam? So -- I -- what I'm wondering is, why is Planned Parenthood such a contentious issue if the benefits are so kind of clear?

KAY

10:41:29
Well, John, I think that's a very interesting perspective, and thank you so much for joining with a very specific example of your experience. Sarah Brown.

BROWN

10:41:36
Well, I think the caller is highlighting one of the principal benefits of the Title X program, which, remember, in the original continuing resolution vote, was to be wiped out altogether for everybody, not just Planned Parenthood. The Title X program requires a very high level of services, so, when he says, you know, comprehensive care, good screening, follow-up counseling, that is not just something that the Rochester affiliates sort of likes to do. It's required by the Title X program. And, I think, all of us who are concerned about the position of this federal source of money -- which, incidentally, was put into law by Richard Nixon -- is that they have really set the standard for comprehensive care.

BROWN

10:42:21
And even though there are many, many other places that do provide care -- for example, I suspect in Rochester -- I'm just guessing -- that the local health department might be able to help. I suspect -- you know, I'm not finger-pointing, but that they don't have the same breadth of services, referral relationships, counseling and so forth. And I also want to just underscore the fact that Title X has always welcomed men as well as women. And I think I'm right about this number, that about 10 percent of the financing of Title X goes to help men with their reproductive health care. So it's not just women.

KAY

10:42:55
Marjorie, let me ask you a question. Do you think that federal funds should be used at all to help women get contraceptive services or men, like John who called, get STD screening, for example?

DANNENFELSER

10:43:08
First, I would just like to speak to his point as well. Where there is money, there will be an entrepreneur. And organizations that are interested in Title X money, that don't have abortion, don't provide abortion services, would very gladly take that transfer from Planned Parenthood because Planned Parenthood will never give up its central abortion mandate, that it requires every single - every one of its affiliates to provide. We have not taken on the Title X program. It is not a desire. But I will say, does anybody wonder why this issue now in a hostile environment to the pro-life issue has come up now? I mean, we have a president who was endorsed by Planned Parenthood. We've got a Senate that is very much on the side of Planned Parenthood. And we've got one House that is very pro-life. And it's not...

KAY

10:43:56
But to get back to my question, Marjorie, about whether you think that federal funds should be used to help women get contraception.

DANNENFELSER

10:44:02
I'm sorry. It was a long way of getting to the point. The reason that going after Title X became an issue was because of the videos that have come out from Live Action, which have caught, red-handed, numerous Planned Parenthood workers willing to send girls back out on the street, after finding out that there was a sexual predator that was trafficking them, and not helping them. Now, these were undercover operations, so they weren't real situations. But what they really did reveal was a willingness. And the -- and if Title X can't control for that type of outrageous behavior and its main recipient...

KAY

10:44:41
So -- sorry, I'm still not totally clear. Are you saying then that you would rather, actually, that there were not federal funds...

DANNENFELSER

10:44:48
No. I'm saying...

KAY

10:44:48
...to help women get contraception?

DANNENFELSER

10:44:50
I'm saying, to me, it was a point where, let's take a deep breath and make sure that, in Title X, there are controls for such things that their recipients have been found guilty of...

KAY

10:44:59
Okay.

DANNENFELSER

10:45:00
...for doing.

KAY

10:45:00
Let's go to Billie in Sterling, Ill. Billie, you've joined "The Diane Rehm Show."

BILLIE

10:45:05
Hi. Yeah, I just -- my comment is I had an IUD put in through Planned Parenthood, and it was free. And then, years later, when I went to my doctor and had one put in -- and I have insurance -- it still cost $700 with insurance. And there aren't a lot of women, insured or especially not insured, that can afford that. And without Planned Parenthood, they wouldn't have that.

KAY

10:45:26
Okay.

BILLIE

10:45:27
And it's just -- it's a cost issue. I mean, Planned Parenthood can help so many people without -- do and don't have insurance, who can't afford it, especially in times like these.

KAY

10:45:37
Laura.

MECKLER

10:45:38
Well, you know, I think the caller is making the argument for Planned Parenthood. I think that has -- in a personal way, that's been expressed by the advocates on the show in sort of abstract terms.

KAY

10:45:48
Sarah, tell us, from your perspective, the difference that you have seen that Planned Parenthood can make in women's lives and in their children's lives from the studies that you've done.

BROWN

10:46:00
Well, we know that the U.S. struggles with very high levels of unplanned pregnancy. And, remember, about over 90 percent of abortions are among women who became pregnant when they didn't want to at the time. And we know that...

KAY

10:46:14
How many of those are teenagers?

BROWN

10:46:16
You know, of the abortion population, it's only about 17 percent. A lot of people think that all abortion, you know, is centered on teens. In fact, it's centered in women in their 20s, and about 20 percent are to married women. Abortion is very, very widespread. And what the caller...

KAY

10:46:32
Do we know what proportion of American women have had an abortion?

