On July 19, the House approved the FY2008 Labor, Health and Human Services, Education, and Related Agencies spending bill (H.R. 3043) (see this week’s issue of The Source). The committee report accompanying the bill includes language detailing a number of programs affecting women and their families. Although report language is not binding, federal agencies give careful consideration to such language as it indicates programs or initiatives that are particularly important to appropriators.
The report announces two “crosscutting initiatives”: increasing access to health care for the uninsured and reducing the need for abortion. The committee provides, across a number of programs, “a $622.875 million increase over FY2007 and $645.302 million over the [budget] request for critical safety net health programs in order to respond to the nation’s healthcare crisis.”
The report states, “Twenty years ago, fewer than 30 million Americans lacked health insurance. Today, Census Bureau data show that there are approximately 46.6 million uninsured Americans. This means life-saving care is out of reach for almost 16 percent or one in six Americans. If current trends continue, the ranks of the uninsured will balloon to 56 million by 2013. To date, the federal government has responded to the health insurance crisis by patching the frayed safety net of health programs, chiefly through Medicaid and the State Children’s Health Insurance Program (SCHIP). Nationally, 50 million Americans, including 24 million children, will be enrolled in Medicaid during fiscal year 2008. An average of 4.4 million children were enrolled in the SCHIP program at a particular point in time last year. However, these programs do not generally cover adults without children or those with incomes above $20,420, which is 200 percent of the federal poverty level for one person. In addition, 1.8 million eligible children are not yet enrolled in either Medicaid or SCHIP.”
It continues, “The committee first addressed the problem of the uninsured by funding state planning grants during FY2000-2005. States used these grants to collect data about the characteristics of the uninsured within their state and to develop proposals to offer affordable health insurance coverage…The committee believes that now is the time to build on the earlier state planning grants program to help states make further advances in covering uninsured Americans. Due to the considerable differences in the share of the population that has access to employer-based health insurance, the share covered by government benefit programs, and the geographic distribution of health care providers, these new state grants will be able to target programs in a way that is specific to their particular needs.”
According to the committee report, the bill “includes a $647.021 million increase over the FY2007 level, and $1.375 billion over the [budget] request, for several programs and new initiatives that are intended to help reduce the number of abortions in America by alleviating the economic pressures and other real life conditions that can sometimes cause women to decide not to carry their pregnancies to term.”
The report continues, “Nearly half of all pregnancies in the United States are unintended, and of these four in ten end in abortion. Women living below the federal poverty level are more than four times more likely to have an abortion than those with incomes above 300 percent of the federal poverty level. Over the last several years, federal investments aimed at preventing unintended pregnancies and providing critical health and social support services that can help vulnerable women and families overcome economic pressures and other life challenges have been significantly curtailed. This bill provides a first installment toward restoring and expanding prevention and support services to address this important issue.”
Department of Labor
The Women In Apprenticeship and Nontraditional Occupations (P.L. 102-530) program would receive level funding of $1 million in FY2008. The administration would have eliminated the program. The Department of Labor Women’s Bureau would receive $10.5 million in FY2008, $834,000 more than FY2007 and $668,000 more than the budget request. The committee “encourages the Women’s Bureau to continue to support national networks for women’s employment that advance women in the workplace through education and advocacy. The committee believes that organizations that continue to exceed annual performance goals and that are strategically aligned with the goals of the women’s bureau deserve increased support.”
Dislocated worker assistance would be level-funded at $1.472 billion in FY2008, $356.964 million more than the administration’s request.
Job Corps would receive $1.649 billion in FY2008, $42.641 over FY2007 and $98.232 million more than President Bush’s request. Included in that amount is “$5 million for a competitive program for existing Job Corps Centers to establish child care development centers. Historically, low-income young people with children have been the most difficult to serve population in Job Corps. Further expanding child care services on Job Corps campuses will enable more economically disadvantaged single parents to obtain the education, training, and parenting skills needed to make a better life for their children and for themselves.”
The Youthbuild program would receive $60 million, $10.5 million above FY2007 and $10 million more than the administration’s request.
The new Responsible Reintegration of Ex-Offenders Program, which merges the Responsible Reintegration of Youthful Offenders and Prisoner Re-entry Initiative, would receive $68.746 million in FY2008, $29.146 million above President Bush’s request.
The bill “provides that $10 million be used for a new young parents demonstration program in order to provide educational and occupational skills training that fosters family economic self-sufficiency to young parents (both mothers and fathers) and expectant mothers ages 16 to 24. The committee intends that competitive awards be made to local workforce investment boards, one-stop career centers, community-based organizations, community colleges, and other applicants that demonstrate linkages to the local workforce investment system…Projects are to be encouraged to serve young parents in high-risk categories, including those under the jurisdiction of the justice system, in the child welfare or foster care system, homeless individuals, or victims of child abuse.”
The bill would level-fund the Bureau of International Labor Affairs (ILAB) at $72.516 million, $58.419 million more than President Bush’s request. The committee “rejects the administration’s proposal to slash funding for ILAB by over 80 percent. In May 2006, the International Labor Organization (ILO) issued a report entitled ‘The End of Child Labor: Within Reach’. The report states that child labor is in decline worldwide and that if the current pace of decline were to be sustained, the global commitment to stop child labor could feasibly eliminate most of the worst forms of this practice within 10 years. The committee is therefore particularly concerned that the department’s budget request eliminates funding for child labor grants, including the U.S. contribution to sustain the successful efforts of the ILO’s international program for the elimination of child labor. Withdrawing from these efforts would damage the credibility and reputation of the United States in the countries whose governments are real partners to the United States in this effort.”
