The latest major headline about the ongoing attack on abortion rights is one of the most upsetting yet. You may have seen news swirling about a “domestic gag rule” on abortion and the fact that Planned Parenthood decided to pull out of the Title X program as a result of that gag rule. But you might not know what all of that means, and especially what it might mean for your right to a safe, legal abortion.
It’s a lot of political and legal jargon to work through on your own, which can conceal the stark reality here: This is a huge deal, and reproductive rights nationwide are in even more jeopardy than before. Here’s what you need to know.
Is this a domestic gag rule on abortion?
According to this new rule, health clinics can’t receive certain funding if they provide abortions or even if they refer patients to other health centers where they can receive abortions. The federal funding we’re talking about here is Title X funding, which makes family planning and other preventive health services more affordable and accessible, but has never been used to directly fund abortion. (We’ll explore Title X in more detail in the next section.) President Donald Trump first released a proposal for the rule in May 2018, and the U.S. Department of Health and Human Services (HHS) released the final rule in February 2019.
The rule requires “financial and physical separation” between facilities or programs that provide any kind of health service using Title X funds and those that provide abortions. It also “[prohibits] referral for abortion as a method of family planning.” The rule says that providers can still offer “non-directive counseling on abortion,” but as SELF previously reported, non-directive counseling is already the medical standard. That simply means that doctors go over all treatment options, along with the pros and cons, in an effort to make sure patients have all the information they need to best look after their health. Because of the limitations of this rule, though, non-directive counseling would mean a doctor wouldn’t actually be able to tell a patient where they could go to access an abortion, unless it is a medical emergency.
According to the HHS, this is not a gag rule, because providers can still counsel their patients on abortion. However, the rule states that providers are only allowed to give abortion referrals in cases of medical emergencies. So, hypothetically, if a patient is seeking an abortion for any other reason, their provider is not allowed to tell them where they can get one. That sounds like a gag rule to us, so we’ll be referring to it as such from here on out.
We have a precedent for this internationally: the Mexico City Policy, often referred to as the global gag rule on abortion, as it affects U.S. funds going to international health organizations. You may remember that in 2017, President Trump reinstated this policy, which prevented U.S. money from funding international health organizations that offer abortions or even just information about abortions—even if U.S. dollars aren’t paying for the actual abortion-related services, as they don’t in the United States. The ban was introduced by President Reagan in 1984, and it’s been rescinded and reinstated many times since then.
The domestic gag rule leaves Title X facilities that provide abortions as well as other health services in a maddening bind: Either they forgo the funding they receive through Title X, or they stop providing some information and services related to abortion. The resulting outcry has been swift and fierce.
“Restrictions on funding family planning services is a targeted attack on patients, and that is infuriating to me both as a mother who timed pregnancy and as a physician who helps other women to control their reproductive futures,” Katie McHugh, M.D., board member with Physicians for Reproductive Health and an ob/gyn in Indiana, tells SELF. “There are no other types of patients or medical procedures that are regulated in this way.”
Cutting Title X funding to health clinics unless they pretend abortion doesn’t exist will make affordable health care even harder to access. “This rule is quite dangerous,” Fabiola Carrion, senior staff attorney with the National Health Law Program, tells SELF. “It rolls back progress that is already in place to ensure that all women and people have access to quality care, including birth control and other reproductive health care.”
While it’s clear that this rule is aimed at restricting access to abortions, the HHS says that the goal is to make sure that providers “are not required to choose between participating in the [Title X] program and violating their own consciences by providing abortion counseling and referral.” By this, they’re referring to the fact that the previous Title X rules required providers to answer a patient’s questions about abortion if asked and to refer them to somewhere that does provide abortions, if requested. However, the fact that the new rules now prohibit referrals for abortions that aren’t deemed “medical emergencies” presents a new dilemma for providers: They’re now required to choose between participating in the Title X program and providing their patients with all of the information that they’re requesting.
How does Title X work?
The Title X program is a pool of federal funds dedicated to ensuring access to family planning and other preventive health services like birth control, screening for sexually transmitted infections, breast and cervical cancer screening, family planning counseling, and other reproductive health services. Just over $286 million is designated for Title X use in 2019, according to the Congressional Research Service.
As the only federal grant program earmarked for this cause, it’s impossible to overstate how crucial Title X is for people’s health nationwide. Around 4,000 clinics receive this funding (that is, before clinics started leaving the program due to the gag rule), which allowed them to help over 4 million people each year, according to the Guttmacher Institute.
Those who use Title X-funded clinics are often low-income people of color who are underinsured or uninsured, leaving these groups especially vulnerable to reduced access to care.
“This attack is devastating to the future prospects of these people,” Dr. McHugh says. “Without access to health care and contraception, they are not empowered to control their futures or invest in society.”