BROWN

10:46:35
You know, I think it's something like one out of three by the time they're 45. It's a very, very high level. The abortion reflects, though, the underlying level of unintended pregnancy. So, to your question, what family planning does -- Planned Parenthood being one example of it but not the only -- is it reduces the need for abortion. It also saves taxpayer money. I mean, I think what was so ironic about this debate last week was that, here we were supposed to be, you know, rigidly focused on the fiscal health of the U.S., and we got centered on family planning and Planned Parenthood. Planned Parenthood and family planning reduce the need for abortion. And they save taxpayer dollars.

DANNENFELSER

10:47:15
I have to address that. I can't let that go because I -- continue, but, please, let me address that point.

BROWN

10:47:21
Well, in any event, Planned Parenthood, again, is emblematic of the larger community that provides contraception, is the principal way that abortion can be reduced. When we look at other countries, particularly in Western Europe, that have lower rates of unintended pregnancy and therefore abortion, what we see is that they have much better family planning systems. In many countries, family planning is free. And the caller mentioned being able to get an IUD, which is a terrific method -- you get it free.

BROWN

10:47:52
Here, we have numerous cost barriers, access barriers, political controversy. And I think the enduring question is, why are not the people who are most opposed to abortion most concerned about -- and I understand that -- why are they not the largest advocates, most powerful advocates, of prevention? And, in this case, that's contraception.

KAY

10:48:12
Okay. Marjorie, you wanted to pick up...

DANNENFELSER

10:48:13
Yes.

KAY

10:48:14
...on something that Sarah was just saying, but I want you also to address this issue of why you think it is that America, compared to other Western European countries, for example, has higher rates of unplanned pregnancy.

DANNENFELSER

10:48:23
I think it's partly because of this approach. Number one, Planned Parenthood -- let's challenge them to stop providing abortions, and then they -- there will be no problem. Its tenacious hold on being the number one abortion provider in the nation is the only reason we're talking about this right now. However, from 2000 to 2009, Planned Parenthood saw an 80 percent increase in taxpayer funding, receiving $202 million in 2000 and $363 million in 2009. They performed 197,000 abortions while making 2,000 or 2,500 adoption referrals. That means 80 -- an 80 percent increase in taxpayer funding resulted in a 69 percent increase in the number of abortions and a 61 percent decrease in the number of adoption referrals.

KAY

10:49:13
Okay.

DANNENFELSER

10:49:15
So I'm only saying, there is a basic flaw in the reasoning that says, you continue to put -- send out contraception, contraception, contraception, contraception and expect the abortion rate to go down. It's just not happening.

KAY

10:49:27
Right. Well, let me -- there's an email here that picks up on this point, who writes to us from Sherry -- Sherry Hop (sp?) is writing to us. She says, "Good morning. I suggest that the increase in abortions at Planned Parenthood that you've just referred to, Marjorie, is related to the decrease in other abortion providers in many areas of the country." Laura.

MECKLER

10:49:45
You know, that well may be true. I think -- I don't know for a fact whether that's true or not. Obviously, the -- providing abortion is a difficult thing to do. There's protest outside of many clinics. There are a lot of places that have decided it's just not worth it. I don't know if there's a correlation between those two things or not. I think what this fundamental debate, though, comes down to is, you know, do you hate abortion so much that you're willing to cut off the stuff that Planned Parenthood does that has widespread support because you just don't like what they do in terms of offering abortion?

MECKLER

10:50:20
I mean, I suspect that the reason why they're providing more abortions than there are adoption referrals is -- and Sarah will probably know better than I do -- is that probably people who are seeking abortions go to Planned Parenthood, and people who have basically decided they want to do adoption probably go somewhere else.

KAY

10:50:35
Sarah, is that the case?

BROWN

10:50:36
Well, I think the adoption issue is important to flag. All Planned Parenthood clinics and all family planning clinics, abortion providers and so forth, understand and counsel about, as they say, options, which include adoption. But the fact is that adoption has become a less-sought option over many years. It used to be that many adoptions were, you know, teen, pregnant teenagers who went to sort of disappear for six months to, you know, stay with Aunt Betsy or whatever, and then they placed their babies for adoption.

BROWN

10:51:06
Right now, fewer than 2 percent of teens choose to do that. I think the principal reason is that we are much more accepting of non-marital childbearing. People used to worry about that, so they would elect adoption or, perhaps, abortion. The overall sort of choice of adoption has just decreased dramatically in this country. That has very little to do with Planned Parenthood or Title X or contraception. It's that the forces that used to lead women to place babies for adoption have changed dramatically. The culture has changed. I think it's a very important option. I think that, you know -- like the Ryan-DeLauro bill has provided more support for adoption services -- it's a very important thing to couple with family planning, always.

KAY

10:51:49
I'm Katty Kay. You're listening to "The Diane Rehm Show." And if you'd like to join us, please, do call 1-800-433-8850, or send an email to drshow@wamu.org. I want to pick up on something that's come to us on Facebook. Gene writes to us on Facebook. And I'm going to confess I hadn't heard this one. But can you address what she's calling the lie that Fox News told American women over the weekend, namely that low, no-cost Paps and breast exams are available at Walgreens? Sarah, is that the case?