Department of Health and Human Services
Health Resources and Services Administration (HRSA): HRSA programs would receive $7.081 billion in FY2008, $665.007 million more than FY2007 and $1.26 billion more than the budget request.
The committee “is concerned that there is a widespread lack of awareness among health care providers that cardiovascular disease is the leading killer of women in the United States. The committee encourages HRSA to conduct an education and awareness campaign for physicians and other health care professionals relating to the prevention, diagnosis, and treatment of heart disease, stroke, and other cardiovascular diseases in women.”
Community health centers would receive $2.188 billion in FY2008, $199.961 million more than FY2007 and $199.533 million more than the budget request.
The measure would provide $75 million for “state health access grants to begin to address the problems faced by the 46.6 million uninsured in our country.”
The bill would fund the Maternal and Child Health Block Grant at $750 million, $57 million more than FY2007 and the administration’s request. Within that amount is $15 million “for new competitive grants to states to increase public awareness of resources available to women preparing for childbirth and new parents through advertising campaigns and toll-free hotlines. The committee recommends this funding as part of its initiative to help reduce the number of abortions in America by alleviating the economic pressures and other real life conditions that can sometimes cause women to decide not to carry their pregnancies to term.”
The Healthy Start infant mortality initiative would receive $120 million in FY2008, $18.482 million above FY2007 and $19.497 million above President Bush’s request. The committee “recommends the…increase as part of its initiative to help reduce the number of abortions in America by alleviating the economic pressures and other real life conditions that can sometimes cause women to decide not to carry their pregnancies to term. Healthy Start provides discretionary grants to communities with high rates of infant mortality to provide ongoing sources of primary and preventive health care to mothers and their infants. Currently, 99 communities have Healthy Start grants. The increase provided in the bill will support approximately twenty new grants to communities.”
Universal newborn hearing screening would receive $11 million in FY2008, $1.196 million more than FY2007. The administration would have eliminated the program.
Ryan White: The Ryan White Care Act would receive a total of $2.237 billion, a $99.291 million increase over FY2007 and $79.174 million more than the administration’s request.
Part D of the Ryan White CARE Act, which provides funding for programs for children, youth, women, and families, would be funded at $71.8 million, $6,000 more than FY2007 and President Bush’s request. According to the committee report, “HIV-infected children, youth, women, and affected family members have multiple, complex medical, economic, and social service needs which often require more intensive care coordination, intensive case management, child and respite care, and direct service delivery to engage and maintain adolescents and mothers in care. Funds support innovative and unique strategies and models to organize, arrange for, and deliver comprehensive services through integration into ongoing systems of care. Currently, 89 grants support health care and support services for over 53,000 women, infants, children, and youth living in 31 states, D.C., and Puerto Rico.”
National Cord Stem Cell Inventory: The National Cord Stem Cell Inventory would be level-funded at $3.963 million in FY2008, $1.997 million above the budget request.
Family Planning: Title X, the nation’s family planning program, would receive $310.91 million, $27.764 million over FY2007 and $27.807 million more than President Bush’s request. The program “provides grants to public and private non-profit agencies to support a range of family planning and reproductive services, as well as related preventive health services, such as patient education and counseling, breast and cervical cancer examinations, STD and HIV prevention education, counseling, and testing and referral, and pregnancy diagnosis and counseling. The program is the only source of health care for many of its clients.”
The committee “recommends the $27.764 million increase as part of its initiative to help reduce the number of abortions in America by alleviating the economic pressures and other real life conditions that can sometimes cause women to decide not to carry their pregnancies to term. The program currently serves over five million low-income women and men at 4,400 clinics nationwide. This funding increase will allow the program to serve 98,000 new clients. Family planning funds in the bill are expected to prevent more than one million unintended pregnancies.” The committee “remains concerned that programs receiving Title X funds ought to have access to these resources as quickly as possible. The committee again instructs the department to distribute to the regional offices all of the funds available for family planning services no later than 60 days following enactment of this bill. The committee intends that the regional offices should retain the authority for the review, award, and administration of family planning funds, in the same manner and timeframe as in FY2006.”
Centers for Disease Control and Prevention (CDC): The measure would allocate $6.458 billion for the CDC in FY2008, a $255.16 million increase over FY2007 and $475.181 million more than the administration’s request.
The committee “recommends $516.273 million for the immunization program authorized by section 317 of the Public Health Service Act [42 U.S.C. § 317], which is $58.75 million above the FY2007 funding level and $91.15 million above the budget request. The committee is aware that prior to 2000 and the introduction of new vaccines, such as the recent human papillomavirus vaccine, the 317 immunization program was adequately providing vaccines to children and adolescents traditionally dependent on the public sector for support, but who were not eligible for the Vaccines for Children Program. Currently, the 317 immunization program is falling far short of the need. The current estimate of the cost to fully immunize a female through age 18 is over $1,240 and for a male it is over $936 this compares with a total cost of $186 for females and males in 1999. As a result of these increased vaccine costs, the number of children receiving vaccines under the 317 program has fallen from 747,000 in 1999 to an estimated 279,000 in 2006. The committee recommendation is the first step toward the goal of fully immunizing all eligible individuals.”
