Compromising Without Compromising Ourselves

A Path Forward for Southern Public Health

Photo by Reproductive Health Supplies Coalition on Unsplash

We’ve all made the trade-off.

If you have worked in public health over the past decade, you have likely found yourself softening a message to protect a budget or keep a seat at the table. We talk about seasonal vaccines but maybe we downplay COVID-19 because it elicits a strong response. We de-emphasize the legally mandatory nature of quarantine during local disease outbreaks to prevent legislative pushback. And in teen pregnancy prevention (TPP), we’ve spent decades accommodating narrow, restrictive constraints just to keep basic education alive in our schools and clinics.

We told ourselves that doing something was better than doing nothing.

But last week’s decision by the Department of Health and Human Services to abruptly cancel dozens of federal TPP grants across the country—erasing $66 million in funding—exposes the flaw in that logic. When public health continuously cedes ground on science to appease political fears, we do not buy long-term security. We just set ourselves up to lose more.

Fear Drives Contradictory Policy

Let’s be clear: this is no critique of the frontline organizations and educators who have led TPP work across the South. Despite being handcuffed by political mandates, these practitioners have achieved extraordinary results. Nationally and regionally, teen pregnancy rates have dropped dramatically over the last few decades because of their grit and ingenuity. They worked miracles within the box they were given.

The problem is the box itself—and the mismatch between political authority and scientific evidence.

Fear - among some parents, communities, and legislators - generates fundamentally contradictory policy. It creates a surreal standard where a teenager is deemed too young and immature to understand birth control, yet mature enough to handle pregnancy, childbirth, and parenthood.

To bridge that gap, public health leaders were are asked to tiptoe. We agreed to emphasize abstinence-only framing, navigate complex parental permission hurdles, and restrict care to a small handful of legally permissible settings. We compromised the presentation of our evidence to soothe political anxiety. Yet, the moment the political winds shifted, those same programs were still accused of “encouraging sexual activity” and stripped of funding.

The Path Forward: Finding Alignment in the South

If we want to build a resilient public health infrastructure—especially across conservative Southern states—we must stop squeezing our work into ever-shrinking political boxes. We need a path forward that matches legislative authority with evidence-based programming.

That does not mean refusing to collaborate or ignoring community concerns. It means learning how to compromise without compromising ourselves.

Here is what that looks like in practice:

1. Draw an unshakeable baseline on science. We can adapt our messaging, respect local governance, and tailor our delivery. But we cannot validate false premises or pretend that medically accurate information is dangerous. Education is protection, not permission.

2. Expose the authority-evidence gap. Public health leaders must speak clearly about where evidence ends and political preference begins. When policymakers choose restricted models, we must ensure the public understands that it is a political choice, not a health recommendation.

3. Funders must step up to fill the void. More than changing our programs, we need philanthropic partners and private funders to fill the gaps created by federal retreats. We need independent, diversified funding streams that allow Southern public health organizations to deliver uncompromised, evidence-based care without fear of sudden political erasure.

At the Southern Alliance for Public Health Leadership, our mission is to equip leaders across our region to build sustainable public health systems. Pragmatism is necessary in leadership, but pragmatism without principles is just surrender.

We can’t negotiate away our core principles. It is time to lead with them—and build the independent alliances required to back them up.