Fair Family Planning

For nearly 50 years, Title X of the Public Health Service Act has been the sole federal program devoted to funding family planning services for low-income and underinsured communities. The Trump Administration’s changes to Title X regulations, however, could restrict access to vital family planning services for communities that need them the most. Title X has funded counseling on a variety of family planning care and alternatives, including abortion. Since the program’s inception, however, clinics have been prohibited from using federal funds they receive from Title X for performing abortions. In addition to counseling, Title X-funded clinics also offer contraceptives, STI testing, and some primary care services. The Trump Administration’s regulations require Title X clinics to maintain “a physical and financial separation” between abortion procedures and Title X-funded services. To remain compliant with these changes while continuing to offer abortion counseling and procedures, clinics would need an additional space physically separate from where they offer existing Title X family planning services. In practice, however, the cost of creating such a space is prohibitive. Clinics instead face an impossible choice: Providers must either limit the scope of their services or continue to offer abortion services but decline further funding from Title X. The regulations also impose what critics describe as a “gag rule” that bars clinicians from providing referrals to abortion clinics or mentioning abortion—even when the patient requests the information. Physicians from groups such as the American Medical Association criticize the gag rule because it “restricts them from providing complete information to patients about all of their health care options and providing appropriate referrals for care.” Although pro-life advocates celebrate the Trump Administration for diverting funds from clinics that provide abortion services, critics argue that the regulations deprive patients of access to the full range of reproductive care. Critics also claim that the Administration’s changes shrink the network of available providers for communities that rely on Title X for family planning services. Because of the economic, practical, and ethical burdens that these regulations impose, several Title X clinics have announced plans to exit the program. This exodus could leave millions of patients without access to essential health care under Title X. Though the incoming Biden Administration may alter Title X and moot the present controversies, 23 states’ attorneys general, multiple family planning organizations, and several individual physicians have filed lawsuits challenging the Trump Administration’s regulations. This week’s Saturday Seminar explores the role of Title X and potential consequences of the Trump Administration’s regulations on access to family planning services