The committee provides $1.042 billion for HIV/AIDS, viral hepatitis, sexually transmitted diseases (STD), and tuberculosis (TB) prevention, $32.112 million more than FY2007 and $14.495 million below President Bush’s request. Included in that amount is level funding of $157.537 million for STD prevention programs, which is $227,000 more than the budget request. Also included in that amount is $715.463 million for domestic HIV/AIDS prevention and research, $17.413 million above FY2007 and $29.644 million below the administration’s request. The committee report states, “The division of STD prevention provides national leadership through research, policy development, and support of effective services to prevent sexually transmitted diseases and their complications, such as infertility, adverse outcomes of pregnancy, and reproductive tract cancer.”
According to the committee report, “TB is an enormous public health crisis in the developing world, killing millions of people in the prime of their lives every year. Despite the development of effective treatments against TB fifty years ago, there have never been more people infected with the disease in the history of the world. Approximately two billion people (approximately 30 percent of the world’s population) have been infected with mycobacterium tuberculosis, the causative agent of TB. TB is a leading cause of death in HIV-infected individuals and in women of childbearing age.”
Chronic disease prevention and health promotion programs would receive $869.479 million in FY2008, $34.481 million more than FY2007 and $35.284 million more than the budget request. Included in that amount is $326.1 million for cancer prevention and control programs, $19.379 million above FY2007 and $19.691 million more than President Bush’s request (included within this total is $19.605 million for the WISEWOMAN program, $9 million to carry out activities authorized by Johanna’s Law (P.L. 109-475), and $6.505 million for activities related to ovarian cancer). Also included is $48.53 million for the safe motherhood and infant health programs, $4.412 million more than the FY2007 funding level and $4.456 million more than the administration’s request.
The committee “is encouraged by the progress that has been made by CDC, in coordination with the Office of Women’s Health, to initiate a national education campaign on gynecologic cancers. In the absence of an available screening test, the committee understands that the best way for gynecologic cancers to be detected early is for women and health professionals to recognize its signs and symptoms. The committee is pleased that these efforts were authorized in statute with the passage of Johanna’s Law: The Gynecologic Cancer Education and Awareness Act. The committee provides funding for activities authorized by Johanna’s Law to support the continuation and expansion of this program. Within the total, a portion is to be allocated toward the completion of a report to Congress providing a description of past and present activities of the Department of Health and Human Services to increase awareness and knowledge of the public with respect to different types of cancer, including gynecologic cancers as well as past efforts to increase awareness and knowledge of health care providers with respect to different types of cancer, including gynecologic cancers.”
The committee “is pleased by the progress made by CDC on educating the public and professional communities about interstitial cystitis (IC). In addition to generating public attention to IC, the committee encourages CDC to develop and implement a comprehensive structured outreach plan for the provider community.”
A new $10 million initiative “is recommended for grants to state and local public health departments, school districts, and nonprofit organizations to support factually and medically accurate, age-appropriate approaches to preventing teen pregnancies, including information about both abstinence and contraception, and dissemination of science-based tools and strategies to prevent HIV, STD, and teen pregnancy. The Secretary of Health and Human Services shall require each applicant for financial assistance under this program to certify that all materials proposed in the application and funded during the project period of the grant are medically accurate. The Secretary of Health and Human Services shall require a panel of medical experts to review all grant applications and assess whether the materials proposed are medically accurate. These demonstration projects shall be evaluated based on their success in reducing the rate of teen pregnancies in their respective communities. The committee’s recommendation for this activity is part of its initiative to reduce the number of abortions in America by alleviating the economic pressures and other real life conditions that can sometimes cause women to decide not to carry their pregnancies to term.”
The committee “recognizes the importance of monitoring risk factors that science has demonstrated contribute to youth drinking, and urges CDC to develop and continue its work to monitor and report on the level of risk faced by youth from exposure to alcohol advertising.”
Birth defects, developmental disabilities, disability and health programs would be allocated $132.733 in FY2008, $8.069 million more than FY2007 and $8.196 million above President Bush’s request.
The committee “is concerned about the prevalence of fetal alcohol syndrome (FAS) in the U.S. and notes that drinking during pregnancy continues to be the nation’s leading known preventable cause of mental retardation and birth defects. The committee encourages CDC to continue and enhance efforts to prevent, reduce, and diagnose FAS disorders. The committee requests that CDC submit a progress report within six months on the contributions made to preventing and reducing FAS disorders, and for CDC’s future plans, including programmatic and funding priorities.”
The committee “is aware of a recent analysis conducted by CDC that showed folate concentrations among non-pregnant women of child bearing age have decreased by 16 percent from 19992000 through 20032004. These findings are troubling and the committee is concerned that women are not receiving an adequate level of folic acid to prevent neural tube defects. Within the funds provided, the committee has included sufficient resources for CDC to expand the folic acid education campaign and inform more women and healthcare providers about the benefits of folic acid, particularly for the Hispanic population.”
According to the committee report, “Preterm birth is a serious and growing public health problem that occurs in 12.5 percent of all births in the U.S. The committee strongly encourages CDC to conduct additional epidemiological studies on preterm birth, including the relationship between prematurity, birth defects, and developmental disabilities. The committee also encourages the establishment of systems for the collection of maternal-infant clinical and biomedical information to link with the pregnancy risk assessment monitoring system and other epidemiological studies of prematurity in order to track pregnancy outcomes and prevent preterm birth.”