One of the most frustrating aspects of this news is that federal law already doesn’t allow Title X money to directly fund abortion. Using these federal funds to pay for an abortion in any way is simply not happening. (Thanks to the controversial Hyde Amendment, federal Medicaid funding also does not cover abortion costs outside of very narrow exceptions.) So, despite any claims to the contrary, this gag rule is not about limiting federal funds going to abortion—that is already prohibited.
What the gag rule actually does is threaten to revoke Title X funding for any health center that provides abortions or even talks to patients about abortions. This gag rule means that if a provider at a clinic even answers a patient’s questions about how to access an abortion, they can’t receive this Title X funding for the other important health services they provide, like affordable birth control methods that would prevent unwanted pregnancies. It also means that they need to stop providing abortions altogether, or stop receiving their Title X funding altogether—again, even though that funding was not being used for abortions.
Why did Planned Parenthood pull out of the Title X program?
On August 19, Planned Parenthood Federation of America announced that it was pulling out of the Title X grant program rather than halting abortion services and referrals. Planned Parenthood serves around 1.5 million Title X patients every year, or about 40 percent of all people who receive care from a Title X clinic, the organization says in a statement. Monday was the deadline for Title X grantees to agree that they’d follow the domestic gag rule and provide a plan for doing so, according to the HHS.
“I want our patients to know: while the Trump administration may have given up on you, Planned Parenthood never will,” Alexis McGill Johnson, acting president and CEO of Planned Parenthood Federation of America, says in a statement. “Our doors are open today, and our doors will be open tomorrow.”
Planned Parenthood isn’t the only group that has decided to leave the Title X program instead of providing a limited spectrum of care. According to the Associated Press, the Maine Family Planning network of clinics also announced that it will no longer use Title X funds. And earlier this month, Public Health Solutions, a group of clinics in New York, announced that they would leave the Title X program instead of complying with the gag rule, as reported by Vice.
What happens next?
By September 18, all clinics intending to comply with these rules must submit a statement to that effect and “supporting evidence with compliance requirements,” according to the HHS. By March 4, 2020, they would need to submit a statement along with evidence that they’ve separated facilities providing Title X services from those providing abortion services or referrals.
Clearly, if the domestic gag rule goes into effect, it will impact the ability to receive a safe and legal abortion or information about how to access one.
“With the changes in the Title X rules and Planned Parenthood being forced out, anti-abortion and abstinence-only fake health centers will be emboldened to target even more young people, especially those young people who are specifically needing low-cost care,” Diana Thu-Thao Rhodes, director of Public Policy at Advocates for Youth, tells SELF.
But the impact could be even more devastating than that.
Clinics that opt not to comply and therefore lose Title X funding might struggle to stay open or provide as wide a range of care as many do, Hal Lawrence, M.D., ACOG executive vice president and CEO, tells SELF in a statement. “This endangers women’s health, leaving them with fewer options for safe, timely, and comprehensive preventive care, and is certain to delay provision of care or altogether deter women from seeking care at all,” he says.
The exact impact this might have will vary from clinic to clinic. As the Associated Press explains, some states, like Illinois and Vermont, will use state funds to make up for any lost Title X money. Some health clinics are also coming up with ways to technically stay in the Title X program while hoping the rule will be overturned. As POLITICO reports, Essential Access Health, California’s main Title X grantee, could use up to $250,000 of state funds per clinic as a one-time assistance program. But the impact could be greater in states that don’t have this type of contingency plan and rely heavily on Planned Parenthood as a Title X grantee, such as Minnesota, where Planned Parenthood serves 90 percent of Title X patients, per the Associated Press.
However heartening they may be, these stop-gap measures can’t undo the cruel inanity of this ruling. Overall, “there aren’t enough Title X clinics to absorb all the patients from clinics that are pulling out of the program,” Dr. McHugh says. “Young women, youth of color, low-income [people], LGBT youth, immigrant youth—all deserve better,” Rhodes adds.
“Those that can afford it will need to travel farther for their care, endure longer wait times, take more time off work and away from their families, or even accept substandard care. They will not have access to the same health care that others do, simply because they are low-income, and this is unacceptable,” Dr. McHugh says.
As with so much that the Trump administration has put forth, this rule is being challenged in the courts. The National Family Planning & Reproductive Health Association is suing to overturn the rule, resulting in an extensive legal volley. Organizations such as the American Medical Association and Planned Parenthood have joined the legal battle against this rule as well. Oral arguments in the case to overturn the gag rule are scheduled for the week of September 23 before San Fransisco’s 9th Circuit Court of Appeals, the Washington Post reports.
“We are continuing to fight this rule in court, and we will do everything we can to make sure our patients don’t lose care,” Erica Sackin, senior director of communications for Planned Parenthood Federation of America, tells SELF. “With the help of our 13 million supporters, we will be on the ground urging Congress to act now to stop the gag rule, and protect birth control and reproductive health care for millions of people.”