Over the summer, the Trump administration’s new rule regarding Title X, the federal family planning program that is designed to help low-income and other underserved groups obtain contraception, sexually transmitted infection (STI) testing, and other reproductive health-care services, went into effect. The domestic “gag rule” cuts off funding from providers who offer abortions or give patient referrals to doctors who can perform them, ostensibly, with the goal of reducing abortion rates in the United States.
But if the government’s aim is to reduce abortion rates, its strategy to make this crucial medical procedure even more inaccessible than it already is doesn’t even seem needed.
Indeed, abortion rates have been on the decline in the United States since the 1980s, with an 8 percent drop occurring between 2014 and 2017 alone. Those advocating to increase restrictions on abortion might want to take credit for this drop. Yet a new report from the Guttmacher Institute, a research organization focused on reproductive and sexual health and rights, paints a different picture: Fewer births and people getting pregnant in the first place. That is something the report suggests could be attributed to several factors, including an increase in the use of long-acting reversible contraceptive methods (LARCs), which coincided with the Affordable Care Act’s expansion of contraceptive coverage (though the Trump administration has been fighting to roll back that benefit since 2017).
Even as the largest provider of Title X services in the country has pulled out of the program and more seem primed to follow, the impact of the new Title X rules has yet to be fully realized. But one real possibility is that rather than furthering the decline in abortions, the domestic gag rule will actually contribute to its rise, including an increase in self-managed abortions.
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There are a few reasons for this.
1) The Title X rule will inevitably limit access to contraception. After all, restrictions on abortion and restrictions on birth control go hand-in-hand. Recent government grants related to sexual and reproduction health have gone to groups that oppose both abortion and contraception. Similarly, in recent years there has been an increase in “conscience clauses,” which permit people and organizations, primarily health-care providers and pharmacists, to refuse to provide certain types of health-care services by citing religious freedom. For example, pharmacists around the country have used this law to support their refusal to dispense emergency contraception, a form of birth control that can prevent pregnancy after unprotected sex. It goes without saying that when contraception access is limited, there are more unintended pregnancies.
2) While the Trump administration has put strict rules on federal funding of reproductive health-care services, the same cannot be said of its funding for abstinence-only programs (now sometimes called “sexual risk avoidance”). These tend to teach that the single acceptable place to have sex is in an opposite-sex marriage, typically for the purposes of reproduction, and they omit any practical information about sexuality in the process. Such programs only teach about condoms and other forms of contraception in terms of failure rates, and they only mention abortion to stigmatize the service or share fabricated rates of emotional and physical harm. The impact can be significant. In fact, a study published this year in the American Journal of Public Health found that in conservative states, abstinence-only education actually increased teen pregnancies.
3) Planned Parenthood’s announcement in August to withdraw from Title X, rather than comply with the new restrictions, means that health centers around the country are likely to shutter. This is true even of centers that do not provide abortions, since the rule requires providers that receive Title X funds to physically and financially separate those services from abortion services. The result is that because some Planned Parenthood health centers perform abortions, all Planned Parenthood centers are barred from getting Title X funding. These closures will affect millions of people who utilize these centers, many of whom do so solely to obtain contraception.
As a health and sexuality educator who works with young people, the anticipated effect of Trump’s Title X rule, and the broader climate in which it has emerged, is chilling. One just needs to consider the fact that in countries where abortion is illegal, the abortion and complication rates are far higher than in countries where it is legal and accessible.
Making contraception available is one of the best ways to help increase reproductive health. Now thanks to the Guttmacher Institute’s new report, we know that expanded access to contraception is likely a main driver behind the drop in abortion rates. To be sure, as Guttmacher notes, efforts aimed at reducing abortion through coercive measures, such as forced pregnancy or eugenic practices, “are a direct violation of individuals’ dignity, bodily autonomy, and reproductive freedom.”
People should have access to abortion care whenever they need it.
And yet, anti-abortion advocates have not tried to hide their goal of ending abortion. If they really wanted to do something to reduce the abortion rate, they might reconsider their Title X rule while expanding access to contraception and re-examining their priorities when it comes to sexual health education. But of course they won’t do that, because more than ending abortion, this is about exerting reproductive control over women, and abortion restrictions are just one way to do that.