Environmental health programs would receive $165.005 million in FY2008, $15.518 million above FY2007 and $15.741 million more than the administration’s request. Included in that amount is level funding of $35.903 million for childhood lead poisoning prevention programs, $54,000 more than the budget request.
The committee would fund injury prevention and control programs at $140.146 million in FY2008, $1.529 million more than FY2007 and $1.736 million above President Bush’s request.
The committee “applauds CDC’s activities in the area of child maltreatment. A growing body of research indicates that childhood abuse and neglect may contribute significantly to the development of both acute and chronic health conditions throughout the lifespan, including obesity and heart disease. The committee encourages CDC to develop a network of consortia that will address research and training, as well as the dissemination of best practices and prevention efforts, on the health harms of child abuse and neglect.”
Global health program activities would be allocated $381.337 million, $47.299 million more than FY2007 and $1.618 million more than the administration’s request.
The committee “recognizes that malaria is a global emergency affecting mostly poor women and children. While malaria is treatable and preventable, tragically it remains one of the leading causes of death and disease worldwide. The committee appreciates the integral and unique role that the CDC malaria program plays in national and global efforts to prevent and control malaria. The committee urges CDC to expand malaria-related research, program implementation, and evaluation. Insecticide resistance and drug resistance have the real potential to compromise global malaria efforts and point to the need for the development and testing of new technologies and materials for insecticide-treated nets and new anti-malarial therapies. The committee is concerned that failure to support these efforts could seriously impair future control efforts. Additionally, the committee encourages CDC to provide technical assistance and support program research in non-African malaria-affected countries, which, in turn, can then be used to strengthen control efforts in African countries.”
National Institutes of Health (NIH): NIH would receive $29.65 billion in FY2008, $750 million more than FY2007 and $1.029 billion above President Bush’s request.
The committee recommends $110.9 million for the second full year of implementing the National Children’s Study. The FY2007 appropriation was $69 million; under the administration’s budget this program would not have been funded. The committee also fully funds the budget request of $300 million for transfer to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The committee report states, “Today, in the United States, one woman will be diagnosed with a gynecologic cancer every seven minutes. That is almost 200 per day and 80,000 in a given year. Furthermore, almost 30,000 women die from a gynecologic cancer each year. Existing NCI [National Cancer Institutes] funding for specialized programs of research excellence, program projects, the early detection network, and investigator-initiated grants has accelerated basic, molecular-based research discoveries for gynecologic cancers. The committee encourages NCI to give priority to gynecologic cancers under its nanotechnology plan, its oncology biomarker qualifications initiative, and its cancer genomics atlas project, jointly conducted with NHGRI [National Human Genome Research Institute]. This will allow laboratory discoveries to be translated into clinical applications at the bedside causing a decrease in the mortality rates for women with gynecologic cancer.”
The committee “recognizes NCI’s longstanding commitment to improving the health of women through gynecologic oncology clinical trials. These trials have led to the identification of new therapeutic agents and techniques for treating gynecologic cancers. This effort has directly produced improved outcomes for ovarian cancer patients as a result of changes in the way ovarian cancer is treated and the development of a vaccine for preventing the virus that causes cervical cancer. The committee encourages NCI to continue its support of gynecologic oncology clinical trials through public-private partnerships with the pharmaceutical and biotechnology industries and the NCI-sponsored cancer centers and cooperative groups.”
The committee “encourages NCI to study if there are clinical and cost benefits of prospectively tracking pap test results and outcomes in women who have been vaccinated for human papillomavirus (HPV). The committee encourages NCI to support research that will identify the most cost-effective management strategy for cervical cancer screening in the era of HPV vaccines and to identify the circumstances where pap test/HPV screening fails in vaccinated women.”
According to the committee report, “Today, in the United States, there is no widely available screening test for ovarian cancer. More than 22,000 women will be diagnosed with ovarian cancer this year and 16,000 women are expected to die from it. Ovarian cancer has a high mortality rate, 55 percent over five years, mainly because there is no proven effective method for early detection. Research is being conducted on glycomic profiling which may identify unique patterns of glycosylation that may be more sensitive and specific than CA125, an existing blood marker, in identification of early stage ovarian cancer. Circulating plasma proteins, another blood marker, could also possibly serve as biomarkers to differentiate women with ovarian cancer from healthy women. The committee encourages NCI to make randomized, prospective studies that would lead to the validation and acceptance of these and other biomarkers for the early detection of ovarian cancer a priority.”
The committee “remains concerned that as the population ages women will continue to be affected by cardiovascular disease at high rates. The committee encourages the [National Heart, Lung and Blood] Institute to place a high priority on heart disease, stroke, and other cardiovascular diseases in women by intensifying its investment in basic, clinical, translational, and trans-institute cardiovascular disease research. Despite new therapies, the committee continues to believe that research is needed to better understand the causes of these diseases in women, develop more effective treatments and cures, and prevent cardiovascular diseases, which remain a major cause of permanent disability and the number one killer of women.”