BROWN

10:52:16
Well, yes. I think this was -- this has been all over YouTube, and I took a look at it. There was just a comment made that, you know, you can get all of these services at Walgreens. Now, Walgreens and a number of other large stores have these sort of ambulatory services, kind of walk-in, urgent care, whatever. But they tend to be for things like a blood pressure check or vaccinations. In no way, do they provide Pap smears, contraception, any of the women's health care services that we've been talking about. They do sometimes provide very low-cost contraception. But the notion that all of these important women's health care services that we've been discussing are available at Wal-Mart or Target or anything is simply not true.

KAY

10:52:55
Laura, the lines -- I mean, when I listen to this debate -- and, you know, obviously I come here from another country, which does not have a big debate about abortion and family planning funding -- it seems to me that the lines are so intransigent on this issue. Is there any chance that people can find common ground or that politicians can find common ground to try and resolve this? Or are we always going to find that we are dealing with this issue every time a budget comes up? I mean, look, you know, we're going to be discussing the 2012 budget fairly soon. Is this going to be at the center again?

MECKLER

10:53:29
You know, I don't know if it will always be an issue, but it certainly has been an issue for a long time. There have been some sporadic efforts to try to find common ground answers. Sarah referred to the Ryan-DeLauro bill, which is a bipartisan effort to try to say, okay, what do we agree on? It hasn't really gotten a lot of attention. The White House had an effort to try to find common ground -- sort of disappeared. There is -- there just seems to be so much emotional energy on both sides of this debate, and it's kind of hard to see that going away anytime soon. I -- you know, I don't know if I'm going to, you know, spend the rest of my career periodically writing about this issue, but, frankly, it would not surprise me. I -- every so often, when it kind of goes away for a minute, just pops its head back up.

KAY

10:54:19
And does it change? I mean, you've spent, as you say, years, writing about this issue on and off. Is the issue basically the same? Or has it evolved?

MECKLER

10:54:27
Well, it comes out in different places. So I think the central core issues are the same, and they have to do with abortion itself. Having said that, they have different expressions. Lately, we've seen a lot of efforts tagged on to this idea of whether you're indirectly funding it with federal money because we did have a debate for a long time of whether there should federal funding for abortion just straight up through the Medicaid program. And that has fairly well been resolved that, no, we should not.

MECKLER

10:54:54
But now it's been coming up again, like in the health care debate. The question was, as people may remember, whether if you get subsidies through the new health care exchanges and so part of -- there are some federal money going into your premium, can that health care plan include abortion? So that was another case where it was not, you know, clear cut federal funding. But, you know, was it fungible or not? And that was, like I said, almost right down the health care bill.

KAY

10:55:18
Okay. We just have two minutes left on the program. I want to each ask you, Marjorie, and you, Sarah, what each of you think other things that the government can do that would best protect the health and welfare of women in the country.

DANNENFELSER

10:55:30
I would say the most important thing it could do at this point is to completely sever abortion services from what it considers primary care and family planning. And then it would open it up to all sorts of organizations that believe in those things, but are very happy to hear what taxpayers said, what American public has said, that it just does not want its money involved in any way, shape or form in the abortion business. That would be a way to clear this whole thing up, but this president is just as tenaciously attached to abortion being in family planning as we are tenaciously attached to it not being in family planning.

KAY

10:56:04
Sarah Brown.

BROWN

10:56:05
Well, I think that what we need is an expanded commitment to making sure that all women have a payment source for the services they need. We haven't talked about the upcoming vote on the Affordable Care Act. I mean, if that were, for example, to be eliminated, we would remain with large numbers of women, particularly women at young age -- sort of 18 to 30 -- uninsured. We need a payment source for women's health care, and then, in particular, we need a very rich array of preventive women services that are defined as basic benefits that everybody get. And that includes family planning.

KAY

10:56:40
Okay. Sarah Brown, CEO of the National Campaign to Prevent Teen and Unplanned Pregnancy, Marjorie Dannenfelser, president at the Susan B. Anthony List, Laura Meckler, White House correspondent for The Wall Street Journal. It has been a fascinating hour. Thank you all for joining me.

MECKLER

10:56:53
Thank you.

DANNENFELSER

10:56:53
Thanks very much.

KAY

10:56:54
I'm Katty Kay, sitting in for Diane Rehm. Thank you so much for listening.

ANNOUNCER

10:56:58
"The Diane Rehm Show" is produced by Sandra Pinkard, Nancy Robertson, Susan Nabors, Denise Couture, Monique Nazareth and Sarah Ashworth. The engineer is Toby Schreiner. Dorie Anisman answers the phones. Visit drshow.org for audio archives, transcripts, podcasts and CD sales. Call 202-885-1200 for more information. Our email address is drshow@wamu.org and we're on Facebook and Twitter. This program comes to you from American University in Washington. This is NPR.
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