Bush Appointment Threatens Public Health and Personal Privacy
The Bush administration’s appointment of Dr. Susan Orr—an anti-contraception enthusiast—to the position of acting deputy secretary for the Office of Population Affairs isn’t just bewildering; it shows implicit disregard for the best information we have on family planning.
Dr. Orr does not have a medical degree and has no direct experience in family planning. Her public statements indicate a lack of experience and an ideologically-based commitment to extreme points of view that bring into question her qualifications for the job and her ability to objectively assess and apply accepted best practices in health care to Federal policy.
Americans value their right to decide when and whether to have children, and sound public policy supports their ability to make those decisions.
What’s worse, this is the second time in a year that the administration has appointed an anti-contraception activist to the position. In November 2006, the administration appointed Dr. Eric Keroack, a non-board certified gynecologist, who received “two formal warnings from the Massachusetts board of medicine ordering him to refrain from prescribing drugs to people who are not his patients and from providing mental health counseling without proper training,” just before he resigned in March amid Medicaid fraud allegations.
Dr. Orr’s appointment is only the most recent example of a trend that will take years to repair. The administration’s unapologetic long-term political strategy of diminishing the value of scientific integrity to create doubt and achieve ideologically-driven political goals is becoming more widely recognized. Unfortunately this appointment is another clear-cut example of an administration appointee whose background and ideology are at odds with the majority of reproductive health professionals.
In Title Only
Dr. Orr’s appointment highlights some particularly difficult challenges that will likely have negative implications for people in America who don’t have full access to health care. Her position oversees Title X, the federal family planning program that serves more than 5 million low-income Americans annually through more than 4,400 community-based clinics. Seventy-five percent of U.S. counties have at least one clinic that receives Title X funds, and it is estimated that over 1 million unintended pregnancies are prevented each year through contraceptives made available for low income Americans by Title X services each year.
Application of Dr. Orr’s position on family planning places undo hardship on those least able to pay for contraception.
But the controversy of her appointment is about more than the possible subversion of policies that have proven effective for preventing unintended pregnancies and abortions. Few would question that the person filling this position should have a commitment to evidence-based science and to all aspects of reproductive health care including disease prevention and family planning. Title X-supported clinics provide patient education and counseling; breast and pelvic examinations; breast and cervical cancer screening; sexually transmitted disease (STD) and Human Immunodeficiency Virus (HIV) prevention education, counseling, testing and referral; and pregnancy diagnosis and counseling.
Steering the ship responsible for funding such services requires respect for the value of providing people with informed options for their health care. Americans value their right to decide when and whether to have children, and sound public policy supports their ability to make those decisions. The Centers for Disease Control and Prevention included family planning in its list of the “Ten Great Public Health Achievements in the 20th Century,” yet Title X funding has declined by 60 percent since 1980, when adjusted for inflation, even though 17 million U.S. women rely on public funding to obtain contraception.
With almost half of all pregnancies in the United States being unintended—80 percent of teen pregnancies fall in this category—any neglect of basic services can be directly linked to failures in education and public policy. The American public will benefit from a significant increase in funding to make all methods of contraception available to all who want and need them, to research new approaches to family planning, and to provide comprehensive, evidence-based reproductive health and sexuality education in schools and communities.
Steering the ship responsible for funding such services requires respect for the value of providing people with informed options for their health care.
Application of Dr. Orr’s position on family planning places undo hardship on those least able to pay for contraception. Further restriction on these funds will inevitably result in more unintended pregnancies and more abortions, an outcome that runs directly counter to the stated goals of the program she is supposed to be directing.
While most private insurers cover contraception, it is ethically and fiscally sound public policy to ensure that all Americans have equal ability to decide what is best for them and their families. Dr. Orr’s position as senior director for marriage and family care at the Family Research Council, an organization that advocates restricting access to family planning, makes her entirely unsuitable to run the agency whose mandate is to provide access to needed family planning care for our nation’s men and women.
One Tired Finger
Americans deserve a deputy assistant secretary for population affairs who will advocate for increased access to contraception for all who need and want it, and for the full range of reproductive health services that enhance quality of life. We believe that we must communicate the value of reproductive health services to individuals first and, second, to society as a whole.
Simply put, we are advocating for reproductive health professionals to compensate for the inability of Dr. Orr, her predecessors, and this administration to achieve those goals. As scientists, we must learn to appeal to the positive aspects of belief systems outside of our experience to communicate scientific values, to change minds and to affect public policies.
But it is insufficient to simply point our finger at the administration and Dr. Orr. We also must accept responsibility for failing to effectively communicate with the public and policymakers.
It isn’t completely clear why it’s been so easy to take anti-science policy positions in the United States in the last decade. One answer lies in the U.S. public’s ambiguity about science and the role it plays in their lives. In the most recent survey of public perceptions about science by the National Science Foundation, 55 percent of the respondents agreed that “we depend too much on science and not enough on faith,” and 70 percent agreed that “scientific research these days doesn’t pay enough attention to the moral values of society” and that “scientific research has created as many problems for society as it has solutions.”
These findings indicate that the anti-science faction that has taken root in Washington of late has reason to cheer. This unfortunate trend is not merely the result of overzealous ideologues; there seems to be a level of indifference among much of the lay public to the importance of science and the policies that directly affect them. For many, “science” is a necessary but somewhat remote, dusty, and godless venture that has no direct impact on their everyday lives. These findings should also serve as a warning that regime change in Washington 15 months from now will not be enough to turn the tide of public sentiment.
We also know that lecturing the public about scientific principles and research outcomes in the desire to convince them about our correctness is oftentimes a wasted effort; our intended audiences often consider this approach condescending and patriarchal, despite our opposite intention. If our goal is to change minds, this approach just does not work and should be abandoned as a primary course of action.
Behavioral science theory tells us that most people operate from the screens of their own interests and beliefs; they are not going to listen to or be swayed by data that contradict their belief systems, regardless of accuracy. Without getting overly academic (we tried that), we have to reinvent the way we communicate the value of applying science to health policy in the context of the values that we share with an angry and doubting but concerned public.
The scientific community and the general public have a lot more in common than not. That’s why we as scientists must be prepared to channel the public’s skepticism of science toward a broader understanding of the progressive values that should always underpin scientific inquiry and public policymaking.
Wayne C. Shields is the President and CEO, Association of Reproductive Health Professionals. Rivka Gordon is the Director of Strategic Initiatives, Association of Reproductive Health Professionals.
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