March 4, 2019

Trump Administration Scores 0 Out of 10 on Title X

Freya Riedlin Federal Policy Counsel, Center for Reproductive Rights


There’s a reason that birth control is considered one of the ten great public health achievements of the 20th century. Birth control allows women to plan and space their pregnancies. It helps women protect their health, meet their educational and employment goals, and support their families. Avoiding closely spaced pregnancies also reduces the risk of premature birth and low birth weight, and preventing unintended pregnancy can help women manage certain health conditions, such as diabetes, hypertension, and heart disease. That’s why the Title X program, which for decades has provided high-quality family planning services to low-income individuals across the country, is so important. It’s also why the administration’s attack on Title X is so devastating.

On February 22, the Department of Health and Human Services released a copy of its finalized “domestic gag rule,” which makes sweeping and damaging changes to the Title X program. The gag rule is the latest in a number of attacks on women’s health by the Department of Health and Human Services, which has been stacked with political appointees determined to dismantle women’s access to reproductive health care. The domestic gag rule recycles bad ideas from an old playbook: the rule reintroduces and expands upon provisions of a Reagan-era Title X rule that was never fully implemented and was suspended by presidential memorandum only a few years later. Then, as now, the rule was bad policy.

Among the rule’s most troubling new program provisions:

Title X health care providers are prohibited from referring for abortion care. In a blatant violation of medical ethics, the final regulation prohibits providers from giving a referral for abortion care. If they so choose, physicians and advanced practice providers are permitted, but not required, to instead provide a list of comprehensive primary health care providers, some but not the majority of which may be abortion providers. Neither the list nor the health care provider may identify which of the providers listed performs abortion services.

A requirement for strict physical and financial separation of Title X services from abortion services. This means that Title X grant recipients that also provide abortion care may be required to undergo expensive construction, or even build entirely separate facilities, to comply with the regulation, which suggests that compliance would require separate entrances and exits, separate staff and waiting rooms, and separate medical records, among other burdensome and costly requirements.

A shift away from medically proven contraceptive services toward abstinence-only education and faith-based, antiabortion counseling centers. The final rule rescinds a prior requirement that the range of family planning methods to be offered be medically proven, opening the door to funding grantees that refuse to offer a broad range of FDA-approved contraceptive methods. The rule also rescinds a prior requirement that all Title X funding recipients offer information and counseling to pregnant patients regarding prenatal care and delivery, infant care, foster care and adoption, and abortion, allowing providers to withhold basic information about a pregnant woman’s health care options.

In rulemaking, agencies are required by law to engage in a substantive cost-benefit analysis of the impact of the rule they are crafting. But despite hundreds of thousands of comments submitted in opposition to the proposed version of the rule, and vocal opposition from more than 100 family planning and public health organizations, the final rule fails to consider adequately the substantial harms the rule would cause, or provide a coherent reason for why this rule is needed.

The Title X program currently serves more than 4 million low-income, uninsured, and underserved clients, including communities of color, immigrants, LGBT patients, and rural residents who may otherwise lack access to care. In 2015, Title X-funded clinics helped women avert 822,300 unintended pregnancies, in addition to providing services that include STD and HIV testing, breast and cervical cancer screenings, and infertility services. Six in ten women receiving Title X services have reported that a Title X–funded health center was their usual source of medical care, and four in ten reported it was their only source of care. For some of these women, this rule threatens to eliminate their sole entry point into the health care system—all because this rule may force providers that are unable or unwilling to comply with its unreasonable requirements to close their doors.

The Department of Health and Human Services is tasked with enhancing and protecting the health and well-being of the public and providing for effective health and human services. With this rule, HHS has fundamentally failed in its mission —and has failed millions of women who have a right to, and an urgent need for, quality health care.