The Title X Family Planning Program was established by President Richard Nixon in 1970 in order to help alleviate poverty and improve the health of women and children. It fulfilled Nixon’s promise that “no American woman should be denied access to family planning assistance because of her economic condition.” This promise was made in response to research that showed low-income women were more likely to experience unplanned pregnancies, that closely spaced pregnancies had a negative impact on the health of both mothers and children, and that unintended pregnancies increased poverty, reliance on public assistance, and poor health outcomes.
Today, Title X remains the only federally-funded program solely devoted to providing affordable contraception and preventive reproductive health services. Title X services include pregnancy testing; contraceptive counseling and services; pelvic exams; screening for cervical and breast cancer, high blood pressure, anemia, diabetes, and sexually transmitted infections (STIs) and HIV/AIDS; infertility services; health education; and referrals for health and social services.
On Tuesday May 22, the Trump Administration published a long-anticipated new rule that withholds the the distribution of Title X funds to any healthcare provider who provides abortion care, or even refers patients considering abortion to abortion care. Critics are calling it “domestic gag rule.”
In many parts of the country including many parts of Pennsylvania, Planned Parenthood healthcare centers and independent clinics that provide both abortion and the full range of reproductive healthcare including birth control and cancer screenings are the only place for low-income people to go for healthcare—reproductive and otherwise. In 2015, six in ten women who obtain their healthcare from a Title X-funded provider consider it their usual source of healthcare.
The new rule:
Will have significant negative affect on health of Pennsylvanians: Pennsylvania has the third largest patient population that qualifies for Title X funding in the country, after California and New York. In 2017, 191 healthcare providers used Title X funds to provide low-income Pennsylvanians with reproductive healthcare such as STI screenings and contraception. Thirty-six percent of all Pennsylvania patients relying on Title X services obtain those services at a Planned Parenthood.
Will likely increase the unintended pregnancy rate in Pennsylvania: Pennsylvania’s unintended pregnancy rate is already higher than the national average. It is estimated that 53% of all pregnancies in Pennsylvania are unintended, (compared to a national average of 45%).
Disproportionately affects women of color: Title X patients are disproportionately black and Hispanic or Latino, with 21% of Title X patients self-identifying as Black or African American and 32% as Hispanic or Latino (as compared to 13.3% and 17.6% of the nation, respectively)
Will likely increase the abortion rate: Contraception reduces unintended pregnancy. Increasing the number of unintended pregnancies, of course, lead to increase in abortion rates.
Mandates substandard healthcare for low-income patients: Physicians will be forced to provide substandard healthcare to patients by withholding full information about the complete range of options in the wake of an unintended or complicated pregnancy
Interferes into the doctor-patient relationship: Physicians will be forced to withhold information for no reason other than political interference of the Trump Administration
Negatively affects men, too: More men rely on Title X for healthcare in Pennsylvania than the national average. In Pennsylvania, 12% of patients using Title X services are male, compared to a national average of 10%.
Will likely increase government spending: The Guttmacher Institute estimates that for every dollar invested in family planning, the taxpayer saves $7.09. Services provided in Title X-supported centers alone yielded $7 billion of the $13.6 billion in net government savings that resulted from publicly funded family planning services in 2010.
Is just one part of Trump’s mission to undermine the goals of Title X program: The latest funding opportunity announcement, the paperwork that invites grantees to submit for funding, was published months behind schedule and introduced significant changes and alarming rhetoric. It failed to mention “contraception” at all, requires providers to prioritize abstinence despite being ineffective strategy and regardless of patient needs. These changes among others prompted a legal challenge from the ACLU and the National Family Planning & Reproductive Health Association on the grounds the document is counter to the Title X statute and regulations.
“This proposed rule undermines the goals of the Title X program and public health goals at large,” says WLP Senior Staff Attorney Susan Frietsche. “It is mind-boggling that this proposed rule is being celebrated as pro-life, or somehow conservative, when it is designed to decrease access to healthcare like contraception and cancer and STI screenings, and increase the unintended pregnancy rate, the abortion rate, and overall government spending. This is a truly authoritarian attack on women, which will negatively affect just about everybody whether they realize it now or not.”
Next, the public is invited to comment on the proposed rule. More to come, and we will keep you posted.
The Women’s Law Project is a public interest law center in Pennsylvania devoted to advancing the rights of women and girls.
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