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Trump’s ‘Gag Rule’ Will Target Planned Parenthood—Along With Low-Income Women’s Access to Health Care (Updated)

Ally Boguhn

Title X provides family planning services to nearly 4 million patients with low incomes in the United States, many of whom are people of color who face systemic barriers to health-care access.

UPDATE, May 22, 5:33 p.m.: The Trump administration announced Tuesday that it would officially move to reinstate the “gag rule.” The administration’s proposal includes a policy that would “encourage family participation in a minor’s decision to seek family planning services,” along with a religious imposition measure that would eliminate the “requirement that [Title X health providers] provide abortion counseling and referral.”

The Trump administration will seek to reinstate a Reagan-era anti-choice restriction blocking federal family planning funds from organizations that provide abortion services in the same location as their Title X-funded services.

The U.S. Department of Health and Human Services (HHS) is reportedly set to submit the “Protect Life Rule” to the Office of Management and Budget to begin the rulemaking process. An administration official told USA Today that unlike the Reagan-era version of the restriction, the rule would “not prohibit counseling for clients about abortion,” but it would eliminate the current requirement that Title X patients receive counseling and referrals for all pregnancy options.

Though the administration denies that the policy is a “gag rule,” Kashif Syed, senior policy analyst at Planned Parenthood Federation of America, said on a Friday press call that removing the requirement would “strip patients of the right to get all the information they need from their health care provider, and that creates the possibility that people won’t get all the information about their medical options.”

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Title X provides family planning services to nearly 4 million patients with low incomes in the United States, many of whom are people of color who face systemic barriers to health-care access. Along with contraceptive care, education, and counseling, those services include breast and cervical cancer screening and sexually transmitted disease testing.

According to NBC News, an “administration official framed the proposed rule as a choice for Planned Parenthood: separate themselves from abortion services or fund themselves entirely with private money.”

Title X already prohibits federal funds from going to abortion, Syed noted on Friday’s press call. “So there’s no conceivable purpose for a rule like this except as a political attack on Planned Parenthood and reproductive health providers like it,” he said.

Conservatives have been clear that the restriction is an attempt to defund Planned Parenthood. In a pitch to Trump urging him to support the domestic gag rule, White House Counselor Kellyanne Conway reportedly said that the policy would fulfill the president’s campaign promise to defund Planned Parenthood. Republican lawmakers pointed to the policy change favorably in a letter sent to HHS Secretary Alex Azar urging him to move forward with the proposed rule.

“This is an attempt to take away women’s basic rights, period,” said Dawn Laguens, executive vice president of Planned Parenthood Federation of America, in a statement.

Carrie Flaxman, deputy director of public policy litigation and law at Planned Parenthood Federation of America, said on Friday’s press call that the organization would “resist this rule through the rulemaking process and through standing up and mobilizing all of the large number of people who recognize this as terrible medicine for women and this country writ large.”

In response to a question about whether the organization would consider physically separating its abortion services in order to accommodate the rule, Flaxman said “it is really inconceivable and also unwarranted … that a safe legal medical procedure that is part of women’s reproductive health should have to be stigmatized and put off to the side in some kind of separate facility.” Planned Parenthood “is not planning at this time to do anything” to indicate that the full range of women’s reproductive health care options aren’t important and legal in the United States, she added.

Though anti-choice advocates claim other clinics and federally qualified health centers could absorb some of the patient load created by cutting Planned Parenthood’s Title X funds, analysis from the Guttmacher Institute has found that “unrealistic.” In Planned Parenthood’s absence, other Title X sites would have to increase their client caseloads by an average of 70 percent to accommodate the change. Planned Parenthood serves roughly 40 percent of Title X patients.

Other reproductive health advocates sounded the alarm. Dr. Jenn Conti, a fellow with Physicians for Reproductive Health, called the policy “unconscionable” in a Friday statement, adding that “it undermines medical ethics by allowing health care professionals to withhold accurate and timely medical information from patients.”

“As a provider of comprehensive reproductive health care, it is my number one priority to keep my patients safe and honor the trust they give me. If my patient decides to have an abortion, I should be able to give them a referral to a high quality provider,” Conti said.

Earlier in the week, 110 health and civil rights organizations—including the American Civil Liberties Union, the National Family Planning & Reproductive Health Association, and the American Sexual Health Association—sent a letter to Azar urging him not to advance the looming restriction on Title X. The letter called the restriction “nothing less than an effort to eviscerate access to care and information for people with low incomes and underserved populations.”

The policy faces opposition from many members of the U.S. Congress. More than 200 federal lawmakers this week signed on to separate letters to Azar voicing their opposition to the anti-choice policy.

Though the domestic gag rule was first implemented under President Ronald Reagan, “it never went into effect as written, although the Supreme Court ruled that it was an appropriate use of executive power,” as the Associated Press reported. President Bill Clinton rescinded the restriction in 1993. It was later formally done away with under an HHS rule published in 2000.

The domestic restriction follows the Trump administration’s decision to reinstate and expand the global gag rule, also known as the “Mexico City Policy,” immediately upon taking office in 2017. That policy restricted foreign nongovernmental organizations from receiving U.S. family planning aid if they provide abortion care or information about the medical procedure. 

Previous iterations of the global gag rule had already been found to have dire consequences for global reproductive health care. And according to a February 2018 report from Time, one year after the policy was announced, “health care workers say the policy has had disastrous effect; as expected, clinics are shutting down, unsafe abortions are predicted to rise sharply and families are losing critical services across the globe.”

Friday’s announcement is the latest attack on reproductive health care from an administration that has stacked HHS with anti-choice activists. It comes days before President Trump is set to address the anti-choice Susan B. Anthony List’s annual gala, an event promoted by the abortion rights opponents with a contest offering free stays at Trump’s hotel as the prize, as Media Matters for America reported.

This is a developing story. Rewire.News will continue to report as more information emerges.

UPDATE: This piece has been updated to clarify the potential impact of the revised rule.

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