“The government doesn’t care about women’s health,” Jennifer Welch, the CEO of Planned Parenthood of Illinois (PPIL), told me recently. On June 20, the 17 centers across the state were forced to temporarily suspend the use of key federal funds that support their family planning services. PPIL serves 68,000 people, and in six counties is the sole reproductive health-care provider that offers affordable treatment through Title X. But the decision to forgo federal funds was, in some ways, not a decision at all. After the recent ruling on Trump’s “domestic gag rule,” the women’s health organization couldn’t compromise its dedication to reproductive health care just because the government has chosen to disregard it.
On June 20, the Ninth Circuit Court of Appeals ruled in favor of Trump and the Department of Health and Human Services’ “domestic gag rule,” a regulation that would block clinics in the Title X network from receiving federal funds if they offer abortion procedures and referrals. The rule is part of HHS’s revision to Title X and imposes new restrictions that push an anti-abortion agenda and place a burden on both patients and providers. The domestic gag rule represents a piecemeal change with consequences for millions. It threatens not only the right to an abortion, but access to unbiased, affordable reproductive care, putting the most vulnerable populations at risk. While the focus of reproductive rights under Trump has been on threats to repeal Roe v. Wade and the more recent Republican-backed abortion bans, all of which are indeed urgent, seemingly subtle regulation changes like this should not be overlooked, and courts and policymakers alike need to take notice.
Title X, since its bipartisan implementation in 1970, has been foundational in the provision of contraceptive care and ensured that all Americans have true access to affordable family planning services, regardless of their income or their insurance policy. The federally funded program supports a network of nearly 4,000 service sites across the country where patients can receive a wide range of family planning care, including contraceptives, wellness exams, cancer screenings, and testing for STIs and HIV at little or no cost. Most importantly, these services are used by the most vulnerable populations; 67 percent of those who visit Title X sites have incomes at or below the poverty line and nearly half are uninsured. People of color, who continually face discrimination and widening health disparities, account for two-thirds of Title X patients. Patients who qualify for Title X are billed on a sliding scale, where their income determines the cost of their treatment. For many, Title X is the only thing that allows them to get the care they need.
In the spring of 2018, Trump and HHS proposed the domestic gag rule to undermine reproductive health and push key providers like Planned Parenthood out of the federally funded network. To be sure, the Hyde Amendment already prevents any government funding of abortion, and clinics like Planned Parenthood use non–Title X and non-Medicaid funds to cover abortion costs. The gag rule then is both a redundant and strategic effort by the administration. The rule requires full physical and financial separation between facilities that offer family planning care and those that perform abortions, imposing stringent division, from separate buildings to separate email addresses. But the gag rule also undermines Title X sites that don’t actually perform abortions by banning abortion referrals—even upon a patient’s request. Not only would Title X providers face legal ramifications if they give information on where to get an abortion, but they are required to refer patients to prenatal care. The rule effectively withholds some information from patients while forcing other information on them, a situation that perfectly aligns with the ideological stance of the administration.
The final proposal was made public in March of this year and met with a lawsuit from the National Family Planning and Reproductive Health Association (NFPRHA), represented by the ACLU, as well as the state of Washington, who were granted a preliminary injunction to block the rule. On June 20, the Ninth Circuit lifted that injunction and allowed the rule to go into effect. Four days later, NFPRHA filed a motion for reconsideration. Attorneys from the Center for Reproductive Rights filed a similar emergency request in Maine, where up to 85 percent of abortion clinics could be eliminated. Until the courts’ decisions, however, the gag rule has the green light.
For Planned Parenthood, the medical information they provide is about the patient’s right to understand every medical option available—and make their own decision. With the new regulations, the Trump administration has leveraged vital funds that support the most marginalized communities in order to impose a political ideology. And in doing so, the government has forced Title X providers to choose between legal and monetary ramifications on the one hand and compromising their roles as true health-care providers on the other. With new restrictions, even sites that still qualify for Title X funds could withdraw from the program out of concern for new liabilities and clinical standards of care, thereby shrinking the network and limiting options for low-income communities. But because family planning covers a wide range of services, the effects of the rule will be felt by all Title X patients, regardless of the care they seek.
Planned Parenthood said it “will be unable to participate in the administration’s unethical Title X program” but urged patients to contact their health center to understand their options, particularly patients without insurance, as legal uncertainty continues. As Jennifer Welch told me, regardless of the government’s effort to shut them, she wants “the people of Illinois to know that Planned Parenthood’s doors are still open.”
This article has been updated.