The report continues, “Gender differences in health and disease are well established. For example, while cardiovascular disease is the number one killer of both women and men, women die of cardiovascular disease an average of ten to twenty years later than men. Numerous primary and secondary randomized controlled prevention trials have been conducted in men showing the benefit of lowering total and LDL cholesterol. Women have been included in many of these studies but not in sufficient numbers to permit a meaningful analysis of the benefits for women alone. As a result, women are currently treated according to the data from studies where there is a preponderance of men—namely, the treatment is designed to lower total and LDL cholesterol. This is done on the assumption that this treatment regime is the best approach to primary prevention in women. However, there are some significant indications that high HDL-cholesterol and low triglycerides are more important for women’s cardiovascular health. The Women’s Health Initiative did not substantiate the expectations from observational studies that postmenopausal hormone therapy reduces the risk of coronary heart disease in spite of lowering total cholesterol and LDL-cholesterol. New research is needed to answer the question of the optimal lipid profile in primary prevention of cardiovascular morbidity and mortality in women and to define gender differences. The committee encourages NHLBI [National Heart, Lung, and Blood Institute] to undertake this type of research.”
The committee “commends NHLBI for its leadership in advancing research on PH [pulmonary hypertension], a rare, progressive, and fatal disease that predominantly affects women. The committee continues to view research on pulmonary hypertension as a high priority. It encourages the Institute to consider expanding its specialized centers of clinically oriented research program in this area and to establish a PH research network to facilitate collaboration and data sharing among leading PH investigators.”
The committee “remains very interested in efforts to find a cure for LAM [lymphangioleiomyomatosis], a progressive and often fatal lung disease of women with no effective treatment. The committee supports both intramural and extramural means of expanding research on LAM and urges NHLBI to use all available mechanisms as appropriate, including support of state-of-the-science symposia, request for applications, and facilitating access to human tissues, to stimulate a broad range of clinical and basic LAM research.”
The report states, “NIH-supported research indicates that millions of women suffer from chronic pelvic and genitourinary pain conditions, such as vulvodynia. The committee encourages NINDS [National Institute of Neurological Disorders and Stroke], in coordination with the NICHD [National Institute of Child and Human Development], Office of Research on Women’s Health (ORWH), the NIH pain consortium, and other institutes, to strengthen its support of research in this area, with a focus on etiology and multi-center therapeutic trials. The committee also encourages NINDS to work with ORWH and other relevant institutes and government agencies, as well as patients and professional organizations, to implement an education outreach campaign on vulvodynia.”
The committee “applauds NICHD for supporting demographic research. As a result of this support, important strides have been made in our understanding of family dynamics especially how these factors influence marriage and the health and development of children. In addition, interdisciplinary demographic research has uncovered clues regarding the causes of health disparities across racial, ethnic, educational, and income groups. The committee encourages NICHD to maintain its levels of investment in demographic training and infrastructure support and to support opportunities for interdisciplinary research into the complex environmental and biological mechanisms that produce health disparities.”
The committee report states, “Screening is used for early identification of infants affected by certain genetic, metabolic, hormonal, or functional conditions for which there is effective treatment or intervention. Screening detects disorders in newborns which, if left untreated, can cause death, disability, mental retardation, and other serious illnesses.”
According to the committee report, “POF [premature ovarian failure] is a condition in which the ovaries stop functioning normally in a woman younger than age 40. Studies show that women who have POF of unknown cause have a one in fifty chance of being a pre-mutation carrier of the FMR1 gene, the same gene that causes fragile X syndrome. Women with POF and a family history of female relatives with POF have a one in fifteen chance in carrying this pre-mutation. The committee acknowledges the importance of furthering research into the FMR1 pre-mutation to inform the research community about the genetic causes of infertility and disorders of altered ovarian function.”
“A recent national study showed that the rate of preterm births among first pregnancies has increased 50 percent over the past decade. The data also revealed that women in their first pregnancy are at highest risk for developing preeclampsia, which puts them at risk for devastating maternal complications and fetal death. In addition, the study also showed a racial disparity with black women at a two-fold higher risk than white women. The committee understands that the prediction and prevention of these first pregnancy complications is problematic and that there is a shortage of research on the etiology and prevention interventions for this cohort of women. The committee requests that NICHD conduct research on women in their first pregnancy in order to fill the gap in knowledge for the prevention of these complications.”
The report states, “ART [assisted reproductive technology] over the past two decades has allowed thousands of infertile couples to have children, accounting for 1.1 percent of total U.S. births and 17.1 percent of U.S. multiple births. There is recent evidence of higher rates of adverse pregnancy outcomes even in single birth pregnancies associated with ART, including increased low birth weight, fetal growth restrictions, genetic disorders, and congenital disorders. The committee encourages NICHD to support an initiative for a multi-site cohort study on ART that would emphasize pregnancy outcomes, and short and long term effects on children to determine if the adverse outcomes are specifically related to ART procedures.”
The committee “applauds NICHD’s efforts in addressing stillbirth, a major public health issue with morbidity equal to that of all infant deaths. The committee understands that the NICHD cooperative network has an ongoing study using a standard protocol at five clinical sites and encourages NICHD to continue supporting this effort.”
“As a result of efforts funded by the NICHD, the number of highly qualified scientists interested in researching vulvodynia has greatly increased. The committee commends NICHD for reissuing its program announcement in this area and suggests that a request for applications be considered. The committee encourages NICHD to strengthen its support of vulvodynia studies in 2006, with a particular emphasis on etiology and multi-center therapeutic trials. The committee commends NICHD for working with ORWH to implement an educational outreach campaign on vulvodynia and calls upon the Institute to continue these efforts.”
