“No American woman should be denied access to family planning—Former President Richard Nixon, 1969
assistance because of her economic condition.”
Richard Nixon’s historic 1969 promise (yes, that Nixon) provided the basis for Title X—the nation’s first federal program dedicated to the provision of family planning services, which at the time, garnered strong bipartisan support.
And on Wednesday, just three days into Black Maternal Health Week, the Biden administration initiated a roll-back of the Trump-era domestic gag rule—a policy which strips Title X funding from any provider who offers abortion care or provides referrals for these resources.
The announcement marks a major victory for reproductive rights advocacy groups who have been waiting since the beginning of President Joe Biden’s term, when he promised to “reverse my predecessor’s attack on women’s health access” and “undo the damage that Trump has done.”
#BREAKING🚨: Great news! Today @HHSGov issued a proposed rule to end the harmful Title X gag rule.— Center for Reproductive Rights (@ReproRights) April 14, 2021
We are pleased @HHSgov has taken critical action to #MakeItRight for #TitleX. This is a major step to improve health equity for people across the country.
Biden’s proposal, published on Wednesday, Apr. 14, would restore the original function of Title X, a measure that funds family planning programs such as affordable contraception and STD screenings. Although Title X was never terminated, its positive impact was greatly diminished by the domestic gag rule’s exclusions.
According to the Department of Health and Human Services (HHS), former President Donald Trump’s 2019 ruling “undermined the mission of the Title X program by helping fewer individuals in planning and spacing births, providing fewer preventive health services, and delivering fewer screenings for STIs.” As a result, “71,145 fewer individuals who were pregnant or sought pregnancy were served.”
Reproductive care is health care.— Rep. Suzan DelBene (@RepDelBene) April 14, 2021
Grateful that @HHSGov is restoring & strengthening access to reproductive health care by ending the Title X gag rule.
The prospect is a relief to patients and providers alike, with clinics no longer having to make the impossible decision between granting pregnant people their right to choose or serving the underserved.
Dr. Jamila Perritt, CEO of Physicians for Reproductive Health, released a statement Wednesday morning, applauding the administration’s decision.
“Providers of comprehensive reproductive health care, including abortion care, base their relationships with their patients on trust. The Title X gag rule went against everything we knew as providers of ethical, evidence based health care by forcing providers at Title X funded clinics to withhold information that their patients needed and requested.
“Over four million people rely on Title X funded clinics to receive their reproductive health care, including access to birth control, STI screening and treatment, and breast and cervical cancer screenings. These four million people deserve the same information about all of their health care options. I applaud the Biden-Harris administration for agreeing with this basic tenet of health care and look forward to our continued partnership.”
The decision will disproportionately impact communities of color, who are more likely to rely on Title X funding, and face heightened barriers to abortion access—even without the gag rule. In 2020, 18.8 percent of Black Americans were in poverty, as well as nearly 16 percent of Hispanic and Latinx people in the U.S.. That number is less than half for white Americans: just 7.3 percent. These disparities were exacerbated throughout the rest of the year-long COVID-19 pandemic.
Hoping to be able to offer full assistance to marginalized communities as soon as possible, organizations like Planned Parenthood and the National Women’s Law Center (NWLC) stand ready to defend the proposal over the course of its 30-day public comment period.
“Due to centuries of systemic racism and injustice, the rule has disproportionately harmed people of color and people with low incomes, all at a time when access to affordable preventive health care has never been more critical. We stand ready to mobilize our partners, and Planned Parenthood’s 17 million supporters, to swiftly end this discriminatory policy and to create a pathway for health care providers that were forced out by the gag rule to re-enter the program, so that patients can once again obtain health care through Title X from trusted community providers …
“The proposed regulations released today, when finalized, will end the Title X gag rule and make other modifications to strengthen the program and better ensure access to equitable, affordable, client-centered, quality health care services for patients under Title X. In the coming days, a 30-day comment period will allow the public to underline the harm the gag rule has wrought and emphasize why it must be ended as swiftly as possible.”—Alexis McGill Johnson, president & CEO of Planned Parenthood Federation of America
🙌GREAT NEWS! The Biden-Harris admin just proposed ending the Title X gag rule! This dangerous policy undermines the only federal program dedicated to providing sexual and reproductive health care to people with low incomes. pic.twitter.com/hxyoW4OHkM— Planned Parenthood Action (@PPact) April 14, 2021
“We applaud the Biden Administration for moving to halt the damaging Trump Administration rule that gagged health care providers and prevented patients from accessing critical reproductive health care through the Title X family planning program. This rule especially harmed people who already face barriers to care, including people of color, patients with a low income, and those who are uninsured. Everyone deserves quality health care, which includes receiving accurate information about abortion. That’s true now more than ever – in the midst of a public health and economic crisis, people need the important care that Title X health centers provide. We’re glad the Biden Administration is moving to restore this program and we will continue to fight for quality care alongside the Biden-Harris administration, Title X family planning providers, and their patients.”—Fatima Goss Graves, president and CEO of the National Women’s Law Center (NWLC)
However, much damage has already been done, and it’s going to take time to rebuild: HHS reported six states have lost all Title X services entirely since 2019. Even in California, participating sites dwindled by 36 percent, deserting 700,000 patients in the state receiving the most support. In New York, the 174 providers receiving Title X funding dropped to just two.
“As a result of the decrease in clients able to receive Title X services, it is
estimated that the 2019 Final Rule may have led to up to 181,477 unintended pregnancies,” HHS wrote in its proposal.
Reversing the Trump-Pence #TitleX gag rule is a game-changer for the millions of patients whose access to health care was threatened by their dangerous rule—& will help ensure patients can get the care they need from the providers they trust.— Senator Patty Murray (@PattyMurray) April 14, 2021
Biden’s move to rescind the gag rule was a necessary first step, but restoring Title X to its full potential will be a long, arduous and expensive process. Power to Decide—a group that advocates for and educates young people on their reproductive choices—stressed the urgency of funding Title X’s recovery.
“All people no matter who they are or where they live deserve the power to decide if, when and under what circumstances to get pregnant and have a child. …
“The domestic gag rule more than undermined the integrity of the Title X program, it worked to prevent people with low incomes from accessing the reproductive health services they need, with the burden falling hardest on Black and brown people. We appreciate the actions of the Biden-Harris administration and this new rule that will help to undo the damage to the Title X program and strengthen the program’s commitment to equity. But to fully realize the promise of this proposed rule, the program also requires additional annual funding to meet the needs of our communities. It’s estimated that approximately $737 million is needed each year to fully meet the needs of people who depend on these health centers. Funding at this level would not only restore the integrity of the program, but also significantly expand access to affordable and high-quality contraception for people struggling to make ends meet.”—Dr. Raegan McDonald-Mosley, CEO of Power to Decide
Without swift reversal of the domestic gag rule and adequate funding to facilitate Title X’s rebound, disparities in health care will only continue to grow.
“Ultimately, continued enforcement of the 2019 rule raises the possibility of a two-tiered healthcare system in which those with insurance and full access to healthcare receive full medical information and referrals, while low-income populations with fewer opportunities for care are relegated to inferior access,” wrote HHS in its report. “Given that so many individuals depend on the Title X program as their primary source of healthcare, this situation creates a widespread public health concern.”
But to boil this down to a public health concern is only part of the picture. The 2019 gag rule is one of many posing a direct contradiction to our right to the full range of reproductive health services. It is also a threat to the dignity and autonomy of all Americans. Biden’s move to end the gag rule is key to achieving progress towards reproductive freedom.