This story was originally published August 16. It was updated August 19. Roxy Szal contributed reporting.
Planned Parenthood announced Monday it will withdraw from Title X, rather than comply with a new rule that restricts what health providers can say about abortion.
The Trump administration’s domestic gag rule dictates that Title X recipients are prevented from performing, counseling or referring patients to abortion services and providers—primarily affecting low-income patients seeking family planning care.
Efforts to reduce family planning funding for abortion providers are especially harmful for women of color and those in low-income communities. Of the 4,000 entities designated as Title X grantees, 40 percent are Planned Parenthood health facilities. Moreover, half of the people served at Title X clinics are people of color.
“The patient-provider relationship is inherently one of unequal power: The patient is seeking expertise, in many cases, from a person with the power to act as a gatekeeper, said Dr. Monica McLemore, associate professor at the University of California-San Francisco School of Nursing, when testifying before Congress in June about threats to Title X.
“That power imbalance is often intensified by class, health literacy, race, sexual orientation and gender identity differences between providers and patients—with potentially catastrophic consequences. The successful patient-provider relationship relies on trust: in state and federal regulations, in accrediting organizations and in the provider acting in partnership with the patient. The proposed rule changes to Title X destroys that fragile balance between power and trust.”
(McLemore’s full written testimony can be found here.)
The domestic gag rule contradicts the wishes of both patients and providers. Research from Advancing New Standards in Reproductive Health (ANSIRH) shows that people want to be able to discuss their pregnancy options—including abortion—with their prenatal care provider.
“There is a subset of women who, despite entering prenatal care, are uncertain of their decision and wish to discuss their options with their health care provider,” writes ANSIRH. “Screening tools and probing questions are needed to support prenatal care providers in ensuring unbiased, non-directive counseling on all pregnancy options.”
Last week, in a letter to the 9th Circuit Court of Appeals, Planned Parenthood outlined its plan to withdraw from Title X by Monday unless the court moves to protect funding for the organization. Acting Planned Parenthood president Alexis McGill Johnson said the changes to the rule are “unethical, and a gag on health care providers.” She stated that the new rules will raise the cost of contraception and other services, as well as increase wait times at clinics around the U.S.
The decision to withdraw from Title X will have far reaching repercussions for low-income patients of Planned Parenthood. McGill Johnson says that the Trump administration’s changes to the almost 50 year old program will result in “putting birth control, breast and cervical cancer screenings and STI testing and treatment at risk for millions of people struggling to make ends meet,” and added that “this is a blatant assault on our health and rights, and we will not stand for it.”
Dr. Monica McLemore, a Title X expert and professor at the University of California-San Francisco School of Nursing explained “These rule changes force providers into an impossible choice: Will we care for the pregnant person in front of us and make a requested referral for abortion related services, or will we accept funds allowing us to care for thousands of others? The proposed changes to the rule are not about “paying for abortion”—rather, if directly asked for an abortion referral, providers would have to respond that as a Title X grantee, we cannot refer them, and we would be limited instead to providing a resource list of comprehensive providers without specifying whether they offer abortion services.”
The Trump administration made changes to Title X earlier this year, making organizations that provide abortion services ineligible for federal funds that help to provide other healthcare services. Planned Parenthood has been part of Title X since its creation in 1971 and currently serves 40 percent of its grantees. According to Planned Parenthood, abortion services make up only 3 percent of its overall programs. Federal funding of abortion is prohibited by the Hyde amendment but the Trump administration’s changes to Title X will prevent recipients from even speaking about, counseling, or referring patients to abortion providers.