The committee “recognizes that prematurity is the leading cause of newborn death and an estimated twenty percent of infants who survive suffer long term consequences, including cerebral palsy, mental retardation, and developmental delays that affect the child’s ability to do well in school. The committee encourages NICHD to strengthen research on the underlying causes of preterm delivery and the development of treatments for the prevention of premature birth. Furthermore, the committee is aware that a 2006 Institute of Medicine report found that a multidisciplinary research approach is needed to better understand premature birth, and therefore encourages NIH to use this strategy to fund research on pre-term birth.”
The committee “commends NIAAA [National Institute on Alcohol Abuse and Alcoholism] for its interdisciplinary approach to understanding and addressing underage drinking within the context of overall physical development. The committee is aware that this framework formed the scientific foundation of the ‘Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking.’ The committee further commends NIAAA for spearheading research to address key aspects of underage drinking. This includes research projects to engage health care systems in identifying and addressing underage drinking, particularly in rural areas. NIAAA is also supporting projects to address fundamental questions about the impact of child and adolescent alcohol consumption on the developing brain including: (1) what are the effects (both long and shorter-term) of alcohol exposure on the developing brain; (2) what is the effect of timing, dose, and duration of alcohol exposure on brain development; and (3) to what extent do these effects resolve or persist.”
According to the committee report, “Suicide is the third leading cause of death among teenagers; for the first time in sixteen years, teen suicide rates have increased in the U.S. Depressive disorders, one of the major risk factors for suicide, continue to be very common in adolescence. The committee therefore strongly encourages NIMH [National Institute of Mental Health] to strengthen its investment in finding ways to better identify the risk factors for suicide in adolescents, improving the criteria for identifying those at risk, and examining the outcomes of actions taken to assist those found to be at risk.”
The report states, “The Office of Research on Women’s Health works in collaboration with the institutes and centers of NIH to promote and foster efforts to address gaps in knowledge related to women’s health through the enhancement and expansion of funded research and/or the initiation of new investigative studies. ORWH is responsible for ensuring the inclusion of women in clinical research funded by NIH, including the development of a computerized tracking system and the implementation of guidelines on such inclusion. ORWH is also involved in promoting programs to increase the number of women in biomedical science careers, and in the development of women’s health and sex and gender factors in biology as a focus of medical/scientific research.”
The committee “is pleased with the increased focus on IBS [irritable bowel syndrome] at ORWH and encourages the office to continue strengthening research on this prevalent functional gastrointestinal disorder. It is estimated that between 25 and 45 million Americans, disproportionately women, suffer from IBS.”
According to the report, “There is an urgent need to expand the development pipeline with more microbicide candidate products, particularly those that target HIV in new ways. In addition to candidates that may arise from basic research efforts, the best possibilities may be found within pharmaceutical companies where there are dozens of potential compounds already developed as therapeutics that could move into clinical development as microbicides if made available. In recent years, nonprofit groups have entered into innovative agreements with leading pharmaceutical companies to jointly test and develop leading AIDS drugs as microbicides. The committee believes that more partnerships like these between the pharmaceutical industry and the nonprofit community will be critical and should receive the active support of NIH leadership.”
The report continues, “Women and girls are the new face of HIV/AIDS and are increasingly affected by the disease in every region of the world. The committee has long advocated that NIH accelerate and better coordinate its microbicide research and notes with approval that NIH has stated its intent to establish a dedicated microbicide branch at NIH with clearly identified leadership, funding, and staffing. The committee strongly supports establishment of this branch and requests that NIH prepare within six months of passage of this bill a report detailing progress made in establishing a microbicide branch, including detailed information on staff and funding dedicated to this effort.”
“In the last decade, NIH has supported three important research conferences on vulvodynia, as well as the first prevalence study and clinical trial of the disorder. These efforts demonstrated the need for additional research and served to heighten the research community’s interest in studying vulvodynia. The committee recommends that the director build upon these initial successes by coordinating through ORWH collaborative extramural and intramural research into the causes of, and treatments for, vulvodynia. This effort should involve ORWH, NICHD, NINDS, and other relevant ICs [institutes and centers], as well as the NIH pain consortium. The committee also commends ORWH for working to plan an educational outreach campaign on vulvodynia. The committee encourages the director to work with the Center for Scientific Review and the institutes and centers to ensure that experts in vulvodynia, and related chronic pain and female reproductive system conditions, are adequately represented on peer review panels.”
The committee “notes that, in 2001, the Institute of Medicine released a report that stressed the importance of biological gender as a basic variable that needs to be considered in all areas of biomedical research. Recent findings have demonstrated that significant differences between men and women exist in health and disease. One of the fields where such differences are most pronounced is neuroscience. The committee strongly encourages each of the 15 institutes involved in the NIH Neuroscience Blueprint to carefully analyze its NIH Neuroscience Blueprint research portfolio to ensure gender is included as a variable, when appropriate, and to require that all reported results include gender specific analysis”.
Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA would receive $3.394 billion in FY2008, $66.82 million above the FY2007 and $226.252 million more than the budget request.
