Planned Parenthood announced Monday that its grantees have no choice but to leave the federal Title X family planning program, after a federal appeals court ruling allowed a Trump administration policy barring abortion referrals to take effect.
During a telephone press conference, Planned Parenthood’s acting president, Alexis McGill Johnson said, “Today we are announcing that due to an unethical and dangerous gag rule, the Trump administration has forced Planned Parenthood grantees out of Title X.”
She added, “Our affiliate grantees will submit letters saying as much to [the Department of Health and Human Services] today. Planned Parenthood is still open. Our doors are open today and our doors will be open tomorrow … I want our patients to know that while the Trump administration may have given up on you, we never will.”
Illinois Gov. J.B. Pritzker (D) called the gag rule “fundamentally wrong” and said it was “doing extraordinary harm to low-income patients, particularly women of color.”
On Friday, the 9th U.S. Court of Appeals refused to reverse a decision it made last month allowing the new Trump administration policy to take effect. In February, the administration announced it would impose a domestic gag rule for health care providers that essentially aims to defund Planned Parenthood and restrict low-income people’s access to quality reproductive health care.
Title X, a federal grant program administered by the Department of Health and Human Services (HHS), is the country’s only federal family planning program. Planning services funded through Title X support testing and treatment for sexually transmitted infections, cervical and breast cancer screenings, birth control, and contraception education.
In April, attorneys general from 23 states, family planning providers, and the American Medical Association filed legal challenges in federal court and lower courts blocked some of its provisions. In June and July, the 9th Circuit decided against them. On Friday, the court refused to reverse its decision.
Title X provides family planning and other health services to an estimated 4 million low-income uninsured and underserved people each year. Providers have to demonstrate a capacity to meet needs in the community before receiving funds.
Not only does the new policy not allow abortion referrals, but it does not allow agencies that receive Title X funds to provide abortion, even though they are using nonfederal funds to do so. Regardless of pregnant patients’ wishes, the rule would mandate that physicians refer those patients for social services and prenatal services.
When asked about the effect on Planned Parenthood’s budget, McGill Johnson would not provide specific numbers, but did describe the effect on low-income people who benefit from the services Planned Parenthood provides.
“The impact that will happen to our patients is that they will be delayed. They will in some cases forgo care because they can’t afford to take extra time off to get care and it means that certain affiliates like an affiliate in Ohio won’t be able to use their mobile health unit to go out in communities and do STI screening,” she said.
The rule would go against informed consent and shared decision-making in medical ethics as the American Medical Association defines it. The AMA says physicians should tell patients about “the burdens, risks, and expected benefits of all options, including forgoing treatment.”
Last year, the American Nurses Association (ANA) said regarding the proposed policy, “As the most ‘honest and ethical’ profession, nurses must guard against any erosive policy that hinders patients from making meaningful, informed decisions about their own health, or that blocks access to care.”
The rule also requires the financial and physical separation of Title X projects and facilities “from programs and facilities where abortion is a method of family planning.”
The impact on low-income people who need reproductive health services could be dramatic. A study from the National Campaign to Prevent Teen and Unplanned Pregnancy found that in 105 counties across the country, Planned Parenthood is the only clinic offering comprehensive contraceptive services.
Planned Parenthood health centers serve 32% of women who receive contraceptive care from a family planning center, according to a 2017 Guttmacher report. Planned Parenthood represented 13% of clinics and 41% of contraceptive clients among Title X-funded family planning clinics. (The report did not address transgender men and nonbinary people who may be clients who receive contraceptive care at family planning centers.)
Kinsey Hasstedt, a public policy associate in the Guttmacher Institute, wrote for Health Affairs that the rule would reduce people’s access to a full range of options. She said the Trump administration policy favors primary care-focused health care providers over reproductive health care providers and allows more ideological control of health care:
Individuals’ ability to obtain the methods that are best for them and successfully avoid pregnancy depends not just on having a provider nearby, but also on the range of options available at those sites. Directing Title X funds away from reproductive health–focused providers—74% of which offer a full range of contraceptive methods onsite—and toward ideologically motivated single-method providers would sharply diminish patients’ access to a broad range of options. And while the rule clarifies that contraceptive methods are expected to be provided as part of a Title X project, it repeals the requirement that ‘medically approved’ methods be among the broad range of options available, to the dismay of many provider organizations.”
According to POLITICO, a few states have already responded to the policy. In July, Illinois said it would not use Title X funding while the policy remains in effect. That same month, Washington state informed HHS it could no longer act in accordance with the rule and would no longer take Title X funds. Oregon Health Authority spokesperson Jonathan Modie told POLITICO last week that the state is using its general fund to keep the clinics going in order to forgo Title X funds. Hawaii has also said it wouldn’t comply with the rule.
HHS released a statement that focused on Planned Parenthood in particular.
“To the extent that Planned Parenthood claims that it must make burdensome changes to comply with the Final Rule, it is actually choosing to place a higher priority on the ability to refer for abortion instead of continuing to receive federal funds to provide a broad range of acceptable and effective family planning methods and services to clients in need of these services,” the department said.