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New US public-health chief is a champion for women and children

This article has been updated

In sharp contrast to President Trump, Brenda Fitzgerald has put maternal and child health at the heart of her policies.

New CDC head Brenda Fitzgerald has a different attitude to women’s health from the White House. Credit: Branden Camp/AP/REX/Shutterstock

Scientists have reason to be concerned over the proposed head of the US public-health agency the Centers for Disease Control and Prevention (CDC). Brenda Fitzgerald, an obstetrician and gynaecologist who recently led the Georgia Department of Public Health, has no background in scientific research. She has also been criticized for promoting controversial anti-ageing medicine while working in private practice. 

Still, her tenure has been met, by and large, with praise from colleagues. She is regarded as an effective leader, who raised the profile of public-health efforts in the state. And she was driven by a trait that scientists can appreciate: a healthy respect for data. 

Key to improved public health in Georgia, the data showed, was to target mothers and children, particularly in low-income areas. Fitzgerald put maternal and child health at the forefront of many of her policies. And this is what makes her a curious choice to head the CDC during the administration of a president whose policies promise to cut health care for mothers and children around the world.

Once in office, President Donald Trump moved quickly to reinstate and expand the ‘global gag rule’, a policy that prevents organizations that receive money from certain US programmes from providing information about or access to abortions, regardless of whether they use their US funding to do so. Formally called the Mexico City Policy, the gag rule has been put in effect by several Republican presidents. But Trump expanded it to include organizations that receive funding from the US National Institutes of Health and the President’s Emergency Plan for AIDS Relief. 

This decision was not rooted in analysis of the data. The desired effect, presumably, is to reduce the number of abortions around the world. But the data suggest that the gag rule does the opposite: by limiting access to contraception, a past iteration of the rule may have increased the number of abortions in sub-Saharan Africa (E. Bendavid et al. Bull. World Health Organ. 89, 873–880C; 2011). Trump has also attacked contraception in other ways, including a proposed US$523-million decrease in funds for services providing contraceptives to women in developing nations (Nature 546, 185; 2017). 

Meanwhile, Trump’s immigration policies have left undocumented pregnant mothers unwilling to seek medical attention for fear of being deported. And US-born children of undocumented immigrants — frightened that immigration officials will take their parents away — are experiencing mental-health damage (Nature 544, 148–149; 2017). 

Another of Trump’s favourite rallying cries — to repeal Obamacare, the health-care plan put in place by former president Barack Obama — could mean that millions lose their health insurance. The repeal bills backed by Trump and under consideration by US lawmakers could also dramatically raise the cost of health insurance for pregnant women. The bills may also roll back provisions for Medicaid, a health-care programme for those on lower incomes that has been used to bolster health-care options for pregnant women, children from poorer backgrounds and children with special needs. Collectively, these policies could have lasting consequences: poor health of pregnant mothers and children during the first few years of life is associated with poorer health trajectories for the rest of those children’s lives. 

Fitzgerald will now lead an agency with an uncertain future. Trump has proposed to reduce the agency’s funding by $1.2 billion (about 17%) in 2018. The proposal may never come into being — it is US lawmakers, not Trump, who will develop the country’s budget — but it clearly conveys his lack of interest in the agency. 

In her time at the Georgia Department of Health, Fitzgerald lobbied conservative Georgia state politicians to support her efforts. She opens many of her speeches with reference to the data that drives her decision making. It has been an effective strategy: under her tenure, funding grew, even as the state tightened budgets in other arenas. Scientists should support her if she employs the same determination to promote maternal and child health on the national stage — even in the face of strong headwinds.

Change history

  • 14 July 2017

    A previous version of this Editorial incorrectly referred to Fitzgerald as the “proposed” head of CDC. This was incorrect: she had already taken office as of 7 July.

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New US public-health chief is a champion for women and children. Nature 547, 137–138 (2017). https://doi.org/10.1038/547137b

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