According to the committee report, “Research shows that more than 90 percent of those who suffer from eating disorders are women between the ages of 12 and 25. Data indicate that eating disorders are almost as prevalent as alcohol or drug problems among middle and high school female students, but that far less time is spent on preventing eating disorders than on substance abuse prevention programs. Therefore, the committee urges SAMHSA to integrate eating disorder education and prevention programs into its core mental health programs, particularly those that serve middle and high school students.”
Center for Mental Health Services: The bill would provide $910.625 million in FY2008, $26.767 million above FY2007 and $103.397 million more than the administration’s request.
Within the funds provided, the committee “recommends $32.36 million for the national child traumatic stress initiative, which is $2.942 million more than FY2007 funding level and $4.292 million more than the budget request. This program has established 54 treatment development and community service centers to treat children who have experienced trauma and also supports the national center for traumatic stress. It is estimated that more than 34,000 traumatized children and their families will directly benefit from services delivered as a result of this initiative.”
The Mental Health Block Grant would receive $441.256 million, $13 million more than FY2007 and President Bush’s request.
Center for Substance Abuse Treatment (CSAT): The measure would provide $2.196 billion for substance abuse treatment programs in FY2008. This allocation is $38.453 million more than FY2007 and $85.312 million more than the administration’s request.
The Substance Abuse Prevention and Treatment Block Grant would be funded at $1.794 billion, $35 million more than FY2007 and the administration’s request.
Agency for Healthcare Research and Quality (AHRQ): As requested by the administration, the bill would fund AHRQ at $329.564 million in FY2008, $10.578 million above FY2007.
Administration for Children and Families
Social Services Block Grant (SSBG): The SSBG would be level-funded at $1.7 billion in FY2008 and $500 million more than the administration’s request.
Child Care and Development Block Grant (CCDBG): The CCDBG would receive $2.137 billion in FY2008, $75 million over FY2007 and the administration’s request.
Children and Family Services Programs: Head Start would receive $6.964 billion in FY2008, This amount is $75 million more than FY2007 and $175 million above the budget request.
Consolidated runaway and homeless youth programs would receive $ $97.837 million in FY2008, $10 million more than FY2007 and the administration’s request.
Child abuse and neglect prevention and treatment activities would be funded at $63.84 million, $11.053 million above FY2007 and $695,000 more than President Bush’s request.
A new $10 million “home visitation initiative for mothers is included under the child abuse discretionary program. These funds will be used for evidence-based home visitation projects designed to help mothers improve prenatal health, teach them to become better parents, and improve their quality of life by assisting them with education services and employment opportunities. Research has shown that home visitation can reduce incidents of child abuse and neglect and improve other important outcomes for mothers and their children.”
Programs to increase abandoned infant assistance would be level-funded at $11.835 million in FY2008, as requested by the administration. As requested by the administration, child welfare services and training would be level-funded at $286.754 million in FY2008.
Adoption: The measure would provide level funding of $26.848 million for adoption opportunities, as requested by the administration. Adoption awareness programs would be funded at $14.674 million, $2 million more than FY2007 and the budget request. Adoption incentives would be funded at $9.5 million, $4.5 million above FY2007 and $4 million below President Bush’s request.
Child Support Enforcement: As requested by the administration, the measure would allocate $2.95 billion for payments to states for child support enforcement and family support programs, $313.965 million less than FY2007.
International Trafficking: Under the Refugee and Entrant Assistance Account, a program to aid victims of trafficking would be funded at $9.814 million in FY2008, $9,000 less than FY2007 and $5.002 million less than the president’s request.
The committee “supports efforts to ensure that child trafficking victims do not remain trapped in life-threatening situations out of fear of being interrogated by law enforcement authorities. The committee requests the department to expedite letters of eligibility so that minor victims may be connected to benefits without delay. Furthermore, the committee is concerned about the low number of child trafficking victims being identified and recommends that the department expand its practices on the identification of human trafficking victims.”
Unaccompanied Minors: Under the Refugee and Entrant Assistance Account, a program to assist minors entering the country without a parent or guardian would receive $129.635 million in FY2008, $34.317 million more than FY2007 and $5.027 million less than President Bush’s request.
The committee “supports the department’s efforts to provide medical services that meet quality standards for the children under its care. The Committee directs the department to provide the committee a report on expenses incurred in FY2007 and 2008 and what it expects to incur in FY2009 delivering routine, emergent, and emergency mental and physical medical services to UAC [unaccompanied children].”
Mentoring Children of Prisoners: The Mentoring Children of Prisoners program would be level-funded at $49.493 million in FY2008, $507,000 less than the administration’s request.
Promoting Safe and Stable Families: The Promoting Safe and Stable Families program would be level-funded at $434.1 million in FY2008, an amount equal to the budget request.
Violence Against Women: The Family Violence Prevention and Services Act (FVPSA) (P.L. 98-457) would receive $134.731 million in FY2008, $10 million above FY2007 and the budget request. The FVPSA awards grants to public and private entities to promote domestic violence intervention and prevention activities, including shelter services for victims.
As requested by the administration, the National Domestic Violence Hotline would be level-funded at $2.97 million in FY2008. The committee’s “recommended eight percent increase is part of its initiative to help reduce the number of abortions in America by alleviating the economic pressures and other real life conditions that can sometimes cause women to decide not to carry their pregnancies to term. Increased funding will permit states to expand domestic violence prevention services to more at-risk women.”
