03/07/2011 10:13 pm ET | Updated May 25, 2011

Planning for Effective Parenthood

From the moment I stepped foot in the waiting room, my first visit to the gynecologist in Indonesia was unforgettable: not because I was the only foreigner seeking services, but because I was quite evidently the only woman in the room who was not pregnant.

Thirty minutes and an awkward appointment later, I left feeling confused and belittled, the doctor uninterested in checking my health once I confirmed that I was neither married nor pregnant.

As my Indonesian girlfriends confirmed for me in a detailed discussion the following day, it is assumed in their (comparatively) conservative society that young women are not sexually active until marriage, and therefore would never be expected to visit a gynecologist until they become pregnant. The unfriendly service suddenly made sense to me: I was making a very unwelcome social statement in the act of seeking sexual health services.

All my health economics arguments aside, my girlfriends' lives were evidence enough of how problematic such logic is: of the five, all are living with HIV, one also with cervical cancer, and not one had ever visited a gynecologist before. I began to fully understand their struggle thanks to Indonesian film producer Nia Dinata's At Stake/Pertaruhan -- which highlights the horrifying consequences of suppressing women's rights around sexual health -- and I am reminded of their struggle again this week, with the House Appropriations Committee's passing of the short term Continuing Resolution (CR).

Within the House-proposed program cuts (full list here) are a $317.5 million cut to Family Planning Services, a $1 billion cut to Community Health Centers, and a complete defunding of voluntary family planning projects under Title X of the Public Health Service Act, including those of Planned Parenthood.

While I certainly admire the urgency with which Representatives are aiming to decrease our deficit and promote the fiscal health of our nation (and surely, to "win the future"), I challenge House Speaker Boehner's statement last week that, "The goal here again is to cut spending."

If the goal is to cut spending, where is the long-term strategy to show, over time, how these cuts in spending will transform our nation into a healthier and more peaceful nation? It seems the House has overlooked some key data that would suggest cuts to family planning and sexual health are likely to cost us exponentially more into the future. Consider that:
  • A Guttmacher Institute cost-benefit analysis found that, "providing millions of poor and low-income women access to free or low-cost contraceptive care unequivocally results in substantial government savings: More than $4 is saved for each $1 spent."
  • The CDC reports that for every HIV infection prevented, $355,000 is saved in HIV care and treatment costs. A second CDC report shows that no increased funding for HIV prevention could cause a 38 percent increase in HIV prevalence (and up to $237 billion in health care costs) in the US from 2010 to 2020. Spending $4.5 billion on HIV prevention now would save $104 billion in health care costs over ten years.
  • The CDC's latest calculation estimates that cervical cancer treatment costs the US about $160 million per year, down dramatically from the 2005 estimation of $2 billion year - the National Institutes of Health attributes this decline largely to the regularity with which women get Pap Tests that find cervical pre-cancer before it turns into cancer.
If this CR is about cutting costs, the economic argument is clear: invest in preventing HIV, cancer, unwanted pregnancies, and sexually transmitted infections, a set of services most effectively and efficiently provided by free, community-based providers like Planned Parenthood.

But if the fight here is instead about crafting a moral message or new social code - the kind that challenges my sisters in Indonesia and in countries around the world - politicians must understand the implications of their proposed legislation: Blocking access to knowledge and information about sex and sexual health will not result in women abstaining from sex; it will result directly in women making poor and unsafe decisions about sex. And without free and confidential sexual health services, our country will surely see higher rates of HIV and cervical cancer, unwanted pregnancies, and botched abortions. Is this the great society that such budget cuts seek to shape?

Boehner has cryptically referred to "the opportunity to win the big war" in discussing the defunding of Planned Parenthood in the CR, and this is a war I surmise has little to do with cutting spending, and more to do with shaping society's values.

But what kind of value statement is made in the restriction of a woman's right to knowledge about her own well-being? It is precisely organizations like Planned Parenthood that enable millions of young women and men every year with sufficient information, confidence, and knowhow to lead healthy lives, whether they choose to be sexually active or not.

Economically it is clear that unplanned parenthood costs exponentially more than planned and avoided parenthood. Morally it seems just as clear that a healthy society is one in which citizens have unobstructed access to accurate information about their health.

The current CR will provide funds to keep the government operating until March 18, at which time either an agreement will be reached between the House, Senate and White House, or the US will see a government-wide shut down. I encourage you to reach out to your Congresswomen and men over the next two weeks to insist that they avoid fighting yet another expensive war, and instead, diminish spending cuts to family planning and sexual health services.

Because effective parents - and politicians - don't make decisions for their children, they provide them the necessary conditions in which they can make healthy decisions for themselves.

(To get involved immediately, stand with Planned Parenthood.)