The future of accessible family planning services in the United States and abroad is unclear. During the administration of Bill Clinton, the influence of political conservatives in public policy debates about family planning was greatly diminished. Clinton's appointments to key health policy positions of individuals strongly committed to family planning, especially in the area of adolescent pregnancy prevention, sharply reversed the trends of the Reagan-Bush era.
Ideological battles were temporarily muted, but they will never entirely disappear because of a change in presidential administration. At the state and local levels, many of the bitter struggles over the public provision of reproductive health services continued. Bill Clinton attempted to reform health care in general and largely failed. The election of George W. Bush signaled an immediate return to the ideologically conservative policies of his father.
The abortion issue remains among the most politically explosive and unresolved issues in bioethics. Provision of abortion services has endangered funding for other family planning services and endangered the lives of providers and consumers alike. Concerns of political conservatives and anti-abortion groups have affected policy debates as diverse as end of life decision-making in New York State and Federal regulation of embryonic stem cell research. In August of 2002, George Bush revealed his decision on stem cell research. Had it not been for the terrorist attacks that occurred shortly thereafter, stem cells might have been the defining issue of his presidency. Bush allowed future work with stem cell lines already produced, but his policy did not allow for the development of additional cell lines. By sitting on the fence, Bush did not satisfy either side in the debate. Anti-abortion forces were not happy that the existing cell lines, obtained from aborted fetuses, would still be used. Those in favor of stem cell research did not think that the existing cell lines would be adequate to study the possible benefits of stem cells for those with diseases such as Parkinson's Disease, Alzheimer's Disease, and diabetes.
The historical context is important for the current ethical and policy debates related to fertility control. Efforts to empower all women, including poor women of color, must be balanced with a keen sense of the abuses evident in the history of the birth control movement. Racism and eugenic concerns have been consistent issues in debates about controlling fertility, and our targeted educational programs and initiatives must be sensitive to community concerns. Empowering women to make their own reproductive choices is a praiseworthy goal, but it is not a desirable one for some.
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