The Trump administration plans to fundamentally change the country’s only federal family planning program dedicated to providing reproductive care to low-income people, by cutting funding for clinics that provide abortions and barring doctors from telling patients where they can obtain the procedure.
The aim is to “defund” Planned Parenthood, a top priority for social conservatives. But the practical effects are more widespread, injuring access and quality of health care for people who depend on public programs. The proposed regulation was expected to be announced on Friday, but no announcement has been made yet.
Trump’s presidency so far has been an onslaught of attacks against reproductive rights, from symbolic moves, like being the only sitting president to speak at the anti-abortion rally March for Life, to concrete policy decisions, like rolling back the Obamacare birth control mandate. Trump’s proposal — dubbed the “Protect Life rule” — is just the latest blow.
Three days into office, President Donald Trump reinstated and expanded a “global gag rule” (or Mexico City Policy) which meant foreign non-governmental organizations (NGOs) could not perform or even discuss abortion or else risk losing U.S. aid. This policy led to clinics closing — many of which offered HIV/AIDS treatment and counseling on sexual violence, like rape and female genital mutilation — and, thus, left communities stranded for care. Now, the policy is expected to come to the United States.
The anti-abortion group Susan B. Anthony List contends this isn’t a gag rule like the one imposed under the Reagan administration, which never went into effect. But Planned Parenthood said it amounts to a “domestic gag rule,” as it bars providers from referring abortion.
The proposed policy will cut off Planned Parenthood from Title X, a federal grant program administered by the Department of Health and Human Services. The group receives $50 million to $60 million in annual funding through the Title X program, with a total operating budget of $286 million.
This is concerning, as Planned Parenthood sees 1.6 million of the 3.8 million clients whose contraceptive care is paid for by Title X dollars. Various research suggests that other clinics, like community health centers, would be unable to fill the void. When Texas barred Planned Parenthood from a Medicaid-funded family planning program, patients lost access to contraception and Medicaid-paid deliveries increased by 27 percent within 18 months.
But the implications for Trump’s proposal like this do not stop at Planned Parenthood. The domestic gag rule calls for Title X-funded services to be physically separated, in addition to the existing financial separation. (No federal dollars go to providing abortion services.) Other sites like hospitals that do offer abortion using non-federal dollars, in addition to providing services like HIV testing and prenatal care, will also lose funding. Roughly 10 percent of Title X clinics are at risk of losing federal dollars.
Trump’s new policy also undermines comprehensive pregnancy counseling, as doctors cannot help patients who decide to terminate their pregnancy after weighing all their choices. The White House says doctors can discuss, but not refer abortion, but Planned Parenthood says that’s a distinction without a difference. This could exacerbate a situation where people already have a hard time finding abortion providers, with all the abortion clinic closures and rise in crisis pregnancy centers.
This means reproductive care for Title X patients — who are low-income people and a majority of whom are people of color — will be less comprehensive. (Of the 4 million people Title X serves, 30 percent identify as either black or African American, Asian, Native Hawaiian or Pacific Islander, or American Indian or Alaska Native, and 32 percent identify as Latinx.)
“As a provider of comprehensive reproductive health care, it is my number one priority to keep my patients safe and honor the trust they give me,” said Dr. Jenn Conti, fellow with Physicians for Reproductive Health. “If my patient decides to have an abortion, I should be able to give them a referral to a high quality provider.”
Title X was created under President Richard Nixon in 1969 to fulfill a promise that “no American woman should be denied access to family planning assistance because of her economic condition.”
Now, the Trump administration aims to “creat[e] a health system that favors those with more resources,” said Guttmacher Institute senior policy manager Kinsey Hasstedt. “It’s repugnant.”
The Trump administration’s move is sure to please anti-choice voters and conservative lawmakers ahead of upcoming primaries. As The Hill reporter Jessie Hellmann pointed out on Twitter, some organizations have already started rallying around the issue:
SBA List fundraising off of announcement today. This is seen as a big deal for pro-life voters and Republicans ahead of the midterms. pic.twitter.com/xeY5WSnDJG
— Jessie Hellmann (@jessiehellmann) May 18, 2018
This policy comes as family planning clinics bid for federal dollars. Applications for the Title X family planning program are May 24, and already it’s been a complicated process. The Trump administration was four months late announcing the Title X grant. When officials did, they changed the funding criteria, prioritizing applications from groups with religious backgrounds and those that counsel abstinence.
For this, the National Family Planning and Reproductive Health Association (NFPRHA), represented by the American Civil Liberties Union (ACLU), and Planned Parenthood affiliates filed lawsuits in federal court in early May to challenge the 60-page funding announcement — that makes no mention of contraception. Twenty Attorneys General filed a legal brief Wednesday, signaling support for reproductive rights groups.
Trump’s proposal is likely to be met with lawsuits. In a call with reporters Friday, Planned Parenthood officials said they will fight the proposal with “whatever means are necessary” and are committed to providing comprehensive reproductive care. This means Planned Parenthood will likely lose Title X dollars next funding cycle because they don’t intend to follow Trump’s measure, should it go into effect.