Abstinence-only Education: As requested by President Bush, the bill would provide $141.164 million for the abstinence education program in FY2008, $27.764 million above FY2007.
The committee’s “recommended increase is part of its initiative to help reduce the number of abortions in America by alleviating the economic pressures and other real life conditions that can sometimes cause women to decide not to carry their pregnancies to term. The increase will provide support for an additional 63 grants over FY2007. The $27.764 million increase for the community-based abstinence education program is identical to that recommended for the family planning program…The Secretary of Health and Human Services shall require each applicant for financial assistance under the abstinence education program funded under this heading to certify that all materials proposed in the application and funded during the project period of the grant are medically accurate; and a panel of medical experts shall review such grant applications and assess whether the materials proposed are medically accurate.”
Administration on Aging: The Administration on Aging’s Supportive Services and Senior Centers would receive $357.595 million in FY2008, $7 million above FY2007 and the administration’s request. Family caregiver support programs would be level-funded at $156.167 million in FY2008, $1.98 million more than President Bush’s request.
Office of the Secretary
Public Health Service’s Office of Minority Health: The Office of Minority Health would receive $49.284 million in FY2008, $4.171 million less than FY2007 and $5.509 million more than the administration’s request.
Public Health Service’s Office on Women’s Health: The Office on Women’s Health would be funded at $28.8 million in FY2008, $554,000 more than FY2007 and $1.431 million more than the budget request.
Minority HIV/AIDS: As requested by President Bush, the measure would provide level funding of $51.891 million for minority HIV/AIDS prevention and treatment activities.
Adolescent Family Life: The Adolescent Family Life program would receive level funding of $30.307 million in FY2008, an amount equal to the administration’s request.
Embryo Adoption Awareness Campaign: As requested by President Bush, the measure would level-fund embryo adoption awareness at $1.98 million in FY2008.
Office for Civil Rights: As requested by the administration, the office would receive $37.062 million in FY2008, $2.153 million more than FY2007.
Department of Education
No Child Left Behind: Title I Grants to local educational agencies under the No Child Left Behind Act (P.L. 107-110) would receive $14.363 billion in FY2008, $1.525 billion above FY2007 and $452.924 million more than President Bush’s request.
William F. Goodling Even Start Family Literacy Program: The Even Start program would receive $99 million in FY2008, $16.717 million over FY2007. Under the administration’s request, this program would not have received funding.
Reading First and Early Reading First: The bill would fund the Reading First program at $400 million in FY2008, $629.234 million less than FY2007 and $618.692 million less than President Bush’s request. The Early Reading First program would be funded at $114.55 million in FY2008, $3.116 million below FY2007 and the administration’s request.
Teacher Quality: Under the bill, level funding of $3.187 billion would be provided to states to improve teacher quality in FY2008, $300 million above FY2007 and $399.951 million more than President Bush’s request.
Math and Science Partnerships: The Math and Science Partnerships program would receive level funding of $182.16 million in FY2008, $36,000 more than the administration’s request.
Mentoring Programs: Mentoring programs would receive level funding of $48.814 million in FY2008. Under the administration’s budget request, these programs would not have received funding.
21st Century Community Learning Centers: The learning centers would be funded at $1.106 billion in FY2008, $125 million above FY2007 and $124.986 million more than President Bush’s request.
Individuals with Disabilities Education Act (IDEA): Total spending for special education would be $12.311 billion in FY2008, a $507.964 million over FY2007 and an $825.684 million increase over the budget request.
Education for Homeless Children and Youth: Under the bill, these programs would receive level funding of $66.878 million in FY2008. This amount is $5.007 million more than FY2007 and $5 million more than the administration’s request.
Vocational Education: The measure would level-fund vocational education at $1.207 billion in FY2008, $25 million more than FY2007 and $606.553 million more than the budget request.
Adult Education: In FY2008, adult education would be funded at $588.975 million, $25 million above FY2007 and $24.901 million more than the administration’s request.
Pell Grants: The bill would provide $15.583 billion in FY2008 for Pell Grants. This amount is $1.922 billion more than FY2007 and $2.169 billion more than the president’s request. The maximum Pell Grant award would increase to $4,700 in FY2008, $390 more than FY2007 and $100 more than President Bush’s request.
Child Care Access Means Parents in School (CCAMPIS): CCAMPIS would receive $17.81 million in FY2008, $2 million above FY2007 and the budget request.
The report states, “This program helps to ensure that low-income student parents have access to postsecondary education and affordable and convenient child care. Colleges and universities may receive discretionary grants of up to four years to support or establish a campus-based child care program primarily serving the needs of low-income students enrolled at the institution. Priority is given to child care programs that leverage significant local or institutional resources and utilize a sliding fee scale. Grants can only be used to supplement child care services or start new programs. The committee’s recommendation includes the $2 million increase as part of its initiative to help reduce the number of abortions in America by alleviating the economic pressures and other real life conditions that can sometimes cause women to decide not to carry their pregnancies to term. With this increase, the number of college campuses receiving assistance for campus-based child care will increase by nearly 13 percent to 196 campuses.”
Office for Civil Rights: The measure would provide $93.771 million in FY2008 for the Office for Civil Rights to enforce laws that prohibit discrimination on the basis of race, color, national origin, sex, disability, and age in all programs and institutions funded by the Department of Education. This funding level is $2.566 million more than FY2007 and equal to the budget request.
