As expected, the Trump administration has moved ahead with a federal rule that will make it more difficult for women, especially poor women, to obtain family planning services, including abortions.
The order, issued last week, limits how health providers that participate in Title X, the federally funded family planning services, can talk to their patients about abortion.
The unnecessary and overreaching rule change will primarily hurt poor women, many of whom are receiving health care services, including contraceptives, through Title X-funded clinics.
More than 4 million low-income Americans access reproductive health care through Title X, including 22,000 in Maine.
In Maine, the rule affects Maine Family Planning and Planned Parenthood, both of which provide a full range of family planning services as well as other health care screenings at numerous facilities across the state. These providers are already banned from using federal funds for abortion services, but they could partner with privately funded providers for such services.
As it seeks to hobble Planned Parenthood, the administration last year elevated natural family planning and abstinence counseling, which are less reliable than other family planning methods, to be Title X funding priorities.
Medical professionals, major medical and public health associations, 200 members of Congress and more than 500,000 members of the public submitted comments opposing the Title X rule change on constitutional, legal, ethical and policy grounds.
Fortunately, state and federal lawmakers are already looking for ways to maintain the health and family planning services that are threatened by the order. Lawsuits are being filed.
“We oppose federal funding of abortion. Yet we have also consistently opposed efforts to restrict certain providers from Title X and other federal health care programs because we believe that timely and convenient access to contraception services has been critical to reducing the number of abortions in our country over the past three decades,” Sens. Susan Collins and Lisa Murkowski said in a June letter expressing their concerns about the proposed rule change. “Regrettably, some of the changes suggested in the proposed rule may undermine that success.”
Maine Gov. Janet Mills also decried the rule change as “backward policy that will silence health care providers, withhold vital medical information from patients, and prevent women from getting the basic health care they need.”
Mills pledged to work with the Department of Health and Human Services, Legislature and state attorney general to see what the state can do to protect the health care of Maine women. When she was attorney general, Mills joined 18 other states in a lawsuit attempting to block the Title X changes.
There are two main provisions of the rule that will put health care access at risk for millions of people.
The so-called gag rule makes it illegal for health care providers in the Title X program to counsel patients about abortion options or to refer them for an abortion. Censoring these providers inhibits the patient-provider relationship and compromises medical ethics by prohibiting providers from providing patients information about all of their options.
The rule also requires “physical separation” between areas where abortions are provided and areas where other health care services are provided. This could require separate entrances and staff members, which could be cost prohibitive for some providers.
Planned Parenthood of Northern New England, which serves nearly half the people who rely on Title X in Maine, would no longer participate in the federal program under these restrictions, said Nicole Clegg, the organization’s vice president of public policy.
As a result, thousands of Maine women would be forced to seek health care and family planning services through other providers, many of whom don’t have capacity for new patients.
Title X health care providers commit to providing care to all who need it, regardless of ability to pay. Almost half of the patients who receive Title X services are at or below the federal poverty level.
Women in rural areas already report poorer health and more pregnancy and birth complications than women in metropolitan and suburban areas. Shuttering Title X programs will only exacerbate these discrepancies.
Title X also saves money. For every dollar invested in publicly funded family planning programs like Title X, the government saves $7.09 in Medicaid-related costs. In Maine, Title X saves the state more than $25 million a year.
The Trump administration gag rule is not based on science, will harm women and waste money. Repealing the rule change in Congress, or acting at the state level to ensure these services remain available in Maine, is essential to protect a full range of family planning and medical services for all women.